bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lack of Evidence of Transmission of Bloodborne Viruses by Improperly Reprocessed Fiberoptic Endoscopes
Authors: Sellick John , Oda Gina , Schirmer Patricia , Lucero-Obusan Cynthia , Holodniy Mark 
Published: November 2020

Background: A sterile processing service (SPS) technician was found to inadequately clean fiberoptic endoscope channels during reprocessing prior to high-level disinfection. Channels were only brushed once and 7 of 30 audited scopes had measurable bioburden. Consistent with VA policy, a retrospective investigation, along with public disclosure, was performed. Methods: A potentially exposed case (PEC) was defined as any patient who had flexible fiberoptic endoscopy between April 19, 2015, and June 23, 2017, when the identified SPS technician worked in the endoscope reprocessing station. Using the internal log of the automated high–level disinfection equipment (Medivators/Cantel, Minneapolis, MN), device serial numbers were matched to patients in endoscopy suite procedure logs. Additionally, the VA Corporate Data Warehouse (CDW) was queried for CPT and International Classification of Disease, Ninth Revision (ICD-9) and ICD-10 procedure codes to verify identified cases and to search for other PECs. All PECs were notified by telephone and mail, and serologic testing for human immunodeficiency virus (HIV-1), hepatitis C virus (HCV), and hepatitis B virus (HBV) was offered. Results were compared to prior bloodborne pathogen (BBP) testing results extracted from the CDW. Facility microbiology laboratory records of positive cultures/microscopy for enteric pathogens also were compared to the list of PECs; no active testing was performed. Results: Of the 565 PECs, 552 (98%) were successfully contacted. 8 declined testing or preferred non-VA testing, and 22 died before testing could be initiated. Repeat testing at 6 months was requested for PECs who had initial testing performed <6 months after exposure; 32 refused additional tests or did not respond to additional requests. In total, 522 PECs (92%) had testing performed for 1 or more BBPs: (1) 521 were anti–HIV negative with 1 previously known positive; (2) 481 were anti–HCV negative—43 were previously known positive and 1 PEC with an undetectable HCV viral load was newly identified; (3) 461 were negative for both HBV core or surface antibodies and surface antigen—32 were previously known positive and 17 were newly positive for one or both antibody tests with negative HBV surface antigen. Of 17 newly identified positive PECs, 16 had undetectable HBV DNA; 1 died prior to HBV DNA testing. Conclusions: There was no evidence of transmission of BBPs in this cohort of PECs who had procedures with potentially improperly cleaned fiberoptic endoscopes. Although not all patients completed all retrospective BBP testing, <10% were missing all or some tests. Local passive surveillance did not indicate enteric pathogen transmission. Additional education regarding and monitoring of reprocessing procedures have been instituted.Funding: NoneDisclosures: None
Leptospirosis Outbreak in a Hill Due to Water From an Unprotected Well, Keerakadu Village, Kollihills, Namakkal, Tamilnadu, India
Authors: Mohankumar Sree Kalpana , Govindarajan Ramesh Kumar , Chokkalingam Mohanasundari 
Published: November 2020

Background: Annually, an estimated 1.03 million leptospirosis cases lead to 2.9 million disability adjusted life years. A cluster of fever cases was reported in Keerakadu village, Kollihills block in Namakkal district of Tamilnadu state, India, on April 28, 2017. We investigated to control the outbreak. Methods: We did a cross-sectional survey between April 29 and May 1. We defined a case of fever as any resident of Keerakadu village with fever for >2 days, with or without headache or myalgia, between April 15 and May 1, 2017. We conducted active surveillance. We reviewed medical records. We collected the line list from nearby health centers. We computed proportions to calculate the attack rate. We collected 11 serum samples and tested for dengue, scrub typhus, hepatitis A and leptospirosis by IgM ELISA method. We did a Widal slide agglutination test. We conducted an environmental survey to identify water sources. We performed a dengue larval survey. We collected 5 water samples: 1 from unprotected well, 1 from overhead tank and 3 from the houses of residents. We tested for fecal coliforms in the district public health laboratory. Results: The population of Keeradu village was 540. We identified 11 cases, for an attack rate of 2% (11 of 