bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of UV-C Disinfection in Hyperbaric Chambers
Authors: Warren Bobby , Masker Jason , Brown Gregory , Gamez Isabella , Smith Becky , Anderson Deverick John , Turner Nicholas 
Published: November 2020

Background: UV-C light reduces contamination of high-touch clinical surfaces. Few studies have tested the relative efficacy of UV-C devices in real-world clinical environments. Methods: We assessed the efficacy of the Tru-D (SmartUVC) and Moonbeam-3 UV-C (Diversey) devices at eradicating important clinical pathogens in 2 hyperbaric chambers at a tertiary-care hospital. Formica sheets were inoculated with 106–107 CFU of MRSA (USA300) or 104–105 CFU of C. difficile (NAP1). Sheets were placed in 6 predetermined locations throughout the chambers. Two Moonbeam-3 UV-C devices were positioned in the center of each chamber and were run for 3-minute (per manufacturer’s instructions) and 5-minute cycles. One Tru-D was positioned in the center of the chamber and was run on the vegetative cycle for MRSA and the spore cycle for C. difficile. UV-C dosage was measured for both machines. Quantitative cultures were collected using Rodac plates with DE neutralizing agar and were incubated at 37C for 48 hours. C. difficile was likewise plated onto sheep’s blood agar. Results: We ran each combination of chamber, microbe, and UV-C device in triplicate for In total, 108 samples per species.

For MRSA, the Tru-D vegetative cycle, the 5-minute Moonbeam cycle, and the 3-minute Moonbeam cycle resulted in average CFU log10 reductions of 7.02 (95% CI, 7.02–7.02), 6.99 (95% CI, 6.95–7.02), and 6.58 (95% CI, 6.37–6.79), respectively (Fig. 1). The Tru-D vegetative and 5-minute Moonbeam cycles were similarly effective (P > .99), and both were more effective than the 3-minute Moonbeam cycle (P < .001 and P < .001, respectively). MRSA samples receiving direct UV-C exposure had significantly greater log10 reductions (6.95; 95% CI, 6.89–7.01) than did indirect exposure (6.67; 95% CI, 6.46–6.87; P < .05) (Fig. 2). For C. difficile, the Tru-D sporicidal, the 5-, and 3-minute Moonbeam cycles resulted in average CFU log10 reductions of 1.78 (95% CI, 1.43–2.12), 0.57 (95% CI, 0.33–0.81) and 0.64 (95% CI, 0.42–0.86), respectively (Fig. 1). Tru-D was significantly more effective than either the 3- or 5-minute Moonbeam cycles (P < .00). C. difficile samples receiving direct UV-C exposure had higher dosage and significantly greater log10 reductions (1.34; 95% CI, 1.10–1.58) than did indirect exposure (0.58; 95% CI, 0.31–0.86; P < .01) (Fig. 2). Conclusions: Use of the Tru-D vegetative cycle and the Moonbeam 3- and 5-minute cycles resulted in similar reductions in MRSA; both resulted in significantly greater reductions than the manufacturer’s recommended 3-minute Moonbeam cycle. Therefore, healthcare facilities should carefully evaluate manufacturer-recommended run times in their specific clinical setting. For C. difficile, the Tru-D sporicidal cycle was significantly more effective than either of the Moonbeam cycles, likely due to higher irradiation levels. As such, direct UV-C exposure resulted in greater average reductions than indirect exposure.Funding: NoneDisclosures: None
Enhanced Environmental Cleaning to Reduce Rates of Clostridioides difficile Infection on Oncology Units
Authors: Ziegler Matthew , Pegues David , Gaynes Steven , Desphy-Carter Ariel , Omorogbe Jacqueline , Gilmar Cheryl , Tolomeo Pam , Lautenbach Ebbing , Han Jennifer 
Published: November 2020

