bluuebunny/crossref_metadata_2025_split huggingface dataset:
1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital
Authors: Banks Maureen , Phillips Andrew , Chin Keith , Ann Bruno-Murtha Lou 
Published: October 2019

Abstract

Background
Hand hygiene (HH) is the cornerstone of infection prevention and improved compliance has been associated with reduced healthcare-associated infections (HAIs). However, traditional methods for HH data collection have limitations and may not accurately reflect true compliance. We sought to evaluate whether an electronic hand hygiene monitoring system (HHMS) can improve data collection, compliance, and reduce HAIs.

Methods
A HHMS was implemented as part of a pilot at a single facility in June 2018 for all healthcare workers (HCWs) who entered patient rooms. The system prompted HCWs to perform HH with an audible and visual reminder emitted from a badge if a HH event had not been registered within specific timeframes of entering or exiting a patient room. The system captured compliance with preferential handwashing (soap and water) for at least 15 seconds upon exit of Clostridioides difficile (C. difficile) designated rooms. All HH data were collected by the HHMS. Hand hygiene compliance and HAI data were compared for the pre-intervention (June 2017-May 2018) and intervention periods (July 2018-March 2019). No changes were made to environmental cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices.

Results
HH compliance by direct observation in the pre-intervention period was 91% (1,612 observations). HH compliance with the HHMS during the intervention period was 97% (2,778,402 observations). The mean monthly HH opportunities recorded during the pre-intervention period was 134, while the HHMS captured 308,711, a greater than 2,300-fold increase. The incidence of healthcare facility-onset C. difficile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41 GDH+/Toxin+ laboratory-identified [labID] events/42,726 patient-days). With the HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID events/31,169 patient-days). No policy changes in environmental cleaning of high-touch surfaces were made or observed during the pilot.

Conclusion
The use of an HHMS facilitated more comprehensive HH data and improved compliance. The preliminary findings also support an association between more robust HH compliance data and a significant decrease in toxin-producing CDI.

Disclosures
All authors: No reported disclosures.
1209. Seroprevalence of Measles, Mumps, and Rubella in Korean Healthcare Workers and Strategy for Vaccination
Authors: Ju Choo Eun , Yoon Park Se 
Published: October 2019

Abstract

Background
The measles, mumps, and rubella (MMR) vaccination to children was accelerated in South Korea as the National Immunization Programs in 1985. A two-dose MMR vaccination schedule was introduced in 1997. However, outbreaks of measles in healthcare institution continued to occur. Recent studies revealed that the seroprevalence of measles in healthcare workers (HCWs) was approximately 40–60% in twentieth. The purpose of this study was to determine the seroprevalence of MMR antibodies in HCWs to establish strategy for vaccination.

Methods
To prevent nosocomial transmission of measles, test for MMR antibody of HCWs was conducted in three teaching hospitals from January to February in 2019. The testing was conducted only in the patient contact departments. We excluded HCWs who did a history of vaccination after starting their work. Anti-measles IgG and anti-mumps IgG was detected using chemiluminescence immunoassay. Anti-rubella IgG was detected using chemiluninescence microparticle immunoassay. Equivocal value was treated as negative. We also compare the costs between strategies two-dose vaccination without antibody tests and vaccination after antibody testing.

Results
Total 598 HCWs were included in analysis. Of the HCWs tests, 92.6% were seropositive to measles, 86.6% to mumps, and 79.7% to rubella. In the linear regression analysis, the seropositive of measles and rubella antibodies was increased in proportion to age (β-coefficient 43.4, 95% CI 35.1–51.6, P < 0.001 and β-coefficient 10.2, 95% CI 7.2–13.2, respectively). But, the seropositive to mumps was not related to age (β-coefficient 2.6, 95% CI -5.4–10.7, P = 0.52). The HCWs who has seropositive to all MMR was 67.2%. It was highest in 1970th birthyear (77.1%) and lowest in 1980th birthyear (60.6%). It costs less 18,000 wons ($15.5) per HCWs in strategy of vaccination after antibody testing than two-dose vaccination without antibody testing.

