bluuebunny/crossref_metadata_2025_split huggingface dataset:
1229. Two-Step Water Filtration and Control of Delftia acidovorans Hemodialysis Pseudo Outbreak
Authors: Yassin Mohamed , Gagu Marian , Dixon Heather , Hariri Rahman 
Published: October 2019

Abstract

Background
Reverse Osmosis (RO) technology improved the quality of water needed for hemodialysis (HD). Guidelines require low colony count (<100 cfu/ mL) in product water used for HD. It is not unusual to see occasional water cultures above the maximum allowable count. In this event the RO machine is pulled out of service, disinfected and returned to service only after repeat culture is negative

Methods
In our institution, we had positive water culture from RO machine over a year duration that became persistently positive. Identification of the bacteria revealed Gram-negative environmental water cultures Delftia acidovorans. Despite all attempts to contain the pseudo outbreak (no clinical cases), all the RO were persistently positive. Renovation and replacement of all RO machines with Heat disinfection RO machines were performed.

Results
Delftia acidovorans grew from disinfection line, pump and product water were highly related using whole-genome sequencing. City water cultures were directly cultured repeatedly negative, and only after large volume filtration cultures grew Delftia. Despite the renovation, many machines were turning positive again. Two-step water filtration at the incoming water to the HD suite, was extremely effective in maintaining all water cultures negative for over 2 years after the pseudo outbreak.

Conclusion
Delftia Is a waterborne pathogen that is capable of forming a biofilm. 2-Step filtration (with 4 micron and less than a micron) is an expensive and effective way to improve the incoming water quality. Heat disinfection RO has a lower risk for development of a biofilm as compared with chemical disinfection RO.

Disclosures
All authors: No reported disclosures.
1235. A Survey of Surgical Site Infection (SSI) Surveillance Practices in US Hospitals, and their Association with SSI Rates
Authors: Pop-Vicas Aurora E , Osman Fay , Safdar Nasia 
Published: October 2019

Abstract

Background
Current US hospital reimbursement models rely on self-reported SSI rates. The impact of variability in SSI surveillance on publicly reported SSI rates is unknown.

Methods
Cross-sectional survey to US hospitals administered during November 18 – 2/19 through the Association for Professionals in Infection Control. We assessed SSI surveillance practices, and asked for self-reported facility standardized infection ratios (SIR) for hysterectomy and colon surgeries. We performed bivariate analysis and used Kendall’s ranks correlation for trend analysis.

Results
Of the 2,851 hospitals surveyed, 491 (17.2%) responded. Table 1 shows facility descriptors. Critical Access Hospitals (OR 6.11 [3.12 – 11.750, P < 0.005) and Ambulatory Surgical Centers (OR 3.92 [1.68 – 8.64], P < 0.001) were more likely to have less than one full-time ICP. University Hospitals were more likely to have ≥4 ICPs (OR 12.15 [6.73 – 22.04, P < 0.001). The majority (83%) of the 477 respondents reported electronic software for SSI surveillance, with Epic (23%), Theradoc (22%), and Cerner (11%) as the most common packages used. Manual surveillance was more likely for Critical Access Hospitals (OR 2.80 [1.47 – 5.19], P < 0.001). University Hospitals were more likely to have higher rates in 2016 for colon surgery (P = 0.02) and hysterectomy (P = 0.002). Table 2 shows characteristics of SSI surveillance practices reported by study participants. Ambulatory Surgical Center ICPs were more likely to use reports from surgeons and/or surgical staff as the initial trigger for SSI surveillance. University Hospital ICPs were significantly more likely to spend increased time (mean hours/month 69.77 vs. 28.99, P < 0.001), and to use more data sources for SSI review (mean 4.58 vs. 3.99, P = 0.001). In our trend analyses, we found the number of data sources used for SSI surveillance to be positively associated with higher SSI rates: (KT =0.14, P = 0.028 for colon SIR in 2017; KT = 0.20, P = 0.009; KT = 0.25, P = 0.001 for hysterectomy SIR in 2016 and 2017, respectively).

Conclusion
SSI surveillance practices across US hospitals vary significantly, and rigorous surveillance methods are associated with higher SSI rates. Standardizing SSI surveillance is necessary to accurately capture SSI burden of disease.

