bluuebunny/crossref_metadata_2025_split huggingface dataset:
1157. GET IT OUT! Nurses and Clinical Quality Improvement Specialists Drive Initiative to Reduce Standardized Utilization Ratios for Indwelling Urinary Catheters in Hospitalized Patients
Authors: Martinez Aldo , Parilla Deborah , Green Melissa , Murphy Anne , Suarez-Ponce Sylvia , Rasmussen Teresa , Thomas Karen , Patel Shruti B , Smith Kevin R , Gomez Belkys T , Parada Jorge P 
Published: October 2019

Abstract

Background
Urinary tract infections (UTIs) account for 34% of all healthcare-associated infections (HAI). Urinary catheters (UC) are placed in 15–25% of hospitalized patients and >75% of HAI UTIs are UC-related. Bacteria introduced via UC can colonize the bladder within 3 days. So, the greatest risk factor for acquiring a catheter-associated urinary tract infection (CAUTI) is prolonged use of indwelling UC. Nursing (RN) staff noted inconsistency with appropriate use of UC and commonly UC remained in place well after their original indication had expired.

Methods
As part of a multi-faceted approach for quality improvement and patient safety, we rolled out an Agency for Healthcare Research and Quality (AHRQ)-based initiative to reduce UC days/Standardized Utilization Ratio (SUR). Daily critical reviews of the indication for UC were conducted by two groups. First, frontline night shift RN staff identified patients who no longer had a valid justification for continued UC. They handed-off the information to day-shift RNs, who recommend removal of UC during daily rounds with the physician teams. A second review was performed by Clinical Quality Improvement Specialists (CQIS) based on defined criteria from our nursing decatheterization protocol. Their discontinue UC recommendations were also sent to the care teams. The critical reviews of UC for CAUTI reduction started with 4 ICUs in August 2018, with additional ICUs added in December, January and March. Monthly UC SURs were tracked

Results
Figure 1 shows the number of UCs recommended for removal by RNs vs. CQIS (bars), as well as the percent discordance between RNs and CQIS (line). CQIS identified many more removable UCs than the RNs (888 vs. 256). 211 UC were removed after RN recommendations, and an additional 386 UCs were removed as a result of the CQIS audits. Figure 2 shows the marked corresponding decline in our SUR over this intervention.

Conclusion
As more units participated in the initiative, we saw increasing numbers of “discontinue UC” recommendations. Over time there was also a moderate decrease in the discordance between RN and CQIS recommendations for UC removal. CQIS routinely identified many more UCs to be removed compared with RNs, and more than doubled the number of discontinued UC. Notably, the UC SUR markedly improved, decreasing from 0.98 to 0.78.

Disclosures
All authors: No reported disclosures.
1176. Antibiotic Prophylaxis Strategies Prior to Left Ventricular Assist Device Implantation: A Survey of Practice
Authors: Mourad Ahmad , Bishawi Muath , Arif Sana , Miller Rachel , Miller Rachel , Maskarinec Stacey 
Published: October 2019

Abstract

Background
Short duration, single-agent antimicrobial prophylaxis with anti-staphylococcal activity is recommended at the time of left ventricular assist device (LVAD) placement to prevent infection-related complications. Despite consensus guidelines, there continues to be wide variability in antimicrobial regimens among implantation centers. The aim of this study was to characterize current peri-operative antimicrobial prophylactic strategies at different LVAD implantation centers.

Methods
A survey study was conducted from September 26, 2017 to October 25, 2017. Surveys were distributed electronically to both LVAD coordinators and infectious diseases specialists at 75 US medical centers identified as having an LVAD program. Data collection included information about antimicrobial selection, duration, MRSA screening and decolonization procedures.

Results
We received 29 survey responses. The majority of surveys were completed by infectious diseases physicians [72.4% (21/29)]. Most responding centers reported LVAD programs established for >10 years [20/29 (69%)]. Cardiac transplantation was performed in 28/29 (96%) centers. Of centers reporting a defined antimicrobial prophylaxis regimen for nonpenicillin allergic patients [97% (28/29)], 17.9% (5/28) reported a four-drug regimen, 35.7% (10/28) reported a three-drug regimen, and 46.4% (13/28) reported a two-drug regimen, while no centers reported a single-drug regimen. Empiric fluconazole was common [50% (14/28)] and 96.4% (27/28) of regimens included Vancomycin. Duration of antimicrobial prophylaxis (24 h-5 d), MRSA screening, decolonization procedures, and alterations due to drug allergies varied significantly across participating centers.