540). The hospitalization rate of cases was 81% (9 of 11). Median age was 45 years (range, 23–65). Of 11 samples, 3 were positive for leptospirosis; all were negative for dengue, scrub typhus, hepatitis A, and typhoid. The single water source for the whole village was an open, unprotected well. This well supplied water every day to the community, both for drinking purpose and domestic use. No breeding of dengue larva was observed. All the 5 water samples tested positive for fecal coliforms. Water was not chlorinated regularly. All patients were isolated and treated in the primary health center. Prophylactic antibiotics were given to the whole community. Conclusions: There was a leptospirosis outbreak in Keerakadu village, probably due to contaminated water from unprotected well. There were no cases after May 1, 2017. We recommended that the community chlorinate the water regularly and protect the well. We also recommend continued surveillance and a rodent survey.Funding: NoneDisclosures: None
Leveraging Electronic Health Record Clinical Decision Support to Identify Clostridium difficile Infection in Clinically Appropriate Patient Populations
Authors: Cook Amy , Fruehan Sharon , Goodling Pamela 
Published: November 2020

Background: In 2017, the IDSA and the SHEA released updated Clostridium difficile practice guidelines. Implementing institutionally accepted criteria for identifying clinically appropriate patients for testing was endorsed. When utilizing NAAT as the sole laboratory testing methodology, testing clinically symptomatic patients is important to reduce inappropriate treatment of C. difficile colonization. C. difficile rates at a regional community health system were higher than expected, and patient case reviews identified inappropriate patient testing as an issue. Therefore, the infection prevention team sought to optimize and standardize protocols surrounding appropriate patient selection for C. difficile testing. Methods: Current recommendations were evaluated, and processes formulated to implement an innovative process to support our clinicians in identifying clinically appropriate patients to test for C. difficile infection. The electronic decision support is summarized as a bundled approach with 4 best practice alerts that incorporate algorithms that warn providers of potentially inappropriate testing scenarios. These alerts include the following criteria: (1) a laxative having been administered within 48 hours of attempted order, (2) a negative test resulted within 7 days, (3) a positive test resulted within 14 days, and (4) identification of patients at high risk for C. difficile infection (based on recent long-term care facility exposure, recent inpatient hospital visits, recent antimicrobial therapy). Outcomes of our acute-care hospitals were monitored by real-time evaluation of each hospital’s quarterly C. difficile LabID standardized infection ratio (SIR) as defined by the NHSN. For statistical analyses, the cumulative second and third quarters of 2018 (before the intervention) were compared to the cumulative second and third quarters of 2019 to account for seasonality of C. difficile infections. Results: Utilizing the NHSN statistical calculator to compare 2 SIRs, there was a statistically significant decrease (P = .0026) in the largest hospital’s C. difficile LabID SIR when comparing representative preintervention cumulative quarters to the postintervention cumulative quarters. Although the other hospitals did not see a statistically significant decrease in their C. difficile LabID SIR, a clinically significant decrease was appreciated for 2 of our hospitals. Conclusions: Electronic health record–based decision support helps clinicians identify clinically appropriate patients to test by NAAT alone for C. difficile infection. By limiting the number of patients tested without clinical signs or symptoms of infection and/or after receiving laxatives, hospitals more accurately capture their true C. difficile rates and maximize reimbursement based on this measure within the CMS Safety of Care Measure.Funding: NoneDisclosures: None
Leveraging the Electronic Medical Record to Identify Patients at Risk of Antibiotic Resistant Organisms
Authors: Rasmusson Jenna , Barth Jean , Mahler Sarah Bellows , Apenhorst Debra , Dalton Mary , Senst Laura , Siple Leah , Faller Rebecca , Sampathkumar Priya 
Published: November 2020

