bluuebunny/crossref_metadata_2025_split huggingface dataset:
1159. Multidisciplinary Leadership Rounds Are Associated with Decreased Urinary Catheter and Central Venous Catheter Device Utilization at a Tertiary Care, Academic Hospital
Authors: Bowling Jason , Taylor Barbara , Tuazon Nelson , Lewis Brian , Volk Emily , Solis Laura 
Published: October 2019

Abstract

Background
Optimizing use of urinary catheters (UCs) and central venous catheters (CVCs) is crucial to prevent catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and other complications. Despite education and adoption of catheter removal protocols, indwelling devices not meeting approved indications were still noted.

Methods
Twice a week, UC and CVC surveillance rounds were conducted by a team of directors from nursing, vascular access, infection prevention, and hospital epidemiology. Different hospital units were selected each week in random distribution. Rounds emphasized face-to-face discussion with nurses and device observations to identify any removal opportunities and appropriate maintenance. Device utilization was monitored using CDC National Healthcare Safety Network (NHSN) standardized utilization ratio (SUR) and CAUTIs and CLABSIs were monitored using NHSN definitions. Relative ratios of SURs during pre-intervention (pre-INT) and post-intervention (post-INT) time periods for UCs and CVCs were compared using an exact binomial test and mid-P 95% confidence interval (CI). CAUTI and CLABSI rates were compared using Fisher’s exact test using mid-P value.

Results
A baseline time period A of 12 months pre-INT (June 2017-May 2018) was used to compare with the 10-month post-INT time period B (June 2018-March 2019). The UC SURs for periods A and B were 0.813 and 0.696 (Figure 1). The relative ratio shows a post-INT UC SUR that was 85.6% of the pre-INT period (95% CI: 84.1%, 87.2%, P < 0.001). CAUTI rates for periods A and B were not statistically significantly different at 2.276 vs. 2.164/1000 catheter days (P = 0.803). The CVC SURs for periods A and B were 1.244 and 1.081 (Figure 2). The relative ratio shows a post-INT CVC SUR that was 86.9% of the pre-INT period (95% CI: 85.7%, 88.0%, P < 0.001). CLABSI rates for periods A and B were statistically significantly different at 1.27 vs. 0.804/1000 central line days (P = 0.0335).

Conclusion
Leadership rounds were associated with a significant decrease in utilization of UCs and CVCs. A significant decrease was noted in CLABSI rates but not in CAUTI rates. Multidisciplinary oversight improved adherence to existing policies and should be considered for optimizing device utilization.

Disclosures
All authors: No reported disclosures.
1180. Colonization with Multidrug-Resistant Organisms Is Associated with Subsequent Infection in the Ventricular Assist Device Population
Authors: Roberts Scott C , Rich Jonathan D , Pham Duc T , Harap Rebecca , Stosor Valentina 
Published: October 2019

Abstract

Background
Infection is a leading cause of morbidity and mortality in the ventricular assist device (VAD) population. We performed a retrospective cohort study outlining the epidemiology of multidrug-resistant organism (MDRO) colonization and infection rates in this population.

Methods
We performed a longitudinal retrospective cohort of all patients receiving continuous-flow (axial and centrifugal) ventricular assist devices from July 2008 to September 2018 at Northwestern Memorial Hospital. Peri-operative prophylaxis from July 2008 to June 2013 was vancomycin, rifampin, ciprofloxacin, and fluconazole, and vancomycin plus cefuroxime from June 2013 to September 2018. VAD-specific and VAD-related Infections were classified according to ISHLT 2013 definitions. Patients were screened for methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis or Enterococcus faecium, or extended-spectrum β-lactamase producing Gram-negative rods. Statistics were performed using IBM® SPSS Statistics version 25.0. Comparative statistics were performed using two-sided Fisher’s exact test with a P-value of <0.05 deemed significant.