Conclusion
Our survey results indicate a wide variation in the peri-operative antimicrobial prophylaxis regimens among participating LVAD centers. These results highlight the need for further studies evaluating the utility, toxicity, and stewardship implications of multi-drug regimens and whether specific clinical factors that prolong antimicrobial duration impact post-operative LVAD-related infection rates.

Disclosures
Rachel Miller, MD, Synexis: Research Grant.
1187. Estimation of Individual Healthcare Workers’ Relative Hand Hygiene Compliance Using an Anonymous Electronic Monitoring System
Authors: Tremblay Maxime-Antoine , Abou Sader Mona , Longtin Yves 
Published: October 2019

Abstract

Background
The current hand hygiene (HH) auditing and feedback strategy include anonymized data collection using direct observation and feedback of aggregated data. We aimed to evaluate whether an anonymous (without wearable device) HH electronic monitoring system (EMS) could detect patterns associated with individual healthcare workers (HCWs) and estimate their relative HH performance.

Methods
Observational study of HH compliance via an EMS in 10 rooms in a tertiary care hospital. The EMS measures HH product dispenser activation (an indicator of HH events) as well as entries and exits from patient rooms (a surrogate of HH opportunities). HH rates were obtained by dividing the number of HH events by the number of opportunities. HH rates were aggregated at room-shift level (i.e., an 8-hour period for a single room). For each room-shift, the HH rate was converted to a Z score, which was then associated with the individual HCW assigned to that room-shift. The relative HH performance of individual HCWs was estimated by comparing the mean Z scores of each HCW with the rest of the group by the Student T-test, with a level of significance set at P < 0.001 after adjustment by Bonferroni’s correction. To investigate whether any association could be due to chance, we looked into the potential association between average Z scores and calendar days, as a counterexample.

Results
Over a 100-day period, there were 45 775 HH events and 136 821 opportunities (global compliance, 33%). Schedules were available for 2980 room-shifts. Fifty-four individual HCWs took part in at least one room-shift (average per HCW, 52 room-shifts; range 1–140). Eight HCWs (15%) had a mean Z score significantly above the group average (Figure 1, green boxes; mean Z score 0.71; range, 0.52 to 0.86; P < 0.001), whereas 9 HCWs (17%) had a significantly inferior Z score (Figure 1, red boxes; mean Z score -0.47, range -0.58 to -0.31, P < 0.001). In contrast, there was no significant difference in Z scores between calendar days (Figure 2; p >0.001).

Conclusion
Cross-linking a high-volume HH database with HCW schedules identified a significant association between individual HCWs and HH compliance in the rooms to which they were assigned. If confirmed in further studies, anonymous EMS could be used to provide HCWs with personalized relative HH compliance feedback.

Disclosures
All authors: No reported disclosures.
1195. Hand Hygiene Compliance of Patients’ Family Members in India: Importance of Educating the Unofficial “Fourth Category” of Healthcare Personnel
Authors: Biswal Manisha , Angrup Archana , Rajpoot Surria , Kaur Rupinder , Kaur Kulbeer , Kaur Harinder , Kaur Harpreet 
Published: October 2019

Abstract

Background
In India,due to manpower constraints, patients’ family members are often actively involved in healthcare activities of their near and dear ones. They have significant contact with the patient at all the 5 moments for hand hygiene (HH) as listed by WHO. At our tertiary care hospital in north India, we have been monitoring HH compliance (HHC) for nearly a decade. In this study, we analyzed the impact of decade long awareness campaigns to improve HH compliance in our patients’ attendants.

Methods
Trained infection control nurses directly observed the compliance to hand hygiene at each of the five moments for patients’ attendants over different areas of the hospital over a period of 5 years (January 2014–December 2018). Compliance was calculated as percentage of events over total opportunities and compared.

Results
7290 opportunities were observed with an overall compliance of 46.3%. The overall HHC in patient attendants has increased from 35.5% in 2014 to 48.2% in 2018 (P < 0.0001). Compliance at WHO moment 1, 2, 3, 4 and 5 was 51.2%, 47.8%, 67.8%, 48.9% and 24.4% respectively. Among family members, mothers of newborn babies had a much higher HHC (77%) than others (44.7%) (P < 0.0001). Also, the compliance was higher in medical vs. surgical wards and pediatric wards vs. adult wards (P < 0.0001 in both).