Background: Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) pose a serious public health threat. The CDC guidelines for combating CP-CRE include a recommendation to screen selected high-risk patients. Objective: We describe a program to identify and screen patients at risk for CP-CRE. Setting: An academic, tertiary-care center with 1,297 licensed beds and 62,071 admissions per year. Methods: A report was created in the electronic medical record (EMR) to identify adult patients admitted in the previous 24 hours from countries and states with known CP-CRE transmission based on address and ZIP code. Patients with a known travel history outside the United States were also reviewed, but these data were inaccurate. Initially, a physician from Infection Prevention and Control (IPAC) placed orders for CP-CRE screening of these patients. Subsequently, a nursing protocol was developed to facilitate infection preventionists placing orders for CP-CRE screening earlier in the eligible patient’s hospital stay. An electronic communication is sent via the EMR alerting the patient care team to the order, the rationale for the order, and links to a tool kit with resources to help answer patient questions. A single perirectal swab is obtained by the nurse caring for the patient and is tested for Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), oxacillinase-48 (OXA-48), and Verona integron-encoded metallo-β-lactamase (VIM) by polymerase chain reaction (PCR). Results: From May 2018 to November 2019, 688 patients were screened for CP-CRE using the case-finding report and the nursing protocol. Overall, 9 patients with CP-CRE were identified: 1 KPC, 2 NDM, and 5 OXA-48, and 1 patient was identified to have both NDM and OXA-48. The yield of 1.3% from this screening is higher than that reported previously in the literature. Use of the nursing protocol has enabled IPAC to complete timely CP-CRE surveillance and prevent transmission to other patients. We are currently using a similar process to identify and screen persons at risk for the emerging infection Candida auris.Conclusions: The EMR can be leveraged for early identification and screening of patients with epidemiologically significant pathogens. Protocols within the EMR can be effectively replicated and modified to respond to emerging infections and changing surveillance guidelines.Funding: NoneDisclosures: Consulting fee-—Merck (Priya Sampathkumar)
Linezolid-Resistant Staphylococcus haemolyticus: Emergence of G2447U and C2534U Mutations at the Domain V of 23Sr RNA Gene
Authors: Kumari Sanjana , Rawre Jyoti , Trikha Anjan , Sireenivas Vishnubhatla , Sood Seema , Kapil Arti , Dhawan Benu 
Published: November 2020

Background: Linezolid an oxazolidinone drug available in both parenteral and oral formulations has emerged as a novel alternative to vancomycin and other second-generation drugs for the treatment of infections from gram-positive cocci. Clinical isolates of linezolid-resistant staphylococci and enterococci were reported. Since then, linezolid-resistant strains have become an increasing problem worldwide. The most frequently reported mechanisms of linezolid resistance include the mutation in 23S ribosomal nucleic acid and presence of cfr gene. Methicillin-resistant coagulase-negative staphylococci (MR-CoNS) and vancomycin-resistant Enterococcus (VRE) have become a worrisome clinical problem. Objective: Therefore, we aimed to determine the distribution of linezolid-resistant strains in an inpatient setting of a tertiary-care hospital in India and to evaluate the resistance mechanisms among these isolates. In addition, the clonal diversity of the isolates was determined by pulsed-field gel electrophoresis (PFGE). Methods: The distribution, clonal diversity, and resistance mechanism of linezolid resistant-Staphylococcus haemolyticus (LRSH) strains were determined. The isolates were identified by MALDI-TOF. The mechanism of resistance was determined by sequence analysis of the domain V of 23SrRNA and screening for cfr gene. Clonal relatedness was defined by PFGE. Results: In total, 13 LRSH isolates were recovered from pus specimens. The 13 LRSH strains isolated had an linezolid MIC of 256 g/mL. Sequencing results revealed G2576T mutations in 7 (53.8%), G2447U in 4 (30.7%) and C2534U in 1 (7.6%) isolate of S. haemolyticus. One isolate of S. haemolyticus showed 2 simultaneous mutations (G2576T and G2447U) in the domain V region of 23Sr RNA gene. PFGE of the LR-SH isolates revealed the presence of 11 clones. Of the 11 clones, clones I and II had 2 isolates each. Isolates of clone I exhibited a band pattern identical with the previous isolates of LRSH isolated from the orthopedic unit. Similarly, isolates of clone II also shared the same band pattern with the previous LRSH isolates from the dermatology unit of our center. Conclusions: This study highlights the importance of continuous monitoring of vigilance of linezolid resistance in staphylococci. Rationalizing the use of linezolid and implementing methods to control the spread of hospital clones is of paramount importance to prevent further dissemination of these strains.Funding: NoneDisclosures: None
