bluuebunny/crossref_metadata_2025 huggingface dataset:
Relative risk of primary bloodstream infection in patients with mechanical circulatory support devices
Authors: Wolansky Rachel , Burke Patrick , Miller Ryan , Fraser Thomas
Published: September 2023

Background: Patients requiring mechanical circulatory support (MCS) during episodes of cardiogenic shock are at risk for hospital-acquired bloodstream infection (HABSI). Clinically MCS devices include extracorporeal membrane oxygenation (ECMO) devices, durable and temporary left ventricular-assist devices (VADs), and intra-aortic balloon pumps (IABPs). However, the MCS exclusion to the NHSN central-line–associated bloodstream infection (CLABSI) surveillance rules in 2018 did not include IABP as a qualifying device. We have described utilization and incidence of primary HABSI (pHABSI) in our patients requiring MCS. Methods: The setting for this study was 9 cardiothoracic and heart failure intensive care units with 131 total beds at the Cleveland Clinic Main Campus. Surveillance for HABSI to include determination of CLABSI was performed prospectively. MCS-associated pHABSI were patients who had ECMO, LVAD, or IABP present for >2 calendar days with device in place on the date of infection or removed the day before. A patient with 2 device types at time of infection was counted as a pHABSI for both groups. Patient, device, and MCS days were extracted from an electronic database. Non-MCS patient days were calculated as the difference between total patient days and total MCS days. The incidence of ECMO-, VAD-, and IABP-associated pHABSI were compared to each other and to non–MCS-associated pHABSI using OpenEpi version 3.01 software. Results: Surveillance results are shown in Table 1. During the observation period, there were 221 pHABSIs and 139,013 patient days. Moreover, 67 pHABSIs were associated with an MCS device over 17,044 total MCS days: 43 ECMO days, 18 VAD days, and 13 IABP days. Also, 9 patients had >1 type of eligible device and 7 (39%) of the IABP-associated pHABSIs were CLABSIs.

The cumulative incidences of pHABSI associated with ECMO, VAD, and IABP were 5.68, 4.59, and 2.34 per 1,000 MCS days, respectively. The incidence of IABP pHABSI was not significantly different from VAD pHABSI (P = .06), but it was different from ECMO pHABSI (P < .01). The pHABSI rate for non-MCS days was 1.26 per 1,000 patient days. Conclusions: In our patients requiring MCS, the risk of pHABSI associated with IABP was significantly greater than in patients without MCS and was similar to patients with VAD. MCS of all types should be considered a risk for HABSI in patients with cardiogenic shock beyond the presence of a central line. Protocols to further prevent HABSI morbidity in IABP patients are needed.

Disclosure: None
Modifying water use practices to eliminate Pseudomonas aeruginosa bloodstream infections in the neonatal intensive care unit
Authors: Camelo Ingrid , Neshangi Srilatha , Thompson Amy
Published: September 2023

Objective: To describe the strategies implemented at a tertiary-care healthcare center neopnatal intensive care unit (NICU) to control and assure prevention of subsequent central-line bloodstream infections (CLABSIs) with Pseudomonas aeruginosa after 4 cases of CLABSI with this organism were detected. Methods: During the months of September 2020 to February 2021, 4 cases of CLABSI with Pseudomonas aeruginosa were reported in our NICU in patients meeting criteria for extremely low birthweight (ELBW) infants. All patients were treated according to IDSA guidelines for management of bloodstream infections. To avoid the appearance of new events and to improve existing policies, we implemented a stepwise approach by reviewing routine disinfection and/or cleaning procedures of isolettes: (1) liners for bath basins were applied, (2) sterile water was provided for bathing newborns, (3) we ensured timely biomed preventive maintenance of water reservoirs for patient care equipment (nebulizers, isolettes and fluid warmers), and (4) we implemented the installment of point-of-care filters for tap water. Results: Measures were implemented from February 2021 to July 2021. During the following year from July 2021 to June 2022, no CLBSIs related to Pseudomonas aeruginosa were reported in our NICU in patients meeting criteria for ELBW infants. Conclusions: Recognition of CLABSI from organisms from water resources is important to implementing focused prevention strategies targeting water resources and water utilization practices. In our institution, these interventions yielded complete resolution, with no new infection events.

Disclosure: None
Screening infection prevention policies for equity impacts
Authors: McGrath Caitlin , Fatemi Yasaman , Mirisola Therese , Ferreira Tanya , D’Alo Adrienne , Konold Victoria , Tieder Alicia , Durkin Ashley , Kronman Matthew , Zerr Danielle
Published: September 2023