Results
A total of 89 patients with ventricular assist devices developed either VAD-specific or VAD-related infections and were included in the analysis. 77% of patients (n = 66) were colonized with an MDRO; 29% (n = 25) with MRSA, 73% (n = 63) with VRE, and 24% (n = 21) with an ESBL organism. 17.9% (n = 16) of patients who went on to develop infection was secondary to MDROs. Colonization with an MDRO was associated with subsequent infection secondary to these organisms (P = 0.018).

Conclusion
Colonization rates of multidrug-resistant organisms in the VAD population are high. VRE rates were significantly higher than MRSA or ESBL, possible as a result of peri-implantation utilization of vancomycin as surgical site prophylaxis. MDRO colonization was associated with progression to VAD-specific or VAD-related Infection.

Disclosures
All authors: No reported disclosures.
1193. Assessing Sustainability of Hand Hygiene Adherence 5 Years after a Contest-Based Intervention in 3 Japanese Hospitals
Authors: Sakihama Tomoko , Kayauchi Naomi , Saint Sanjay , Fowler Karen E , Ratz David , Tokuda Yasuharu 
Published: October 2019

Abstract

Background
To evaluate the 5-year sustainability of a multimodal intervention which included a prize to the hospital with the highest overall hand hygiene adherence rates among healthcare workers.

Methods
Design: An observational study using direct observation of hand hygiene adherence performed by a trained observer coupled with a survey of healthcare workers about their knowledge of hand hygiene practices. Setting: Three Japanese tertiary care hospitals. Study Population: Physicians and nurses working on an inpatient medical or surgical ward, an intensive care unit (ICU), or the emergency department. Outcome Measures: Hand hygiene adherence rates before patient contact using unobtrusive direct observation. Secondary outcomes were survey responses on a World Health Organization (WHO) questionnaire on hand hygiene.

Results
Data for the current study were collected between September and December 2017 at the 3 participating hospitals. An additional 2,485 observations were conducted during this 5-year post-intervention assessment. These observations were compared with 2,679 observations from the pre-intervention period, and 2,982 observations from the 6-month post-intervention period. Hand hygiene adherence rates had previously improved significantly after the introduction of a multimodal intervention – based on principles recommend by the WHO – in 2012 and 2013 in 3 Japanese hospitals (18.0% pre-intervention to 32.7% 6-months post-intervention; P < 0.001). No significant changes were found in hand hygiene adherence in these hospitals 5 years after the original intervention (31.9% 5-years post-intervention; P = 0.53); however, substantial variability in hand hygiene adherence by unit and healthcare worker type was noted.

Conclusion
A multimodal hand hygiene initiative achieved sustained improvement in hand hygiene adherence in 3 Japanese hospitals 5 years after the original intervention.

Disclosures
All authors: No reported disclosures.
1201. Use of Remote Video Auditing to Monitor Adherence to High-Concern Isolation Guidelines in a Patient Infected With Candida auris; Use of Remote Video Auditing to Monitor Adherence to High-Concern Isolation Guidelines in a Patient Infected with Candida auris
Authors: Singh Vansha , Malhotra Prashant , Khameraj Aradhana , Epstein Marcia , Susan Wirostek , Armellino Donna , Rasul Rehana , Schwartz Rebecca , Farber Bruce 
Published: October 2019

Abstract

Background
Preventing the transmission of multidrug-resistant organisms requires strict adherence to isolation precautions. Candida auris (CA), an emerging multidrug-resistant fungal pathogen, can cause widespread and persistent contamination of environmental surfaces within healthcare facilities and lead to outbreaks. While direct observation (DO) with “secret shoppers” is traditionally used to monitor adherence to isolation precautions and personal protective equipment (PPE) use by healthcare personnel (HCP), this method is limited by logistic and cost issues. We studied the use of remote video auditing (RVA) to monitor adherence to isolation precautions in a patient with CA fungemia.

Methods
This is a cross-sectional study of HCP who were in contact with a single patient with CA fungemia. This patient was placed on standard and contact precautions and held in isolation in a single room in an acute care setting. Adherence to isolation precautions by HCP was observed by DO and RVA. RVA consisted of recording videos of HCP entering and exiting the room and auditing adherence using a standardized protocol by remotely-placed observers. Hand hygiene (HH) on entry and exit, the use of gloves and gowns upon entry, correct gown donning and the proper doffing sequence upon exit were observed by both methods. In the DO method, data were recorded per visit and not by entry/exit.