Background:Clostridioides difficile infection (CDI) is a major contributor to morbidity and mortality in patients with hematologic malignancy. Due to both immunosuppression and frequent antibiotic exposures, up to one-third of inpatients receiving chemotherapy or stem-cell transplant develop CDI. Transmission of C. difficile in healthcare facilities occurs due to environmental surface contamination and hand carriage by healthcare workers from colonized and infected patients. We investigated the effectiveness of enhanced room cleaning in collaboration with environmental services (EVS) staff to prevent CDI transmission and infection.Methods: From April 1, 2018, to September 30, 2018, a multimodal enhanced cleaning intervention was implemented on 2 oncology units at the Hospital of the University of Pennsylvania. This intervention included real-time feedback to EVS staff following ATP bioluminescence monitoring. Additionally, all rooms on the intervention units underwent UV disinfection after terminal cleaning. We performed a system-level cohort study, comparing rates of CDI on the 2 study units to historic and 2 concurrent control units. Historic and concurrent control units received UV disinfection only for rooms with prior occupants with MRSA or CDI. All units during the intervention period received education on the importance of environmental cleaning for infection prevention. Mixed-effects Poisson regression was used to adjust for system-level confounders. Results: A median of 1.34 CDI cases per 1,000 patient days (IQR, 1.20–3.62) occurred during the 12-month baseline period. There was a trend toward a reduced rate of CDI across all units during the intervention period (median, 1.19; IQR, 0.00–2.47; P = .13) compared with all units during the historical period. Using mixed-effects Poisson regression, accounting for the random effects of study units, the intervention was associated with an incidence rate ratio for C. difficile of 0.72 compared to control units (95% CI, 0.53–0.97; P = .03). Average room turnaround time (TAT) increased across all units during the study period, from 78 minutes (IQR 74–81) to 92 minutes (IQR, 85–96; P < .001). Within the intervention period, TAT was higher on intervention units (median, 94 minutes; IQR, 92–98) compared to concurrent control units (median, 85; IQR, 80–92; P = .005). Conclusions: Enhanced environmental cleaning, including UV disinfection of all patient rooms and ATP bioluminescent monitoring with real-time feedback, was associated with a reduction in the incidence of CDI.Funding: NoneDisclosures: None
Epidemiologic Characteristics of ESBL-Producing ST131 E. coli Identified Through the Emerging Infections Program, 2017
Authors: Duffy Nadezhda , Campbell Davina , Reses Hannah E. , Basiliere Elizabeth , Bower Chris , Dumyati Ghinwa , Kainer Marion , Muleta Daniel , Byrd-Warner Benji , Stanton Richard , Daniels Jonathan , Halpin Alison , Lutgring Joseph , See Isaac 
Published: November 2020

Background: Extended-spectrum β-lactamase–producing (ESBL) Escherichia coli infection incidence is increasing in the United States. This increase may be due to the rapid expansion of ST131, which is now the predominant ESBL strain globally, often multidrug resistant, and has been shown to establish longer-term human colonization than other E. coli strains. We assessed potential risk factors that distinguish ST131 from other ESBL E. coli. Methods: From October 1 through December 31, 2017, 5 CDC Emerging Infections Program (EIP) sites pilot tested active, laboratory-based surveillance in selected counties in Colorado, Georgia, New Mexico, New York, and Tennessee. An E. coli case was defined as the first isolation from a normally sterile body site or urine in a surveillance area resident in a 30-day period resistant to 1 extended-spectrum cephalosporin antibiotic and susceptible or intermediate to all carbapenem antibiotics tested. Epidemiologic data were collected from case patients’ medical records. A convenience sample of 117 E. coli isolates from case patients was collected. All isolates underwent whole-genome sequencing to determine sequence type and the presence of ESBL genes. We compared ST131 E. coli epidemiology to other ESBL E. coli. Results: Among 117 E. coli isolates, 97 (83%) were ESBL producers. Of the 97 ESBL E. coli, 52 (54%) were ST131 (range, for 4 EIP sites submitting >10 isolates: 25%–88%; P < .001). Other common STs were ST38 (12%) and ST10 (5%). ST131 infections were more likely to be healthcare-associated than non-ST131 (56% vs 36%; P = .05) (Table 1). Among specific prior healthcare exposures, only residence in long-term care facilities (LTCFs) in the year before culture was more common among ST131 case patients (29% vs 11%; P = .03). Notably, 85% of ESBL E. coli collected from LTCF residents were ST131. ST131 E. coli were more common among patients with underlying medical conditions (81% vs 60%; P = .02). No statistically significant difference by sex, race, age, culture source, location of culture collection, and frequency of antibiotic use in the prior 30 days was observed. Conclusions:The prevalence of ST131 E. coli varies regionally. The association between ST131 and LTCFs suggests that these may be particularly important settings for ST131 acquisition. Improving infection control measures that limit ESBL transmission in these settings and preventing dissemination in facilities receiving patients from LTCFs may be necessary to contain ST131 spread.Funding: NoneDisclosures: None
Establishment of a Sink Gallery to Investigate Growth of Carbapenemase-Producing Klebsiella pneumoniae and Biofilms in P-Traps
Authors: Ganim Christine , Mazher Mustafa , Breaker Erin 
Published: November 2020

