bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring Implementation of Antibiotic Stewardship in Critical Access Hospitals Using the NHSN Annual Facility Survey
Authors: Vargas Natalia , Brinkman Sarah , Grangaard Laura 
Published: November 2020

Background:
Critical access hospitals (CAHs) serving rural communities have numerous limitations regarding resources, infrastructure, and staffing to support antibiotic stewardship programs (ASPs) and related quality improvement activities. The Federal Office of Rural Health Policy (FORHP) established the Medicare Beneficiary Quality Improvement Project (MBQIP) to provide CAHs with specialized technical assistance in quality improvement data collection and reporting to drive improvements in the quality of care and to reduce barriers to establishing ASPs. In 2016, FORHP developed an antibiotic stewardship process measure in partnership with the CDC to assess progress on implementing ASPs and to optimize hospital quality improvement practices related to antibiotic use. This is the first measure to be successfully implemented and reported at a national level to improve the judicious use of antibiotics in hospitals. Methods: A process measure was developed to assess adherence to the 7 core elements of a successful hospital ASP (ie, leadership, accountability, drug expertise, action, tracking, reporting, and education), as defined by CDC guidelines. Implementation was accomplished through CAH participation in the NHSN Annual Facility Survey (AFS). Responses were analyzed to assess fidelity to each core element, to identify trends, and to benchmark measure reporting among 1,350 CAHs across the United States. Responses were mapped to 7 core element categories, and the total number of positive responses were matched to each core element for a specific survey year to track progress. Overall, the measure assessed progress in meeting all 7 core elements, as well as program robustness in the number of actions implemented and the amount of data tracked and reported at each hospital. NHSN reports were generated to tailor technical assistance activities and to assist hospitals with measure uptake and reporting. Results: CAH participation in the NHSN significantly increased from 2014 to 2018 (83% response rate). From 2014 through 2018, reporting of the new antibiotic stewardship measure consistently increased. CAHs that met all core elements increased from 18% (2014) to 73% (2018). Performance-based benchmarks enabled hospital comparisons and the establishment of reporting goals. Conclusions: This study highlights viable approaches to measuring antibiotic stewardship at a national level to drive improvements in care at hospitals of any size. The implementation of the antibiotic stewardship measure across CAHs demonstrates the impact of federal programs like MBQIP for hospitals that are building capacity for quality improvement. For the first time, CAHs were able to measure and compare their implementation of ASPs to other hospitals at the state and national level.Funding: NoneDisclosures: None
Accuracy of Infection Control Surveillance in Identifying Genomically Confirmed Cross Transmission Clusters
Authors: Hansen Kyle , Ellison Richard T. , Ward Doyle V. , Holler Devon J. , Ashworth Judy L. , Fortunato-Habib Mary M. , Carmona Juan J. , Gross Brian D. 
Published: November 2020

Background: Infection prevention surveillance for cross transmission is often performed by manual review of microbiologic culture results to identify geotemporally related clusters. However, the sensitivity and specificity of this approach remains uncertain. Whole-genome sequencing (WGS) analysis can help provide a gold-standard for identifying cross-transmission events. Objective: We employed a published WGS program, the Philips IntelliSpace Epidemiology platform, to compare accuracy of two surveillance methods: (i.) a virtual infection practitioner (VIP) with perfect recall and automated analysis of antibiotic susceptibility testing (AST), sample collection timing, and patient location data and (ii) a novel clinical matching (CM) algorithm that provides cluster suggestions based on a nuanced weighted analysis of AST data, timing of sample collection, and shared location stays between patients. Methods: WGS was performed routinely on inpatient and emergency department isolates of Enterobacter cloacae, Enterococcus faecium, Klebsiella pneumoniae, and Pseudomonas aeruginosa at an academic medical center. Single-nucleotide variants (SNVs) were compared