Results
RVA captured data for 120 visits by HCP (entry data [n = 62]; exit data [n = 58]) and DO captured data for 173 visits by HCP during 23 days. Table 1 shows the compliance rates determined by both methods. RVA yielded lower compliance rates on most measures than the DO method. Also, there were a higher number of missing observations in the DO group

Conclusion
RVA, when used to monitor adherence to isolation precautions in a high-concern CA patient, demonstrated lower compliance rates compared with DO and had fewer missing data elements. These results suggest that RVA is a novel monitoring method that may be a more precise alternative to DO for ensuring adherence to isolation precautions and the prevention of nosocomial transmission of high-concern pathogens such as CA.

Disclosures
All authors: No reported disclosures.
1204. Increased Risk of Respiratory Infections Among Healthcare Personnel (HCP) Caring for Children
Authors: Nyquist Ann-Christine , Rattigan Susan M , Gibert Cynthia L , Gorse Geoffrey , Perl Trish M , Perl Trish M , Price Connie S , Radonovich Lewis , Rodriguez-Barradas Maria C , Simberkoff Michael , Bessesen Mary T , Gaydos Charlotte A , Cummings Derek 
Published: October 2019

Abstract

Background
Healthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015.

Methods
Swabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults.

Results
The main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses.

Conclusion
The risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections.

Disclosures
Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.
1207. Vaccinia Virus Infection Acquired from an Occupational Needlestick—San Diego, California, 2019
Authors: Whitehouse Erin R , Rao Agam , Yu Yon , Yu Patricia , Griffin Margaret , Gorman Susan E , Angel Kristen A , McDonald Eric , Manlutac Anna Liza M , Isakari Marcia , Petersen Brett W 
Published: October 2019

Abstract

Background
Vaccinia virus, a virus similar to but less virulent than variola virus, is a component of smallpox vaccines and increasingly used for medical research. Vaccinia immunoglobulin intravenous (VIGIV) and tecovirimat are stockpiled in the U.S. Strategic National Stockpile (SNS) for potential smallpox bioterror events, but only VIGIV is licensed for vaccinia treatment. On January 12, 2019, CDC was consulted for worsening infection in a laboratory worker after a needlestick with vaccinia.

Methods
We investigated demographic, clinical, vaccination, and exposure history and determined likelihood of vaccinia virus infection. Identity of the specific strain was sought because some have genetic modifications that might impact virulence. Discussions among stakeholders informed treatment decisions and facilitated medication access and usage. Swabs from the lesion were tested by real-time polymerase chain reaction for orthopoxvirus DNA, which includes vaccinia.

Results
The affected worker was an otherwise healthy 26-year-old woman who developed a pustular lesion at the needlestick site on her left index finger (Image). The patient had been injecting vaccinia virus into a mouse and had declined nationally recommended vaccination. Edema, lymphadenopathy, and fever raised concern for severe illness; neither the patient nor occupational health were certain of the vaccinia strain type. CDC, SNS, local health departments, drug manufacturers, and clinicians rapidly collaborated to make treatment decisions based on available information and ensure delivery of both biologics and administration of tecovirimat under an expanded access investigational new drug protocol. Eventually, a wound swab tested positive and the strain was determined to be one with no known impact on virulence.

Conclusion
With increasing use of vaccinia in research, occupational infections may continue to occur. Health clinics should extensively counsel staff who decline vaccination and have documentation on-hand about vaccinia virus types to inform treatment decisions. This response prompted CDC to develop outreach materials specifically for occupational vaccinia exposures.