Disclosures
All authors: No reported disclosures.
1240. Evaluation of Preoperative Staphylococcus aureus (SA) Decolonization with Nasal Iodine for Hips/Knees and Fusion Surgeries
Authors: Neelakanta Anupama , Clutts Kristi , Strollo Stephanie , Passaretti Catherine 
Published: October 2019

Abstract

Background
Preoperative decolonization for patients with known nasal carriage of Staphylococcus aureus is recommended in some surgical site infection (SSI) guidelines, however, meaningful implementation is often challenging with poor compliance. We evaluated utilization of nasal iodine with S. aureus polymerase chain reaction (PCR) screening on the day of surgery as an alternative approach.

Methods
For all total hip replacements (THR), total knee replacements (TKR) and fusion patients in a 250-bed community hospital, we implemented day of surgery S. aureus PCR for all patients who had not been screened in the 2 weeks prior in August 2018. Those known to have S. aureus colonization in the 2 weeks prior to surgery as well as those who had no screen in the 2 weeks prior were treated with nasal iodine and received a chlorhexidine (CHG) bath in the preoperative area. Postoperatively any patient found to have (methicillin-resistant S. aureus) MRSA from preoperative screen or who had a history of MRSA in the past year were automatically decolonized with 5 days of intranasal mupirocin and CHG baths in addition. Compliance with S. aureus screening in preoperative area, results of screens and rates of THR, TKR and fusion SSI per National Health Safety Network (NHSN) definitions were monitored throughout the study period. SSI standardized infection ratios (SIR) during the study were compared with data 1 year prior to intervention date.

Results
Between August 2018 and January 2019, 694 THR, TKR and fusion surgeries were performed. Preoperative nursing compliance with completing the SA screen was 79. 2% and percent compliance with administering/documenting nasal iodine was 77.8%. Of those screened 21.7% (126/578) were found to have SA. Only 15% (n = 19) of SA positive PCRs were positive for MRSA. SSIs decreased in intervention period compared with preintervention (August 2017–July 2018) as shown in Table 1.

Conclusion
Preoperative nasal iodine has been effective and helped reduce our infection SIR to below 1. These results could be confounded by the presence of other initiatives but looks promising and large-scale studies would be helpful to make these results generalizable.

Disclosures
All authors: No reported disclosures.
1245. Does Complexity of Infection Prevention Bundles Matter in Colorectal Surgery? A Systematic Review and Meta-Analysis
Authors: Pop-Vicas Aurora E , Abad Cybele Lara R , Osman Fay , Baubie Kelsey , Safdar Nasia 
Published: October 2019

Abstract

Background
Surgical site infection (SSI) prevention bundles in colorectal surgery are common. The optimal bundle composition and impact of increasingly complex and resource-intensive bundled interventions on SSI remain unclear.

Methods
(1) A systematic review and meta-analysis of randomized and observational trials with pre-post implementation data for colorectal SSI prevention bundles to study their effect on superficial, deep, and organ-space SSI. (2) A meta-regression to determine whether the bundle size (number of different bundle elements) affects SSI. (3) A correlation analysis to identify individual bundle elements with greatest SSI reduction. We used the METAN, METAEFF, and METAREG packages in STATA SE 15 for analysis.

Results
We included 38 studies in the systematic review, and 29 studies (49,589 patients) in the meta-analysis. Bundle composition was highly variable, ranging from 3 – 13 guideline-recommended elements per bundle. Meta-analyses showed bundles to be associated with relative risk reductions of 43% for any SSI (RR 0.57 [95% CI 0.48–0.67]; 44% for superficial SSI (RR 0.56 [95% CI 0.42–0.75]; 33% for deep SSI (RR 0.67 [95% CI 0.45–0.98], and 37% for organ/space SSI (RR 0.63 [95% CI 0.49 – 0.81]). On meta-regression, bundle size, especially ≥10 elements, was significantly associated with SSI reduction for any SSI (P = 0.04) and for superficial SSI (P = 0.005). Individual bundle elements correlated with strongest SSI reductions were mechanical bowel prep combined with oral antibiotics (R = −0.68, P = 0.0028) and pre-operative chlorhexidine showers (R = −0.49, P = 0.04) for organ/space SSI. Protocols including separate instrument trays and glove ± gown change prior to surgical wound closure (R = −0.55, P = 0.009), and standardized postoperative wound dressing change at 48 hours (R = −30.59, P = 0.005) correlated with highest superficial SSI reductions.

