bluuebunny/crossref_metadata_2025_split huggingface dataset:
1149. Reducing Piperacillin/Tazobactam Use in Children with Acute Perforated Appendicitis
Authors: Seddik Talal B , Bio Laura , Bassett Hannah , Contopoulos-Ioannidis Despina , Qureshi Lubna , Schwenk Hayden 
Published: October 2019

Abstract

Background
Children with perforated appendicitis have more frequent complications compared with nonperforated appendicitis. Existing data suggest broad-spectrum antibiotics are not superior to narrow-spectrum antibiotics for this condition. In an effort to safely decrease broad-spectrum antibiotic use at our hospital, we evaluated the impact of an antimicrobial stewardship program (ASP) intervention on the use of piperacillin/tazobactam (PT) and clinical outcomes in children with perforated appendicitis.

Methods
Single-center, retrospective cohort study of children ≤ 18 years with perforated appendicitis who underwent primary appendectomy. Children with primary nonoperative management or interval appendectomy were excluded. Prior to the intervention, children at our hospital routinely received PT for perforated appendicitis. An electronic health record (EHR)-integrated guideline that recommended ceftriaxone and metronidazole for perforated appendicitis was released on July 1, 2017 (Figure 1). We compared PT utilization, measured in days of therapy (DOT) per 1,000 patient-days, and clinical outcomes before and after the intervention.

Results
A total of 74 children with perforated appendicitis were identified: 23 during the pre-intervention period (June 1, 2016 to June 30, 2017) and 51 post-intervention (July 1, 2017 to September 30, 2018). Thirty-three patients (45%) were female and the median age was 8 years (IQR: 5–11.75 years). Post-intervention rate of guideline compliance was 84%. PT use decreased from 556 DOT per 1000 patient-days to 131 DOT per 1000 patient-days; incidence rate ratio of 0.24 (95% CI: 0.16–0.35), post-intervention vs. pre-intervention. There was no statistically significant difference in duration of intravenous antibiotics, total antibiotic duration, postoperative length of stay (LOS), total LOS, ED visits/readmission, or surgical site infection (SSI) between pre- and post-intervention periods (Table 1).

Conclusion
An EHR-integrated ASP intervention targeting children with perforated appendicitis resulted in decreased broad-spectrum antibiotic use with no statistically significant difference in clinical outcomes. Larger, multicenter trials are needed to confirm our findings.

Disclosures
All authors: No reported disclosures.
1151. A Comparison of Periurethral Cleaning Between Normal Saline and Savlon Solutions Before Indwelling Urinary Catheterization in Reducing Catheter-Associated Bacteriuria: A Randomized Controlled Study
Authors: Khahakaew Sarin , Suwanpimolkul Gompol , Wongkeskij Thanittha , Punakabutra Napawan , Suankratay Chusana 
Published: October 2019

Abstract

Background
Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections. To date, there have been no randomized controlled studies to recommend the most appropriate antiseptic solution for periurethral cleaning before indwelling urinary catheterization. This study was aimed to compare normal saline solution (NSS) and Savlon solution for periurethral cleaning before indwelling urinary catheterization in reducing catheter-associated bacteriuria.

Methods
A randomized controlled, noninferiority, cross-over study to determine the incidence of significant bacteriuria (SB) on day 5 after Foley catheterization, using 2 different solutions for periurethral cleaning (NSS and Savlon solutions), was carried out in all adult patients admitted in the 2 medical intensive care units (ICUs), 1 surgical ICU, 2 neurosurgical ICUs, 4 medical wards, 4 surgical wards and 1 emergency room (ER) of King Chulalongkorn Memorial Hospital, Thailand, from June 2018 to March 2019. The acceptable prespecified noninferiority margin was set to be 10%. Each solution was used alternately every 3 months in each unit. Urine culture was collected on day 1, 3, and 5 of Foley catheter.

