bluuebunny/crossref_metadata_2025_split huggingface dataset:
858. Inter-rater Reliability of Hand Hygiene Observers with an Electronic Monitoring System
Authors: Bailey Pamela , Armstrong-Novak Jo Dee , Cooper Kaila , Stevens Michael , Bearman Gonzalo , Doll Michelle 
Published: January 2021

Abstract

Background
Hand hygiene (HH) is the bedrock of infection prevention. Knowing the limitations of hand hygiene observers, Virginia Commonwealth University Health System invested in technology to remotely monitor health care workers’s (HCW) HH. Each hand sanitizer and soap dispenser in the patient care areas has a sensor, as well as each patient’s bed and each HCW. As the HCW moves around the environment, the sensors detect whether or not HH was performed for each opportunity.

Methods
While monitoring HH via observations, we compared the manual observations and the technologic hand hygiene observations.

Results
Of 31 witnessed and manually recorded HH observations, 30 were noted in the electronic system (96.7% correspondence). There was only one witnessed opportunity that the technology failed to capture, when the staff member was performing hand hygiene while standing in the doorway talking to the nurse inside the room. There were multiple missed opportunities for HH while in patient rooms, as defined by the WHO’s Five Moments.

Conclusion
There was excellent correspondence between the manual observations and the HH technology in this study. There is significant limitation in what an observer can do, while the HH technology will average around 35,000 ‘observations’ on a daily basis and is capable of capturing more of the 5 moments of HH. We have previously noted interference in the wireless technology in the healthcare environment. However, failure of providers to perform HH when indicated overshadow the failures of technology to capture HH that is performed. Better understanding of the indications for HH in accordance with the WHO 5 Moments may improve provider trust in the technology.

Disclosures
All Authors: No reported disclosures
60. Evaluation of Outcomes Associated with Intermittent Versus Extended Infusion of Piperacillin/tazobactam in Acutely Ill Veterans
Authors: Encarnacion Marianne Angeli , Ma Ariel , Johns Scott T 
Published: January 2021

Abstract

Background
Antibiotic dosing optimization is a key principle of antimicrobial stewardship. This study evaluated the impact of an extended infusion piperacillin/tazobactam dosing protocol on clinical outcomes in acutely ill veterans treated for infections at VA San Diego.

Methods
This retrospective cohort study looked at veterans admitted to the medical-surgical unit who were treated with piperacillin/tazobactam for at least 48 hours. The control group included patients who received treatment between 12/14/2017 to 7/22/2018, and the “protocol” or after protocol implementation group included patients who received treatment between 7/23/2018 to 2/28/2019. Excluded from the study were veterans with microbiological cultures showing intermediate sensitivity or resistance to piperacillin/tazobactam, those who experienced interruption in therapy, or those who required dialysis. Primary clinical outcomes included in-hospital mortality rate, 30-day mortality rate, hospital length of stay (LOS), and 30-day readmission rates. Rates of adverse effects such as elevated liver enzymes, thrombocytopenia, acute kidney impairment (AKI), and Clostridium difficile infection were also collected. χ 2, Fisher’s exact, and Mann-Whitney U tests were used for statistical analysis.

Results
260 veterans were included in the final analysis: 96% male, mean age 65 years, mean BMI 29, 84 met SIRS criteria for sepsis, and 55% received at least 48 hours of concomitant vancomycin. Groups had similar outcomes for median LOS, in-hospital mortality, and 30-day mortality. The incidence of AKI was significantly lower in the protocol group (39.2% vs. 56.9%, p=0.004), in veterans on concomitant vancomycin (42.3% vs. 63.2%, p=0.011), and in veterans with obesity (36.4% vs. 70.8%, p=0.001). Rates of liver enzyme elevation, thrombocytopenia, and C. difficile infection were lower in the protocol group though these were not significant.

Conclusion
There was a significantly lower rate of AKI with EI dosing which supports enhanced patient safety. This may be the preferred method of administration for obese patients and/or those receiving vancomycin concurrently. This is the first study to demonstrate that EI piperacillin/tazobactam dosing significantly reduces rates of AKI in patients on concomitant vancomycin.

