bluuebunny/crossref_metadata_2025_split huggingface dataset:
859. Remote Video Auditing (RVA) To Assess Personal Protective Equipment (PPE) Compliance In Rooms With Clostridioides difficile Patients
Authors: Khatri Akshay M , Khameraj Aradhana , Franklin Tony , Malhotra Prashant , Farber Bruce 
Published: January 2021

Abstract

Background
Nosocomial Clostridioides difficile (Cdiff) outbreaks can be prevented by PPE use and hand hygiene (HH) by healthcare providers (HCPs). A rise in Cdiff cases in our oncology unit prompted the use of novel educational and monitoring measures for infection control. Remote video auditing (RVA), a new technique to ensure isolation adherence, is more objective and reliable than standard direct observation. In this study, we used RVA to assess HCP compliance with PPE in Cdiff patient (pt) rooms (rms) and other rms in the same unit.

Methods
A prospective observational study (supported by the Karen Brown research fund) was conducted over 8 months. RVA involved video recording of HCP encounters at entry/exit from Cdiff pt rms and other rms in the same unit. Adherence to PPE (gowns/gloves), HH and PPE doffing sequence was reviewed by independent trained observers using a uniform protocol. Data was captured from electronic records and infection prevention data (using NHSN criteria). Data from 2 time periods [P1 (July 2019-Oct 2019), P2 (Nov 2019-Feb 2020)] and historical controls (HC) were compared for significance using students t-test.

Results
We compared PPE/HH rates in 5685 encounters in all rms in the unit to PPE/HH rates from HC and surprisingly saw lower compliance rates during the study (Table 1). We also analyzed 507 encounters in Cdiff rms (Table 2). An increased compliance with PPE (but not HH) was noted at rm entry in P2 as compared to P1, but it was not statistically significant (Table 2). There was significantly increased compliance with PPE/HH and proper doffing when exiting a pt rm in P2 as compared to P1 (Table 2). Cdiff cases per patient day decreased from P1 to P2 (0.003 to 0.001). We believe the discordant findings were due to Hawthorne effect (change in behaviors due to the awareness of being observed) and the well-known inherent unreliability of direct observation methods used for monitoring HC.
Table 1: Comparison of PPE compliance rates (use of gowns, gloves, and mask) and hand hygiene for the entire unit, between the entire study period and historical control rates

Table 2: Comparison of PPE compliance rates (use of gowns, gloves, and mask), proper doffing sequence and hand hygiene at entry and exit at a Cdiff patient’s room, between two time periods [#: Doffing was recorded by RVA only at time of exit from Cdiff rooms]

Conclusion
RVA is a more reliable and less labor-intensive assessing adherence to isolation precautions than direct observation. RVA recorded increased PPE compliance over time (particularly at exit from isolation rms), resulting in reduced Cdiff infections. Thus, RVA, by ensuring strict isolation precautions, may be better than direct observation in preventing communicable infections like Cdiff.

Disclosures
All Authors: No reported disclosures
863. Outcomes of Healthcare-Associated Respiratory Viral Infections in a Pediatric Hospital: A Historical Cohort Study
Authors: Most Zachary , Jackson Patricia , Sebert Michael , Perl Trish M , Perl Trish M 
Published: January 2021

Abstract

Background
Healthcare-associated respiratory viral infections (HARVI) occur frequently at pediatric hospitals. The spectrum and attributable outcomes of these infections are unknown.

Methods
Using a matched historical cohort design, HARVI cases identified between July 2013 and June 2018 at a large pediatric referral hospital in Dallas, Texas were defined as patients who tested positive for one of eight respiratory viruses during their hospitalization, had new respiratory symptoms develop during hospitalization, and had symptom onset on a hospitalization day that was greater than the maximum incubation period for the specific respiratory virus. Controls were matched 1:1 for index time, meaning that the control had a hospital length of stay that was at least as long as the length of stay in the matched case prior to viral testing. Controls were also matched for year and month of infection as well as hospital unit and/or age. The primary outcome was additional length of stay following infection or index time. Additional outcomes included transfer to intensive care, need for intubation, hospital charges, and all cause in-hospital mortality.

