bluuebunny/crossref_metadata_2025_split huggingface dataset:
Core Elements of a State HAI/AR Program With Emphasis on Partnership Networks
Authors: Joshi Cecilia , Mothershed Elizabeth , Vance Wendy , McLees Anita , Paek Margaret , Coteau Adina de , Paragini Salina , Shah Rhea , Meka Sruthi 
Published: November 2020

Background: There is a critical need for comprehensive and effective healthcare- associated infection and antibiotic resistance (HAI/AR) programs in the United States. Since 2009, the CDC has funded and engaged public health, healthcare, academic, community, corporate, federal, and other stakeholders to develop effective HAI programs that rely upon such these stakeholders for success. State and local public health programs play a central role in these programs because they bridge healthcare and the community. They may regulate and assess facilities, collect and validate data on infections, and implement prevention programs. Myriad other state, federal, and privately supported stakeholders play essential roles. CDC is developing a framework for highly effective state HAI/AR programs that describes core program elements and can be used as a strategic tool, both in day to day processes and in a public health crisis, such the COVID-19 response. Program elements may include engaged leaders and champions, reliable data for action, effective policies, evaluation, program innovation, communications, and partner networks. This presentation describes a success framework for developing and leveraging HAI/AR partner networks to achieve and sustain their capacities and impact.Methods: CDC collected qualitative data in select states and combined with expert opinion to draft core elements for success among a network of partners working to achieve HAI/AR and COVID-19 response and prevention in states. The core elements serve as a foundation for the framework. Ongoing analyses will inform refinement of the core elements and framework. The CDC is gathering stakeholders’ input on the framework for applicability and usability in states, with the goal of national implementation. Results: Currently, data indicate the following core elements for partner networks: leadership, strategy and structure; policies; innovation and adaptability; implementation; expertise and resources; communications; and monitoring and evaluation. The framework includes a process for partner network development and sustenance, maturity levels, and supporting tools. States have reported support for core elements and agreed that a success framework is beneficial to achieving core elements. Multiple states have reported support for a process that includes building partner networks and clearly defining roles, as a critical step toward full implementation of Program core elements. Conclusions: A framework for building high-level strategy and competency in partner networks has never been developed for HAI/AR programs. Effective partner networks represent an essential core element of a comprehensive state HAI/AR program. This framework could be applied to a variety of programs and public health contexts, increasing the effectiveness of partner networks.Funding: NoneDisclosures: None
Creating an Outpatient-Specific Antibiogram to Guide Treatment for Urinary Tract Infections
Authors: Grigoryan Larissa , Goebel Melanie , Willis Samuel , Danek Lisa , Matas Jennifer , Kachalia Neal , Katta Anna , Muldrew Kenneth , Zare Mohammad , Hudson Forrest , Atmar Robert , Trautner Barbara 
Published: November 2020

Background: Outpatients with uncomplicated urinary tract infections (UTIs) are often treated empirically without culture, whereas urine cultures are typically collected from patients with complicated UTI. Susceptibilities for fosfomycin (a first-line agent) are not routinely performed or reported in the antibiogram. Understanding the prevalence of antibiotic resistance for UTI is critical for empiric treatment and antibiotic stewardship in primary care. Methods: We developed a UTI-focused antibiogram from a prospective sample of outpatients (women and men) with UTIs from 2 public family medicine clinics in an urban area with a diverse, international population (November 2018 to present). During the study period, providers ordered a urine culture for any adult patient presenting with UTI symptoms, including uncomplicated and complicated infections. We estimated the prevalence of resistance to UTI-relevant antibiotics in the overall study population and compared it between patients born in the United States and other countries. Results: We collected 678 urine cultures from 644 unique patients (79% female). Of these cultures, 158 (23.3%) had no growth, 330 (48.7%) grew mixed urogenital flora, and 190 (28.0%) were positive (>10,000 CFU/mL). Patients with positive cultures were mostly female (88.2%), and their mean age was 46.6 ± 14.8 years. Among patients with positive cultures, 42.7% were born in the United States and 57.3% were born Mexico or Central America. Escherichia coli was the most commonly isolated organism (Fig. 1). Susceptibility results for E. coli and all gram-negative organisms combined are presented in Fig. 2. Susceptibility of uropathogens to TMP-SMX was significantly higher in patients born in the United States compared to patients from Mexico or Central America (82% vs 61%; P = .03). Susceptibility to ciprofloxacin was similar in patients born in the United States and other countries (79% vs 72%; P = .50). Of 77 E. coli isolates, 11 (14%) were positive for extended-spectrum β-lactamase production, including 8 isolates from patients whose country of origin was Mexico or a Central American country. Conclusions: More than 20% of outpatients presenting with UTI symptoms had a negative urine culture. Among outpatients with uncomplicated and complicated UTI, uropathogens had a high prevalence of resistance to ciprofloxacin and TMP-SMX, but susceptibility to fosfomycin (restricted in our system) was 100%. Resistance rates for TMP-SMX were higher in patients from Mexico and Central America. Our findings question whether TMP-SMX should remain a first-line agent in US primary-care settings.Funding: This project was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1AI104681.Disclosures: None
De-escalation of Antibiotics in Severe Sepsis and Septic Shock at a Large Municipal Hospital
Authors: Kondo Maiko , Uppal Amit , Horowitz Harold 
Published: November 2020