Missing the Point in Point Prevalence: Harnessing EMR Data to Identify Epi-Linked Patients in an Outbreak Investigation
Authors: Stancill Lisa , DiBiase Lauren , Sickbert-Bennett Emily 
Published: November 2020

Background:
A critical step during outbreak investigations is actively screening for additional cases to assess ongoing transmission. In the healthcare setting, one widely used method is point-prevalence screening on the whole unit where a positive patient is housed. Although this point-prevalence approach captures the “place,” it can miss the “person” and “time” elements that define the population-at-risk. Methods: At University of North Carolina (UNC) Hospitals, we used business intelligence tools to build a query that harnesses the admission, discharge, and transfer (ADT) data from the electronic medical record (EMR). Using this data identifies every patient who overlapped in time and space with a positive patient. An additional query identifies currently admitted overlap patients and their current location. During an outbreak investigation, an analyst executes these queries in the mornings when surveillance screens are scheduled. The queries generate a list of patients to screen that are prioritized on the number of days they were in the same unit with the positive patient. This overlap methodology successfully captures the person, place, and time associated with possible disease transmission. We implemented the overlap method for the last 3 months following 1 year of point-prevalence approach screening during a novel disease outbreak at UNC Hospitals. Results: In total, 4,385 unique patients overlapped with previously identified infected or colonized patients, of which 781 (17.8%) from 40 departments were screened over 15 months. During a subsequent, currently ongoing, outbreak, we are utilizing the overlap method and in 6 weeks have already screened 161 of the 1,234 overlapping patients (13%). After 3 rounds of overlap screening, we have already been able to identify 1 additional positive patient. This patient was on the same unit as patient zero 4 months prior but was readmitted to a unit that would not have received a point-prevalence screen using the standard approach. Conclusions: Surveillance screening is a time-consuming, resource-intensive effort that requires collaboration between infection prevention, clinical staff, patients, and the laboratory. By harnessing EMR ADT data, we can better target the population at risk and more efficiently utilize resources during outbreak investigations. In addition, the overlap method fills a gap in the current CDC guidelines by focusing on patients who were on the same unit with any positive patient, including those who discharged and readmitted. Most importantly, we identified an additional positive patient that would not have been detected through a point-prevalence screen, helping us prevent further disease transmission.Funding: NoneDisclosures: None
Molecular Landscape of Carbapenemase-Producing Acinetobacter baumanii in the United States
Authors: Burrell Kellan , Huang Jennifer , Karlsson Maria , McAllister Gillian , Brown Allison 
Published: November 2020

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) are an urgent public health threat because they cause healthcare-associated infections that are difficult to treat and can spread in healthcare environments. Acinetobacter spp may develop resistance to carbapenems through various mechanisms, including decreased permeability, overexpression of efflux pumps, and production of carbapenemases. Carbapenemases found in CRAB commonly belong to the group of carbapenem-hydrolyzing class D β-lactamases, which can be either intrinsic or acquired. The most clinically relevant class D enzymes are the OXA-23-like, OXA-24/40–like, and OXA-58–like because they are commonly plasmid mediated and thereby have the potential for rapid dissemination. We describe the molecular epidemiology of CRAB in the United States using a convenience sample of isolates collected from reference submissions, an isolate-based surveillance system, and the Antibiotic Resistance Laboratory Network (ARLN). Methods: Beginning in August 2017, 7 public health laboratories in