Disclosures
All Authors: No reported disclosures
861. Evolution of Antifungal Use Over Fifteen Years in a Burn Intensive Care Unit
Authors: Kiley John L , Barsoumian Alice , Giancola Stephanie , Pruskowski Kaitlin , Rizzo Julie , Blyth Dana M 
Published: January 2021

Abstract

Background
Systemic antifungals (AF) and surgery are the cornerstone of therapy for burn-related fungal infections. Multiple AFs were introduced in the last decade with broader spectrum and improved safety profiles, but use in burn patients has yet to be thoroughly described. Here we evaluate 15 years of AF prescribing patterns in a burn intensive care unit (BICU).

Methods
We included all US Army Institute of Surgical Research BICU patients who received &gt; 1 dose of AF from 2004-18. First we sought to describe overall AF prescribing. Clinical features, mortality and AF use (including in combination) from 2004-8 (T1), 2009-2013 (T2), 2014-18 (T3) were compared.

Results
Between 2004-18, 361 patients with a median total body surface area (TBSA) of 45% (IQR: 25-60) received AF. Median duration of hospital stay prior to and duration of initial AF (AF1) were 13.5 (IQR: 7-22) and 4 days (IQR: 2-9), respectively. Patients prescribed AF had a median of 2 (IQR 1-3) different AFs. AF1 was most commonly fluconazole [FLC; n=141 (39%)], amphotericin [AMB; n=62 (17%)] and voriconazole [VRC; n=55 (15%)]. Of those who survived, (N=233) AF1 was AMB, 40 (17.2%); FLC, 102 (43.8%); itraconazole, 1 (0.4%); VRC, 35 (15%); posaconazole (POS), 6 (2.6%); isavuconazole (ISA), 4 (1.7%); caspofungin (CAS), 7 (3%); micafungin (MFG), 28 (12%), VRC/AMB, 8 (3.4%); FLC/AMB, 0; FLC/CSP, 1 (0.4%); and VCR/MFG 1 (0.4%). AF1 use differed across T1, T2, and T3 (Table). Notably, there was shift towards use of POS, ISA, and MFG. The use of AF1 combination therapy differed across T1, T2, and T3 (p = 0.002). 200 patients had a second AF (AF2) prescribed at a median of 4.15 days (IQR 1.1-12.5) after AF1 for a median duration of 5.3 days (IQR 2-9.7). AF2 were most commonly VRC (n=54, 27%), AMB (n =46, 23%) and FLC (n=44, 22%). There were no differences in AF2 over time.
Table. Clinical characteristics and antifungal use by five year increments

Conclusion
AF use evolved to include echinocandins and broader spectrum triazoles and decreased use of AMB as part of AF1. However, AF2 remained most commonly VRC, AMB, and FLC.

Disclosures
All Authors: No reported disclosures
862. Impact of Caregiver Health on Pediatric Healthcare-Associated Viral Respiratory Infections (HAVRIs): A Retrospective Study
Authors: Paquette Maude , Shephard Allyson , Bedard Pat , Thampi Nisha , Thampi Nisha 
Published: January 2021

Abstract

Background
The burden of healthcare-associated viral respiratory infections (HAVRIs) in children is significant, with increased healthcare costs and risk of poor outcomes. However, while healthcare workers are the main target of infection prevention measures, little is known about the impact of sick contacts during hospitalization on the incidence of HAVRIs. The objective of our study was to determine the proportion of pediatric HAVRIs following contact with an ill caregiver or visitor. Secondary objectives were to describe the characteristics of affected patients as well as the complications associated with the HAVRI episodes.

Methods
This is a retrospective chart review that took place in a pediatric tertiary care center with both multiple and single-bed rooms. All cases of HAVRIs that occurred between December 2017 and July 2019 in patients aged less than 18 years old were included in the study. HAVRIs were defined as a laboratory confirmed respiratory viral illness occurring after 72 hours of admission.

Results
Forty-four HAVRIs were included in the analysis. The majority (n=32, 72.7%) were among patients aged less than 24 months. Only 2 patients had no comorbidities and almost half (n=21, 47.7%) had multiple complex medical conditions. Rhinovirus was the most frequently isolated virus (n=20, 45.5%). Nine patients (20.5%) had a documented contact with a sick caregiver (n=8, 88.9%) or sick visitor (n=2, 22.2%) in the 7 days prior to the onset of new respiratory symptoms and subsequent HAVRI diagnosis. In the 72 hours prior to HAVRI onset, 18 patients (40.9%) were in a single-bed room and 6 patients (13.6%) were already under droplet/contact precautions. Twelve patients (27.3%) had new or increased O2 requirements and 4 (9.1%) were transferred to the intensive care unit. There were no associated deaths.