Conclusion
Complex colorectal bundles with ≥10 clinical guideline-recommended prevention elements are associated with higher reductions in any SSI and in superficial SSI. Further research should evaluate how complex SSI prevention colorectal bundles can be implemented and sustained with high fidelity in the clinical setting in a cost-effective manner.

Disclosures
All authors: No reported disclosures.
1252. Development of a Surgical Site Infection at a Tertiary Hospital in Colombia: A Clinical and Microbiological Profile
Authors: Vallejo Marta , Cuesta Diana , Florez Luz E 
Published: October 2019

Abstract

Background
Surgical site infections (SSIs) are the most common healthcare-associated infections in developing countries, it represents a problem of patient safety and as well as evidence of quality of care. The objective of the study was to estimate the incidence of SSIs in surgical procedures of the surgical service, the microbiological profile and clinical evolution of patients.

Methods
Design: A retrospective, longitudinal cohort study using electronic health record data. Settings: Conducted between January and December of 2017 at tertiary hospital in Medellín, Colombia. Participants: Patients whose primary surgical procedures of gastrointestinal surgeries and abdominal wall hernias were included and followed up for 30 days after discharge. Main outcome measures: demographics, surgical risk scale, surgical procedures data, SSI according to NHSN-CDC criteria, microbiological isolates and clinical outcomes were registered and descriptive measures were obtained.

Results
There were 546 clinical charts analyzed, 55% were women, the mean age was 47 years (SD: 21), 74% at intermediate or high surgical risk. Antibiotic prophylaxis was administered at least 120 minutes before the incision and the cefazolin + metronidazole scheme was the most frequent to 70% of the patients. The incidence of SSIs was 12% (64/546), 1% superficial incisional SSIs, 3% deep incisional SSIs and 8% organ / space. Among them, 52% were NHSN-2, 55% had dirty wounds and 43% contaminated. E. coli were isolated in 16% (7/10 were BLEE+), S. aureus in 10% (all MRSA−). SSI was more frequent in laparotomy due to intra-abdominal infection in 36%, 20% colectomy, and 19% appendicectomy. The SSIs were treated in 27% with imipenem and 19% imipenem + vancomycin, for a median of 7 days (p25-p75: 7–10); 36% of the patients with SSIs underwent percutaneous drainage, 30% have been reoperated, 34% were unplanned readmission and 9% died, only two death were attributable to SSIs; the median of length of post-procedure stay days was 12 (p25-p75: 7–23) and overall 14 (p25-p75: 8–32).

Conclusion
The incidence of SSIs was higher than reported in the literature, perhaps due to the greater complexity and risk of the patients. It is necessary to implement preventive strategies in health personnel in order to reduce their incidence and complications.

Disclosures
All authors: No reported disclosures.
1261. Alarming High Rate of HIV Detected by Testing and Prevention Opportunities: Observations From the Largest HIV Program in Liberia
Authors: Ogbuagu Onyema , Watchekwa Ian , Donato Sean , Nuta Cecilia , Barakat Lydia A 
Published: October 2019

Abstract

Background
HIV/AIDS remains one of the world’s most significant public health challenges. Sub-Saharan Africa is home to only 12% of the world’s population, yet accounts for 71% of the global burden of HIV infection. While the HIV prevalence among reproductive aged Liberians (age 15–49 years) is estimated at 1.9%. As the critical first step in HIV disease management is detection of cases, it is important to optimize HIV testing particularly among high-risk groups. Identifying these high-risk groups for HIV infection also provides information on prevention opportunities. We report on 5 year HIV testing data at a tertiary hospital in Monrovia, Liberia stratified by age and gender.