Conclusion
Our data warrant the needs for routine antibody test for MMR, followed by MMR vaccination in Korean HCWS. We expect that this strategy can save costs and avoid unnecessary vaccination.

Disclosures
All authors: No reported disclosures.
1211. Microbiologic Evaluation of Mobile Phones and Hands of Healthcare Professionals in Two Intensive Care Units in a Brazilian University Hospital
Authors: Patricia Sanchez Espinoza Evelyn , Viera Perdigão Neto Lauro , Alves dos Santos Sania , Risek Camila , Renata Gomes Franco Maria , Martins Roberta C R , Pereira, Bsc Gaspar C O , Guimaraes Thais , Boszczowski Icaro , Rossi Flavia , Pinheiro Freire Maristela , Sara Shafferman Levin Anna , Costa Silvia F 
Published: October 2019

Abstract

Background
Healthcare-associated infections (HAIs) are a worldwide concern because of their high morbidity, mortality, and associated costs. Mobile phones (MP) are an important work tool in the healthcare setting, but they can be a reservoir of nosocomial pathogens if not carefully cleaned and cause re-contamination of the healthcare professional’s (HCP) hands. We aimed to evaluate bacterial colonization of HCP’s hands and their respective MPs.

Methods
A cross-sectional study was performed in two Intensive Care Units (ICUs), an internal medicine and a burn unit, of a Brazilian tertiary university hospital. These units were chosen because of their different hand hygiene (HH) compliance. We assessed HH and MP handling practices by an electronic inquiry and collected samples from the dominant hand (DH) by the sterile bag technique and of MPs by moistened sterile swab. MALDI-TOF was used for bacterial identification and Dilution Agar (DA) was used to screen Gram-negative bacteria (GNB) susceptibility to carbapenems and colistin.

Results
Forty-seven HCPs were evaluated; of whom, 30% were medical residents, 19% nurses, 17% nurse-technicians, 17% physiotherapists, 13% cleaning staff, and 4% radiology technicians.Overall, 85% of HCPs reported use of MP at work, 26% had never cleaned it, and 34% reported optimal HH compliance practices. All of them believed that MPs can have HAIs agents. DH culture showed 94% of colonization and the most common Gram-positive bacteria (GPB) and GNB were S. epidermidis (n = 17∕44) and A. baumannii complex (n = 11∕44), respectively. MP were colonized in 89% of the cases and the most common GPB and GNB were S. epidermidis (n = 16∕42) and Pseudomonas spp (n = 9∕42), respectively. Overall, in the screening 38% of GNB were resistant to meropenem and 22% to colistin. A. baumannii was the most common meropenem (n = 4) and colistin (n = 2) resistant GNB. In the two units, 32% of HCPs had the same microorganism species isolated in the MP and in the DH (Table 1).

Conclusion
There was a high rate of bacterial colonization on the MP and DH of HCPs and some of these bacteria were carbapenem or colistin resistant. A policy for MP handling in the healthcare setting should be implemented in order to avoid cross-contamination between the MP and the hand of HCPs.

Disclosures
All authors: No reported disclosures.
1217. Predicting the Efficacy of an Antimicrobial Surface Coating Utilizing X-Ray Fluorescence Spectroscopy (XRF)
Authors: Asgari Parham , Fang Jie , Price Val , DeClue Don , Grossman Gavri , Shrestha Sunav , El Sayed Maha 
Published: October 2019

Abstract

Background
Contaminated surfaces are a critical risk factor for transmitting infectious disease. Current disinfection products provide short-term antimicrobial action; however, these surfaces can be re-contaminated within hours after cleaning. To address this limitation, long-lasting antimicrobial polymer coatings have been developed as an adjunct to traditional disinfecting and cleaning protocols. Due to the micro-scale thickness and transparency of the coating, confirmation of its presence on surfaces is difficult with conventional methods; therefore, this study explores a novel approach to measuring durable polymer coatings on stainless steel coupons to validate their presence and relative antimicrobial activity.