Results
During the study period, there were 207 and 160 patients in the NSS and Savlon groups, respectively. 202 (55%) patients had received Foley catheterization in the emergency room. There were no significant differences in the indication, the current illness, and preexisting condition between the 2 groups. The overall incidence of SB on day 3 and 5 after catheterization was 4% and 8.2%. The incidence of CAUTI was 3.43/1,000 catheter-day. The median duration of catheterization was 5 (IQR 3, 7) days. On day 5 after catheterization, noninferiority was demonstrated for the incidence of SB with an adjusted difference of 4 (95% CI of the difference: −2.1% to 8.9%, P = 0.05). Regarding the incidence of CAUTI, there was no significant difference between the 2 groups.

Conclusion
To the best of our knowledge, our study was the first randomized controlled study to compare the 2 solutions for periurethral cleaning before indwelling urinary catheterization in different departments. This study demonstrates the noninferiority of NSS to Savlon solution in reducing the incidence of SB.

Disclosures
All authors: No reported disclosures.
1158. Discontinuation of Urine Cultures by Infection Preventionists in Hospitalized Patients with Indwelling Urinary Catheters: Is It Safe?
Authors: Faith Monsalud Cherie , Lim Rachel , Zelencik Shane , Singh Kamaljit 
Published: October 2019

Abstract

Background
A majority of healthcare-associated urinary tract infections (UTIs) are caused by the use of urinary catheters (CAUTI). Finding of bacteriuria is common in catheterized patients and often leads to unnecessary antibiotic treatment, increased length of stay and additional healthcare costs. We implemented an innovative intervention to improve urine culture (UCx) orders and prevent overdiagnosis of CAUTIs.

Methods
Orders for UCx in adult patients with short-term urinary catheters at NorthShore University HealthSystem, IL were reviewed daily for appropriateness based on the Infectious Diseases Society of America Guidelines. Appropriate urine testing was defined as: (1) presence of fever ( >38°C) within past 48 hours, (2) new urinary complaints: flank or suprapubic pain/tenderness or dysuria, frequency, urgency or incontinence within 48 hours after catheter removal, and (3) no other reasonable explanation for fever. If UCx was deemed inappropriate, ordering provider was contacted to cancel the order. Chart review was performed at least 30-days post-discharge to determine whether patients developed recurrent UTI, sepsis, were readmitted or expired.

Results
Between 1 January to 31 March 2019, 65 UCx were submitted. Sixty-four patients (98%) did not meet criteria for testing. Most common reasons for not meeting criteria were absence of fever (60%) and no localizing UTI signs or symptoms (57%). 35 (54%) UCx were canceled after discussion with ordering providers. 21/35 patients (60%) were treated with antibiotics. All 35 patients were discharged, with a majority going to a skilled nursing facility (34%) or home (31%). 4/35 (11%) had a subsequent positive UCx. Two patients developed symptomatic UTI (sUTI) during the index admission. Two patients developed sUTI within 30-days post-discharge; one patient was transitioned to hospice after completion of therapy. All 4 patients were treated for sUTI.

Conclusion
We were able to safely discontinue UCx in 89% of patients. A majority of patients were already started on empiric treatment and development of subsequent sUTI was infrequent (11% of patients). Our findings suggest that discontinuation of inappropriately ordered UCx is safe with low risk for sepsis or mortality.

Disclosures
All authors: No reported disclosures.
1161. Frequency of Urine Cultures, their Positivity, and CAUTI: Analysis of a Large Health System
Authors: Fakih Mohamad G , Sturm Lisa K , Saake Karl , Daragjati Florian , Sebastian Danielle , Bufalino Angelo 
Published: October 2019

Abstract

Background
Hospitalized patients with bacteriuria are often identified based on positive urine cultures during the workup of urinary tract infection (UTI). However, the frequency of obtaining urine cultures varies between hospitals and may affect the detection of asymptomatic bacteriuria and symptomatic UTI.

Methods
We evaluated the frequency of urine cultures, their positivity and any association to CAUTI in the inpatient setting (excluding emergency department) of 53 hospitals during 2017 and 2018. Total inpatient urine cultures, positive urine cultures and positive urine cultures identified >2 days post-admission were normalized to patient-days. In addition, the rates of positive urine cultures >2 days post-admission were compared per institution to the corresponding CAUTI SIR. We compared small (75,000 patient-days per year).