Methods
A single-center academic hospital-based retrospective analysis of HIV testing data over a period of 5 years (January 2014 to December 2018) obtained from the Infectious Disease Center (IDC) of John F. Kennedy Medical Center in Monrovia, Liberia. The IDC has a peer-led counseling program on site and offers HIV testing daily. Data on the study population (all individuals screened for HIV disease at the center) was extracted from ledgers and registries within the IDC. The following information was collected on all participants: age, sex, and pregnancy status. Positive test results are reported as simple proportions of either all patients or all individuals tested within the category reported.

Results
Over the 5-year study period, 41,343 individuals were screened for HIV disease including 2 key demographics - 7875 individuals aged 15–24 years and 24,913 pregnant women. 4,066 individuals were diagnosed with HIV (a case detection rate of 10%), and ranged from 7% (909/12821) in 2018 to 13% (678/5079) in 2014. Case detection rates for individuals aged 15–24 were 7%, 5%, 4%, 6% and 3% for years 2014, 2015, 2016, 2017 and 2018, respectively. From 2014–2018, 2–3% of all pregnant women tested were diagnosed with HIV infection. Almost three-quarters (74%) of diagnosed cases were subsequently enrolled in an HIV clinic.

Conclusion
A peer-led HIV testing program is effective in HIV case detection, with young individuals (aged 15–24 years) and pregnant women having higher case detection rates than expected. These findings highlight opportunities for HIV prevention targeting these high-risk groups.

Disclosures
All authors: No reported disclosures.
1270. Population-Based Estimates of PrEP Access in Oregon, 2012–2016
Authors: Menza Timothy William , Capizzi Jeff 
Published: October 2019

Abstract

Background
PrEP is an important HIV prevention modality. Population-based metrics of PrEP uptake and access are critical to the evaluation of public health efforts to increase PrEP use.

Methods
Using the Oregon All Payers All Claims administrative dataset, we determined the number of unique individuals at least 16 years of age starting PrEP, defined as at least one prescription of >30 days of Truvada, each year from 2012–2016. People with HIV or hepatitis B were excluded. We created two metrics of PrEP access in 2016: the number of individuals starting PrEP per 100K population and the number of individuals with a PrEP prescription in each of the four quarters of 2016 per 100K population (i.e., prevalent users). Using public health surveillance data, we created three metrics of PrEP need in 2016: the number of HIV diagnoses per 100K population; the number early syphilis and gonorrhea diagnoses per 100K population; and the number of acute or chronic hepatitis C diagnoses among patients aged 16–30 years per 100K population. We calculated six metrics of PrEP access-to-need by dividing each of the access measures by the need measures.

Results
The number of individuals with a new PrEP prescription increased from 8 in 2012 to 571 in 2016. Most new PrEP users were men, aged 25–34 years, identified as white, lived in an urban area, had commercial insurance, and had an internal medicine PrEP prescriber. In 2016, there were 17.2 PrEP starts and 9.9 individuals with a PrEP prescription in all four quarters of 2016 per 100K population. There were 6.7 HIV cases, 136.0 early syphilis and gonorrhea cases, and 109.1 acute and chronic hepatitis C cases per 100K population. Per HIV diagnosis, there were 2.6 PrEP starts and 1.5 prevalent users. However, there were 0.13 PrEP starts and 0.07 prevalent users per early syphilis and gonorrhea diagnosis and 0.16 PrEP starts and 0.09 prevalent users per hepatitis C diagnosis. Women, people aged 16–24, people of color, and people in rural areas experienced lower PrEP access-to-need.

Conclusion
Access metrics based on prevalent users (a measure of longer-term adherence to PrEP), STI diagnoses (a measure of HIV acquisition risk), and HCV diagnoses among those less than 30 years of age (a measure of need among people who inject drugs) may provide a more complete assessment of PrEP access-to-need than those based on PrEP starts and HIV diagnoses.

Disclosures
All authors: No reported disclosures.
1275. Factors Associated with Patient-Provider Discussions about Preexposure Prophylaxis Among Young Men Who Have Sex with Men in Washington, DC
Authors: Ware Chelsea , Yellin Hannah , Kulie Paige , Levy Matthew E , Magnus Manya , Kuo Irene , Siegel Marc O 
Published: October 2019

Abstract

Background
The CDC estimates that 1.2 million people in the United States are eligible for HIV pre-exposure prophylaxis (PrEP). However, only about 120,000 people have received PrEP prescriptions through 2017. Healthcare providers’ (HCP) willingness to engage patients in discussions regarding sexual health, including PrEP, is integral to increasing PrEP uptake in the United States. Our objective was to identify factors associated with patients having discussions about PrEP with their HCP.

