bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Design and Implementation of an IPC Certificate Course: Experiences From Sierra Leone
Authors: Weiss Jamine , Kolwaite Amy , Lyman Meghan , Kassa Getachew , Rabkin Miriam , Maruta Anna , Murrman Marita , Benya Hassan , Conteh Christiana 
Published: November 2020

Background: Trained infection prevention and control (IPC) practitioners are critical to reducing healthcare-associated infections (HAI) and improving patient safety. Despite having HAI rates 3 times higher than high-income countries, many low- and middle-income countries (LMICs) lack trained IPC professionals. During the 2014–2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS) recognized this need and appointed and trained IPC focal persons at all district hospitals. Following the outbreak, MoHS requested assistance from the US CDC to develop and implement a comprehensive IPC training program for IPC specialists. Methods: The CDC, alongside its partners, convened a multidisciplinary team to develop an IPC certificate course. ICAP led the curriculum development process using a “backwards design” approach, starting with development of competencies and learning objectives, then designing an evaluation framework and learning strategies, and finally, identifying course content. The curriculum was based on existing resources, primarily designed for high-income countries, which were adapted to the Sierra Leone context and aligned with national IPC policies and guidelines. Additionally, an IPC steering committee, led by MoHS, was established to provide national leadership and oversight and make country-level decisions regarding accreditation and career pathways for IPC specialists. Results: The course includes three 2-week workshops over 6 months consisting of classroom didactics and hands-on activities. Topics include standard and transmission-based precautions, microbiology, laboratory, HAI, quality improvement, leadership, and scientific writing. Between sessions, participants conduct IPC activities at their work site and share results during subsequent workshops. Participants receive electronic tablets, which contain course content, assessment tools, and references, to upload their work into a cloud-based storage system for facilitators to provide feedback. They also receive in-person mentorship and connect with peers through a group messaging platform to share lessons learned. Participants’ knowledge and skills are assessed using a before-and-after test and observing them perform IPC practices using standardized checklists. The first cohort of 25 participants will complete the course in November 2019. Conclusions: The IPC certificate course is the first comprehensive, competency-based IPC training in Sierra Leone. Successes, challenges, sustainability, and lessons learned remain to be determined; however, based on similar models, the course has the potential to significantly improve IPC in Sierra Leone. Additionally, it is a model that can be replicated in other resource-limited settings.Funding: NoneDisclosure:None
Use of a Multidisciplinary Incident Command System in Response to Measles Outbreak in Maryland
Authors: McIlquham Taylor , Sick-Samuels Anna , Billman Carrie , Andonian Jennifer , Dudley Melissa , Husain Amyna , Maloney Robert , Oruc Cagla , Brown Mary , Maragakis Lisa , Milstone Aaron Michael 
Published: November 2020

Background: Measles is a highly contagious virus that reemerged in 2019 with the highest number of reported cases in the United States since 1992. Beginning in March 2019, The Johns Hopkins Hospital (JHH) responded to an influx of patients with concern for measles as a result of outbreaks in Maryland and the surrounding states. We report the JHH Department of Infection Control and Hospital Epidemiology (HEIC) response to this measles outbreak using a multidisciplinary measles incident command system (ICS). Methods: The JHH HEIC and the Johns Hopkins Office of Emergency Management established the HEIC Clinical Incident Command Center and coordinated a multipronged response to the measles outbreak with partners from occupational health services, microbiology, the adult and pediatric emergency departments, marketing and communication and local and state public health departments. The multidisciplinary structure rapidly developed, approved, and disseminated tools to improve the ability of frontline providers to quickly identify, isolate, and determine testing needs for patients suspected to have measles infection and reduce the risk of secondary transmission. The tools included a triage algorithm, visitor signage, staff and patient vaccination guidance and clinics, and standard operating procedures for measles evaluation and testing. The triage algorithms were developed for phone or in-person and assessed measles exposure history, immune status, and symptoms, and provided guidance regarding isolation and the need for testing. The algorithms were distributed to frontline providers in clinics and emergency rooms across the Johns Hopkins Health System. The incident command team also distributed resources to community providers to reduce patient influx to JHH and staged an outdoor measles evaluation and testing site in the event of a case influx that would exceed emergency department resources. Results: From March 2019 through June 2019, 37 patients presented with symptoms or concern for measles. Using the ICS tools and algorithms, JHH rapidly identified, isolated, and tested 11 patients with high suspicion for measles, 4 of whom were confirmed positive. Of the other 26 patients not tested, none developed measles infection. Exposures were minimized, and there were no secondary measles transmissions among patients. Conclusions: Using the ICS and development of tools and resources to prevent measles transmission, including a patient triage algorithm, the JHH team successfully identified, isolated, and evaluated patients with high suspicion for measles while minimizing exposures and secondary transmission. These strategies may be useful to other institutions and locales in the event of an emerging or reemerging infectious disease outbreak.Funding: NoneDisclosures: Aaron Milstone reports consulting for Becton Dickinson.