Methods
In this study, we utilized a hand-held X-ray fluorescence spectroscopy (XRF) analyzer to quantitatively evaluate the amount of antimicrobial polymer coating deposited on stainless steel test surfaces. Stainless steel surfaces with amounts of coating ranging from 0.12 to 3.60 mg/in.2 were analyzed for their XRF profile using a hand-held spectrometer. Additionally, the relationship between the XRF spectra and antimicrobial activity was evaluated using a modified version of an existing sanitization protocol for hard surfaces using Staphylococcus epidermidis as the test organism.

Results
Comparison of the amount of antimicrobial polymer coating (in mg) and the XRF values (photon count) revealed a calibration curve with a high degree of linearity (R2 = 0.993) especially for surfaces that had lower mass (Figure 1). In addition, the relationship between XRF values and antimicrobial efficacy also were found to be well-correlated with a logarithmic trend (R2 = 0.9308) (Figure 2).

Conclusion
The observed trends between coating mass, XRF value and antimicrobial efficacy suggests that these analytical techniques are viable options for determining the presence of invisible antimicrobial polymer coatings. Additionally, laboratory-based calibration curves based on XRF values can be used to predict the level of antimicrobial activity of surfaces that have been treated with polymer coatings. These findings suggest that the use of a hand-held XRF spectrometer can be a rapid and cost-effective method for assessing the presence and efficacy of polymer coatings.

Disclosures
All authors: No reported disclosures.
1231. Legionella Variability From Routine Environmental Testing Across All Veterans Health Administration (VHA) Medical Facilities
Authors: Jinadatha Chetan , Coppin John David , Gamage Shantini D , Kralovic Stephen , Roselle Gary 
Published: October 2019

Abstract

Background
VHA Legionella prevention policy requires quarterly testing of potable water samples, for its 170 medical facilities (“stations”) distributed across the United States. We modeled the variability in Legionella positivity rates by location structure and by time to understand Legionella prevalence and distribution across VHA nationwide. Our goal was to understand when, where and why variations in Legionella positivity happens across VHA facilities.

Methods
Data from quarterly water samples from sinks and showers from 2015 through 2017 and for which complete information was reported were used for the model. A multi-level Bayesian logistic regression model was run in R version 3.5.1. The hierarchical location group levels consisted of room nested within floor, within building, within station, within region. The time group-level effects included quarter nested within year. Variabilities within groups were estimated as standard deviation (SD) on the log-odds scale.

Results
Among 138,553 samples, there was little seasonal effect (SD: 0.32) in Legionella positivity based on the quarter in which they were sampled. The largest variability in Legionella positivity occurred at the station level (SD: 2.38), with substantial variation at the building level also (SD: 1.85). The 5% of stations most likely to be positive for Legionella represented only 7.5% of total samples but accounted for 39.7% of all positive samples. The 5% of stations least likely to be positive for Legionella represented 10.4% of total samples, but only had 2 positive samples.

Conclusion
Buildings with the highest probability for Legionella positivity are clustered together within stations. We saw no major seasonal variations in Legionella positivity across facilities. We were able to better predict stations with higher positivity as well as lower overall positivity for Legionella water sampling. The observed dominant station-level effects could be due to overarching influences such as a single water source and suggests approaches at this level can impact Legionella control. These results demonstrate a mechanism for understanding the distribution and probability of Legionella and can inform prevention practices and future policy.

Disclosures
All authors: No reported disclosures.
1251. Determinants of Infection at a Nontransplanting Cardiothoracic LVAD Program
Authors: Milgrom Alexander , Collins Amanda , Grubbs J Aaron , Derrick Caroline , Logan Kristin , Edelson William , Branham Stephany , Mardis Andrew , Martin Jeffrey , Weissman Sharon 
Published: October 2019

Abstract

Background
Left ventricular assist devices (LVADs) are a treatment option for end-stage heart failure, traditionally used as a bridge to a transplant. However, LVADs as a destination therapy is an option for individuals with contraindications for transplant. Infections are a common and devastating complication with significant morbidity and mortality. The purpose of this study was to assess the impact of risk factors for LVAD-associated infections in a nontransplant LVAD center.