Methods
Men who have sex with men (MSM) aged 16–25 in the Washington, DC metro area recruited from the community completed a web-based survey in 2016 about their perceptions of and experiences with PrEP. We used multivariable logistic regression to calculate adjusted odds ratios (aOR) for associations between sociodemographic characteristics (including: age, race/ethnicity, insurance, student/employment status, education, income, living arrangements, social support, depressive symptoms) and patient-provider discussions, including willingness to have or ever having a discussion about PrEP.

Results
Among 239 MSM, 51% were Black, 25% were White, and 16% were Hispanic. 154 participants (65%) were willing to ask a HCP about PrEP without their HCP bringing it up. 159 participants (67%) reported that a HCP had never talked to them about PrEP, although 100 of the 159 (63%) expressed interest in discussing PrEP with a HCP. Participants aged <21 were less willing to ask a HCP about PrEP (aOR: 0.49, 95% CI 0.28–0.85) and insured participants were more willing to ask their HCP about PrEP (aOR: 3.64, 95% CI 1.42–9.33). In multivariable analyses, no sociodemographic characteristics were associated with having talked to a HCP about PrEP, and among those who had never talked to a HCP about PrEP, no characteristics were associated with wanting to do so.

Conclusion
There is a need to increase PrEP uptake in populations at high risk for HIV exposure. While MSM >21 and those with health insurance were more willing to ask their HCP about PrEP, there were no other differences across multiple demographic groups. Our study suggests that a wide PrEP engagement strategy that encourages HCPs to address PrEP with their patients regardless of their demographics would be beneficial to increase PrEP uptake.

Disclosures
All authors: No reported disclosures.
1276. Changes in Primary Care Pre-exposure Prophylaxis prescribing in a Large Healthcare System after the Implementation of an HIV Screening Alert and Educational Intervention
Authors: Ludden Thomas , Shade Lindsay , Thomas Jeremy , Mohanan Sveta , Leonard Michael , Tapp Hazel 
Published: October 2019

Abstract

Background
The number of providers that prescribe pre-exposure prophylaxis (PrEP) for HIV remains low. Primary care providers (PCPs) are less knowledgeable than HIV providers (HIVPs) with regards to PrEP: fewer PCPs had heard of PrEP (76% vs. 98%), knew about prescribing PrEP (28% vs. 76%), or ever had prescribed it (17% vs. 64%). PCPs limited knowledge about PrEP and questions about insurance coverage were identified as barriers to prescribing PrEP. Additional information on changes in prescribing PrEP in primary care within a large healthcare system is limited.

Methods
12 practices were part of a systemwide implementation of an HIV screening Electronic Medical Record (EMR) alert in October 2017 for patients ages 18–64. The 12 primary care practices were also included as part of an educational intervention regarding HIV prevention presented in the first quarter of 2018. As part of the educational intervention, information on prescribing PrEP was included along with resources for linkage-to-care and insurance coverage. The number of PrEP prescriptions were summarized for all 12 practices one year prior to the EMR alert and one-year post-EMR alert. Paired T-test statistics were used to test the number of patients prescribed PrEP by each practice pre- and post-EMR alert. The same analysis was conducted one-year pre- and post- the educational intervention.

Results
Across the 12 practices, 62 PrEP prescriptions were written one year prior to the implementation of the EMR alert (M=5.2, SD=7.3) and 88 post-EMR alert (M=7.3, SD=6.4), a 42% increase (P = 0.02). There were no differences in PrEP prescriptions one-year pre- and post- the educational intervention (n = 69).

Conclusion
While the number of PrEP prescriptions written showed significant increase after the implementation of the EMR alert, the overall number of prescriptions in primary care are still relatively low. While there has been national attention to increase PrEP prescribing through initiatives with local health departments, efforts to increase PrEP uptake require additional interventions above and beyond education interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP.

Disclosures
All authors: No reported disclosures.