Results
A total of 238,451 urine cultures were obtained in 53 hospitals over a period of 2 years with bacteriuria detected in 97,138 (40.74%). Hospitals varied in how often urine cultures were obtained, the % of positive urine cultures, and positive urine cultures per 10,000 patient-days (table). Medium size hospitals had significantly higher number of cultures per 10,000 compared with large hospitals (mean difference= 191; P = 0.006), while % positives were significantly lower (mean difference= -8.4; P = 0.02). There was no significant association between the rate of positive urine cultures >2 days after admission and CAUTI SIR (figure).

Conclusion
Our findings underscore the importance of addressing appropriate urine culturing as part of the infection workup in the hospital setting. A lower detection of bacteriuria after 2 days of admission did not necessarily result in a reduction of CAUTI, reflecting the importance of working on a better identification of patients likely to have a urinary tract infection.

Disclosures
All authors: No reported disclosures.
1171. Impact of Catheter Management on the Clinical Outcome in Adult Cancer Patients with Gram-Negative Bacteremia
Authors: Fares Johny , Khalil Melissa , Hajjar Chaftari Anne-Marie , Jiang Ying , Hachem Ray Y , Raad Issam I 
Published: October 2019

Abstract

Background
Over the last 2 decades, Gram-negative organisms have been on the rise as an etiology of bloodstream infections (BSI) in cancer patients. Management of the central venous catheter (CVC) in the setting of Gram-negative BSI remains challenging. The aim of our study was to evaluate cancer patients with different types of Gram-negative BSI, in the presence of an indwelling CVC, and assess the impact of line management on the outcome of the BSI.

Methods
We identified all the patients older than 14 years with CVC who had a documented BSI with a Gram-negative organism at M.D Anderson Cancer Center, from May 2017 until May 2018. Patients were divided into three groups. Group 1 (G1) included patients with central-line associated bloodstream infection and no mucosal barrier injury (non-MBI CLABSI) and/or those who met the catheter-related bloodstream infection (CRBSI) criteria; Group 2 (G2) consisted of patients who had a CLABSI with a mucosal barrier injury that did not meet the CRBSI definition; and Group 3 (G3) consisted of patients who had a non-line-related BSI. We assessed catheter management (CVC removed/exchanged or retained) at 2 days after the onset of bacteremia. We then determined the effect of line management on clinical and microbiologic outcomes through various measures.

Results
A total of 300 patients were included with 100 patients in each group. The univariate analyses showed that in G1, CVC removal within 2 days of bacteremia was significantly associated with higher rate of microbiologic eradiation of the bacteremia compared with delayed CVC removal (3 to 5 days) or CVC retention (98% vs. 72% vs. 78% respectively, P = 0.002; P < 0.001), and lower overall mortality rate at 3 months follow-up (3% vs. 22% vs. 17% respectively, P = 0.02; P = 0.01). By multivariate analysis, this association persisted (P = 0.018 and P = 0.016, respectively). CVC removal within 2 days of bacteremia did not affect the outcome of BSI in G2 and G3.

Conclusion
CVC removal within 48 hours of the onset of Gram-negative bacteremia significantly improved the infectious outcome and the overall mortality in adult cancer patients with definite CRBSI and CLABSI without MBI.

Disclosures
All authors: No reported disclosures.
1190. Hygiene of the Hands 90/90: A Program of Continuous Improvement for the Compliance of the Hygiene of the Hands
Authors: Trejo Roxana , Koretzky Solange G 
Published: October 2019

Abstract

Background
Healthcare-associated infections (HAIs) are associated with high rates of morbidity and mortality, which translates into an increase in the days of hospitalization and costs of care. The research of hand hygiene in health workers demonstrate that this action decreases the spread of pathogens; however, the compliance of hand hygiene remains low among health workers. Hand hygiene is a cheap method to prevent infections. It has been estimated that the total cost of hand hygiene promotion represents <1% of the costs associated with the HAIs. Our goal is to strengthen the culture of hand hygiene (In and Out) in all health professionals in a period of 90 days, achieving a 90% compliance.