the ARLN began testing CRAB isolates submitted by participating sentinel clinical laboratories across their region. Carbapenem-resistant isolates were identified by resistance to imipenem, meropenem, or doripenem. Testing included molecular detection of 4 targeted carbapenemase genes: blaKPC, blaNDM, blaVIM, and blaIMP. Participating labs reported testing results to CDC at least monthly. A separate collection of isolates from CDC reference and surveillance activities between 2013 and 2015 underwent whole-genome sequencing (WGS) to evaluate the presence of acquired carbapenemase genes, including class D OXA-variants. Results: From August 2017 through July 2019, the ARLN tested 2,368 CRAB isolates across 44 states. Only 12 (0.5%) of these harbored a bla- gene: blaKPC (n = 5), blaNDM (n = 5), blaIMP (n = 1), and blaVIM (n = 1). Of 95 reference and surveillance isolates sequenced, none harbored these targeted carbapenemases. However, 69 (73%) harbored at least 1 acquired class D OXA gene; OXA-23 was the most commonly acquired OXA variant (n = 46, 48.4%). Conclusions: Using a multipronged approach, our studies indicate that the presence of class D β-lactamases of the OXA type are common in CRAB among surveillance and reference samples that underwent WGS analysis. Other acquired carbapenemases appear to be rare. To prevent the spread of highly resistant CRAB, particularly those carrying the targeted, emerging carbapenemase genes, continued testing, and rapid infection control are necessary to improve patient safety and maintain situational awareness.Funding: NoneDisclosures: None
Multidrug-Resistant Organism Carriage in Wisconsin Children
Authors: Kates Ashley , Putman-Buehler Nathan , Watson Lauren , LeCaire Tamara , Malecki Kristen , Peppard Paul , Sethi Ajay , Wald Ellen , Mares Julie , Shirley Daniel , Suen Garret , Safdar Nasia 
Published: November 2020

Background: Children attending daycare are at increased risk of carrying multidrug-resistant organisms (MDROs) compared to children not attending daycare. Carriage of MDROs greatly increases the risk of infection, not only in the child but also for others living in the household. Understanding the epidemiology of MDRO carriage in children is essential to devising effective containment strategies. Here, we present the findings from a cross-sectional study assessing MDRO carriage in daycare-attending and nonattending children in Wisconsin. Methods: We applied the following enrollment criteria: Children aged between 6 months and <6 years and not enrolled in kindergarten; children who did not have an MDRO infection in the previous 6 months and did not receive any antimicrobials in the previous month; and children who did not have a gluten allergy, asthma, eczema, allergic rhinitis, cystic fibrosis, or an immunodeficiency. Children were enrolled by a parent or guardian who filled out a questionnaire on MDRO risk factor history and diet. Samples were collected from the nares, axilla or groin (pooled swab), and stool. Nasal samples were cultured for H. influenzae, S. pneumoniae, M. catarrhalis, and methicillin-resistant S. aureus (MRSA). Skin samples were cultured for MRSA, and stool samples were cultured for MRSA, C. difficile, vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase–producing Gram-negative bacilli (ie, ESBL GNR). Results: In total, 44 children were enrolled in this study. The average age was 2.6 years and 50% were girls. Furthermore, 30 (68.2%) were identified by their parents as white, 9 (20.5%) as black, and 5 (11.3%) as other or multiracial. Incidentally, 23 children (52.3%) were enrolled in daycare. Overall, 18 children were positive for at least 1 organism, 9 of which had daycare exposure, and 5 children (1 in daycare) were positive for >1 organism (11.4%). From stool samples, 6 children (13.6%, 2 in daycare) were C. difficile carriers, 3 were VRE carriers (6.8%, 1 in daycare), 8 carried an ESBL GNR (18.2%, 4 in daycare), and 3 carried MRSA (6.8%, 1 in daycare). One child was positive for H. influenzae (2.3%, not in daycare) and 2 were positive for S. pneumoniae (4.6%, 1 in daycare) from nares swabs. One child was positive for MRSA (2.3%, not in daycare) from a skin swab. We detected no significant differences between children with and without daycare exposure for any organism. Conclusions: Children in this population had higher than expected rates of ESBL GNRs and MRSA for a community population. Daycare exposure was not correlated with increased carriage in this small pilot study, though larger longitudinal studies are needed.Funding: NoneDisclosures: None