Validation of Administrative Codes for Identification of Staphylococcus aureus Infections Among Electronic Health Data
Authors: Rose Ashley , Gokhale Runa , See Isaac , Baggs James , Slayton Rachel , Fridkin Scott , Hatfield Kelly 
Published: November 2020

Background: Epidemiological studies have utilized administrative discharge diagnosis codes to identify methicillin-resistant and methicillin-sensitive Staphylococcus aureus (MRSA and MSSA) infections and trends, despite debate regarding the accuracy of utilizing codes for this purpose. We assessed the sensitivity and positive predictive value (PPV) of MRSA- and MSSA-specific diagnosis codes, trends, characteristics, and outcomes of S. aureus hospitalizations by method of identification. Methods: Clinical micro biology results and discharge data from geographically diverse US hospitals participating in the Premier Healthcare Database from 2012–2017 were used to identify monthly rates of MRSA and MSSA. Positive MRSA or MSSA clinical cultures and/or a MRSA- or MSSA-specific International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD-9/10 CM) diagnosis codes from adult inpatients (aged ≥18 years) were included as S. aureus hospitalizations. Septicemia was defined as a positive blood culture or a MRSA or MSSA septicemia code. Sensitivity and PPV for codes were calculated for hospitalizations where admission status was not listed as transfer; true infection was considered a positive clinical culture. Negative binominal regression models measured trends in rates of MRSA and MSSA per 1,000 hospital discharges. Results: We identified 168,634 MRSA and 148,776 MSSA hospitalizations in 256 hospitals; 17% of MRSA and 21% of MSSA were septicemia. Less than half of all S. aureus hospitalizations (49% MRSA, 46% MSSA) and S. aureus septicemia hospitalizations (37% MRSA, 38% MSSA) had both a positive culture and diagnosis code (Fig. 1). Sensitivity of MRSA codes in identifying positive cultures was 61% overall and 56% for septicemia, PPV was 62% overall and 53% for septicemia. MSSA codes had a sensitivity of 49% in identifying MSSA cultures and 52% for MSSA septicemia; PPV was 69% overall and 62% for septicemia. Despite low sensitivity, MRSA trends are similar for cultures and codes, and MSSA trends are divergent (Fig. 2). For hospitalizations with septicemia, mortality was highest among those with a blood culture only (31.3%) compared to hospitalizations with both a septicemia code and blood culture (16.6%), and septicemia code only (14.7%). Conclusions: ICD diagnosis code sensitivity and PPV for identifying infections were consistently poor in recent years. Less than half of hospitalizations have concordant microbiology laboratory results and diagnosis codes. Rates and trend estimates for MSSA differ by method of identification. Using diagnosis codes to identify S. aureus infections may not be appropriate for descriptive epidemiology or assessing trends due to significant misclassification.Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.