Background: Infection prevention teams utilize policies to guide practice; however, some policies may inadvertently uphold institutional racism and discrimination. Our institution utilizes an equity impact assessment tool during new policy creation or existing policy updates to identify, reduce, eliminate, and prevent inequities in care. Methods: We reviewed all 119 current institution-wide policy documents related to or managed by the infection prevention division at Seattle Children’s Hospital using an institutional equity impact assessment tool. The tool asks 6 open-ended questions to help policy owners identify potential inequities and to evaluate how marginalized groups may be affected. Each policy was assessed for its potential to create or sustain inequities for patients, families, or staff. Policies determined to have potential inequities were examined for any language to suggest that equity considerations had been incorporated into the existing policy. Initial policy review was performed by 2 infection prevention physicians, and disagreements were resolved by consensus. We defined the presence of equity considerations as any explicit mention of disparate impact of the policy on marginalized groups or mitigation of such effect. Results: Of the 119 policies reviewed, 43 (36%) were identified as having substantial potential to impact marginalized groups and create or sustain inequities. Among them, 42 (98%) of these policies lacked existing equity considerations. The policies with potential equity implications covered the following categories: COVID-19 (including masking, workforce restriction, testing), visitor restrictions, tuberculosis, central-line–associated bloodstream infections (CLABSIs), multidrug-resistant organisms (MDROs), public health reporting, medical behavioral unit policies, off-site affiliate housing policies, special pathogens program (including Ebola, MERS, SARS), surgical-site infections, home care including dialysis, and occupational health-related policies. Examples of policies that did not highlight inequities included those pertaining to construction, water intrusion, and transmission-based precautions. One example of change driven by use of the equity impact assessment tool concerned communication with patients and families about tuberculosis isolation and resulted in creation of a standardized multidisciplinary care conference to better communicate tuberculosis isolation processes (including testing required, visitor restrictions, and anticipated duration of isolation) to families in their language of care. Conclusions: Hospital-wide infection prevention policies have the potential to create or sustain existing inequities. Systematic consideration of equity implications using an equity impact assessment framework could be the first step in mitigating these effects and can result in concrete actions to reduce systemic racism.

Disclosure: None
Modeling the impacts of influenza antiviral prophylaxis strategies in nursing homes
Authors: Zipfel Casey , Morris Sinead , Paul Prabasaj , Biggerstaff Matthew , Slayton Rachel
Published: September 2023

Background: Antiviral chemoprophylaxis for influenza is recommended in nursing homes to prevent transmission and severe disease among residents with higher risk of severe influenza complications. Interim CDC guidance recommends that long-term care facilities initiate antiviral chemoprophylaxis with oral oseltamivir for all non-ill residents living in the same unit following the start of an outbreak in a facility (ie, ≥2 patients ill within 72 hours and of whom at least 1 resident has laboratory-confirmed influenza). Prophylaxis continues for a minimum of 2 weeks and for at least 7 days after the last laboratory-confirmed case. However, facilities may not strictly adhere to this guidance, with 1 study showing up to 68% of facilities were nonadherent to national guidance (Silva et al 2020). Here, we model the potential impacts of different antiviral prophylaxis strategies. Methods: We developed a susceptible–exposed–asymptomatic–infected–recovered (SEAIR) compartmental model of an average-sized nursing home comprising short-stay residents, long-stay residents, and healthcare personnel (HCP). Persons treated with antiviral chemoprophylaxis were less susceptible to infection, had a lower probability of symptoms if infected, a reduced viral load, and a shortened duration of infectiousness. We included influenza vaccination for residents and HCP through reduced probability of symptomatic infection. Coverage rates were estimated from CDC FluVaxView and CMS COVID-19 nursing home data. As a base case, we modeled a scenario with prophylaxis implemented according to guidance. We varied uptake by residents and HCP (from 10% to 90%), case thresholds for prophylaxis initiation (1–5 cases identified), and timing of prophylaxis cessation: either time dependent (ie, 10–14 days of prophylaxis) or case-dependent (ie, continuing prophylaxis for 1–7 days with no cases). Results: In the scenario based on current guidance, prophylaxis reduced resident cases by 16% and resident hospitalizations by 45%, compared to no prophylaxis (Fig. 1A). Scenarios that differed from the guidance altered case burden and timing: Time-dependent prophylaxis cessation increased resident cases and hospitalizations (Fig. 1A). Timing of prophylaxis initiation had slight effects on the timing of the epidemic and minimal effects on resident cases and hospitalizations (Fig. 1B). High resident uptake was important for reducing resident cases and hospitalizations (Fig. 1C), but increasing HCP uptake had minimal effect (Fig. 1D). Conclusions: Our findings support the current prophylaxis guidance. Promptly implementing prophylaxis reduces resident cases and hospitalizations. Continuing prophylaxis until cases are no longer identified reduces cases and hospitalizations.

Disclosure: None
Ambulatory antibiotic prescribing for children in a practice research network
Authors: Mitchell Lauren , Kronman Matthew , Cole Allison , Poole Nicole
Published: September 2023

Background: Most antibiotic use occurs in ambulatory settings. Antibiotic prescribing for children living in the United States in medically underserved areas or in populations is not well understood.

Objective: To characterize antibiotic prescribing for children in a practice-based research network (PBRN).