Background: Early de-escalation of antibiotics in sepsis may be safe and effective. In our study, we performed a retrospective chart review of patients admitted to a large municipal hospital who were treated for severe sepsis or septic shock to compare outcomes in patients who experienced early de-escalation (DEG) with outcomes of those who did not (NDG).Methods: The observational study was conducted at Bellevue Hospital Center (an 850-bed municipal hospital affiliated with New York University School of Medicine, New York, NY). Patients admitted from January 1 to December 31, 2015, who were treated for severe sepsis or septic shock during any time of their hospital stay were reviewed for the study. De-escalation was defined as narrowing or discontinuation of 1 or more antimicrobial therapies < 3 days after sepsis onset. Results: Overall, 277 patients were included (DEG, 90 patients, 32%; NDG, 187 patients, 68%). The groups were similar in terms of sex, comorbidities, length of stay, and severity of illness: septic shock (47% DEG vs 49% NDG; P = .693) and ICU stay (27% DEG vs 32% NDG; P = .406). DEG patients were slightly older than NDG patients: (DEG age, 63+16 years vs NDE age, 58+16 years; P = .028). There was no difference in hospital mortality (8% DEG vs 12% NDE; P = .257). Nearly half of the patients in both groups (46% DEG and 47% NDG) had no causative microorganisms identified using conventional microbiology culture. The common sources of primary infection were respiratory, urinary tract, and gastrointestinal infections, and these were not different between groups. Also, 69% of DEG patients and 79% of NDG patients received antibiotics for >7 days (P = .002). Empiric intravenous vancomycin was initiated in 83% in DEG patients and 74% in NDG patients at sepsis diagnosis. Although organisms covered by intravenous vancomycin were isolated from only 17% of patients in DEG and 23% in NDG, vancomycin was continued for >5 days in 34% of DEG patients and 50.3% of NDG patients (P < .001). 60% of patients in DEG and 61% in NDG were seen by infectious diseases specialists (ID). Patients with infectious diseases consultations had significantly more comorbidities, were more frequently in the ICU, had higher MDRO isolation and longer hospital stays, but they were still de-escalated without a difference in mortality. Conclusions: Microbiology data did not contribute to early de-escalation of antibiotics in this study. This finding may be related to the high percentage of negative culture and unavailability of rapid molecular diagnostic tests. Shorter duration of antibiotics (including vancomycin) was not associated with worse outcome in these severely ill patients.Funding: NoneDisclosures: None
Decision Support Tool for Screening of Tuberculosis Exposed Individuals Seeking Care at a Public Academic Health System
Authors: Cobb Stephanie , Nguyen Stephanie , Raj Deepa , Taherzadeh Dena , Sreeramoju Pranavi 
Published: November 2020

Background:Mycobacterium tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. At our health system, 50–100 patients are diagnosed with tuberculosis every year. One risk factor for TB is residence within a homeless shelter. In response to an increased number of cases in local homeless shelters, the health department sought assistance with contact tracing of individuals potentially exposed to tuberculosis. We report the results of contact tracing performed at our health system. Methods: The setting is a 770-bed, safety-net, academic hospital with community clinics and a correctional health center. Name, date of birth, and social security number of contacts potentially exposed during February 2009 to July 2013 were programmed into the electronic medical records to create a decision support tool upon entering the health system. The best practice alert (BPA) informed physicians of the exposure and offered a link to a screening test, T-spot.TB, and a link to an information sheet. This intervention was implemented from July 2013 to July 2015. After excluding patients with active TB, data on the magnitude of exposure in each homeless shelter and screening test results were analyzed with ANOVA using SPSS v 26 software. Results: Of the 8,649 identified exposed contacts, 2,118 entered our health system. Of those for whom the BPA was triggered, 1,117 had a T-spot.TB done, with 313 positive results and 57 borderline results. Table 1 shows that shelter 3 was correlated with a positive T-spot.TB. Conclusions: The BPA, which prompted physicians to evaluate an individual for TB, was effective at capturing high-risk, exposed individuals. Clinical decision support tools enabled our safety-net health system to respond effectively to a local public health need.Funding: NoneDisclosures: None
Developing a Public Health Model for Regional Infection Prevention Collaboration Among Healthcare Facility Networks
Authors: Garcia Erin P. , Epson Erin 
Published: November 2020