Results
Over the 5-year study period, 317 definite HARVI were identified (0.62 per 1,000 admitted patient days), and only 287 (91%) had a matched control to be included in analysis. Among these cases and matched controls, the median time to index time was 19 days (IQR 10-39 days). The most common causative viruses where rhinovirus/enterovirus (188, 65.5%), RSV (30, 10.5%), parainfluenza virus (28, 9.8%), and seasonal coronaviruses (27, 9.4%). Fewer cases than controls were in an intensive care unit at index time (101 [35.2%] vs. 156 [54.4%]) The mean additional length of stay following index time was shorter in cases than controls (35.2 days vs. 48.1 days, difference = -12.9 days, 95% CI -20.95 to -4.82 days).

Conclusion
Hospital length of stay for cases with HARVI was not longer than for those without HARVI. Possible explanations include confounding and selection bias. Further studies with carefully selected controls are needed.

Disclosures
All Authors: No reported disclosures
870. Mycobacterium chimaera Outbreak: Infection Control and Clinical Experiences in Edmonton, Alberta
Authors: Kula Brittany E , Smith Stephanie 
Published: January 2021

Abstract

Background
Mycobacterium chimaera is responsible for a global outbreak due to contaminated heater-cooler units (HCUs) used in cardiothoracic surgery and has been associated with high mortality. Optimal treatment is not known. The objectives of this study were to describe the Infection Control strategies utilized by the University of Alberta hospital and Mazankowski Heart Institute (MAZ) prior to availability of new HCUs, and outline the clinical course of locally acquired M. chimaera infection.

Methods
We reviewed interventions undertaken to mitigate the risk of M. chimaera infection. Any MAZ patient with M. chimaera isolated at an anatomic site with a history of cardiothoracic surgery from 2012-present were identified. Charts were reviewed for patient and infection characteristics.

Results
All manufacturer’s instructions for HCU cleaning-disinfection were followed. The MAZ was compliant with CDC recommendations for directing HCU ventilation exhaust away from the surgical field and to the use of filtered water. M. chimaera was isolated in 3/8 local HCUs. After decontamination procedure, 1 HCU grew M. chimaera but cleared after a second attempt. Smoke studies demonstrated aerosolization of HCU exhaust in October 2016 therefore the laminar air curtains were manipulated for increased flow in October and November 2016. By June 2017, HCUs were retro-fitted and in late 2017 all pre-2014 Sorin HCUs were replaced.
10 patients have been diagnosed with M. chimaera infection post-cardiothoracic surgery performed at the MAZ. None occurred after manipulation of the laminar air curtain. Mean patient age at time of cardiothoracic surgery was 62.3 years and 6 were male. All had implantation of prosthetic material. The most common culture-positive sites were blood in 9/10, urine in 5/10 and prosthetic material or surgical site in 3/10. 6/10 have died due to infection and mean life expectancy of those deceased from first positive culture is 123 days. An additional survivor has been transitioned to comfort care and lost to follow-up.

Conclusion
M. chimaera post cardiothoracic surgery has been challenging from an infection control perspective but the risk appears to have been mitigated through manipulation of the laminar air curtain. Locally, M. chimaera has been associated with significant (60%) mortality.

Disclosures
All Authors: No reported disclosures
886. Impact of Type of Surgical Management on the Incidence of Recurrent Surgical Site Infections Following Hip and Knee replacements in Calgary, Alberta
Authors: Chavda Swati , Leal Jenine , Puloski Shannon , May Elissa Rennert 
Published: January 2021

Abstract

Background
Recurrent surgical site infections (SSIs) are associated with decreased quality of life for patients and increased economic burden to healthcare systems. Positive cultures at reimplantation and patient co-morbidities have been shown to increase the risk of recurrent SSI in hip and knee surgical site infections. Two-stage exchange has been considered for the most appropriate surgical management for these SSI’s, however, it is unclear whether the type of revision arthroplasty and pathogen of the first SSI impacts recurrence rates.

Methods
A retrospective review of prospectively collected data on all complex SSIs following primary hip and knee arthroplasties between April 1 2012 and March 31, 2019, in Calgary, Alberta was performed. Patients were followed for two years post-index arthroplasty to determine initial management of first complex SSI (Debridement, antibiotics and implant retention (DAIR) vs DAIR+liner exchange vs one-stage vs two-stage), rate of recurrent complex SSI, and microbiological data for first and subsequent SSI’s.