VRE Screening and Isolation: One Size Does Not Fit All
Authors: Vaisman Alon , Mistry Smit , Zanchettin Sarah , Hota Susy 
Published: November 2020

Background: The need for screening and isolation for patients colonized with vancomycin-resistant Enterococcus (VRE) remains controversial. In this study, we examined the effects of discontinuation and reinstatement of these practices on VRE infection and colonization incidence within a multisite, tertiary-care hospital center, including its effects on specific at-risk groups. Methods: We retrospective analyzed VRE clinical isolate, infection, and bacteremia incidence rates at our hospital (1) prior to discontinuation of universal screening and isolation (January 2010–June 2012), (2) during discontinuation (July 2012–April 2017), and (3) after reinstatement of screening and isolation in high-risk wards (intensive care and multiple-organ transplant units, June 2017–April 2019). Monthly incidence rates were calculated for each of 3 sites at our tertiary-care hospital: site A, which includes the transplant program, site B, an adult cancer hospital, and site C, which includes orthopedic and neurology programs. To understand the differential effect of screening and isolation on various risk groups, incidence rates were also calculated for individual programs within our hospital, including medicine, surgery, intensive care, oncology, and transplant programs. Results: During the period of study, 3,167 cases of VRE isolates were identified. Patient colonizations of VRE across the institution increased throughout the study period, with the monthly number of newly colonized patients increasing from 10.4 in the first period of study to 20.6 in the last period. The overall VRE clinical isolate, infection, and bacteremia incidence rates did not increase following the cessation of VRE screening and isolation precautions; however, a significant increase was seen among the patients at site B (Fig. 1, infection rates). Furthermore, there was a significant decrease in VRE clinical isolate, infection, and bacteremia incidence following the reinstatement of screening in the ICU and transplant programs at site A, but no effect was seen in the other programs (Fig. 2, infection rates). Conclusions: The risk associated with discontinuing VRE screening and isolation measures appears depend on the subgroup of patients within a hospital environment. Furthermore, risk-based or unit-based VRE screening and isolation appears to be effective at controlling VRE incidence, even after measures had previously been discontinued. Additional study of other inpatient settings is warranted to determine the effects of screening and isolation for VRE on other patient subgroups.Funding: NoneDisclosures: Susy Hota reports contract research for Finch Therapeutics.
Competency of Infection Preventionists in Japan
Authors: Misao Hanako , Kawakami Kazumi 
Published: November 2020

Backgrounds: In the United States, the Association for Professionals in Infection Control and Epidemiology (APIC) announced a competency model for infection preventionists (IP) in 2011. On the other hand, IPs in Japan must develop their career by themselves because there are no guidelines of career development for Japanese IPs. In recent years, infectious diseases and infection control issues have become more global. Objective: Aiming for international collaboration among IPs, the purpose of this study were to clarify the actual competencies of IPs in Japan and the United States and to compare the competencies of both. We report on the competencies of IPs in Japan. Methods: Semistructured interviews were conducted with 67 certified nurses in infection control (CNIC) who responded to the translated version of the APIC Competency Model Assessment Tool. From the qualitative descriptive analysis of interview verbatim records, we extracted the behavioral characteristics and completed the questionnaire “Survey of Competency for Infection Preventionist,” which consisted of 130 items. A survey form was created using Survey Monkey. We sent e-mails to ask anonymous survey collaboration, including the URL of the survey form, to 2,284 CNIC and CNS in infection control professionals. The research was approved by the research ethics committee at the facility to which the researcher belongs (Juntendo University, approval no. 30–49). Results: The number of responses was 648 and the response rate was 28.4%. The mean years of experience as nurses of 648 respondents was 24.7 (SD, 6.9), and >60% belonged to general hospitals. The scores of mean and standard deviation of each category were as follows: “Clarification of infectious disease process” (mean, 79.1; SD, 