Conclusion
This is the first study about family members’ HHC in a hospital setting in a low and middle-income country. Once trained, family members exhibit fairly good hand hygiene compliance while involved in healthcare activities of their patients. Mothers of newborn babies exhibit exemplary hand hygiene compliance while caring for their babies in our hospital. It is worthwhile empowering and educating patient attendants about the importance and process of hand hygiene as it is likely to result in immense benefit for patients.

Disclosures
All authors: No reported disclosures.
1198. Developing Infection Prevention and Control (IPC) Educational Videos to Improve Knowledge of Respiratory Virus Transmission and Etiquette
Authors: Gianchetti Lauren , Sharova Anna , Hanley Samantha E , Feemster Kristen , Odeniyi Folasade 
Published: October 2019

Abstract

Background
Most pediatric healthcare encounters for influenza-like-illness (ILI) take place in ambulatory settings where there may be multiple opportunities for transmission of respiratory viruses, yet adherence to recommended respiratory etiquette behaviors is inconsistent. We developed brief family education videos and evaluated their impact on knowledge about respiratory virus transmission and IPC practices and intention to use respiratory etiquette behaviors.

Methods
We developed 3 animated, 2–3 minute videos for waiting room display. Content included respiratory virus transmission and the use of hand hygiene, masks, and tissues in a Cover Your Cough Station (CYCS). A convenience sample of caregivers (N = 116) recruited from waiting rooms of two primary care clinics in a large pediatric care network completed a questionnaire measuring perceptions of respiratory virus transmission risk in clinics and knowledge about IPC strategies before and after viewing the videos. Clinical staff (N = 8) from participating clinics revaluated content and clarity of each video using an adapted version of The Patient Education Materials Assessment Tool (PEMAT).

Results
After viewing all videos, a significantly higher proportion of respondents knew where to find a CYCS (59%, 93%, P < 0.0001), accurately named CYCS items (30%, 72%, P < 0.0001), identified why cough etiquette is important (65% vs. 83%, P = 0.0003) and would use CYCS during office visits (61% vs. 89%, P = 0.0001). Baseline knowledge about appropriate hand hygiene and cough etiquette practices was high with no significant change post-video. Most caregivers reported that our videos were easy to understand (90%, 79%, and 82% for videos 1–3, respectively) and that the videos made them want to use a CYCS (95%, 91%, 85% for videos 1–3.). All clinical staff agreed that the videos were appropriate for parents and children and also align with the practices’ IPC policies and other healthcare messages received by clinical staff

Conclusion
Targeted educational videos may be an effective method for increasing awareness of respiratory etiquette resources in pediatric clinics to encourage the use of IPC strategies and prevent the spread of respiratory viruses.

Disclosures
All authors: No reported disclosures.
1200. Parent Perspectives on Infection Prevention and Control in the NICU
Authors: Science Michelle , Khan Sarah , Arnold Callum , Sanchez Pablo J , Lee Kyong-soon , Bacchini Fabiana , Hawes Judith , Mertz Dominik , el Helou Salhab , Kaufman David 
Published: October 2019

Abstract

Background
Infants admitted to the neonatal intensive care unit (NICU) are at high risk for healthcare-associated infections (HAIs) due to their immature immune systems and need for invasive devices. Parents have frequent contact with their infants and present an opportunity for prevention practices. The objective of this study was to evaluate parental opinions related to infection prevention and control (IPAC) in the NICU.

Methods
An online survey was sent to a network of 2,000 parents from the Canadian Premature Babies Foundation. The survey included questions about patient-centered outcomes, IPAC practices experienced during their infants’ NICU admission, and specifically, opinions regarding nonsterile glove use by both healthcare workers (HCWs) and parents.

Results
A total of 72 parents responded to the survey. The majority were parents of infants born at less than 37 weeks (94%) and had been admitted to an NICU after 2010 (89%). When asked about preventing infections in the NICU, 82% of parents indicated they had been given information on how the NICU prevents infection and 96% had been told how they can prevent infection in their infant (Table 1). The most common information was related to hand hygiene (96%) and what to do if they were unwell (89%). Opportunities for improvement included being bare below the elbow, nail care, and feeding human milk. With respect to IPAC outcomes of interest, 96% agreed that it was important to study interventions to reduce bloodstream infections (BSIs). Other outcomes of interest (Table 2) included necrotizing enterocolitis (72%), antibiotic-resistant organism acquisition (69%), and length of stay (67%). With respect to glove use, 89% of parents felt that it was acceptable for HCWs to wear gloves when caring for their infant. Only 37% of parents indicated that they would want to wear gloves if HCWs were wearing gloves, but 47% would consider wearing gloves if there was evidence that it reduced infection in their infant.