Conclusion
Our study suggests that having a contact with a sick caregiver or visitor is a potential risk factor for acquiring a HAVRI. This reinforces the relevance of a strict visitor-screening policy and of educating caregivers on the importance of appropriate hand hygiene when caring for their child. Of note, more than one third of HAVRI cases occurred in patients already in a single-bed room, with or without additional precautions, suggesting that those measures are not entirely protective.

Disclosures
All Authors: No reported disclosures
61. Evaluation of the Impact of a Micafungin Time-Out Protocol for Hospitalized Patients
Authors: Williams Kelsey N , Elshaboury Ramy H , Letourneau Alyssa R , Adamsick Meagan L , Gandhi Ronak G , Paras Molly L , Bidell Monique R 
Published: January 2021

Abstract

Background
Echinocandin overuse is associated with increased prevalence of non-albicans Candida spp, resistance, and high costs. Prospective review of micafungin prescribing by an Antimicrobial Stewardship Pharmacist (ASP) has shown reduced rates of inappropriate therapy. The aim of this study was to describe ASP’s interventions following introduction of a micafungin time out (MTO) protocol.

Methods
The approved MTO protocol was implemented in November 2019. Active micafungin orders for hospitalized patients were reviewed Monday through Friday at initiation and on day five. The MTO algorithm assessed micafungin use based on patient risk factors for Candida infection and de-escalation was guided by clinical status, culture data, and susceptibility testing. Micafungin use and ASP’s interventions were reviewed post-implementation between 12/01/2019 and 02/29/2020. Micafungin use was also characterized between 12/01/2018 and 02/28/2019 to serve as a control.

Results
A random sample of 50 patients who received micafungin for ≥ 48 hours during the pre- and post- protocol periods were included. 39 (78%) and 38 (76%) patients in the pre- and post-MTO cohort had indications for micafungin initiation according to algorithm. In the post-MTO group, 9 (75%) of the 12 micafungin initiations outside of algorithm approval were intervened on successfully by the ASP, increasing appropriate antifungal therapy to 47 (94%) patients. On day five, 18 (50%) and 25 (65.8%) (p=0.17) micafungin orders were according to algorithm in the pre- and post-MTO groups, respectively. Culture data on day five revealed 18 (50%) in the pre-MTO and 13 (34.2%) in the post-MTO group were eligible for de-escalation. An ASP-initiated MTO on day five identified 23 opportunities for antifungal therapy optimization in the post-MTO group. Interventions included de-escalation (13; 61.9%), discontinuation (6; 28.6%), and dose optimization (4; 19%). Of the 23 ASP interventions on day 5, 10 (43.4%) led to micafungin discontinuation or de-escalation, increasing the overall antifungal appropriateness to 35 (92.1%) patients.

Conclusion
An ASP-initiated MTO can facilitate appropriate and timely optimization of antifungal therapy. The most frequent interventions were de-escalation from micafungin or therapy discontinuation.

Disclosures
All Authors: No reported disclosures
871. Assessment of the Wide-resistant Pseudomonas aeruginosa Outbreak at a University Hospital in Brazil: Have We Lost This War?!
Authors: Reis Henry Pablo Lopes Campos e , Rodrigues Ana Beatriz Ferreira , Silva Julio César Castro , de Lima Lia Pinheiro , Quinaher Talita Lima , de Freitas Thaynara Carvalho , Pereira Carla Mônica Porto , de Araujo Breno Queiroz , de Sousa Paulo Cesar Pereira , Pontes Licia Borges , Rodrigues Jorge Luiz Nobre 
Published: January 2021

Abstract

Background
Resistance profile analysis in Pseudomonas aeruginosa isolates is extremely important to prevent its transmission and to detect outbreaks. Broadly resistant strains (BR) have a high mortality rate in invasive infections. By analyzing the clinical and microbiological characteristics of these infections, one can define more effective actions in a nosocomial outbreak setting in a university hospital in Brazil.