within core genome regions on a per-species basis to determine cross-transmission clusters. Moreover, one unique strain per patient was included within each analysis, and duplicates were excluded from the final results. Results: Between May 2018 and April 2019, clinical data from 121 patients were paired with WGS data from 28 E. cloacae, 21 E. faecium, 61 K. pneumoniae, and 46 P. aeruginosa isolates. Previously published SNV relatedness thresholds were applied to define genomically related isolates. Mapping of genomic relatedness defined clusters as follows: 4 patients in 2 E. faecium clusters and 2 patients in 1 P. aeruginosa cluster. The VIP method identified 12 potential clusters involving 28 patients, all of which were “pseudoclusters.” Importantly, the CM method identified 7 clusters consisting of 27 patients, which included 1 true E. faecium cluster of 2 patients with genomically related isolates. Conclusions: In light of the WGS data, all of the potential clusters identified by the VIP were pseudoclusters, lacking sufficient genomic relatedness. In contrast, the CM method showed increased sensitivity and specificity: it decreased the percentage of pseudoclusters by 14% and it identified a related genomic cluster of E. faecium. These findings suggest that integrating clinical data analytics and WGS is likely to benefit institutions in limiting expenditure of resources on pseudoclusters. Therefore, WGS combined with more sophisticated surveillance approaches, over standard methods as modeled by the VIP, are needed to better identify and address true cross-transmission events.Funding: This study was supported by Philips Healthcare.Disclosures: None
Comparative Antimicrobial Efficacy of Current Alcohol-Based Hand Rubs: Formulation, Dose, and Test Methods All Matter
Authors: Arbogast James , Parker Albert , Jarvis William , Macinga David 
Published: November 2020

Background: Alcohol-based hand rubs (ABHRs) are the primary form of hand hygiene in healthcare settings globally. Many developed countries, and most US hospitals utilize wall-mounted ABHR dispensers throughout the facility. The adoption of automated touch-free dispensers is increasing. However, data on the efficacy of ABHRs when used at dispensed amounts are limited. The evidence is strong, showing that formulation matters (not just alcohol concentration) and that agent volume impacts efficacy. Objective: We evaluated the efficacy of ABHR foams on human hands using 2 controlled test methods at variable volumes (ie, typical doses and realistic volumes that healthcare personnel could use in patient care practice). Methods: We tested 8 commercially available ABHR products, the WHO hand-rub formulation, (P1–P9) and a nonantibacterial foam handwash control (P10) on human participants at 2 different application frequencies (“1 application” and “10 applications”) using 2 different ASTM test methods (E1174 and E2755). Studies using ASTM-E1174 evaluated 3 different application volumes (0.7 mL, 1.1 mL, and 2.0 mL) of the 10 products, each tested on 12–13 subjects. Studies using ASTM-E2755 evaluated a single 1.1 mL volume for the 9 ABHR products (P1–P9), each on 2–12 subjects. A linear mixed-effects model was fit separately to log reductions with random effects for subject and date, and a fixed effect for product. Results: Four different foam formulations (P1–P4) consistently outperformed all other formulations by the E1174 method, especially with increasing volumes and after 10 product applications (Fig. 1). When tested with E2755, all formulations performed similarly, with only P1 and P2 differentiating after 10 applications (Fig. 2). ABHR efficacy consistently increased with larger application volumes, whereas the handwash control (P10) achieved a similar efficacy (∼2 log reduction) at all volumes. Efficacy for some ABHR formulations increased, whereas others decreased with repeated applications. Alcohol concentration did not correlate with log reduction. Conclusions: Formulation and the product application volume affect the antimicrobial efficacy of ABHR; therefore, those data should be critically assessed by healthcare personnel assessing ABHR product performance. Test methods matter: when E1174 was used, greater differentiation between formulations was observed. This may be due to the larger contamination volume and greater soil load used in E1174.Funding: GOJO Industries, Inc., provided Funding: for this study.Disclosures: James W. Arbogast and David R. Macinga report salary from GOJO Industries.