Design and Methods: In this retrospective cohort study, we characterized oral antibiotic prescribing in a large PBRN. Patients aged 0–17 years with at least 1 in-person visit between January 1, 2014, and December 31, 2018, at 1 of 25 primary-care clinics located within the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region of the Practice and Research Network (WPRN) were included. Data were extracted from DataQUEST, a centralized data repository from included primary-care clinics. Encounters for wellness visits or those lacking a diagnosis code and patients with complex chronic conditions were excluded. Diagnoses were categorized using International Classification of Disease, Ninth Revision (ICD-9) and ICD-10 codes. Oral antibiotics prescribed within 3 days of an encounter were associated with that encounter. Demographic data included age, sex, race, and ethnicity. Antibiotic appropriateness was determined using a previously published 3-tiered classification system using diagnosis codes as always, sometimes, or never appropriate. Patient-level data (ZIP codes) were used to designate medically underserved areas (MUAs) and medically underserved populations (MUPs). Antibiotic prescribing was then analyzed within these groups. Results: In total, 37,314 patients across 206,845 encounters were included, of which 34,601 encounters (17%) resulted in antibiotic prescription (Table 1). Of those, appropriateness data were available for 34,286 (99%). Of the antibiotics prescribed, 14% were always appropriate, 57% were sometimes appropriate, and 27% were never appropriate (1% missing). In total, 64% and 35% of encounters occurred with patients from an MUA and MUP, respectively. Conclusions: Targets to improve oral antibiotic prescribing for children in a large PBRN include antibiotic prescribing for diagnoses that never require an antibiotic. Larger comparative studies may focus on the role (if any) that MUA/MUP has on antibiotic prescribing.

Disclosures: None
In-depth assessment of critical access hospital stewardship program adherence to the CDC Core elements in Iowa and Nebraska
Authors: Ryder Jonathan , Tigh Jeremy , Watkins Andrew , Preusker Jenna , Schroeder Daniel , Ashraf Muhammad Salman , Schooneveld Trevor Van
Published: September 2023

Background: Critical-access hospitals (CAHs) are required to meet the CDC 7 Core Elements of antimicrobial stewardship programs (ASPs). CAHs have lower adherence to the core elements than larger acute-care hospitals, and literature defining which core-element deficiencies exist within CAHs as well as barriers to adherence is lacking. Methods: We evaluated 21 CAH ASPs (5 in Nebraska and 15 in Iowa) that self-identified as potentially deficient in the Core Elements, via self-assessment followed by in-depth interviews with local ASP team members to assess adherence to the CDC Core Elements for ASPs. Core-element compliance was rated as either full (1 point), partial (0.5), or deficient (0), with a maximum score of 7 per ASP. High-priority recommendations to ensure core-element compliance were provided to facilities as written feedback. Self-reported barriers to implementation were thematically categorized. Results: Among the 21 CAH ASPs, none fully met all 7 core elements (range, 2.5–6.5), with a median of 5 full core elements met (Fig. 1). Only 6 ASPs (28.6%) had at least partial adherence to each of the 7 core elements. Action (21 of 21, 100%) and leadership commitment (16 of 21, 76.2%) were the core elements with the highest adherence, and accountability (4 of 21, 19%) and education (9 of 21, 42.9%) were the lowest. The most frequent high-priority recommendations were to provide physician and pharmacist leader ASP training (19 of 21, 90.5%), to track antimicrobial stewardship interventions (12 of 21, 57.1%), and to provide or track educational activities (12 of 21, 57.1%) (Fig. 2). One-third of programs were recommended to establish a physician leader. The most commonly self-identified barriers to establishing and maintaining an ASP were a lack of dedicated resources such as time of personnel (15 of 20, 75%), lack of infectious diseases expertise and training (8 of 20, 40%), and electronic medical record limitations (5 of 20, 25%) (Fig. 3). Conclusions: CAH ASPs demonstrate several critical gaps in achieving adherence to the CDC Core Elements, primarily in training for physician and pharmacist leaders and providing stewardship-focused education. Further resources and training customized to the issues present in CAH ASPs should be developed.

Disclosures: None
Investigating potential drivers of increased central-line–associated bloodstream infections during the SARS-CoV-2 omicron-variant surge
Authors: Kang HeeEun , Stewart Kathleen O. , Khan Asif , Casale Stephanie C. , Barker Caitlin Adams , Kim Justin
Published: September 2023

Background: Central-line–associated bloodstream infection (CLABSI) rates increased nationally during COVID-19, the drivers of which are still being characterized in the literature. CLABSI rates doubled during the SARS-CoV-2 omicron-variant surge at our rural academic medical center. We sought to identify potential drivers of CLABSIs by comparing period- and patient-specific characteristics of this COVID-19 surge to a historical control period. Methods: We defined the study period as the time of highest COVID-19 burden at our hospital (July 2021–June 2022) and the control period as the previous 2 years (July 2019–June 2021). We compared NHSN CLABSI standardized infection ratios (SIRs), central-line standardized utilization ratios (SURs), completion of practice evaluation tools (PETs) for monitoring of central-line bundle compliance, and proportions of traveling nurses. We performed chart reviews to determine patient-specific characteristics of NHSN CLABSIs during these periods, including demographics, comorbidities, central-line characteristics and care, and microbiology. Results: The CLABSI SIR was significantly higher during the study period than the control period (0.89 vs 0.52; P = .03); the SUR was significantly higher during the study period (1.08 vs 1.02; P < .01); the PET completion per 100 central-line days was significantly lower during the study period (23.0 vs 31.5; P < .01); and the proportion of traveling nurses was significantly higher during the study period (0.20 vs 0.08; P < .01) (Fig. 1). Patients with NHSN CLABSIs during the study period were more likely to have a history of COVID-19 (27% vs 3%; P = .01) and were more likely to receive a higher level of care (60% vs 27%; P = .02). During the study period, more patients had multilumen catheters (87% vs 61%; P = .04). The type of catheter, catheter care (ie, dressing changes and chlorhexidine bathing), catheter duration before CLABSI, and associated microbiology were similar between the study and control periods (Table 1). Conclusions: During the SARS-CoV-2 omicron-variant surge, the increase in CLABSIs at our hospital was significantly associated with increased central-line utilization, decreased PET completion, and increased proportion of traveling nurses. Critical illness and multilumen catheters were significant patient-specific factors that differed between CLABSIs from the study and control periods. We did not observe differences in catheter type, duration, or catheter care. Our study highlights key modifiable risk factors for CLABSI reduction. These findings may be surrogates for other difficult-to-measure challenges related to the culture of safety during a global pandemic, such as staff education related to infection prevention and daily review of central-line necessity.

