bluuebunny/crossref_metadata_2025_split huggingface dataset:
1188. Calibrating a Product Use Metric for Hand Hygiene Compliance
Authors: Shelly Mark A 
Published: October 2019

Abstract

Background
Measuring hand hygiene (HH) by soap and alcohol hand rub product use is a relatively inexpensive and comprehensive way to estimate hand hygiene episodes per unit of patient care. Translating this number to compliance requires a reliable target for full compliance. Published data on this are few. The our objective of this study was to calibrate estimates of HH targeted performance across diverse inpatient medical unit types based on actual product use data.

Methods
Retrospective review of monthly product use and patient volumes in 8 diverse hospitals in central Pennsylvania from 2017 through March 2019.

Results
Over 27 months we calculated 98.2 million HH episodes. Months with no dispenser changes recorded were dropped from consideration, as were months with extraordinarily high replacement counts secondary to remodeling or product expiration. To further correct for variations within and between units, the median and 95th percentile are used. Medians represent observed compliance between 60 and 85% (see table). Given the month to month product use variation, using a 3-month reporting window is appropriate to keep this estimate to ±10%. Using these values for full compliance, the 3-month average rarely exceeds the maximum of 100%.

Conclusion
The product use values recorded here exceed published targets in half of the observed months. By adjusting the target for full compliance to the 95th percentile for the unit type, hand hygiene feedback by patient care area can more accurately estimate actual performance. As compliance improves further, recalibration will again be required.

Disclosures
All authors: No reported disclosures.
1196. Is the Weekend Staff Really to Blame? Challenges in Isolation Compliance at an Academic Tertiary Care Center
Authors: Bassett Sonia , Boston Kelley M , Ostrosky-Zeichner Luis 
Published: October 2019

Abstract

Background
Transmission-based isolation precautions are implemented in an effort to decrease the risk of transmission of pathogens. Weekend staff are perceived to have lower compliance.

Methods
Visual observation of healthcare worker (HCW) compliance with an institutional isolation precautions practices was done at an academic tertiary care center. In the first quarter of 2019, observations were completed for 894 patients who required contact, droplet or airborne isolation precautions. Observations included patients with infection or colonization with multi-drug-resistant organisms (MDRO) or highly transmissible infections. Observations focused on availability of appropriate supplies, compliance with infection control practices, and documentation. Audits were performed on workdays and weekends, and results were communicated to unit leadership via email. Comparison of proportions was calculated using the normal approximation in Minitab18.

Results
Compliance with the different elements of the audit can be seen in Table 1. HCW compliance with the use of personal protective equipment and hand hygiene on exit from the room had the lowest compliance and was statistically lower on weekends than on weekdays, and compliance was significantly lower than all other categories for both weekday and weekend measurements. Fifty-seven percent of all patients had missed compliance on one or more elements. There was not a statistically significant variation in practice between weekends and weekdays in overall compliance.

Conclusion
There is opportunity for improvement in all compliance on isolation practices facility-wide, and elements that require changes in behavior had the lowest compliance, and were lower on weekend shifts. We did not find other differences in performance for weekend staff vs. weekday staff. Educational measures should focus on all individual staff across all shifts.

Disclosures
All authors: No reported disclosures.
1202. It’s a Confidence Scheme—Transmission-based Precautions in the Ambulatory Setting
Authors: McQuaide Colleen , Romano Carrie , Swartz Michelle , Schaffzin Joshua K 
Published: October 2019

Abstract

Background
Following consistent transmission-based precautions (TBP) beyond the inpatient ward can be challenging. Specifically, ensuring patients are removed when eligible can prevent overuse of TBP and PPE and counter the negative connotations of TBP/Isolation. We sought to enhance providers’ ability to provide TBP for indicated patients only.

Methods
We initiated an iterative process to identify patients eligible for TBP discontinuation based on hospital policy. Staff huddle at the start of each clinic to identify patients needing TBP. An electronic medical record (EMR) report was generated and reviewed by an Infection Preventionist (IP) 3 days in advance of a clinic session to identify and remove eligible patients from TBP. When TBP discontinuation required clinical criteria not available in the EMR, clinic staff were notified and asked to collect the information from families so a decision could be made.

Results
Following 6 weeks of review for 5 services, over 30 patients were removed from TBP prior to their visit. IP review entails approximately 20 minutes three times per week. Clinic staff reported greater confidence with enforcing TBP for patients. Specifically, they could trust the list generated the day of clinic, and they understood following TBP was in accordance with policy.

Conclusion
Verifying the need for TBP in ambulatory patients is not labor intensive. Enhancing the accuracy of lists of patients requiring TBP increases provider confidence in communicating with families and preventing transmission. Increased confidence may empower providers to better utilize TBP appropriately, leading to less waste and dissatisfaction.