Conclusion
Reducing infections, specifically BSIs, in infants admitted to the NICU is an outcome of interest for parents. Nonsterile gloving by HCWs is considered an acceptable strategy by parents to reduce infections. Missed opportunities exist for the education of parents in the NICU on IPAC practices.

Disclosures
All authors: No reported disclosures.
1224. Factors Associated with Aerosolization of Gammaproteobacteria from Intensive Care Unit (ICU) Sinks in a Randomized Trial of Copper Alloy vs. Standard Chrome Sink Drains
Authors: Volling Cheryl , Anceva-Sami Sofia , Boyd David , Coleman Brenda , Downing Mark , Hota Susy , Jamal Alainna , Johnstone Jennie , Katz Kevin , Leis Jerome , Li Angel , Mahesh Vinaya , McLeod Chris , Muller Matthew P , Mulvey Michael , Nayani Sarah , Paterson Aimee , Pejkovska Mare , Ricciuto Daniel , Sultana Asfia , Vikulova Tamara , Zhong Zoe , McGeer Allison 
Published: October 2019

Abstract

Background
Hospital wastewater environments are recognized as reservoirs for multi-drug-resistant bacteria, and sink drains in ICUs have been implicated in numerous outbreaks. The mechanism of pathogen transmission to patients, and the best approach to risk mitigation remains unclear. We tested a new copper alloy sink drain for its effect on detection of gammaproteobacteria in sink drains and adjacent aerosols.

Methods
We randomized 90 sinks in 76 ICU rooms/bedspaces in 7 ICUs to new standard chrome or copper alloy drains. We sampled sinks on 4 occasions over 4 months. Drain tailpieces were sampled using cotton swabs of 140 cm2 of the interior surface, inserted into 1mL of Dey-Engley neutralizing broth, and cultured semi-quantitatively for gammaproteobacteria on Mac3CV. 850L samples of air adjacent to sinks were obtained by impaction onto Mac3CV. Faucet swabs were also cultured. Multivariable analysis adjusting for factors associated with growth in air and drains used conditional logistic regression, GEE with an exchangeable correlation matrix, a robust estimate of variance, negative binomial distribution and log link function.

Results
Gammaproteobacteria were detected in 247/424 (58%) tailpiece swabs, 137/456 (30%) air samples, and 31/456 (7%) faucet swabs. In multivariable analysis, growth was less likely from air adjacent to sinks with copper vs. chrome drains [IRR 0.50 (95% CI 0.35, 0.73), P < 0.0001], with reduced effect size observed when drain growth was included in the model [IRR 0.64 (95% CI 0.43, 0.94)], P = 0.025]. Growth in air was more likely when drain growth was 1–899 cfu/cm2 [IRR 2.38 (95% CI 1.46, 3.88), P = 0.001] or ≥900 cfu/cm2 [IRR 3.55 (95% CI 1.87, 6.86), P < 0.001] vs. no growth. Tailpiece swab growth was more likely if rooms were occupied compared with empty [IRR 1.85 (95% CI 1.25, 2.76), P = 0.002], and less likely from copper drains compared with swabs from chrome drains [IRR 0.51 (95% CI 0.47, 0.75), P ≤ 0.001].

Conclusion
Sinks with new copper drains are less likely to have detectable gammaproteobacteria in adjacent air when compared with standard chrome drains, and results suggest this is mediated through reduced bacterial growth in the drains. Ongoing study is needed to determine whether this influences patient risk for hospital-acquired infection.