Disclosures: None
Multidrug-resistant ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic among hospitalized patients in a tertiary-care private hospital
Authors: Aligui Alec Ann Alissa , Abad Cybele Lara
Published: September 2023

Background: Data on the incidence and outcome of ventilator-associated pneumonia (VAP) and multidrug-resistant VAP (MDR-VAP) among COVID-19 patients are limited. We compared the incidence and incidence density (ie, number of VAP per 1,000 ventilatory days) of MDR-VAP prior to and during the COVID-19 period in an urban, tertiary-care hospital. Methods: A retrospective study was conducted to compare the incidence, profile, and outcomes of patients with MDR-VAP during the pre–COVID-19 period (2018–2019) and during the COVID-19 pandemic (2020–2021). Results: In total, 80 (22%) of 362 patients developed VAP and were included in the cohort: 27 (33.75%) from the pre–COVID-19 period and 53 (66.25%) from the COVID-19 period, respectively. Most were male [20 (74%) of 27 vs 34 (64%) of 53], with median ages of 66 years (range, 35–90) and 67 years (range, 32–92) in the pre–COVID-19 and COVID-19 periods, respectively. Comorbidities were similar between the 2 periods, except for cardiovascular disease (14 vs 11; P = .005) and chronic lung disease (14 vs 9; P = .0012), which decreased significantly from the pre–COVID-19 period to the COVID-19 period. Only 15 (56%) of 27 versus 37 (70%) of 53 patients developed MDR-VAP during the pre–COVID-19 and COVID-19 period, with incidence densities of 19.3 of 1,000 and 27.8 of 1,000 ventilator days (P = .0371), respectively. The median length of stay prior to VAP for the pre–COVID-19 and COVID-19 periods were 17 and 10 days, respectively (P < .0001). Extended-spectrum β-lactamase (ESBL) resistance increased significantly from 1 (3.7%) of 27 before COVID-19 to 15 (28.3%) of 53 during the COVID-19 period. Carbapenem-resistant Enterobacteriaceae (CRE) resistance was higher before COVID-19 than during the COVID-19 period: 15 (56%) of 27 versus 10 (19%) of 53. In both periods, Klebsiella pneumoniae and Acinetobacter baumannii were the most common pathogens isolated. Mortality was high in both periods at 93% and 83%, respectively. Only female sex was associated with MDR-VAP in the COVID-19 period on multivariate analysis (OR, 3.47; 95% CI, 1.019–11.824; P < .047). Conclusions: The frequency of VAP and MDR-VAP increased during the COVID-19 period, despite a shorter median hospital stay. Mechanisms of resistance differed in the pre–COVID-19 and COVID-19 periods. Mortality with VAP was extremely high. The factors associated with increased risk of VAP and COVID-19 need to be studied further, and measures to prevent VAP should be prioritized.

Disclosures: None
Characterizing healthcare worker attitudes toward the bivalent COVID-19 booster
Authors: Willebrand Kathryn , Fredrick Jacqueline , Pischel Lauren , Patel Kavin , Roberts Scott , Murray Thomas , Martinello Richard
Published: September 2023