Disclosures
All authors: No reported disclosures.
1203. Epidemiology of Respiratory Viruses in Influenza-Vaccinated Healthcare Workers During an H1N1-Dominant Season
Authors: Wohrley Julie , Collison Maggie , Marrs Rachel , Marchese Ed , Beavis Kathleen , Bartlett Allison , Wilson Patrick , Cobey Sarah , Landon Emily 
Published: October 2019

Abstract

Background
Respiratory pathogens are an important cause of morbidity and mortality in hospitalized patients and nosocomial spread of such pathogens is known to occur. However, little is known about the epidemiology of respiratory viruses in healthcare workers (HCW).

Methods
Between December 28, 2018 and April 26, 2019 enrolled HCW completed a weekly symptom diary, including presence or absence of respiratory symptoms, flu exposure history and whether they received medical attention. Vaccination and flu infection history were collected on enrollment. Participants self-collected flocked nasopharyngeal (NP) swabs every other week and if they reported any symptom on the weekly diary. These were tested using a multiplex PCR platform (Biofire, Salt Lake City, UT) with targets for 14 respiratory viruses. Symptomatic HCW with influenza or respiratory syncytial virus (RSV) were notified and followed policy regarding work restriction.

Results
66 HCWs provided baseline data and 57 continued data submission (9 withdrew). The active participants included 13 nurses (22.8%), 7 advanced practice providers (12.3%), 18 physicians (31.6%), and 19 other (33.3%). Participants received quadrivalent inactivated flu vaccine this season (2 self-reported/unknown type). Compliance was 89.8% (749 of 834) with weekly diary completion and 83.3% (378/454) for biweekly NP swabs. Thirty-nine unique participants reported symptoms on weekly diaries 100 times and submitted 88 total “symptomatic” NP swabs (88% compliance). Of these, 16 swabs revealed any pathogen (18.2%) and 3 had influenza H3N2 (18.8%) (only one reported fever). Other pathogens identified are detailed in Figure 1. 12 of the 366 asymptomatic swabs were positive for respiratory viruses (23.3%, see Figure 1). No participant had asymptomatic influenza.

Conclusion
Pauci-symptomatic influenza has been previously described by our group and others and is noted even in this small cohort. While asymptomatic flu was not found, there were several cases of other asymptomatic respiratory viruses in HCW. Analysis of the impact on patients is still underway from this cohort but the initial data suggest that patients are at risk of contracting healthcare-acquired respiratory infection even from health care providers.

Disclosures
All authors: No reported disclosures,
1215. Ultraviolet-C (UV-C) Monitoring Made Ridiculously Simple: UV-C Dose Indicators for Convenient Measurement of UV-C Dosing
Authors: Cadnum Jennifer , Jencson Annette , Redmond Sarah , Sankar Chittoor Mana Thriveen , Donskey Curtis 
Published: October 2019

Abstract

Background
Ultraviolet-C (UV-C) light is increasingly used as an adjunct to standard cleaning in healthcare facilities. However, most facilities do not have a means to measure UV-C to determine whether effective doses are being delivered. We tested the efficacy of 2 easy-to-use colorimetric indicators for monitoring UV-C dosing in comparison to log reductions in pathogens.

Methods
In a laboratory setting, we exposed methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile spores on steel disk carriers with or without an organic load (5% fetal calf serum) to UV-C for varying times resulting in fluence exposures ranging from 10,000 to 100,000 µJ/cm2. The UV-C indicators were placed adjacent to the carriers. Log reductions were calculated in comparison to untreated controls and the change in color of the indicators was correlated with dose and log reductions.

Results
The UV-C doses required to achieve a 3-log reduction in MRSA and C. difficile were 10,000 and 46,000 µJ/cm2, respectively. For both indicators, there was a visible color change from baseline at 10,000 µJ/cm2 and a definite final color change by 46,000 µJ/cm2 (Figure 1). Organic load had only a modest impact on UV-C efficacy. The indicators required only a few seconds to place and were easy to read (Figure 2).

Conclusion
UV-C doses of 10,000 and 46,000 µJ/cm2 were required to achieve 3 log reductions of MRSA and C. difficile spores, respectively. The colorimetric indicators provide an easy means to monitor UV-C dosing.

Disclosures
All authors: No reported disclosures.
1239. Efficacy of Preoperative Chlorhexidine Gluconate and Mupirocin in the Prevention of Orthopedic Surgical Site Infections
Authors: Kahler Gabrielle , Ing Michael 
Published: October 2019

Abstract

Background
Surgical site infections (SSIs) affect 1–5% of patients undergoing surgical procedures in the United States each year and have a mortality rate of up to 75%. We sought to assess the efficacy of a bundled preoperative decolonization treatment protocol to prevent SSIs in hip, knee, or spine procedures.