Methods
From January to September 2019, 13 patients from the oncohematology services and intensive care unit (ICU) followed by the stewardship program of a public university hospital in Brazil had Pseudomonas aeruginosa (PsA) BR infection. Resistant multidrug (MDR) was defined as resistant to three or more antimicrobial classes. Extensively resistant (XDR) was sensitive to a maximum of two antimicrobial classes. Resistant pandrug (PDR) has been defined as resistant to all antimicrobial classes. Bacterial samples were identified by the automated VITEK®2 system (BioMérieux). The resistance pattern was defined based on the CLSI-M100 2019 criteria. Colistin sensitivity was assessed by the colistin drop test (Pasteran et al., 2018). The modified carbapenemic inactivation method (mCIM) was performed by disk diffusion.

Results
The 13 strains of PsA were isolated from 84.6% (11/13) blood cultures and 15.4% (2/13) tracheal aspirates, being 76.9% (10/13) from the oncohematology unit and 23.1% (3/13) of the ICU. The resistance profile was 23.1% (3/13) strains PsA MDR, 61.5% (8/13) PsA XDR and 15.4% (2/13) strains resistant to all classes (PsA PDR). 69.2% (9/13) of the strains were mCIM positive, in which the therapeutic option was ceftazidime/avibactam in combination with polymyxin. Regarding the sites of infection and use of devices, 53.8% (7/13) of the patients developed the infection after the use of central venous catheter and/or mechanical ventilation. The mortality rate was 76.9% (10/13).

Conclusion
The investigation of the outbreak of Pseudomonas aeruginosa highlights the importance of infectious surveillance of this pathogen with this resistance profile, to better understand the causalities, minimize its damage and reduce potential recurrence of new outbreaks.

Disclosures
All Authors: No reported disclosures
873. Clusters of Postpartum Group A Streptococcus (GAS) Infections on a Labor and Delivery (L&D) Unit June-October 2019
Authors: Haden Michael , Liscynesky Christina , Colburn Nora , Smyer Justin , Gonsenhauser Iahn , Malcolm Kimberly , Isley Michelle M , Hardgrow Michele , Pancholi Preeti , Thomas Keelie E , Cygnor Anita , Tabor Heather , Berger Brynn , Aluko Oluseun , Koch Elizabeth , Tucker Naomi E , Brandt Eric , Cibulskas Katie , Florek Kelsey , Mohr Marika C , Day Shandra R 
Published: January 2021

Abstract

Background
GAS can cause severe postpartum infections and may be transmitted from colonized healthcare workers (HCWs).

Methods
Two cases of GAS bacteremia following vaginal delivery were identified on the L&D unit June-July 2019 (Cluster 1), prompting a carrier-disseminator investigation. Two additional cases were identified September-October 2019 (Cluster 2), followed by an additional 3 cases late October 2019, all of whom delivered on the same night (Cluster 3).
All patients and HCWs were evaluated for GAS risk factors and screened for colonization via throat, vaginal and perirectal cultures. During Clusters 1 and 2, only HCWs with patient contact were screened, but this was expanded to the entire unit in October after Cluster 3 was identified. All GAS colonized HCWs were provided chemoprophylaxis and rescreened 7-10 days after treatment to ensure eradication. GAS isolates from patients and HCWs were analyzed by whole genome sequencing (WGS).

Results
During Cluster 1 a total of 43 HCWs were screened and HCWA was colonized at all three sites. In Cluster 2, nine HCWs were screened; HCWA was negative at that time but HCWB was colonized in the throat only. Patient 3 was confirmed to be community acquired by pulsed-field gel electrophoresis, patient 4 was closely related by WGS. A new policy was instituted that required all HCWs present at delivery to wear gowns, gloves, masks, eye protection, and to undergo infection prevention education and practice review. Following Cluster 3, all HCWs on the unit were screened (681 total). HCWA was again positive at all 3 sites and two additional HCWs were found to be colonized with the outbreak strain on throat swab only. Isolates from patients 1, 2, 4, 5, 6, 7 and the 4 HCWs were identified as subtype emm 28 and all closely related by WGS (figure 1). A household contact of HCWA was colonized with the outbreak strain as well.
Figure 1

Conclusion
A carrier-disseminator investigation identified clusters of nosocomial postpartum GAS infections involving 6 patients, 4 HCWs and a HCW household contact that were highly related based on WGS. The outbreak strain of GAS was likely spread amongst HCWs via ping pong transmission on the unit. Transmission to patients was halted with implementation of strict infection prevention measures and mass screening and chemoprophylaxis of all colonized HCWs.