Background: Recent evidence has shown that the updated COVID-19 bivalent booster is effective in preventing COVID-19 compared with no previous vaccination and prior monovalent vaccination. Despite its effectiveness, uptake has been poor, and a minority of eligible recipients have received the booster. Understanding healthcare worker (HCW) attitudes for and against voluntary uptake of the bivalent booster dose against COVID-19 can help guide communication strategy to maximize uptake. In this survey study, we investigated attitudes toward updated and/or bivalent booster uptake in a behavioral health hospital shortly after a COVID-19 outbreak. Methods: A survey tool was developed and sent to all HCWs at the Yale New Haven Psychiatric Hospital in December 2022. The survey queried demographic data, job category, history of COVID-19, prior COVID-19 vaccinations, perception of COVID-19 exposure, and updated and/or bivalent booster doses. The survey was administered several weeks after a COVID-19 outbreak on multiple inpatient behavioral health units. Receipt of the COVID-19 primary vaccination series and the first booster dose were mandated for HCWs; however, receipt of the bivalent booster was voluntary. Results: The survey was sent to 664 HCWs with primary assignments in behavioral health settings. In total, 182 (27.4%) provided complete responses to the survey and are included in these data. Moreover, 91 HCWs (50.0%) reported previously having COVID-19 at least once. Overall, 100 HCWs (55.0%) received the bivalent booster. The most identified reasons for receiving the bivalent booster were wanting to protect family and friends (n = 113), importance of staying healthy (n = 112), and protecting colleagues and patients (n = 103). The most identified reasons for not wanting to receive the bivalent booster dose were not thinking it provides additional protection (n = 33), “too many” shots already received (n = 31), and concern about side effects (n = 30). Discussion: Bivalent booster dose uptake in HCWs on behavioral health units shortly after a COVID-19 outbreak was greater than the general population. HCWs reported varying reasons for and against receipt of the bivalent booster dose, with the most common being protection of family and friends and perceptions of no additional protection, respectively. A limitation of this study was voluntary response bias, in which results are biased toward individuals more likely to receive a bivalent booster vaccine. It is unclear whether reasons for declining the vaccine are representative of HCWs who did not complete the survey. Assessing attitudes for the bivalent booster dose can assist in guiding communication and outreach strategies to increase vaccine uptake by HCWs.

Disclosures: None
Measuring the efficacy of routine disinfection methods on frequently used physical therapy equipment
Authors: Barrett Aaron , Graves Amanda , Jesus Elaine De , Edelschick Jennifer , McCotter Diandrea , Anderson Deverick , Turner Nicholas , Warren Bobby
Published: September 2023

Background: Frequently used physical therapy (PT) equipment is notably difficult to disinfect due to equipment material and shape, however, the efficacy of standard disinfection of PT equipment is poorly understood. Methods: We completed a prospective observational microbiological analysis of fomites used in adult or pediatric PT at Duke University Health System, Durham, North Carolina, from September to December 2022. Predetermined study fomites were obtained after being used during a clinical shift and standard disinfection had been completed by clinical service staff. Fomites were split into 2 halves, left and right, for sampling. Samples were taken with premoistened cellulose sponges processed using the stomacher technique and were incubated on appropriate selective and general medias. We defined antimicrobial-resistant, clinically important pathogens (AMR-CIP) as MRSA, VRE, and MDR-gram-negative isolates, and non–AMR-CIP as MSSA, VSE, and gram-negative species. Study fomites were grouped as follows: (1) pediatric pig toy, (2) walking aids (walkers or canes), (3) balls (medicine, dodge, etc), and (4) other (foam roller, sliding board, etc). Results: In total, 47 patients, 61 fomites, and 122 were analyzed. Of the study patients, 24 (51%) were female, 13 (27%) had active infections, and 15 (32%) were on contact precautions. Because fomites were split in half, patients in the left and right study arms were identical. Overall, the median total colony-forming-units (CFU) of study fomites was 1,348 (IQR, 398–2,365): 468 (IQR, 161–1,230) for the left side study arm and 540 (IQR, 102–1,221) for the right study arm (P = .45). At the sample level, 52 (43%), 15 (12%), and 37 (30%) of 122 samples harbored any CIPs, AMR CIPs, or non-AMR CIPs, respectively. At the fomite level, 27 (44%), 5 (8%), 15(25%), and 7 (11%) of 61 fomites harbored any CIPs, only AMR-CIPs, only non-AMR CIPs, or both AMR and non-AMR CIPs, respectively. Generally, therapy balls were the most contaminated study fomites (n = 2,237; IQR, 1,425–2,658), and walking aids were most frequently contaminated with any CIPs (n = 26, 72%), AMR CIPs (n = 8, 22%), and non-AMR CIPs (n = 15, 47%). Discussion: Following routine disinfection, frequently used PT equipment remained heavily contaminated and harbored AMR and non-AMR CIPs, supporting the notion that PT equipment is difficult to disinfect via standard disinfection. Additionally, left-, and right-side fomite divisions had similar pathogens, suggesting that this sampling model of intrapatient comparisons may be helpful for resolving case-mix issues in future studies. Future work should focus on PT-specific enhanced disinfection strategies to improve the disinfection of PT equipment.

Financial support: This study was funded by PURioLABS.

Disclosures: None
Decontamination of bedding reduces the risk for contamination of personnel changing bedding: A simulation study
Authors: Cadnum Jennifer , Osborne Andrew , Memic Samir , Donskey Curtis , Torres-Teran Maria
Published: September 2023

Background: The recent worldwide outbreak of Mpox virus infections has raised concern about the potential for nosocomial acquisition during handling of contaminated bedding or clothing. We conducted simulations to test the hypothesis that decontamination of bedding prior to handling could reduce the risk for contamination of personnel. Methods: We conducted a crossover trial to test the effectiveness of spraying contaminated bedding with a hydrogen peroxide disinfectant in reducing contamination of personnel during handling of the contaminated bedding. Bedding was contaminated on top and bottom surfaces with aerosolized bacteriophage MS2. Personnel (N = 10) wearing a cover gown and gloves removed the bedding from a patient bed and placed it into a hamper both with and without prior hydrogen peroxide spray decontamination. After handling the bedding, samples were collected to assess viral contamination of gloves, cover gown, neck or chest, and hands or wrists. Results: Contamination of the gloves and cover gown of personnel occurred frequently during handling of bedding and 20% of participants had contamination of their hands or wrists and neck after the simulation (Fig.). Decontamination of the bedding reduced contamination of the gloves and eliminated contamination of the cover gown, hands or wrists, or neck. Conclusion: Decontamination of bedding prior to handling could be an effective strategy to reduce the risk for nosocomial acquisition of Mpox by healthcare personnel.