Background:
Antimicrobial resistance (AR), including Clostridioides difficile infection (CDI), can spread across the healthcare continuum when patients move between facilities. In 2015, the CDC recommended that healthcare facilities (HCFs) and local public health departments (LPH) coordinate their efforts to prevent the spread of AR and CDI. Accordingly, the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program developed a model for implementing regionally based AR/CDI prevention collaboratives within HCF networks. Methods: The CDPH HAI Program began identifying regions in California with high AR/CDI incidence or risk for AR/CDI emergence using NHSN data. During 2015–2019, we organized AR/CDI prevention collaboratives in these regions. We recruited HCFs for participation by presenting at local professional organization meetings and engaging skilled nursing facility corporate leadership. HAI Program infection preventionists conducted onsite infection prevention assessments at each participating HCF. HAI Program and LPH staff convened quarterly in-person learning and discussion sessions focused on infection prevention and antimicrobial stewardship best practices. Participating HCFs committed to facility-tailored process improvement plans and conducted self-assessments to evaluate infection prevention practice changes at the conclusion of the collaborative. For CDI-focused collaboratives, we used data reported to CDPH via NHSN to assess changes in hospital- and community-onset CDI incidence among participating hospitals before and after the collaboratives. Results: Since 2015, 205 HCFs in 15 LPH jurisdictions have participated in 6 regional AR/CDI prevention collaboratives. Participating HCFs reported improved implementation of AR/CDI prevention strategies. For CDI-focused collaboratives, hospital-onset CDI incidence decreased by ~3% per month among participating hospitals. The collaboratives created forums for communication and relationship building, which previously did not exist among LPH and the HCF networks. We used our experience and feedback from partners to develop an HAI Program AR Prevention Collaborative Tool Kit to help LPHs and healthcare organizations develop and implement regional AR/CDI prevention collaboratives in other at-risk or high AR/CDI prevalence areas in California. The tool kit includes materials developed for each of our collaboratives, which may be adapted to meet local needs. Conclusions: Regionally coordinated AR/CDI prevention initiatives among LPHs and HCFs can contribute to increased AR awareness, improved AR prevention practices, and decreased AR/CDI incidence. The effectiveness of regional AR/CDI prevention collaboratives may be the result of concurrent efforts to improve AR prevention practices both within individual HCFs and across patient sharing networks.Funding: NoneDisclosures: None
Development of National Infection Control and Prevention Guidelines in Georgia, 2017–2019
Authors: Madzgarashvili Lali , Weiss Jamine , Baidauri Marina , Geleishvili Marika , Lyman Meghan , Kolwaite Amy 
Published: November 2020

Background: In 2015, the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs (MoLHSA) of Georgia identified infection prevention and control (IPC) as a top priority. Infection control legislation was adopted and compliance was made mandatory for licensure. Participation in the universal healthcare system requires facilities to have an IPC program and infrastructure. To support facilities to improve IPC, MoLHSA and the National Center for Disease Control and Public Health (NCDC) requested assistance from the US CDC to revise the 2009 National IPC guidelines, which were translated versions of international guidelines and not adapted to the Georgian context. Methods: An IPC guideline technical working group (TWG), comprising clinical epidemiologists, IPC nurses, head nurses, and infectious diseases doctors from the NCDC, academic and healthcare organizations and the CDC was formed to lead the development of the national IPC guidelines. Additionally, an IPC steering committee was established to review and verify the guidelines’ compliance with applicable decrees and regulations. The TWG began work in April 2017 and was divided into 4 subgroups, each responsible for developing specific guideline topics. A general IPC guideline template for low- and middle-income countries was used to develop 7 of the guidelines. Additional reference materials and international guidelines were used to develop all the guidelines. Drafts were shared with the subgroups and the steering committee during 2 workshops to discuss unresolved technical issues and to validate the guidelines. Results: The revised guidelines consist of 18 topics. In addition to standard precautions (eg, hand hygiene, personal protective equipment, injection safety, etc) and transmission-based precautions, the guideline topics include laundry, environmental cleaning and disinfection, decontamination and sterilization, occupational health and safety, biosafety in clinical laboratory, blood bank and transfusion services, intensive care unit, emergency room, and mortuary. They do not include healthcare-associated infection surveillance or organism-specific guidance. To supplement the guidelines, a separate implementation manual was developed. The guidelines were approved by MoLHSA in October 2019. The TWG continues to be engaged in IPC activities, assisting with guideline rollout, training, and monitoring, and drafting the National IPC strategy and action plans. Conclusions: The Georgian Ministry of Health developed national IPC guidelines using local experts. This model can be replicated in other low- and middle-income countries that lack country-specific IPC guidelines. It can also be adapted to develop facility-level guidelines and standard operating procedures.Funding: NoneDisclosures: None
Educational Intervention Improves Clinician Infection Prevention Knowledge and Behavior in a Pediatric Emergency Department
Authors: Linam Matthew , Rangwalla Nikita , Shroff Purvi , Armstead Christopher , Beiter James 
Published: November 2020