Disclosures
All authors: No reported disclosures.
1213. How Often Is Portable Equipment Cleaned in an Acute Care Setting?
Authors: Ng Wong Y Karen , Alhmidi Heba , Sankar Chittoor Mana Thriveen , Jencson Annette , Cadnum Jennifer , Donskey Curtis 
Published: October 2019

Abstract

Background
Portable medical equipment that is shared among patients may frequently become contaminated with healthcare-associated pathogens. Cleaning of these devices may be suboptimal. Here, we aim to determine how frequently mobile equipment is cleaned after being used in an acute care setting.

Methods
Frequency of use and cleaning practices were surveyed by observation. Thirty pieces of mobile equipment from 4 wards including workstations, EKGs, vital signs monitor, and doppler ultrasounds were disinfected with a sporicidal disinfectant. Samples were taken before and after cleaning for recovery of methicillin-resistant Staphylococcus aureus (MRSA), C. difficile spores, and Gram-negative bacilli. After disinfection, each piece of equipment was tagged with a colored tag to indicate the ward location and a fluorescent gel marker (FGM) was applied to study the frequency of cleaning of portable equipment. Mobile equipment was checked for colored tags and fluorescent gel removal five, 12, and 20 days after application.

Results
Mobile equipment was infrequently cleaned and moved readily from ward to ward. In 9 of 10 observations, mobile equipment was used and not cleaned after use. Point prevalence sampling showed that 27.5% of mobile equipment had one or more pathogens on them. At day 5, only 30% of equipment marked with FGM had been cleaned and after 20 days, 23% of marked mobile equipment remained uncleaned (figure). 4 pieces of mobile equipment traveled from their original ward to a different ward.

Conclusion
Our findings demonstrate that portable equipment is frequently used and infrequently cleaned. These items can become contaminated with clinically relevant pathogens. We also saw that portable equipment frequently traveled from ward to ward. There is potential for contaminated portable equipment to serve as a vector for dissemination of pathogens. There is a need for effective strategies to disinfect portable equipment between patients.

Disclosures
All authors: No reported disclosures.
1218. Evaluation of a Novel Sporicidal Spray Disinfectant for Decontamination of Surfaces in Healthcare
Authors: Cadnum Jennifer , Livingston Scott , Sankar Chittoor Mana Thriveen , Jencson Annette , Redmond Sarah , Donskey Curtis 
Published: October 2019

Abstract

Background
Surfaces in healthcare facilities are typically cleaned by manual application of liquid disinfectants. However, thoroughness of cleaning is often suboptimal and application can be challenging and time-consuming when surfaces are irregular.

Methods
We tested the effectiveness of a novel spray disinfectant technology that uses an electrostatic sprayer to thoroughly apply a sporicidal disinfectant to surfaces after minimal pre-cleaning to remove visible soil. In a laboratory setting, we compared the effectiveness of the spray disinfectant vs. manual application of disinfectant for removal of Clostridium difficile spores inoculated onto the seat, armrest, and seat back of a wheelchair and measured the time required for each method of disinfection. In a healthcare setting, we tested the effectiveness of a 15-second spray application for reduction of C. difficile spores on 130 items with irregular or hard to clean surfaces, including 30 wheelchairs, 40 pieces of portable equipment, and 30 waiting room chair seats.

Results
In laboratory testing, application of disinfectant using the electrostatic sprayer was as effective as wiping in reducing C. difficile spores inoculated onto wheelchair surfaces, but required only one-fourth the time for application. C. difficile spore contamination was common on mobile equipment, wheelchairs, and waiting rooms chairs, and spray application of the sporicidal disinfectant was effective in reducing contamination (figure).

Conclusion
Commonly shared items such as wheelchairs, portable equipment, and waiting room chairs were frequently contaminated with C. difficile spores. Application of a sporicidal disinfectant using an electrostatic sprayer provided a rapid and effective means to reduce spore contamination on these surfaces.