Disclosures: None
Genetic relatedness among Neisseria gonorrhoeae isolates in southeastern Michigan
Authors: Shallal Anita , Tibbets Robert , Gurdziel Katherine , Vager Dora , Zervos Marcus , Suleyman Geehan
Published: September 2023

Background: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (NG) is an emerging public health crisis. Whole-genome sequencing (WGS) is an efficient way of predicting AMR determinants and their spread in the population. In a previous study, genotype–phenotype correlation analyses among NG isolates to determine antimicrobial resistance revealed discordance for azithromycin (AZM) and ceftriaxone (CRO) compared to other antibiotics. We investigated the evolutionary relatedness of NG isolated from patients with sexually transmitted infection (STI) using WGS in southeastern Michigan. Methods: Isolates, corresponding demographic data, and minimum inhibitory concentrations (MIC) via E-test (CRO) and broth microdilution (AZM) were obtained from the Michigan Department of Health and Human Services. Whole-genome libraries were prepared using the QIAseq FX kit followed by sequencing on a NovaSeq6000 (>200X Coverage); samples were aligned to NG reference strain TUM19854 (NZ_AP023069.1) using Snippy before phylogenetic tree generation using Neighbor-joining clustering on the core.aln files. Phylogenetic trees were visualized using ATGC:PRESTO. Results: In total, 38 isolates were analyzed. Demographic data and susceptibility testing results are noted in Table 1. Most isolates were from males (63%), Blacks (44.7%), individuals living in Detroit City proper (47.3%), and those with unknown HIV status (55.2%). More than one-third had prior STI, including NG. All isolates were susceptible to CRO (CLSI susceptible breakpoint MIC, 1). Within the phylogenetic tree, 8 main branches were identified (Fig. 1). Moreover, 1 branch contained a cluster with 12 closely related isolates, which included the 9 isolates with nonsusceptible AZM. Nearly all isolates in that cluster had been collected from Detroit City proper and Wayne County, suggesting epidemiological overlap and potential spread of resistant strains in those counties.

Conclusions: Comparative whole-genome and phylogenetic analyses among a subset of NG isolates revealed clustering of AZM resistance strains, suggesting a genomic component to AMR. Further studies are needed to determine the utility of WGS in diagnosis, outbreak investigations, and management of NG infections.

Disclosures: None
Effect of dry hydrogen peroxide on Candida auris environmental contamination
Authors: Sanguinet Jennifer , Marshall Gerard , Moody Julia , Sands Kenneth
Published: September 2023

Background:Candida auris is an emerging pathogen that exhibits broad antimicrobial resistance and causes highly morbid infections. Prolonged survival on surfaces has been demonstrated, and standard disinfectants may not achieve adequate disinfection. Persistent patient colonization and constant environmental recontamination poses an infection risk that may be mitigated by no touch disinfection systems. We evaluated the efficacy of continuous dry hydrogen peroxide (DHP) exposure on C. auris environmental contamination. Methods: The study was conducted in a large tertiary-care center where multiple patients were identified as either infected or colonized with C. auris. DHP-emitting systems were installed in the ventilation systems dedicated to the adult burn intensive care and children’s cardiac intensive care units. Composite surface samples were collected in a sample of patient rooms and shared clinical workspaces among units with current C. auris patients, before and after installation of the DHP system, and from areas with and without exposure to DHP. The samples included “high touch” surfaces near the patient, the general area of the patient room, shared medical equipment for the unit, shared staff work areas, and equipment dedicated to individual staff members (Table 1). Presence of C. auris was determined by polymerase chain reaction (PCR). Association between DHP exposure and C. auris contamination was determined using the Fisher exact test. Results: In the presence of C. auris patients, 5 baseline samples per unit were taken before DHP was installed, and then 5 samples per unit were taken on days 7, 14, and 28 after installation. Prior to initiation of DHP, 7 (70%) of 10 samples were PCR positive for C. auris. After DHP installation, a statistically significant decrease to 5 (16.7%) of 30 samples (P <.05) was observed. In total, 20 samples (5 before installation and 15 after installation) were collected from units without DHP on the same days. At baseline, 2 (40%) of 5 samples were PCR positive for C. auris. During subsequent periods, 4 (27%) 15 samples were positive (P = .66). No adverse effects were reported by patients, visitors, or personnel in association with the operation of the DHP systems. Conclusions: These findings suggest that DHP is effective in reducing surface C. auris contamination in a variety of patient and healthcare worker surfaces.