Disclosures
All authors: No reported disclosures.
1227. Replacement and Rerouting of Pipes to Remediate Intractable Contamination of Potable Water Fixtures in a Pair of ICU Rooms
Authors: Carroll David M , Michelin Angela V , Craig Melanie J , Johnson Johnathan J , Yoo Jonathan N , Evans Michele R , Henderson David K , Lau Anna F , Palmore Tara N , Palmore Tara N 
Published: October 2019

Abstract

Background
“Green” construction approaches may place hospitals at risk for long-term contamination of potable water, presenting hazards for immunosuppressed patients. Remediation may be needed to manage these unanticipated consequences. An indolent, 11-year cluster of Sphingomonas koreensis infections at the NIH Clinical Center was traced to potable water. During the investigation, 4 sinks in 2 ICU rooms were found to have intractable contamination. Despite replacement of sink fixtures, faucet swabs and water continued to grow S. koreensis, and mean free chlorine residual (FCR) from the sinks was 0.27 mg/L (goal > 0.5). We undertook a major project to replace and reroute sections of pipes leading to the sinks (Figures 1 and 2).

Methods
Hot and cold water pipes were removed from the sinks to the supply pipes and replaced. Pipes were rerouted so that hot and cold water supplying the sinks returned in a loop to the domestic hot water heater to eliminate 10-meter drop-down sections of dead-leg pipe. Automatic faucets were replaced with manual faucets. Faucet biofilm was swabbed and cultured monthly for S. koreensis. Environmental samples were cultured on sheep blood agar for 5 days. Yellow colonies were subcultured and identified by MALDI-TOF MS (Bruker).

Results
Demolition of the wall behind the sinks revealed hot and cold water piping containing stagnant water. Water pooled in cold water pipe had heavy growth of S. koreensis; water from the hot water pipe could not be collected. Hot and cold water FCR for the sinks after piping changes averaged 0.74 and 1.07 mg/L, respectively, compared with 0.27 mg/L simultaneously from automated faucets in unmodified ICU rooms. Faucet cultures were negative for S. koreensis after replumbing, and have remained negative for >6 months.

Conclusion
New hospital construction strategies appear to increase potable water contamination risks; novel remediation approaches are needed. Replacing contaminated water pipes and rerouting pipes to minimize stagnation eradicated longstanding contamination of 2 ICU sinks. Although the experiment was conducted on a small scale, it demonstrates that plumbing flaws that jeopardize patient safety can be corrected through multidisciplinary collaboration and creative plumbing strategies.

Disclosures
All authors: No reported disclosures.
1230. Estimating Effective Point-of-Use Biocide Levels for Legionella Control in Building Water Systems Using a Large, Real-World Dataset
Authors: Decker Brooke K , Goto Michihiko , Gamage Shantini D , Kralovic Stephen 
Published: October 2019

Abstract

Background
Legionnaires’ disease is a potentially life-threatening illness often associated with Legionella growth in water sources. Oxidizing biocides, such as chlorine (CL), monochloramine (MC) and chlorine dioxide (CD), can reduce Legionella contamination. However, limited guidance exists regarding optimal target biocide levels in building water systems to prevent Legionella growth. We examined Legionella and biocide data collected by Department of Veterans Affairs medical facilities nationally to estimate effective biocide levels.

Methods
Water samples collected at point of use for routine surveillance purposes between 2015 and 2017 were used for this analysis. Samples were limited to those with reported biocide being CL, MC or CD. Samples with biocide levels above safe drinking water maximums and from nonpotable water sources were excluded. Samples were stratified by hot and cold water and univariate logistic generalized additive models were used to assess nonlinear associations of probability of Legionella positivity and biocide level.

Results
The dataset included 144,458 samples (cold: 72,674; hot: 71,784) from 789 buildings at 168 hospitals, with 99,419 samples with reported biocide as CL, 40,922 as MC, and 4,117 as CD. For CL, cold water analysis showed a minimum probability of positivity at approximately 0.5 parts per million (ppm), but with a second minimum at 2 ppm. Hot water showed an inflection point around 0.6 ppm, but the likelihood of positivity continued to decrease until plateauing beyond 2 ppm (Figure 1). Cold water with MC showed a minimum probability of positivity at 0.3 ppm followed by a second minimum at 1.7 ppm with plateau beyond that concentration. Hot water showed a similar graph with initial minimum at 0.25 ppm and a second minimum at 1.6 ppm (Figure 2). CD graphs for both hot and cold showed a decrease at 0.2 ppm (Figure 3).

Conclusion
The variability in the dynamics of Legionella inhibition by different biocides as seen in our analysis indicates minimum biocide targets for the different agents. For CL and MC, biocide levels >2 ppm at point of use in building water systems may not provide added benefit for suppression of Legionella.

Disclosures
All authors: No reported disclosures.