Methods
A retrospective chart review was conducted for 2224 adult patients undergoing spine, knee, or hip procedures performed at the JL Pettis Memorial VAMC from October 1, 2010 to December 31, 2018. NHSN/CDC criteria were utilized. The study included spine surgeries with or without new hardware, but only hip and knee surgeries with new hardware. Procedures with an infection present at the time of surgery (PATOS) were excluded. A pre-operative methicillin-resistant Staphylococcus aureus (MRSA) nares screen was performed. Patients treated were given mupirocin (MPN) to apply to their nares and 4% chlorhexidine gluconate (CHG) to wash all skin prior to the procedure. Patients undergoing emergent procedures received CHG without MPN. The intention to treat model and chi-square test were utilized. The primary endpoints were the infection rates in both the untreated and treated groups. Secondary endpoints included the MRSA screening result, SSI class, causative organism(s), and the surgical site.

Results
A total of 2,112 procedures were included in the study. Thirty-three (1.56%) procedures met NHSN/CDC criteria for SSI. Of the 1,754 (83.0%) procedures given decolonization treatment with MPN and/or CHG, 22 (1.25%) developed an SSI. Of the 358 procedures not receiving treatment, 11 (3.07%) developed an SSI.

Conclusion
Patients given decolonization treatment had a lower infection rate compared with those who were not treated (1.25% vs. 3.07%, P = 0.0115). Even though the decrease in infection rates were most significant for hip procedures, the overall trend favored the use of a preoperative decolonization treatment protocol for all of the orthopedic procedures studied (Table 1). Current barriers include patient compliance and correct use of decolonization agents, which may affect the actual efficacy of decolonization treatment. A possible confounder was the known increased risk of SSIs in emergent procedures.

Disclosures
All authors: No reported disclosures.
1243. Continuous vs. Intermittent Intraoperative Infusion of Cefazolin on Surgical Site Infections (SSIs) and Acute Kidney Injury in Patients Undergoing Cardiac Procedures
Authors: Tichy Michael , Seidelman Jessica , Lewis Sarah S , Drew Richard H , Drew Richard H , Sarubbi Christina 
Published: October 2019

Abstract

Background
Continuous infusion cefazolin (CI) has been investigated as a means to optimize antibiotic exposure for prophylaxis against SSI, notably in patients undergoing cardiac procedures involving cardiac bypass (CPB). However, data are limited on its impact on late SSIs and adverse events. In 6/16, the Duke University Hospital (DUH) Antimicrobial Stewardship Team implemented a program to promote CI. We compared the incidence of culture-confirmed SSIs through postoperative day 90 (POD90) between patients receiving either intermittent infusion cefazolin (INT) or CI intraoperatively. We also compared the rate of acute kidney injury (AKI) between groups.

Methods
This retrospective quasi-experimental design included adult and pediatric patients undergoing cardiac surgery at DUH between March 2014 and August 2018 and receiving intraoperative cefazolin (alone or in combination with other antibiotics). Patients were categorized as CI (having received at least 1 intraoperative CI infusion) or INT. Culture-confirmed SSIs utilizing NHSN definitions were recorded and a relative risk (RR) determined. AKI was defined as a ≥0.3 mg/dL rise in serum creatinine within 2 days postoperatively.

Results
A total of 2,172 unique surgical procedures (from 2,143 unique patients) were included. Comparisons of groups are summarized in Table 1. Rates of SSIs were 1.1% and 1.6% in the CI and INT groups, respectively (RR [95% confidence interval] for CI 0.73, [0.35, 1.52]). AKI was reported in 12.9% and 17.4% of patients, respectively.

Conclusion
We were unable to detect a difference in late SSIs between intraoperative CI and INT cefazolin. Differences observed between AKI between groups requires further investigation, but likely impacted by confounders, including pre-existing renal dysfunction.

Disclosures
All authors: No reported disclosures.
1246. Outcomes of Extended Spectrum β-Lactamases Producing Enterobacteriaceae Colonization among Patients Underwent Abdominal Surgery
Authors: Apisarnthanarak Anucha , Condo Sumalee , Mingmalairak Chatchai , Mahawongkajit Prasit , Juntong Jatupong , Limpavitayaporn Palin , Sriussadaporn Ekkapak , Tongyoo Assanee , Mundy Linda 
Published: October 2019

Abstract

Background
To evaluate the outcomes of surgical patients colonized with extended-spectrum β-lactamases (ESBL) producing enterobacteriaceae (EN).