Disclosures: None
An infection prevention and control program established in the wake of the Ebola epidemic: Where are we, and how well are we doing?
Authors: Fofanah Bobson , Conteh Christiana , Katawera Victoria , Kamara Ibrahim Franklyn
Published: September 2023

Background: Infection prevention and control (IPC) is a clinical and public health discipline based on a scientific approach and practical preventive and control measures. During the 2014–2016 West African Ebola outbreak, the high number of healthcare worker infections was attributed to inadequate IPC in Sierra Leone. This stimulated the establishment of national and subnational IPC programs. Since then, IPC has remained a priority to improve the health systems and strategic interventions during public health emergencies. Therefore, we conducted a detailed review to assess the status of the IPC programs. Methods: A descriptive analysis of the status of IPC programs in Sierra Leone was done using data from IPC assessments conducted in 2022 by the national IPC team, reviews of reports on program implementation, and experts’ objective opinions. Results:Performance. The national IPC assessment revealed strengths in 4 of 6 WHO IPC core components, with an overall score of 61% positioned at the ‘intermediate’ level of implementation. The best-performing component was ‘IPC guidelines’ (92%) with evidenced-based guidelines being developed and implemented over the years. Secondly, ‘Education and training’ (71%) made progress in basic and advanced IPC training, including the development of a preservice training curriculum. Also, ‘monitoring and audit and feedback’ (69%) and ‘IPC program’ (61%) met the basic requirements of an established Monitoring & Evaluation (M&E) system. Similar progress was made at the healthcare facility level, but with major gaps in ‘workload, staffing, bed-occupancy’ and ‘safe or built environment.’ Sustainability efforts. Evidence-based data on IPC have always been scarce due to a limited capacity to conduct IPC research. The Structured Operational Research and Training Initiative (SORT-IT) on antimicrobial resistance has helped promote evidence-informed decisions and build OR capacity that is relevant to improving program performance. In 2019, Sierra Leone instituted in-country production of alcohol-based handrub and liquid soap as a strategic intervention for providing hand hygiene products for use in healthcare facilities. This intervention was essential during the peak of the COVID-19 pandemic. Although most aspects of IPC implementation are government led with strong leadership support, stable funding and sustainability planning are yet to be achieved and will be crucial for long-term success. Conclusions: Most aspects of the IPC core components have been well implemented at the national level since the establishment of the IPC program. However, the program should continue improving the scope and quality of implementation and focus on the development of long-term plans to sustain existing gains and further improve on gap areas at the national level and especially the healthcare-facility level.

Disclosures: None
Whole-genome sequencing cluster analysis reveals complex healthcare-associated COVID-19 dynamics
Authors: Rader Theodore , Snyder Graham , Harrison Lee , Srinivasa Vatsala Rangachar , Griffith Marissa , Pless Lora , Chung Ashley
Published: September 2023

Background: Identifying and interrupting transmission of severe acute respiratory syndrome coronavirus 2 and resulting disease (COVID-19) in acute-care settings can be challenging due to incubation period, asymptomatic infection, and prevalent community disease. To elucidate routes of infection and interrupt COVID-19 outbreaks with uncertain epidemiological chains of transmission, UPMC utilized reactive whole-genome sequencing (WGS) of viral specimens. Methods: UPMC infection prevention teams identified healthcare-associated COVID-19 clusters with uncertain transmission pathways among patients and/or healthcare personnel (HCP) in acute-care hospitals. Nasopharyngeal samples preserved in viral transport media were obtained for genetic analyses. Nucleic acids were extracted and WGS libraries were prepared by targeted enrichment or multiplex PCR methodologies. Resulting sequencing reads were aligned to the Wuhan-1 reference genome, followed by identification of single-nucleotide polymorphisms (SNPs) among the genomes and construction of a phylogenetic tree. Specimens were considered genetically similar if there were ≤2 SNP differences between viral genomes within a cluster. Results: Between May 2020 until August 2022, infection prevention teams requested WGS for 17 healthcare-associated clusters of COVID-19 involving 182 individuals across 8 UPMC facilities (median outbreak size, 9 individuals; range, 2–26). Of the 182 individuals, 36 lacked clinical specimens and 30 did not pass WGS quality-control criteria of ≥95% of the reference genome with a minimum of 10× coverage. Of the 116 sequenced genomes, 94 (81%) had virus genetically similar to ≥1 other specimen, including 87 (83.6%) of 104 patient viruses and 7 (58.3%) of 12 HCP viruses, comprising 22 clusters (Fig. 1). The remaining 22 (20.6%) specimens were genetically unrelated. In total, 16 (94.1%) of the 17 epidemiologically identified clusters had 2 or more individuals with a genetically similar virus. Also, 7 (41.1%) of these clusters had genetically similar viral genomes for every individual within each cluster. Also, 9 (52.9%) clusters contained both genetically related and unrelated specimens: 5 of these had more complex genomic profiles (including 4 clusters containing 2 distinct subclusters of ≥2 genetically related viruses) and 1 cluster contained 3 subclusters of ≥2 genetically related viruses. In the outbreak with 3 clusters, 3 SNPs separated specimens from 2 temporally proximal clusters, suggesting possible propagation between clusters (cluster B-3 in Fig. 1). Conclusions: WGS can complement traditional epidemiological investigations of healthcare-associated COVID-19 outbreaks, revealing complex transmission dynamics. Future investigations will characterize the impact of WGS on determining specific transmission pathways in acute-care facilities.