Disclosures
All authors: No reported disclosures.
1219. Disinfection of Surfaces Contaminated with Carbapenemase Producing Acinetobacter baumannii Using Ozone Under Complex Room Conditions
Authors: Knobloch Johannes Karl-Mark , Franke Gefion , Belmar Campos Cristina E , Klupp Eva-Maria , Knobling Birte 
Published: October 2019

Abstract

Background
Acinetobacter baumannii is an emerging multiresistant Gram-negative rod, which has caused multiple hospital outbreaks. A. baumannii can display a high ability to survive on inanimate surfaces. Therefore, cleaning and disinfection is an important part in the prevention of A. baumannii transmission. No-touch room decontamination is performed with increasing frequency to reach more standardization in hospital cleaning. In this study, we investigated the efficacy of an automated room decontamination using ozone (Sterisafe™ pro) against A. baumannii under complex room conditions.

Methods
A Carbapenemase-producing A. baumannii outbreak strain was analyzed with respect to its ability to survive on dry surfaces. The Sterisafe™ pro instrument was used in a patient room with an attached bathroom. The A. baumannii strain was dried on three different carriers (ceramic tiles, stainless steel, solid core furniture board) and placed at eight different positions in the rooms. A standard disinfection cycle (80 ppm ozone; 90 % RH; 60 minutes) was conducted in three independent experiments.

Results
The A. baumannii strain displayed a long-term survival on surfaces under dry conditions sufficient for further disinfection experiments. Interestingly, the mean reduction rates of A. baumannii dried on three surfaces displayed significant differences. Reduction rates greater than 5 log were reached on all stainless steel and ceramic carriers even under the complex room conditions using the standard disinfection cycle of the Sterisafe™ pro instrument. In contrast, on furniture board individual carriers displayed reduction rates of even less than 4 log. The mean reduction rate was still 5 log for A. baumannii on furniture board.

Conclusion
A. baumannii dried on different surfaces display a differential susceptibility against automated ozone disinfection. However, the SterisafeTM pro instrument displayed a sufficient reduction of A. baumannii for all tested surfaces even under complex room conditions. The individual behavior of A. baumannii on different materials indicate the necessity for the validation of automated room decontamination systems under varying conditions.

Disclosures
All authors: No reported disclosures.
1222. Are Reduced Concentrations of Chlorine-Based Disinfectants Effective Against Candida auris?
Authors: Kumar Jessica , Cadnum Jennifer , Ng Wong Y Karen , Sankar Chittoor Mana Thriveen , Alhmidi Heba , Donskey Curtis 
Published: October 2019

Abstract

Background
Currently, sporicidal disinfectants such as bleach are recommended for daily and terminal disinfection of the rooms of patients with Candida auris colonization and/or infection. However, bleach and other chlorine-based disinfectants can have adverse effects on surfaces and personnel. Disinfectant solutions with reduced chlorine concentrations are commonly used for other pathogens, but it is not known if diluted or alternative products maintain efficacy against C. auris both in vitro and in vivo.

Methods
We tested the efficacy of different concentrations of a sodium dichloroisocyanurate (NaDCC) product and sodium hypochlorite using the method recommended by the Environmental Protection Agency (EPA) for evaluation of the efficacy of liquid disinfectants against C. auris (EPA MLB SOP MB-35-00) and in a simulated patient room. Carriers were exposed to each disinfectant for 1 and 2 minutes. Log reductions were calculated by subtracting viable organisms recovered after disinfectant exposure vs. deionized water controls.

Results
As shown in the figure, the NaDCC product at 4306 ppm tested with a 2 minute contact time reduced C. auris by ≥5 log10 colony-forming units (CFU) but had reduced efficacy with shorter exposure time or lower concentrations. Sodium hypochlorite was effective with 1 or 2 minute exposure times at a concentration of 6,500 ppm, and was effective at 4,000 ppm with an exposure time of 2 minutes. In the simulated patient room, NaDCC reduced C. auris contamination by ≥6 log10 CFUs on all surfaces.

Conclusion
A chlorine-based NaDCC product was effective at reducing C. auris. Both NaDCC and sodium hypochlorite products exhibited reduced efficacy at lower concentrations, particularly at concentrations below 4000 ppm. The NaDCC products were also effective in reducing contamination in the simulated patient room. UV-C treatment was an effective adjunct to manual cleaning.

Disclosures
All authors: No reported disclosures.