Results
Of the 142 complex SSIs, 95 (66.9%) were managed with DAIR and liner exchange, 25 (17.6%) were managed with DAIR, 13 (9.1%) with one-stage and 8 (5.6%) with two-stage procedures. The recurrence rate was 19/95 (20%) for DAIR and liner, 8/25 (32%) for DAIR alone, 2/13 (15%) with one stage, and 3/8 (37.5%) with two-stage. There was no significant difference in recurrence rates of complex SSI when stratified by surgical management. Of the pathogens, Staphylococcus aureus (S.aureus) (including methicillin-resistant S. aureus (MRSA)) accounted for 35.2% of total first SSI and 50% of recurrences. A significantly higher proportion of S.aureus infections (including MRSA) ended up with a recurrent infection compared to all other pathogens (p=0.045). Of the 32 recurrences, 28.1% were due to the same pathogen as the initial SSI.

Conclusion
S.aureus was the most common pathogen causing initial and recurrent SSIs. This reinforces that S.aureus complex SSIs would likely benefit from early recognition and aggressive treatment. Recurrence of SSI was not impacted by type of revision arthroplasty. This study is limited by a small sample size. These findings contribute to the paucity of literature in this area and suggest a need for expansion to larger populations.

Disclosures
All Authors: No reported disclosures
887. Implementation of a Surgical Site Infection (SSI) Prevention Bundle: Patient Compliance and Experience
Authors: Hockett-Sherlock Stacey , Suh Daniel , Perencevich Eli N , Reisinger Heather Schacht , Streit Judy , Clore Gosia , Ohl Madeline , Herwaldt Loreen , Schweizer Marin L 
Published: January 2021

Abstract

Background
An evidence-based preoperative bundle including chlorhexidine gluconate (CHG) bathing, screening for S. aureus nasal carriage and decolonizing carriers with mupirocin was the standard of care for patients having total joint arthroplasty (TJA) at a VA medical center. We aimed to assess patient compliance with mupirocin and CHG, and characterize patient perceptions of barriers and facilitators to compliance.
Compliance with CHG Bathing & Mupirocin By Methicillin-resistant S. aureus (MRSA) or Methicillin-susceptible S. aureus (MSSA) Colonization Status

Methods
The bundle for S. aureus colonized patients having TJA included nasal mupirocin ointment twice daily and daily CHG bathing for 5 days before surgery. The bundle for non-carriers included CHG bathing the day before and the morning of surgery. From 7/2018-10/2019, inpatients completed a 31-item survey following their TJA.

Results
73 patients completed the survey (~29% of the TJA population). 17 patients (23%) carried S. aureus & 56 patients (77%) were non-carriers. Patients reported high compliance with home use of CHG for the full number of days directed (88% when prescribed for 2 days; 71% when prescribed for 5 days; overall 85% used as prescribed; Figure). 7 (10%) patients reported CHG side effects, including burning or itchy/dry skin. 99% of patients reported willingness to use the CHG before a future surgery. Compliance with home use of mupirocin was lower (53% used as prescribed). Reported side effects included stinging, itching or dryness (N=2, 12%), unpleasant taste (N=2, 12%) & runny or stuffy nose (N=3, 18%). 100% of patients reported willingness to use mupirocin before a future surgery. Barriers to patient compliance with the bundle included forgetfulness and difficulty bathing daily. Facilitators to patient compliance included high facility compliance with S. aureus screening (100% patients reported), patient education regarding CHG and mupirocin use (95% patients recalled), and access to prescribed medications (100% patients received). Most patients (93%) reported no financial burden for mupirocin and 95% of patients reported no financial burden for CHG.

Conclusion
Patients reported high willingness to use the prevention bundle, yet mupirocin compliance was sub-optimal. Replacing patient-applied home mupirocin with nurse-applied day-of-surgery decolonization should be assessed in order to facilitate increased compliance.

Disclosures
All Authors: No reported disclosures
899. Reduction of Surgical Site Infections Post Cesarean Section through Implementation of Novel Evidenced Based Bundle
Authors: Vacca Maria , Mapp Marilyn A , Hiester Ashlee , Vyas Nikunj M , Burke Julia , Covone Kenneth 
Published: January 2021

Abstract

Background
A frequent complication post cesarean section (C-section) is surgical site infections (SSI) which are associated with heightened maternal morbidity and mortality, decreased patient satisfaction, prolonged hospitalization, and increased costs. In Calendar Year 2019, our Infection Control Committee identified an increase in the incidence of post-operative C-section SSI rates over an 8 month period from January through August of 2019.. The purpose of this study was to develop, implement and measure the compliance and efficacy of a novel pre-operative bundle (POB) for patients undergoing C-section.
Calendar Year 2019 Jan. through Aug. C-Section Infections Raw Numbers