13.2); “HAI surveillance and epidemiological survey” (mean, 49.3; SD, 12.3); “Prevention and control of transmission of infectious microorganisms” (mean, 93.8; SD, 17.3); “Management and communication” (mean, 128.5; SD, 23.7); “Education and Research” (mean, 56.8; SD, 11.0); “Employee and occupational health” (mean, 40.6; SD, 9.6); and the total score of all categories (mean, 449.4; SD, 74.4). Based on years of experience as infection preventionists, we divided them into 3 groups: beginners, competent, and experts. As the career level increased, each category score for competency increased (ANOVA, P < .001). However, the mean scores of competency did not reach 70% of the total score for the following categories: “Prevention and control of transmission of infectious microorganisms.” “Education and research,” and “Employee and occupational health.” Conclusions: The competencies that need to be strengthened for the career development of Japanese IPs have been clarified.Funding: This study was supported by JSPS KAKENHI.Disclosures: None
Developing a Competency Model for Nurses Certified in Infection Control in Japan
Authors: Kawakami Kazumi , Misao Hanako 
Published: November 2020

Background: In July 2019, 2,793 nurses were registered as certified nurse in infection control (CNIC) at the Japanese Nursing Association (JNA). Most CNICs work as full-time infection preventionists (IPs) in hospitals. However, a competency model for CNICs has not been developed in Japan yet. Therefore, we developed a competency model for CNICs. Methods: We conducted a 2-phase explanatory sequential mixed-methods study between November 2013 and October 2019. The participants were 1,711 CNICs listed on the JNA website. Phase 1 was a cross-sectional study using self-administered questionnaires that included 10 competency domains based on the Association for Professionals in Infection Control and Epidemiology Competency Assessment Tool. Considering years of experience as an IP and full-time position, participants’ career stages were novice, competent, proficient, and expert. The CNICs who answered the questionnaire were included in the interview during phase 2, which was a descriptive qualitative study. Specifically, 10–30 participants were selected from each career stage. Semi-structured individual interviews were conducted, and verbatim transcripts were analyzed qualitatively. The knowledge, skills, and abilities of CNICs were extracted at each career stage. This study was approved by the Research Ethics Committee of Juntendo University (approval no. 25-27). Results: During phase 1, 1,711 CNICs were invited to participate: 975 returned the questionnaire (57% response rate) and 969 (99.3%) responses were valid and used in the analysis. Only 257 participants agreed to attend the interviews. In phase 2, interviews were conducted with 67 CNICs: 30 novice, 20 competent, 13 proficient, and 4 expert. The mean years of experience as a nurse and CNIC were 22.2 (SD, 7.0) and 5.3 (SD, 3.1), respectively. As the career stage advanced, the contents and range of infection prevention role and activities in the hospital or community expanded across competency domains. In clarification of infection process, one of the crucial competencies, the novice needed to consult reference material about the infectious disease each time due to lack of knowledge. Although the competent CNICs understood the frequent occurrence of infectious disease, they needed the specialist’s advice. However, the proficient and expert CNICs could interpret information independently, and importantly, expert CNICs could distinguish between what they know and do not know. Conclusions: Using an explanatory sequential mixed-methods approach, we developed a competency model for CNICs that may encourage CNICs to develop their expertise and that is useful in assessing the qualities or abilities of CNICs. In the future, this model can be used to develop systematic educational programs for CNICs.Funding: This study was supported by JSPS KAKENHI.Disclosures: None
Effectiveness of Dry Hydrogen Peroxide on Reducing Environmental Microbial Bioburden Risk in a Pediatric Intensive Care Unit
Authors: Melgar Mario , Ramirez Marylin , Matheu Laura , Gomez Miguel , Ferrolino Jose Amadeo 
Published: November 2020