Background: Hand-hygiene sink drains in healthcare facilities may provide an environment for the survival and dissemination of various multidrug-resistant organisms (MDROs), including carbapenemase-producing Klebsiella pneumoniae (CPKP). We developed a sink model system to establish and test native drinking water biofilms containing CPKP in the p-traps of hand-hygiene sink drains. Methods: A handwashing sink gallery was designed to consist of 6-wall mounted stainless-steel sink basins connected to the same municipal water line. Each sink’s plumbing included a chrome-plated brass p-trap. Healthcare facility conditions were simulated to include handwashing events with the addition of hand-soap and municipal water 4 per day, and nutritional shake (simulating liquid waste) 1 per day. Resultant biofilms in the p-traps of each sink were harvested after 28 days for community analysis. Microbial community analyses were performed on selected biofilm samples using 16S rRNA sequencing of the V4 hypervariable region of genomic DNA. Another experiment evaluated 28-day p-trap biofilm inoculated with CPKP CAV1016 (10 mL 7.010E 7 CFU/mL) and was assessed over 14 days. Heterotrophic plate counts (HPCs) were determined on R2A medium (7 days of incubation at 25C). CPKP was quantified on mEndo selective medium (48 hours of incubation at 36C). Results: Biofilms developed in all p-traps, but biofilm HPC (5.78 mean log CFU/cm2, range 4.35–7.16) and community diversity (15–20 genera per p-trap) varied with sink position. Community analysis showed similarities in bacterial community composition and diversity between sinks 1 and 2, and between sinks 3, 5 and 6, but with differences between the 2 groups. The most abundant family in sinks 3, 5, and 6 was Erythrobacteriaceae (76%, 78%, and 55% of the total reads, respectively), whereas sinks 1 and 2 were dominated by Sphingomonadaceae (63% and 36%) and Methylobacteriaceae (19% and 55%). Also, 16S sequencing revealed the presence of potential opportunistic pathogens in the biofilms, including reads attributed to Pseudomonas and Acinetobacter. CPKP CAV1016 inoculated into 28-day p-trap biofilms colonized and persisted in all 6 sinks for 12 days after inoculation. Conclusions: Despite all 6 sinks sharing an incoming water line, soap, and carbon and energy source, there was a significant variation in the bacterial community composition observed between the sinks. CPKP can colonize and persist in the p-trap biofilms; however, additional work is needed to achieve a reproducible model system. Once this is achieved, the sink gallery will be used to investigate interventions to mitigate colonization or persistence of CPKP in p-trap biofilms.Funding: NoneDisclosures: None
Geographic Evaluation of Georgia Vaccination Disparity Among Laboratory-Confirmed Influenza Cases in a Children’s Hospital
Authors: Hoskins Dorian , Kaplan Cynthia , Pruitt Andrea , McCarter Andrea 
Published: November 2020

Background: Vaccination coverage among children aged ≤18 years in Georgia remains one of the lowest in the nation with 39.3% coverage. During the 2018–2019 influenza season, the CDC reported 142 pediatric deaths, 3 of which occurred in Georgia. In a time of increasing complexity of immunization schedules, increase severity with a high level of flu-related deaths and hospitalization, it is important to understand localized factors that contribute to decrease influenza immunization and increased flu-related hospital visits among children. Methods: Data include electronic medical record chart review of 5,827 laboratory confirmed Children’s Healthcare of Atlanta visitor cases from October 1, 2016, to September 24, 2019. System-wide county level data included 3 pediatric hospitals, 5 primary care facilities, 8 urgent care facilities, and 2 outpatient clinics. Characteristics associated with disparities in vaccine were explored using univariate and multiple regressions analysis. Of those children with a primary care physician (PCP), 30% had flu vaccinations, whereas only 16.5% of those without a PCP had been vaccinated (P ≤ .00001). There was a positive relationship between increased county influenza rate and percentage of children in county who were preschoolers <5 years old (r = 0.93; P ≤ .05). Moreover, 78% of children who received the flu vaccine ≤ 2 weeks prior to a confirmed flu diagnosis got the flu during peak flu periods (r = 0.29; P ≤ .05). Predictors of increased flu rate per 1,000 children were associated with flu vaccines given ≤2 weeks before a lab confirmed flu diagnosis (P ≤ .02). Children in counties that had a higher rate of flu during the peak period also had an overall higher rate of flu (P ≤ .005). The higher the percentage of children who got flu during peak flu period, the lower the vaccination rate for the county (P ≤ .001). The percentage of children ≤18 years old with no health insurance was associated with lower vaccination rates in the county (P ≤ .004). There appears to be a positive relationship between receiving flu vaccine 2 weeks prior to lab-confirmed flu diagnosis and onset of illness during the peak flu periods. Missed opportunities to obtain a flu vaccine by a PCP were associated with increased flu-related hospital visits and lower vaccination rates. Results may support predischarge hospital vaccinations and the promotion of flu vaccination education. Pediatric research is needed to facilitate localized PCP vaccination or predischarge hospital vaccinations prior to peak flu periods when hospital-related flu visits increase.Funding: NoneDisclosures: None
Getting to the Heart of the Matter: Epidemiology of Surgical Site Infections Following Open Heart Surgery in Children
Authors: Magyar Matthew , Shephard Allyson , Bedard Pat , Tang Ken , Maharajh Gyaandeo , Thampi Nisha 
Published: November 2020