Methods
All patients with implanted LVADs from 2013–2018 at Prisma Health were screened for inclusion. LVAD-associated infection was defined using INTERMACS criteria. Patient characteristics and device characteristics were evaluated for infection risk. Time to infection and associated mortality were also analyzed.

Results
Fifty-four of 138 (39.1%) patients developed an LVAD infection (driveline infection, or bacteremia). Mean time to infection among those who experienced infections was 7.78 months, with a standard deviation of 9.58 months. Table 1 summarizes baseline patient characteristics. HeartWare devices, compared with HeartMate II, were at an increased risk of infections and had a shorter time to infection (Figure 1) (HeartWare vs. HeartMate II, HR 2.12, P = 0.01). Those with a BMI of ≥35 kg/m2 were found on average to have a number of infections 0.729 greater than those with a BMI < 35 kg/m2 (P = 0.01). Prealbumin, A1C, and chronic kidney disease (any stage) were not found to be associated with infection. Staphylococcus aureus (21, 18.26%), Pseudomonas aeruginosa (24, 20.87%), and Staphylococcus epidermidis (22, 19.13%) were the most common organisms identified.

Conclusion
In an LVAD center where the majority of patients received LVAD as destination therapy, infection rates were similar as those receiving LVAD as a bridge to transplant. Modifiable risk factors for infection are areas for future interventions and prevention efforts.

Disclosures
All authors: No reported disclosures.
1259. Household Income and Its Relationship with Patient-Reported Outcomes Among Older People Living with HIV
Authors: Mazonson Peter , Berko Jeff , Loo Theoren , MacLaren Lynsay , Lowman Erik S 
Published: October 2019

Abstract

Background
Socioeconomic factors have been identified as a root cause of a wide range of health outcomes. However, there are no studies that describe the impact of these factors on patient-reported outcomes (PROs) among older (age 50+) people living with HIV (PLWH). This study examines the relationship between annual household income, sociodemographic factors, and several PROs among older PLWH.

Methods
A cross-sectional analysis examined the relationships between self-reported annual household income, sociodemographic information, and validated PROs. Statistical differences within sociodemographic groups were determined using chi-squared tests, and within PROs using bivariate risk ratios.

Results
Of 922 participants, the median age was 58 years (range: 50–88). The majority of participants were male (89%), gay (79%), and white (70%). Fifty-five percent reported an annual household income of less than $50,000 per year and 45% reported a household income of $50,000 or greater. Among people in the lower-income group, 33% were working full or part time, 24% were retired, and 43% were disabled, whereas among people in the higher income group, 76% were working full or part time, 19% were retired, and 5% were disabled (Table 1). Bivariate analysis showed that while there was not a significant relationship between age and income, income was significantly associated with work status, race, gender, education, relationship status, sexual orientation, and having enough money to meet basic needs. People with lower household income were significantly more likely to be depressed, anxious, and lonely, and to have 4 or more comorbid conditions (Table 2). They were also less likely to have high resilience, high social well-being, and high quality of life.

Conclusion
To the best of our knowledge, this is the first examination of the relationship between self-reported annual household income and PROs among older PLWH. In these bivariate analyses, income was positively associated with desirable PROs, and negatively associated with undesirable PROs. To be successful, programs designed to improve health outcomes for older PLWH must take into account the economic challenges faced by many in this group.

Disclosures
All authors: No reported disclosures.
1260. Seroprevalence of Transfusion–Transmissible Infections (HBV, HCV, HIV, and Syphilis) Among Voluntary Blood Donors in Eastern Regional Blood Center Sri Lanka; A 4 Years Evaluation
Authors: Dewage Hansa Ramanayake Ranpati 
Published: October 2019

Abstract

Background
Blood transfusion can be a lifesaving intervention and it may result in acute or delayed complications and carries the risk of transfusion-transmissible infections such as HIV, hepatitis B and C, syphilis, malaria, etc. as well as hemolysis. Therefore, Blood safety remains a major public health problem in many developing countries owing to inadequacies of national blood transfusion policies and services, appropriate infrastructures, qualified personnel and financial resources. The main aim of this study was to evaluate the sereprevelance of transfusion –transmissible infections such as HBV,HCV,HIV and Syphilis among voluntary blood donors in Eastern Regional blood center on behalf of accessing and recommending safe transfusion in the region.