Methods
In October 2019, our multidisciplinary team consisting of Infection Control, Pharmacy, Nursing, and Physicians developed and implemented POB for patients undergoing C-section. The POB included the following:
1. Mandatory interventions of vaginal cleansing using povidone iodine
2. Chlorhexidine (CHG) 2% wipes to abdomen
3. Addition of Azithromycin 500mg x 1 dose as pre-operative antibiotic.
Primary endpoint of the study was to measure the overall C-section SSI incidence for 8 months period pre and 8 months post implementation of the POB. This Secondary endpoint of the study included POB compliance and efficacy of real-time prospective audit and feedback for non-compliance.
Novel Preoperative Bundle Auditing Compliance

Results
There were total of 212 patients who received C-section in Pre-POB group and 182 in Post-POB group. Baseline characteristics between the groups were similar. Overall C-section rates Pre-POB was 3.8 % vs 0% in Post-POB group. We noted a bundle compliance of 97.9% since implementation of POB. Real time prospective audit and feedback was provided to total of 122 cases after implementation of POB.
Comparison of C-Section Raw Numbers Calendar Year 2019 Pre and Post Novel Bundle Implementation

Conclusion
With implementation of POB, we noticed a significant drop in our C-section SSI. We observed a very high bundle compliance with implementation of prospective audit and feedback approach. This is the first study evaluating implementing a novel pre-operative bundle for patients undergoing C-section. Continued auditing and real time feed back of novel bundle will ensure continued success.

Disclosures
All Authors: No reported disclosures
65. Impact of a Multifaceted Stewardship Intervention on Oral Fosfomycin Prescribing for Treatment of Resistant Organisms in Cystitis
Authors: Pry Marie , Pillinger Kelly E , Dobrzynski David , Crowley Amber , Shulder Stephanie 
Published: January 2021

Abstract

Background
Fosfomycin is an oral antibiotic with activity against multi-drug resistant (MDR) bacteria that is recommended as first line treatment for cystitis. The ability to use an oral agent for these infections will be beneficial due to the decreased need for hospitalizations and clinic visits to manage IV therapy; therefore, reducing healthcare exposure for the patient.

Methods
This was a multi-site, observational study evaluating adult patients with a urine culture growing extended-spectrum beta-lactamase E. coli, vancomycin-resistant Enterococcus, or fluoroquinolone-resistant Pseudomonas urinary isolates and with documented cystitis between September – November 2018 (pre-implementation) and September – November 2019 (post-implementation). The primary outcome was the difference in the rate of fosfomycin use pre and post implementation of multiple stewardship interventions (routine fosfomycin susceptibility reporting on MDR organisms, creation of a fosfomycin order set and provider education).

Results
Of 306 patients reviewed, 148 patients met eligibility criteria (68 pre, 80 post). The majority of patients were female (80%), diagnosed with complicated UTI (82%), treated outpatient (88%), and with ESBL E. coli as the causative pathogen (91%). There was a significantly higher rate of fosfomycin use post-intervention (pre 1.5% vs. post 20%, p&lt; 0.001). No difference was seen between groups in the rates of use of all other antibiotic classes. The most common antibiotic prescribed for empiric or definitive therapy was nitrofurantoin (empiric 43%, definitive 53%). Appropriate fosfomycin dosing was low in both groups (pre 9% vs. post 19%; p &gt; 0.99). There was no difference in the rate of adverse reactions (pre 4% vs. post 5%, p &gt; 0.99).

Conclusion
There was an increase in fosfomycin use after incorporating a multifaceted stewardship intervention. Fosfomycin provides an alternative oral option for MDR urinary isolates and was not shown to be associated with an increase in adverse effects. This was a simple stewardship intervention which made a measurable impact on antimicrobial use. Additional education for providers and pharmacists regarding appropriate dosing could be considered in the future to promote optimal use.

Disclosures
Kelly E. Pillinger, PharmD, BCIDP, Pharmacy Times (Other Financial or Material Support, Speaker)
920. Use of the Web by State and Territorial Health Departments to Promote the Dissemination of State Antimicrobial Resistance Surveillance Data, United States
Authors: Yin Xin , Hamilton Keith W , Tate Heather , M’ikanatha Nkuchia M 
Published: January 2021

Abstract

Background
Antimicrobial resistant (AMR) bacteria pose a serious threat to public health. The national response to this threat includes calls for promoting judicious use of antibiotics in humans and animals and strengthening integrated One Health surveillance of AMR bacteria in humans, animals, and environment. However, the extent to which public health jurisdictions are disseminating surveillance findings to promote judicious use of antimicrobials is unclear.