Disclosures
All Authors: No reported disclosures
881. Efficacy of Antibiotic Prophylaxis with Vancomycin in Cardiothoracic Surgery
Authors: Cooper Margaret , Zhao Jing 
Published: January 2021

Abstract

Background
Due to the high incidence of methicillin-resistant Staphylococcus aureus (MRSA) at the Detroit Medical Center, vancomycin is now routinely part of the prophylaxis regimen for cardiothoracic (CT) surgery. The study aims to compare the rate and types of surgical site infections (SSIs) when vancomycin is added to cefazolin for CT surgery compared to cefazolin alone.

Methods
This was a retrospective cohort study conducted at two university-affiliated hospitals. Patients who underwent CT surgery between January 2008 and August 2017 and had a readmission for SSI within 90 days of procedure were included. Patients who received cefazolin were compared to patients who received both cefazolin and vancomycin for CT surgery prophylaxis. The primary outcome was incidence of SSIs within 90 days of surgery as defined by the Centers for Disease Control and National Healthcare Safety Network.

Results
Out of 828 patients who underwent CT surgeries, there were 32 patients readmitted within 90 days for SSI. SSI occurred in 4.7% of patients who received cefazolin monotherapy, and 2.4% of patients who received both cefazolin and vancomycin (p=0.095). There was no discernible difference in types of SSI between groups. Pathogens were isolated in 78% of SSIs, with 75% Gram-positive and 19% Gram-negative organisms. SSIs resulted in an average 9.8 days in the hospital and 28.9 days of antibiotic therapy, and led to a total of 15 additional procedures.

Conclusion
Vancomycin added to cefazolin for prophylaxis in CT surgery resulted in lower incidence of SSI, however the difference was not statistically significant.

Disclosures
All Authors: No reported disclosures
882. Evaluating the Risk Factors in Postoperative Infections Following Hysterectomy Procedures: Is Antibiotic Prophylaxis the Issue?
Authors: Yi Stacie , Doan Thien-Ly , Jain Sumeet 
Published: January 2021

Abstract

Background
Infectious complications after hysterectomy procedures are associated with an additional financial burden and length of stay for patients. In addition, post-hysterectomy surgical site infection is a metric tied to hospital ranking and financial penalties. The objective of this study was to evaluate the appropriateness of surgical prophylaxis for hysterectomies in patients with postoperative infections.

Methods
This is a 1:1 case-control study, matched based on the year of surgery and surgeon performing the procedure, of women ≥ 18 years who underwent hysterectomies between 2013 and 2019. Cases were diagnosed with infection(s) attributable to the procedure within 90 days post-hysterectomy. Patients who did not receive prophylaxis were excluded. The primary outcome of this study was to determine if postoperative infections following hysterectomies were due to inappropriate antibiotic prophylaxis. Secondary outcomes included hospital readmission and mortality. The primary statistical tests utilized included descriptive statistics and chi-square test.

Results
The study included 86 patients, 43 in each group. Thirty percent of cases and 7% of controls received inappropriate prophylaxis. For cases, reason for inappropriateness was due to underdosing of cefazolin (38%) and gentamicin (54%), and overdosing of cefotetan (8%). For controls, cefazolin (33%) and gentamicin (67%) were underdosed. Twenty-three percent of the cases and 14% of the controls received inappropriate intraoperative redosing. The most common reason for inappropriateness was timing (40% of cases vs 50% of controls) followed by missed intraoperative redosing (50% of cases vs 33% of controls). No difference was observed in the proportion of cases and proportion of controls who received inappropriate treatment (p=0.21). Eighty-eight percent of cases and 5% of controls were readmitted within 3 months (p&lt; 0.0001). Mortality was not noted in either group.

Conclusion
In this study, there was no statistically significant association between inappropriate antibiotic prophylaxis and infection. There was still a high incidence of inappropriate antibiotic prophylaxis in the cases. Therefore, education of providers on antibiotic dosing and criteria for intraoperative redosing is warranted.

Disclosures
All Authors: No reported disclosures