Background: Surgical site infections (SSIs) following open heart surgery involving cardiopulmonary bypass (CPB) among pediatric patients are healthcare-associated infections associated with significant morbidity and mortality. At a pediatric acute-care facility, an increase in SSI incidence prompted an epidemiologic review. We describe the incidence of cardiac SSIs at our hospital; we identified risk factors and areas of practice variation to inform improvement initiatives. Methods: SSI cases following CPB at our hospital have been identified through routine surveillance using NHSN definitions since January 2016. An increase in cases was noted in mid-2018, prompting a common cause analysis with stakeholders across the preoperative, intraoperative, and postoperative care continuum. Areas of practice variability were identified, and an epidemiologic review was performed to determine risk factors among cases compared to noncases between January 2016 and August 2018. The rate of SSIs and 95% confidence intervals were estimated, and univariate logistic regressions were fitted to estimate unadjusted odds ratios (ORs) for the association between each of the predetermined preoperative, intraoperative, and postoperative factors and developing an SSI. Results: Overall, 139 patients underwent surgery involving CPB between January 1, 2016, and August 31, 2018. Preoperative bathing was infrequently documented (9% among cases vs 5% among noncases; P = .56). Operating room observations identified frequent door openings and equipment crowding. Moreover, 11 patients (7.9%) developed a cardiac SSI, with 6 (14.3%) occurring in the first 8 months of 2018 (P = .067). There were no predominant pathogens; 3 of 11 cases were associated with methicillin-susceptible Staphylococcus aureus. Also, 9 cases were classified as deep incisional or organ-space SSI. Each hour increase in total CPB duration was associated with a 63% increase in odds of developing an SSI (OR, 1.626; 95% CI, 1.041–2.539). Each additional day of intubation (OR, 2.400; 95% CI, 1.203–4.788) and peritoneal dialysis (OR, 1.767; 95% CI, 1.070–2.919) during the first 3 days postoperatively were also associated with increased SSI risk. Postoperative documentation of wound assessment occurred in 60% of patients, with no difference between cases and noncases (55% vs 67%; P = .42). Conclusions: Using a mixed-methods approach, preoperative bathing, increased operating room traffic, and postoperative care around wounds and invasive devices were identified as areas of improvement toward safer surgical care. Although no unique organism or process explained the increased rate, determining risk factors and areas of practice variability through stakeholder engagement provided insight into opportunities to prevent SSIs.Funding: NoneDisclosures: None
Hand Hygiene Compliance in a University Hospital in West Bank, Palestine: An Observational Study 2017–2019
Authors: Belkebir Souad , Jeetawi Rawan , Kanaan Alaa 
Published: November 2020