Methods
The ABC Medical Center is a high specialty hospital, on average it has 465 beds. The program led by the Epidemiology Unit was formed by a multidisciplinary team with the patriation of leaders of different areas (Epidemiology, Nursing, Physicians, Human resources, Quality and Teaching). We used the “WHO Guidelines on Hand Hygiene in Health Care” consisting of: (1) system change, (2) training for employees, (3) evaluation and feedback, (4) a reminder at the workplace, (5) institutional security climate, (6) monitoring of the compliance to hand hygiene: The monitoring of the evaluation personnel was carried out in two stages, when entering and leaving the patient’s room.

Results
A total of 9,732 observations were made, of which 55.32% went to the nursing staff, 22.80% to doctors and 21.87% to the hospital staff. The compliance of the hand hygiene at the beginning of the program was 70%, by the and the 91% was reached. Sustainability has been maintained through continuous campaigns of the importance of hand hygiene reaching a 98% adherence to hands hygiene in 2018. The behavior of HAIs is notorious since at the beginning of the program there was a rate of 0.95 and by 2018, with the increase in compliance to hand hygiene, it decreased to 0.56.

Conclusion
The 90/90 Hand Hygiene program is a pioneer in its modality for the implementation of the program in a short period of time and excellence in its scope. It is confirmed that leadership is essential and strategic to ensure quality and safety in patient care. Through the incentive to the staff a clear sense of participation and belonging to the institution is achieved

Disclosures
All authors: No reported disclosures.
1191. Hand Hygiene Education: Why Is It so Critical to Tissue Banking?
Authors: Imrit-Thomas Kavita D , Watson Jasmine , Owens Alexandria 
Published: October 2019

Abstract

Background
In the United States, the most commonly transplanted tissues are bones, tendons, skin, heart valves, vessels and corneas. Over two million tissue grafts are distributed each year.Efforts to advance tissue transplant safety are less defined compared with organ transplant, and continuously being improved and regulated by national agencies. Environmental contamination, postmortem translocation of microorganisms, cross-contamination, and tissue processing are critical components which can be prevented with hand hygiene education thus preventing the transmission of infectious diseases. Microorganisms from technicians’ skin can potentially result in infection and nontransplantable tissue. This is particularly true of regenerative tissue, such as Vivigen, that undergo no sterilization process.

Methods
A review was done of all 2018 ViviGen culture with these organisms: Bacillus, Cornebacterium, Diptheroids, Propionibacterium, Staphylococcus Coagulase negative, and Streptococcus viridians defined as Category 1.

Results
In 2018, 384 out of 1418 ViviGen donors were discarded due to positive cultures. Of the 384, 190 were due the presence of a Cat. 1 microorganism in post-processing cultures, for a discard rate of 17.6%. In these donors, preprocessing cultures were initially negative, thus indicating contamination was due to technician contamination. In the first quarter of 2019, and since implementation of Hand Hygiene education, we have already start to see a decline in acquisition of Cat 1 organism for a total reduction of 6% from Q1 of 2018 compared with 2019.

Conclusion
Tissue banking is a complex process of many steps to assure quality and safety of the tissue. Contamination is critical even when the microorganisms are considered low-virulent skin flora (i.e., Cat 1). This is especially important if these Cat 1 organisms are found in Post-processing cultures of grafts not terminally irradiated or sterilized. Implementation of proper hand hygiene education and aseptic techniques among tissue recovery and processing staff can significantly reduce the bioburden. Furthermore, a reduction in bioburden equates to higher likelihood in honoring the gift of donation in this selfless act of the donor and their loved one while also decreasing the financial loss due to culture results.

Disclosures
All authors: No reported disclosures.
1192. A Visual Family Empowerment Tool Is Associated with Increased Healthcare Worker Hand Hygiene in a Pediatric Intensive Care Unit in Vietnam
Authors: Campbell Jeffrey I , Thanh Thuy Pham , Trang Le , Thi Thu Huong Dang , Chandonnet Celeste , Thi Hoa Truong , Duong Hao , Duc Duat Nguyen , Thi Huyen Le , Thi Ha Tran , Thi Kim Oanh Nguyen , Thi Minh Than Ho , Kien Ngai Le , Pollack Todd , Sandora Thomas 
Published: October 2019

Abstract

Background
Hand hygiene (HH) is the most effective way to prevent healthcare-associated infections. The World Health Organization (WHO) recommends empowering patients and families to remind healthcare workers (HCWs) to perform HH. The effectiveness of patient and family empowerment tools in Southeast Asia is unknown.