Using Machine Learning to Detect Hospital-Specific Risk Factors of Surgical Site Infections
Authors: Kozák Jakub , Vraná Lenka , Vavřinová Petra 
Published: November 2020

Background:
Identification of healthcare-associated infections (HAIs) is just a first step in the surveillance of HAIs. The other part is the analysis and interpretation of collected data, which should help to set up effective preventive measures targeted where they are needed the most. General risk factors of HAIs are mostly well known, but how do the environment and processes of each hospital affect risks of HAI? Can advanced methods of data analytics reveal hidden hospital-specific risk factors of surgical site infections (SSIs)? Methods: We analyzed data from electronic health records stored in the clinical information system of Hospital Jihlava, Czech Republic, with 650 beds and 7,500 surgeries performed annually. For each inpatient stay with a surgical procedure, we automatically observed almost 1,500 features that could lead to a higher incidence of SSIs. These features consist of patient demographic data, information from structured data (eg, patient diagnoses, departments, specific rooms, operating theaters, surgeons and other hospital staff participating in the surgery), and information extracted from clinical notes using natural language processing (eg, procedures, invasive devices, and comorbidities). We used a model based on survival analysis to reveal the risk factors that can increase the probability of SSI during the inpatient stay or outpatient care after discharge. Results: We automatically evaluated risk factors weekly for 4 months (July 2019–October 2019). We detected 16 distinct significant risk factors during this period—between 2 and 6 active risk factors each week. For example, patients visiting a specific department were up to 5 times more likely to develop an HAI than the rest of the patients (P < .001). Some of the risk factors revealed were significant only within a short time, and some of them occurred perpetually. When a feature became significant, it was considered an early warning of a problem that should be addressed by the infection prevention and control team. Trends in risk factors coefficients can also help in assessing the performance of the launched preventive measures. Conclusions: Advanced data analytics can effectively uncover hospital-specific risk factors affecting surgical site infections. Such systems can automatically deliver results that can be further explored and used as a basis for targeted preventive measures.Funding: Datlowe provided support for this study.Disclosures: Jakub Kozák reports salary from and ownership of Datlowe.
A Descriptive Analysis of Outpatient Antimicrobial Use for Urinary Tract Infections in Virginia
Authors: Mazdeyasna Hasti , Bernard Shaina , Kang Le , Godbout Emily , Lee Kimberly , Pakyz Amy , Noda Andrew , Kim Jihye , Markley John Daniel , Doll Michelle Elizabeth , Bearman Gonzalo , Stevens Michael 
Published: November 2020

Background: Data regarding outpatient antibiotic prescribing for urinary tract infections (UTIs) are limited, and they have never been formally summarized in Virginia. Objective: We describe outpatient antibiotic prescribing trends for UTIs based on gender, age, geographic region, insurance payer and International Classification of Disease, Tenth Revision (ICD-10) codes in Virginia. Methods: We used the Virginia All-Payer Claims Database (APCD), administered by Virginia Health Information (VHI), which holds data for Medicare, Medicaid, and private insurance. The study cohort included Virginia residents who had a primary diagnosis of UTI, had an antibiotic claim 0–3 days after the date of the diagnosis and who were seen in an outpatient facility in Virginia between January 1, 2016, and December 31, 2016. A diagnosis of UTI was categorized as cystitis, urethritis or pyelonephritis and was defined using the following ICD-10 codes: N30.0, N30.00, N30.01, N30.9, N30.90, N30.91, N39.0, N34.1, N34.2, and N10. The following antibiotics were prescribed: aminoglycosides, sulfamethoxazole/trimethoprim (TMP-SMX), cephalosporins, fluoroquinolones, macrolides, penicillins, tetracyclines, or nitrofurantoin. Patients were categorized based on gender, age, location, insurance payer and UTI type. We used χ2 and Cochran-Mantel-Haenszel testing. Analyses were performed in SAS version 9.4 software (SAS Institute, Cary, NC). Results: In total, 15,580 patients were included in this study. Prescriptions for antibiotics by drug class differed significantly by gender (P < .0001), age (P < .0001), geographic region (P < .0001), insurance payer (P < .0001), and UTI type (P < .0001). Cephalosporins were prescribed more often to women (32.48%, 4,173 of 12,846) than to men (26.26%, 718 of 2,734), and fluoroquinolones were prescribed more often to men (53.88%, 1,473 of 2,734) than to women (47.91%, 6,155 of 12,846). Although cephalosporins were prescribed most frequently (42.58%, 557 of 1,308) in northern Virginia, fluoroquinolones were prescribed the most in eastern Virginia (50.76%, 1677 of 3,304). Patients with commercial health insurance, Medicaid, and Medicare were prescribed fluoroquinolones (39.31%, 1,149 of 2,923), cephalosporins (56.33%, 1,326 of 2,354), and fluoroquinolones (57.36%, 5,910 of 10,303) most frequently, respectively. Conclusions: Antibiotic prescribing trends for UTIs varied by gender, age, geographic region, payer status and UTI type in the state of Virginia. These data will inform future statewide antimicrobial stewardship efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.