Background: Environmental contamination is a known risk factor for healthcare-associated infection acquisition. Transmission of pathogens from the environment can occur from indirect or direct patient contact with the environment or via healthcare workers’ hands. Dry hydrogen peroxide (DHP) has been shown to reduce microbial contamination in the hospital setting. This novel technology allows safe delivery of hydrogen peroxide in an occupied space, using ambient air and humidity to help create DHP. This study describes the implementation of DHP as an adjunct to routine environmental cleaning and disinfection, with the goal of reducing air and surface microbial bioburden in the intensive care unit (ICU) of a pediatric oncology hospital in Guatemala. Methods: A prospective IRB-approved study was conducted. Two rooms served as controls and 2 rooms served as intervention DHP sites. Air and surface cultures (5 high-touch, 2 low-touch) and adenosine triphosphate (ATP) swabs were collected from study areas for 1 week prior to deployment of the portable DHP units and at various time points for 1 month during the intervention phase. Air samples were collected using settling plates. The level of microbial burden was measured using colony-forming units (CFU) and ATP levels. A comparison between groups was carried out using Poisson regression analyses for CFU counts and linear regression analyses for log-transformed ATP levels. Results: In total, 280 surface cultures and ATP surface swabs were collected and analyzed. The overall mean microbial burden was significantly reduced in the intervention group compared to the control group (mean, 5.50 vs 11.77; P ≤ .0001). Reductions in microbial CFU were observed across all sampling sites in the intervention group. ATP readings in both control and intervention group showed passing levels of surface cleanliness. ATP was measured in terms of relative light units (RLU). A reduction in the mean RLU levels was also noted in the intervention group compared to the control group (172.08 vs 225.83; P ≤ .006). A reduction in aerobic CFU was seen as well in the air samples in the intervention group but was not statistically significant (P = .139). The ICU census was full, and services were not affected. Conclusions: DHP was effective in reducing surface and air microbial bioburden in an occupied space. Further studies of the impact of DHP decontamination on incidence of nosocomial infections should be performed.Funding: This study was supported by Synexis.Disclosures: None
Evaluation of a Continuous Decontamination Technology in an Intensive Care Unit
Authors: BSN Tami Inman , Chansolme David 
Published: November 2020

Background: The scientific literature increasingly indicates the need for the development of continuous disinfection to address the persistent contamination and recontamination that occurs in the patient rooms despite routine cleaning and disinfection. Methods: To determine a baseline microbial burden level on patient room surfaces in the intensive care unit (ICU) of a large urban hospital, 50 locations were swabbed for total colony-forming units (CFU) and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Once the baseline in ICU patient rooms was established, 5 novel decontamination devices were installed in the HVAC ducts near these patient rooms. The devices provide a continuous low-level application of oxidizing molecules, predominately hydrogen peroxide. These molecules exit the duct and circulate in the patient room through normal convection, landing on all surfaces. After activation, environmental sampling was conducted every 4 weeks for 4 months. The effect from continuous low levels of oxidizing molecules on the intrinsic microbial burden and the prevalence of MRSA were analyzed. In addition to external laboratory reports, the facility tracked healthcare-associated infections (HAIs) in the unit. HAI data were averaged by month and were compared to the preactivation average in the same unit. Results: The preactivation average microbial burden found on the 50 locations were 179,000 CFU per 100 in2. The prevalence of MRSA was 71% with an average of 81 CFU per 100 in2. After activation of the devices, levels of microbial burden, prevalence of MRSA, and average monthly HAI rates were all significantly lower on average: 95% reduction in average microbial burden (8,206 CFU per 100 in2); 81% reduction in the prevalence of MRSA (13% vs 71%); 54% reduction in the average of healthcare-onset HAIs. All data were obtained from the averages of sampling data for 4 weeks during the 4-month trial period. Conclusions: The continuous application of low levels of oxidizing molecules throughout the patient rooms of an ICU demonstrated 3 outcomes: reduced overall surface microbial burden, lowered the incidence of MRSA, and significantly decreased the monthly average HAI rate. Please note, the ICU ran other infection prevention interventions at this time, including standard cleaning, as well as and their standard disinfecting techniques.Funding: This study was supported by the CASPR Group.Disclosures: None