Methods
We performed a prospective intervention study in an intensive care unit of a pediatric referral hospital in Vietnam. Using family and HCW input, we created a visual tool for families to use to remind HCWs to perform HH. For 2 weeks pre-intervention, we collected baseline data on HH performance, method (hand rub or soap and water), adequacy, HCW type (e.g., physician, nurse), and WHO 5 moments of HH using direct, unobtrusive observation. During a subsequent 3-week intervention period, consenting families were provided the visual tool and educated on its use to prompt HCW HH. Prospective collection of outcome data continued during the intervention period. The primary outcome was change in HCW HH between baseline and intervention periods. Multivariable logistic regression models were used to identify independent predictors of HH.

Results
A total of 2,014 pre-intervention and 2,498 intervention period HH opportunities were observed. During the intervention period, 73 families received visual reminder tools and education. Overall HCW HH was 46% pre-intervention, which increased to 73% in the intervention period (P < 0.001). Lowest HH adherence in both periods occurred after HCW contact with patient surroundings (WHO Moment 5; 16% pre-intervention and 24% intervention). In multivariable analyses, the odds of HCW HH during the intervention period were significantly higher than pre-intervention (OR 2.94 [95% CI 2.54 – 3.41], P < 0.001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs. evening/weekend), and HH moment. Among completed HH opportunities, HH adequacy was >90% in both periods.

Conclusion
Introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese pediatric intensive care unit. More research is needed to explore acceptability and barriers to the use of such tools in other low- and middle-income settings.

Disclosures
All authors: No reported disclosures.
1199. Provider Perspectives on Nonsterile Glove Use in the NICU
Authors: Khan Sarah , Science Michelle , Arnold Callum , Hawes Judith , Lee Kyong-soon , el Helou Salhab , Sanchez Pablo J , Mertz Dominik , Kaufman David 
Published: October 2019

Abstract

Background
Late-onset infection is a serious cause of mortality and long-term morbidity in NICU patients. Healthcare worker hands are the most common vehicle for transmission of pathogenic organisms to neonates. Studies have suggested a reduction in infections in neonatal and pediatric patients cared for with universal nonsterile glove use.

Methods
We developed an online survey (https://fhspeds.mcmaster.ca/pedsCapOne/surveys/?s=9RDX7EHT79) for clinicians to understand the current glove use and hand hygiene practices in NICUs in North America. The survey was sent to neonatologists and Pediatric Infectious Disease Specialists via the AAP Neonatal-Perinatal Section listserv, SHEA and the Canadian Neonatal Network.

Results
Of 336 responses; the majority were from physicians at level 3 to 4 NICUs (97%), and from the United States (96.1%). Beyond sterile procedures, sterile gloves were used for central line dressing changes (88.4%), contact with central nervous system shunts (61.0%), and direct contact with central lines (57.4%). Nonsterile gloves were used most commonly for universal precautions and diaper changes (Table 1). Almost half of participants also used nonsterile gloves for all patients and 37.5% for extremely low birth weight (<1000 g) infants. While most sites (76.8%) stated that nonsterile gloves were not required for parents, 15.8% requested gloves also for parents. 58% of respondents felt there was not enough evidence for a practice change at this time and 53.3% felt further study was needed to assess the effect of nonsterile gloves and infection (Figures 2 and 3). Almost a third of respondents (n = 109) would be interested in participating in a randomized study to assess glove-based care. Major concerns with this approach included a possible reduction in hand hygiene compliance, environmental waste, and glove contamination (Figure 4).

Conclusion
There is variability in gloving practices across NICUs in North America, with equipoise and interest in a potential randomized study to further explore the hypothesis that nonsterile gloves prevent late-onset infections in neonates.

Disclosures
All authors: No reported disclosures.