Methods
A prospective cohort study was performed from February 1, 2016 to April 1, 2019. All patients who underwent abdominal surgical procedures were enrolled. Enrolled surgical patients were screened for ESBL EN colonization by rectal swab culture 1 day before and 5 days after surgery. Data collection included clinical characteristics, risk of SSIs, previous hospitalization, and type of surgical procedure, antibiotic prophylaxis and duration, ASA risk class, and 28-day postoperative outcomes, inclusive of SSIs and associated microbiological data.

Results
Among 360 prospectively enrolled patients, 204 (56%) were male; the abdominal surgical types included 234 (65%) clean-contaminated, 90 (25%) contaminated, and 36 (10%) dirty cases. Pre-op,129 patients (36%) had ESBL EN colonization. Surgical prophylaxis included second-generation cephalosporins (N = 224, 62%), third-generation cephalosporins (N = 92, 25%), and carbapenems (N = 44, 12%). Post-operative SSIs were identified in 51 patients (14.1%) [superficial SSIs (N = 41) and intra-abdominal SSIs (N = 10)] By multivariate analysis, ESBL EN colonization (aOR = 2.4; 95% CI = 1.19–19.91) and dirty abdominal wound classification (aOR = 3.6; 95% CI = 1.94–16.99) were independent risk factors for SSIs. Culture detection of SSI pathogens differed for superficial vs. intra-abdominal SSIs. Pathogens associated with superficial SSIs included Staphylococcus aureus (10/41;24%), Streptococcus spp. (5/41; 12%), Pseudomonas aeruginosa (6/41; 15%) and non-ESBL EN (16/41;39%). In contrast, all 10 cases of intra-abdominal SSIs were attributed to ESBL EN.

Conclusion
Enteric colonization with ESBL EN was an independent predictor of intra-abdominal SSIs due to ESBL EN, while superficial SSIs were associated with a variety of non-ESBL pathogens. Our study support the need for awareness of the SSI risks associated with ESBL EN. Additionally, the findings support current surgical prophylactic guideline for the use of non-carbapenem among ESBL EN colonizer undergoing abdominal surgery.

Disclosures
All authors: No reported disclosures.
1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy
Authors: Rodrigues Túlio Alves Jeangregório , Fernandes de Oliveira Guilherme , Dias Júlia G C , Campos Laís Souza , Rodrigues Letícia , Correa Paulo Roberto Alvim , Soier Rute Rodrigues , Starling Carlos E F , Couto Bráulio R G M 
Published: October 2019

Abstract

Background
Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery?

Methods
A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%.

Results
A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001).

Conclusion
We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI.

Disclosures
All authors: No reported disclosures.
1248. 30-Day Colon Surgical Site Infections: Using NSQIP to Cross Check NHSN
Authors: Strollo Stephanie L , Neelakanta Anupama , Reinke Caroline , Barringer Michael , Passaretti Catherine 
Published: October 2019

Abstract

Background
While infection prevention (IP) programs utilize National Health Safety Network (NHSN) definitions, surgical site infection (SSI) case-finding methods may vary between facilities based on resources and availability/type of healthcare-associated infection (HAI) electronic surveillance tracking software. Furthermore, surgeons may receive SSI data from other databases such as National Surgery Quality Improvement Project (NSQIP) which has slightly different definitions and case finding methodologies. Our goal was to compare colon SSIs across our health system found by IP using NHSN definitions to those obtained utilizing NSQIP case finding methodology and definitions.

Methods
Between January 2018 and September 2018 across 8 acute care facilities ranging in size from 100 to 898 beds, HAI electronic surveillance tracking triggered IP and infectious diseases (ID) trained physician review for NHSN SSI criteria if a patient was either readmitted or had a positive culture within 30 days of colon surgery. SSI results were compared with NSQIP SSI data which reviews all charts and conducts post-discharge surveillance during active surveillance periods. All discrepant cases were reviewed by an infection preventionist, an ID physician and surgery physician champion. Cases were classified as discrepant due to different case inclusion criteria, different case finding or clinical misclassification.

Results
69 cases were reviewed. Both databases called 11 cases (16%) an SSI initially. NSQIP identified 35 cases that were not detected by IP surveillance. Of the 35 NSQIP detected SSI, 17 (49%) were felt to meet NHSN SSI criteria after review (7 organ space, 10 superficial). Majority (76%) were discordant due to case finding issues (diagnosed as outpatient, same hospital course with no cultures to flag for review). Two infections were missed because of human error. Once the SSIs were entered into NHSN, only one facility had an increase in the SIR which impacted interpretation of SSI performance (from 0.949 up to 1.423). NHSN identified 23 cases that were not identified in the NSQIP database. There were 8 organ space infections and 8 superficial site infections.

Conclusion
Without 100% surveillance, SSIs may be missed. Not all missed infections were superficial. Opportunities were found for both NHSN and NSQIP.

Disclosures
All authors: No reported disclosures.