Background: Worldwide, medical staff adherence to hand hygiene (HH), the most cost-effective measure to decrease healthcare-associated infections (HAIs), is ~40%–60%. The infection control program (ICP) at An-Najah National University Hospital (NNUH), a tertiary-care referral teaching hospital located in Nablus, in northern Palestine, monitors HH compliance by direct observations using the WHO observation checklist. In this descriptive study, we investigated the prevalence of HH across the institution during 2017–2019. Methods: The WHO multimodal strategy to enhance HH in healthcare settings was implemented at NNUH, a tertiary-care referral hospital, in 2017. HH compliance has been measured during routine patient care by direct observation by ICP team and anonymously by other trained observers. Results are reported on monthly basis to the administration and medical team (nurses and doctors), and corrective plans to increase the compliance are discussed. Training is reinforced with ultraviolet light and fluorescent alcohol-based hand rub. Yearly, staff are engaged in HH Day activities (Figs. 1 and 2). Leadership support is constant by securing the annual budget for the HH program and the enforcement of HH policy across the setting. Results: NNUH, using the WHO Hand Hygiene Self-Assessment Framework, is currently in the advanced level (395 of 500) compared to 2017 (intermediate level, 292 of 500). Overall, HCW HH compliance increased from 44% (range, 31%–57%) in 2017 to 53% (range, 30%–72%) in 2018 and to 61% (range, 55%–66%) through October 2019. During the 3-year study period, Nursing compliance increased from 36% to 59% and to 64%, respectively, whereas the compliance for doctors increased from 42% to 56% and 58%, respectively. Regarding the missed opportunities, before patient was the most frequent cause for missed opportunity with a rate of 60% (Fig. 3). This missed opportunity was mainly related to the misuse of gloves (mainly among nurses), which requires an ad hoc intervention. Conclusions: Implementation of the WHO HH strategy is feasible and effective in low-income countries and leads to significant improvements in compliance. Periodic training, personnel engagement, and leadership are key factors of HH improvement in our setting.Funding: NoneDisclosures: None
Healthcare-Associated Pneumonia in a Mexican Tertiary Care Center Micro to Systemic Analysis: A 2017–2019 Case Series Study
Authors: Salcido Miguel Ángel García , González Roxana Trejo , González Lucio Antonio Hernández 
Published: November 2020

Objectives: The aim of this study was to identify the biological, microbiological, and healthcare factors related to the occurrence of nosocomial pneumonia in our confirmed cases during 2017–2019. Methods: We conducted a case series study. For the selection of the cases we used the CDC criteria for hospital-acquired pneumonia, we collected cases from the data set for healthcare-associated infections from a tertiary-care hospital in Mexico City. For the quantitative analysis, we used Stata v14 software, and we obtained frequencies, proportions, accumulated incidence rate, lethality rate, central tendency, and dispersion metrics. This study was a secondary data set analysis; we obtained signed authorization for the use of the data from the Epidemiological Surveillance Unit. Results: During our analysis period (January 2017 to June 2019), we identified 107 cases that fulfilled the CDC criteria: 47 cases (43.93%) from 2017, 38 cases (35.51%) from 2018, and 20.56% from 2019. The month that reported the highest frequency was February, with 17 cases (15.89%). The median age was 63 years (range, 0–97 years; IQR, 36). The most affected age group was 65 years (48.60%), and the most affected 5-year age group was 75–79 years (13.08%). Moreover, 60 cases (56.07%) were men and 47 (43.93%) were women. Regarding the reason for discharge, 71% were discharged due to improvement, 27% died, and 2% were transferred to another healthcare facility. Also, 17 patients (15.89%) required readmission due to respiratory illness within 72 hours of previous discharge. The most common diagnosis was a solid malignant neoplasm (20.19%), followed by heart or vascular malformation or anomaly (12.50%). The mean inpatient hospital stay was 39.95 days (46.40; median, 27 days, range, 2–317 days; IQR 35 days). The median time elapsed until detection was 14 days. The hospitalization area with the most cases was the intensive care unit, with 24 cases (22.43%); the service with most cases was oncology with 21 cases (20.56%). The most isolated pathogen was Pseudomonas aeruginosa (14%). Moreover, 59% were gram-negative, 36% were gram-positive, 19.67% were viruses, and 14.75% were fungi. Our accumulated-incidence-rate was 0.58 cases per 1,000 patient days and our case-fatality-rate was 25.23%. Furthermore, 41% of cases required invasive mechanical ventilation, 52.34% required noninvasive mechanical ventilation, 5% cases had an endo-pleural tube, 9.35% had a nasogastric tube, and 41.12% had a central venous catheter. The most-prescribed antimicrobial was meropenem (33.33%), and meropenem-resistance was 61.54%. Conclusions: Infection prevention efforts should target oncological patients, critical-care units, and the elderly. We must reinforce our antimicrobial policy due to our overprescription of carbapenems. Early detection is needed to reduce mortality.Funding: NoneDisclosures: None