Methods
We used a standardized web audit tool to manually review and document the presence of AMR-related information on the websites of all public health jurisdictions that participate in national notifiable disease surveillance in the United States. We also emailed a survey to representatives in the 54 jurisdictions that participate in the National Antimicrobial Resistance Monitoring System (NARMS) activities coordinated by the Centers for Disease Control and Prevention. The survey asked questions about AMR-related information on their public health department website.

Results
Of the 37 (68.5%) jurisdictions that responded to the email survey, 26 (70.3%) indicated that their websites have information on appropriate antibiotic use for health professionals, veterinarians and general public, compared to 89.3% from the web survey (Figure). Eleven (29.7%) indicated that they have data on antimicrobial susceptibility for pathogens, or antibiograms, on their websites, compared to 48.2% from the web survey. While 11 (29.7%) jurisdictions indicated that they have highlighted appropriate antimicrobial use on the homepage, the web survey found no reference on the homepage.
Comparison of results from email and web survey on public health jurisdictions’ website, United States - 2020

Conclusion
Public health jurisdictions have begun to use websites to increase awareness about the threat of antimicrobial resistance. However, the limited presence of information on appropriate antimicrobial use for the public, health professionals and veterinarians suggest the need for improvement. Gaps exist between the awareness of the epidemiologists and laboratorians and the information reported on public health jurisdictions’ websites. Websites can be expanded and better leveraged to increase visibility of AMR and appropriate antimicrobial prescribing across One Health domains.

Disclosures
All Authors: No reported disclosures
926. Antibody Response to HPV Vaccination in Pediatric and Adolescent People Living with HIV (PLWH)
Authors: Al Hammoud Roukaya , Unger Elizabeth R , Panicker Gitika , Del Bianco Gabriela P , Heresi Gloria , Bell Cynthia , Murphy James , Perez Norma 
Published: January 2021

Abstract

Background
Immune dysfunction related to HIV infection is associated with an inability to clear HPV infection and may compromise the immunogenicity of quadrivalent HPV vaccine Gardasil® (4v HPV).

Methods
Between 2005 and 2017, males and females 7 to 20 years old age, were offered 3-dose 4v HPV vaccine. Plasma IgG titers to HPV 6 (H6), 11 (H11), 16 (H16) and 18 (H18) were measured using multiplex VLP-based ELISA. For the 36 patients, median interval from 1st dose to 2nd and 3rd doses were 73 and 216 days. Plasma sample 1 was collected at median of 91 days after dose 1, sample 2, 169 and sample 3, 740 after respective vaccine doses. A 4th sample was available for 26 patients, median 2327 days after dose 1. Rank-sum test, Χ 2 or Fisher’s Exact Test were employed.

Results
Before vaccination, 10 (28%) were seropositive to 1 or more HPV types. The baseline seropositives were older than seronegatives (16 years vs 11; p=0.007). After dose 3 all participants had an Ab response to at least 1 HPV type and 32 (89%) were seropositive for 4 HPV types. Seroconversions were H18, 87%; H16 97%; H11, 100%; H6, 97%. Seroconversions after 1 dose of 4v HPV among the baseline seronegatives were 61%, 90%, 86% and 86%, respectively and 22 became seropositive for all 4 types. The 4 baseline seronegative PLWH with partial seroconversion had higher median HIV viral load (VL) compared to baseline seronegative group with full seroconversion (12,920 vs 101 copies/ml; p = 0.052), but had comparable CD4 counts. The rate of post vaccination seropositivity and baseline to peak titer response for each HPV type was not significantly different for baseline sero-groups. Among baseline seronegative, all 19 sampled distant from vaccination remained seropositive to at least 1 HPV type (84% to 3 or more types) and 6 (32%) became seronegative (sero-reversion). Those showing sero-reversion had higher VL compared to the 14 who remained seropositive (9100 vs 48; p =0.015). Time from last dose of 4v HPV to sample 4, CD4%, age, gender, and race/ethnicity were similar between the groups.
Bar Graphs representing Ab response to the 4 HPV types following each dose of 4v HPV vaccine

Conclusion
In the complex environment of a pediatric HIV specialty clinic, most PLWH mounted Ab responses to 4v HPV that were durable. H18 was least immunogenic. Patients with higher HIV VL were less likely to seroconvert for all types and were more likely to sero-revert.

Disclosures
All Authors: No reported disclosures