Evaluation of the Performance and Resource Needs of a Construction Infection Prevention and Control Program
Authors: Devine Eric , Fullerton Jessica , Rebelo Carly , Zebarth Karl , Oxley Alexandra , Hota Susy 
Published: November 2020

Background:
The University Health Network (UHN) is a multisite, academic health sciences center in Toronto, Canada, with 1,300 inpatient beds and ∼126,000 emergency department visits annually. Clinical services include a transplant program, cancer center, dialysis units, and rehabilitation sites. Currently, ∼0.83 km2 (>9 million ft2) of UHN real estate, ∼200 construction, renovation and maintenance projects are underway. The UHN Construction Infection Control Program (CICP) was created in 2012 and has expanded to include 3.5 FTEs to meet the needs of infection prevention oversight during these activities. We describe the performance indicators for the UHN CICP between May 2016 and December 2018 that have informed productivity and resource needs. Methods: Since 2016, construction infection preventionists (CIPs) have prospectively collected data on the frequency of activities reflecting CIP productivity and core job functions: number of meetings (attended and missed), site inspections, responses to breaches in control measures, education hours delivered, urgent requests, and after-hours work. Annual activity rates (frequency of activity divided by CIP months) were analyzed for trends, accounting for additions in CICP personnel over time. Results: Human resources and activities performed in the CICP from 2016 to 2018 are outlined in Table 1. As CICP human resources increased, the number of initiatives supported by the CICP team rose. Activity rates for attended meetings, inspections and hours of education provided increased with higher CIP resources, suggesting an improvement in individual productivity of each CIP (Fig. 1). Concurrently, the rate of missed meetings declined and after-hour requests and breach responses remained stable. Conclusions: An appropriately staffed CICP for the volume and risk level of organization-wide construction, renovation, and maintenance activities is crucial to infection prevention. We developed performance indicators based upon key functions of CIPs to evaluate the productivity of our team and ensure we had adequate human resources to maintain patient safety through our evolving needs.Funding: NoneDisclosures: Susy Hota reports contract research for Finch Therapeutics.
Racial Differences in Incidence of Staphylococcus aureus Joint Infections in Metropolitan Atlanta, 2016–2018
Authors: Overton Rahsaan , Sefton Samantha , Thomas Stepy , Fridkin Scott , Webster Andrew , Ray Susan 
Published: November 2020

Background:Staphylococcus aureus is the leading cause of joint infections. These infections may arise in native or prosthetic joints. Previous analysis of population-based surveillance has documented racial differences in incidence of invasive S. aureus bloodstream infections. We hypothesized that racial differences in incidence would not persist among of S. aureus joint infections. Methods: We utilized data from the Georgia Emerging Infections Program (GA EIP), which conducts CDC-funded active, population-based surveillance for iSA within the 8-county area of Atlanta. Cases were defined as residents of the surveillance area with S. aureus isolated during 2016–2018 from joint fluid or tissue, and cultures within a 30-day period after the initial culture date were considered a single case. Age- and race-specific incidence were calculated using US census data; incidence rate ratios (RR) and adjusted rate ratios (aRR) were calculated using the Mantel-Hanzel method. Results: Between 2016 and 2018, 500 iSA joint infections were identified (iMRSA, 28.2% and iMSSA, 71.8%): 34.4% occurred in black patients and 65.6% occurred in white patients. Also, 90 cases (18%) had a bloodstream infection (BSI) within 30 days of the joint infection. Incidence of iSA joint infections dropped 22% from 9.4 per 100,000 in 2016 to 7.5 per 100,000 in 2018 (RR, 0.79; 95% CI, 0.7–0.9). Adjusting for