Methods
A retrospective analysis of blood donor data from January 2015 to December 2018 was conducted in Eastern Regional Blood center. Serum samples were screened for hepatitis B surface antigen (HBsAg), antibodies and antigens to hepatitis C virus (HCV), human immunodeficiency virus (HIV) 1 and 2 and Treponema pallidum using commercially available immunochromatic based kits. Relevant confirmatory test for each infective marker were carried out for repeated reactive samples.

Results
During this study period ELISA screening testing was performed on 56079 blood donors. At baseline screening testing and confirmatory testing revealed that, 7 HBsAg, 10 anti-HCV, and 03 anti-HIV and 9 Treponema pallidum positive results were detected. The overall prevalence of HBV, HCV, syphilis and HIV were 0.012%, 0.017 0.005% and 0.016%.All blood donor were voluntary nonremunerate.

Conclusion
The prevalence of HBV, HCV, syphilis and HIV have not remained a big threat to safe blood transfusion in this region compared with some countries across the globe where the results were very high. Comparing with well-developed services the result are more closed with their findings and therefore, safe transfusion practices are established. The reasons for this results may be complex and low prevalence rate in this population with strict adherence to selection criteria and algorithm of donor screening would be the main reasons of this findings.

Disclosures
All authors: No reported disclosures.
1267. Contribution of Acute Infection to the Community Viral Load of an HIV Care Program
Authors: Friedman Eleanor , Schmitt Jessica , Pitrak David 
Published: October 2019

Abstract

Background
Individuals with acute HIV infection (AHI) are a priority for public health due to higher viral loads and greater risk of transmission. Despite potential clinical and public health benefits, rapid or immediate ART can be resource-intensive, with programmatic implications. We measured the contribution of AHI to our programs community viral load (VL) to inform our expanded testing and linkage to care program.

Methods
We calculated the contribution to the community VL for 3 HIV-positive groups from January 1, 2016 to September 1, 2018; (1) AHI (p24 antigen-positive, negative or indeterminate supplemental antibody testing), (2) new diagnoses (ND), and (3) existing diagnoses (ED). Persons who were AHI or ND were ART naïve at first VL. The contribution of each group to community VL was calculated at the first and second VL assays. Group contributions were characterized as (1) percentage of the total HIV-positive population, and (2) group contribution to community VL.

Results
217 persons tested positive for HIV and had an initial VL, and 69 persons linked to our program had a second VL. Time intervals between first and second VL measurements were similar between groups (Kruskal–Wallis P = 0.55). Initial VL medians were significantly different by group (Kruskal–Wallis P < 0.001), partly due to the large number of ED in care and virally suppressed ( <200 copies/mL) at first VL (n = 82). AHI contributed the fewest persons to the HIV-positive population (7.8%), but contributed the most to first VL (58.6%). ART reduced VL for all groups. The median time from diagnosis to treatment for AHI was 5.5 days (IQR 4–21). Due to both natural decay and ART, AHI contributed the least to total VL load at second assay (5.6%). Using previously published data on treated and untreated VL decay, a delay in ART of 15 days would resulted in an estimated VL of 17,721 copies/mL (95% confidence interval (537- 53,576) vs. the estimated VL with ART, 131 copies/mL (95% CI 5–294), a 135-fold increase in AHI VL.

Conclusion
Patients with AHI are small proportion of our cohort compared with ND and ED, but account for the greatest portion of our community VL. These data quantifies the benefit of rapid initiation of ART for AHI to reduce community VL, a priority for prevention efforts.

Disclosures
All authors: No reported disclosures.