Disclosures: None
Aeromonas nosocomial cluster: Investigation review of possible modes of transmission
Authors: Bisht Anjali , Gray Hannah , Caldera JR , Yang Shangxin , Uslan Dan
Published: September 2023

Background:Aeromonas is a gram-negative rod known to be present in water, sewage and soil which may cause infections especially in immunocompromised hosts. Cases of Aeromonas gastroenteritis have been associated with warmer weather. In total, 3 patients with extensively drug resistant (XDR) Aeromonas were identified at our facility between August and September 2022 on 2 intensive care units (ICUs). Our infection prevention, microbiology, and facility teams investigated these cases to determine whether a common source could be the mode of transmission. Methods: To first determine whether patients’ Aeromonas specimens were related, whole-genome sequencing (WGS) of the clinical isolates from 3 patients was performed using the Illumina DNA Prep Kit and Illumina MiSeq. Sequencing analysis was performed using CLC Genomics Workbench for de novo assembly, single-nucleotide polymorphisms (SNP) calling, and tree generation, Geneious Prime for reference-based assembly, annotation, and quality assessment, KmerFinder for reference identification, and the Comprehensive Antibiotic Resistance Database for resistance gene detection via protein homology. Chart review revealed that patients occupied multiple rooms between 2 ICUs (Fig. 1). Because water is a known source of Aeromonas, facility records were reviewed for water intrusion events. This analysis identified several cases in the affected patient and surrounding rooms. Sinks and faucets from 10 rooms were swabbed followed by direct plating on blood, MacConkey agar, and Aeromonas-selective cefsulodin-Irgasan-novobiocin (CIN) agar plates. Lastly, the city temperatures before and after positive cases were reviewed to identify whether any correlation could be shown between temperature and timing of infection. Results: WGS analysis revealed that the 3 Aeromonas isolates (all identified as A. hydrophila) were not directly related (minimum distance, 934 SNPs) and harbored between 4 and 19 unique antimicrobial resistance genes, including co-occurring carbapenemases VIM-2 and KPC-3 in 1 isolate and OXA-232 in another. Of the 20 environmental samples, few gram-negative nonfermenting bacteria and no Aeromonas isolates were detected (Fig. 1). Elevated city did loosely proceed patient cases of Aeromonas, suggesting a possible role of higher temperature, which may have promoted the growth of Aeromonas during the periods of the 3 cases and thus may contribute to the nosocomial infections (Fig. 2). Conclusions: Although our investigation did not reveal a definitive cause for the Aeromonas cases, it did show the importance prompt identification and investigation can have on mitigating the spread of a cluster. Our facility has not identified any additional nosocomial cases. Monitoring water intrusion events and plans for remediation continue to be a priority.

Disclosures: None
Association of postnatal age with neonatal hospital-onset bacteremia in a multicenter, retrospective cohort
Authors: Prochaska Erica , Xiao Shaoming , Colantuoni Elizabeth , Mukhopadhyay Sagori , Flannery Dustin , Kalu Ibukun , Zerr Danielle , Adler Amanda , Milstone Aaron
Published: September 2023

Background: Prevention of hospital-onset bacteremia (HOB) in all settings is a healthcare priority. The CDC is developing a neonatal-specific HOB quality metric, but the epidemiology of neonatal HOB is poorly understood. Our objective was to validate a prior single-center finding that HOB risk varies by birthweight and postnatal age in a multicenter cohort. Methods: We performed a multicenter, retrospective cohort study of neonates admitted to 4 neonatal intensive care units (NICUs) for ≥4 days between July 1, 2016, and July 1, 2021. HOB was defined as a positive blood culture for bacteria or fungi on day ≥4 of admission. The first HOB event in the hospitalization was counted per neonate. Repeat HOB events during a neonate’s admission were excluded. Poisson regression models with robust variance estimates were used to estimate the incidence rate (IR) of HOB, expressed as HOB events per 1,000 patient days and IR ratios (IRRs), within strata defined by CDC birthweight categories and 4-week postnatal age intervals, adjusting for central venous catheter (CVC) presence at time of HOB and study site. Results: The analysis included 9,267 neonates, contributing 191,295 patient days and 470 HOB events, with an unadjusted IR of 2.46 per 1,000 patient days (Table 1). Of 477 infants born ≤750 g, 153 (30.1%) had a HOB with an IR of 13.3 (95% CI, 10.5–16.0) events per 1,000 patient days in the first 4 weeks after birth (Fig. 1). After adjusting for CVC presence and study site, infants ≤750 g had a higher HOB rate in the first 4 weeks of life (IRR, 7.45; 95% CI, 3.81–14.56) compared to infants ≥2,500 g. After 8 weeks of life, there was no difference in HOB rate in the 2 groups (IRR, 0.8, 95% CI, 0.3–2.7). Conclusions: Neonates born ≤750 g were at highest risk for HOB within the first 4 weeks after birth; however, risk for HOB was not consistent over time. Postnatal age should be considered in a neonatal HOB quality metric.

Disclosures: None