year, incidence was 40% lower among blacks than whites (RR, 0.6,; 95% CI, 0.5–0.7); this finding was attributed to blacks having 60% lower incidence of iMSSA joint infections compared to whites (aRR, 0.4; 95% CI, 0.3–0.5) but similar MRSA incidence (aRR, 1.2; 95% CI, 0.8–1.6). The highest incidence was observed among whites aged >65 years with iMSSA infections (30.2 per 100,000) (Fig. 1). Among cases with a full chart review (n = 138), surgery in the prior 90 days was uncommon (n = 42, 30.4%), and a preceding major orthopedic procedure was even more rare (n = 13, 9.4%). Antecedent therapeutic injections and arthroscopic procedures are under investigation. Conclusions: Unlike S. aureus bacteremia, where previous analysis demonstrates higher incidences among blacks predominantly due to MRSA, our data demonstrate that the incidence of S. aureus joint infections is higher in whites, predominantly due to MSSA. Investigations in differential practices regarding orthopedic illness and injury should be pursued.Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.
Road to Increasing AMR: A Study on Antibiotics Prescribing Pattern
Authors: Fofanah Bobson Derrick , Conteh Christiana , Weiss Jamine 
Published: November 2020

Background: Infectious diseases and the rapid emergence of multidrug-resistant pathogens continue to pose a threat to global health. The development of antimicrobial-resistant organisms is an alarming issue caused by inappropriate use of antibiotic agents. It is estimated that death from antimicrobial resistant pathogens could increase >10-fold to ~10 million deaths annually by 2050 if action is not taken. “It is essential to have reliable data on how medicines are used in order to identify areas to develop targeted interventions” (WHO 2011). Investigating antimicrobial use in hospitals is the first step in evaluating the underlying causes of AMR. In Sierra Leone, no other study related to antibiotic prescribing patterns in hospital setting has been undertaken. Objective: To investigate antibiotic prescription patterns using the WHO hospital antimicrobial use indicator tool at the Kingharman Hospital for 1 month. Methods: Data were collected from patient charts for 1 month, January 1–31, 2019. A data extraction tool was used to capture information on patient demographics, diagnosis, and antibiotics prescription details regarding dosage, duration, and frequency of administration. The tool adopted 6 selected indicators from the WHO antimicrobial use manual to measure the extent of antibiotic use in hospital and performance among prescribers. Results: Of the 189 charts reviewed, 175 included antibiotic prescriptions. The percentage of prescriptions involving antibiotics was 92.5%. The average number of drugs prescribed was 2, with an average duration of 5.2 days. Moreover, 50.5% of antibiotics prescribed were generic, and 96.6% were from the Ministry of Health and Sanitation Essential Medicine List (EML). The most commonly used antibiotics were ciprofloxacin (38.8%), followed by ceftriaxone (23.0%), amoxicillin (16.8%), metronidazole (8.5%), and others(12.7%). Typhoid accounted for 34.8% of broad-spectrum antibiotics, UTI accounted for 17.7%, malaria accounted for 12.5%, 25.5% were unspecified, and 9.5% were for unclear diagnoses. Typically, combinations of fluroquinolones and cephalosporins were used to treat typhoid and UTIs. Conclusions: This cross-sectional study represents a broad picture of antibiotic prescribing patterns at the King Harman Hospital. There was no strict adherence to the WHO recommended prescribing guidelines. These findings also indicate the degree of irrational and inappropriate prescribing of broad-spectrum antibiotics. This study highlights the need for a comprehensive assessment of antimicrobial use to gain a better understanding of national antibiotic use and to guide interventions to reducing AMR.Funding: NoneDisclosures: NoneIf I am discussing specific healthcare products or services, I will use generic names to extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.DisagreeChristiana Kallon