Background: Children with contagious illness are frequently cared for in the pediatric emergency department. Incomplete infection prevention knowledge and incorrect practices create opportunities for transmission of pathogens. We implemented an educational intervention to improve clinician infection prevention knowledge and behavior. Methods: Clinicians providing care in an academic tertiary-care affiliated, pediatric ED were invited to participate in a 3-month educational intervention focusing on basic infection prevention principles such as hand hygiene and symptom-based isolation. Qstream, an educational platform that employs spaced-learning and game theory, was used to develop and electronically distribute 7 scenario-based questions. Questions were distributed 1 question per day 3 times per week. Questions were repeated until they were answered correctly twice. Round 1 of questions began in March 2019. After a ~4-week hiatus, the process was repeated in May 2019 (round 2). The Kirkpatrick model was used to measure the effectiveness of the educational intervention. Outcomes included clinician assessment of acceptability of the intervention, change in correct responses to knowledge-based questions over time, hand hygiene performance of clinicians and the number of infectious exposures in the emergency department. Results: Overall, 61 (73%) clinicians participated, of whom >90% liked the format, found it easy to use, and thought it required an appropriate amount of time. During round 1, average proficiency increased from 36% to 64%. During round 2, average proficiency increased from 62% to 78%. Starting in May 2019, physician hand hygiene gradually increased from a baseline of 78% to 100%. In the 10 months before and after March 2019, there were 2 exposure events involving 10 healthcare personnel versus 3 exposure events involving 4 healthcare personnel. Conclusions: Novel education strategies that utilize adult learning principles are user-friendly effective strategies that improve infection prevention knowledge and practice.Funding: NoneDisclosures: None
Emergence of Vancomycin Resistance after Treatment of Enterococcus: Risk Factors for Subsequent Pathogen Resistance
Authors: Shepard Zachary , Woods Robert , Patel Twisha 
Published: November 2020

Background: Vancomycin-resistant Enterococcus (VRE) is a leading cause of nosocomial infections that carries an increased risk of mortality when compared to vancomycin-sensitive Enterococcus (VSE). Data on the frequency of conversion between VSE and VRE in patients are scarce. Among patients presenting with VSE infections, little is known about the subsequent risk of conversion to VRE in the initial treatment period. Methods: A descriptive analysis of VSE to VRE conversion and a retrospective case-control study were performed examining cases of VSE that had subsequent cultures positive for VRE within 90 days within a quaternary healthcare system. Cases were obtained from June 2013 through December 2018. Controls were patients who had VSE culture followed by another VSE culture and were matched by organism (E. faecalis or E. faecium), time between cultures, and initial culture site. Age, gender, healthcare, antibiotic, Clostridiodes difficile, proton pump inhibitor (PPI) exposure, and H2 blocker exposures, and prior VRE infection or colonization were abstracted from the electronic medical record. A univariate analysis with the Fisher exact test was performed with significance considered for P < .05. Results: In total, 8,913 cases of E. faecalis and 2,322 cases of E. faecium were included in the study. Of 8,913 cases of E. faecalis, 51 of 8,503 (0.6%) cultured VRE after VSE, and 47 of 403 (11.7%) cultured VSE after initial VRE. Of E. faecium, 51 of 783 (6.5%) cultured VRE after VSE, and 76 of 1,532 (5.0%) cultured VSE after initial VRE. In total, 76 cases were matched with 99 controls. Patients converting from VSE to VRE were more likely to have prior admission to an intensive care unit (P = .0207), prior positive swab or culture for VRE (P = .0114), previous C. difficile infection (P = .0155), prior vancomycin (P = .0022) and cefepime (P = .0089) exposure. Patients receiving vancomycin after initial VSE culture were more likely to have subsequent cultures positive for VRE (P = .0053). There was no difference in age (P = .966) or male sex (P = .7588). Conclusions: Conversion from VSE to VRE is common, and E. faecium is more likely to become resistant than E. faecalis. Reversion to a vancomycin-sensitive phenotype is also common, and E. faecalis is more likely to show subsequent sensitivity than E. faecium. Previous admission to an intensive care unit, prior colonization or infection with VRE, prior C. difficile infection, and exposure to vancomycin and cefepime are risk factors for emergence of VRE after treatment for vancomycin-sensitive Enterococcus.Funding: NoneDisclosures: None