bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of Hospital-Based Candida auris Surveillance Screening Among At-Risk Patients
Authors: de St. Maurice Annabelle , Hallmark Amy , Hilt Evan , Price Travis , Uslan Daniel , Bisht Anjali , Yang Shangxin , Garner Omai 
Published: November 2020

Background:Candida auris is an emerging multidrug-resistant pathogen associated with outbreaks in hospitals and skilled nursing facilities (SNFs). Patients with C. auris can have invasive disease or asymptomatic colonization. Because C. auris can be difficult to treat and eradicate in the environment, the CDC recommends using contact precautions and sporicidal agents during patient care. After C. auris was identified in a patient from an LA County SNF (SNF-X), our institution initiated surveillance screening on high-risk patients. Methods: Nurses identified patients residing at SNF-X on admission and contacted infection prevention. These patients were placed on contact or spore precautions. Bilateral axilla and inguinal folds were swabbed with an Eswab and sent for testing by a clinical laboratory-developed RT PCR assay, which can detect C. auris with high sensitivity and specificity with a rapid turnaround time (4–6 hours). This PCR assay was based on a commercial platform IntegratedCycler (Diasorin) and reagents from the same vendor. Environmental swabs from the index patient’s room were sent for PCR by HardyCHROM Candida agar (Hardy Diagnostics) before and after cleaning with OxyCideTM. PCR-positive samples were set up for culture. Results: In total, 27 patients from SNF-X were screened by PCR. Of these patients, 15 (55%) had a tracheostomy present on admission. Moreover, 26 swabs were negative; 1 was positive in the index patient (cycle threshold [Ct] value, 26). Clinical specimens from the index patient’s blood did not grow C. auris; the tracheostomy sample grew predominantly C. albicans which made identification of C. auris challenging by culture. However, investigational testing of this sample by PCR was positive (Ct value, 31). Environmental swabs collected from the patient room were obtained before and after cleaning (Table 1); all environmental cultures were negative at 5 days. Conclusions: Developing hospital-based, high-risk patient screening for C. auris is feasible and may be useful for controlling the spread of C. auris within the community. Further study is needed to determine the usefulness of PCR for environmental testing to assess the risk of nosocomial transmission of C. auris.Funding: NoneDisclosures: None
Implementing an Automated Pneumonia Surveillance System
Authors: Ding Dan , Phillips Michael , Iturrate Eduardo , Hochman Sarah , Stachel Anna 
Published: November 2020

Background: Although definitions from the CDC were developed to increase the reliability of surveillance data, reduce the burden of surveillance in healthcare facilities, and enhance the utility of surveillance data for improving patient safety, the algorithm is still laborious for manual use. We implemented an automated surveillance system that combines 2 CDC pneumonia surveillance definitions to identify pneumonia infection in inpatients. Methods: The program was implemented at an academic health center with >40,000 inpatient admission per year. We used Window Task Scheduler with a batch file daily to run a validated pneumonia surveillance algorithm program written with SAS version 9.4 software (SAS Institute, Cary, NC) and a natural language processing tool that queries variables (Table 1) and text found in the electronic medical records (EMR) to identify pneumonia cases (Fig. 1). We uploaded all computer-identified positive cases into a Microsoft Access database daily to be reviewed by a hospital epidemiologist. Every week, we also validated 5 computer-identified negative cases from the prior 2 weeks to ensure accuracy of the computer algorithm. We defined negative cases as pneumonia present on admission or chest x-ray indicative of pneumonia but without CDC-defined surveillance symptoms. We also wrote a program to automatically send e-mails to key stakeholders and to prepare summary reports. Results: Since November 2019, we have successfully implemented the automated computer algorithm or program to notify, via e-mail, infection prevention staff and respiratory therapy providers of CDC-defined pneumonia cases on a daily basis. This automated program has reduced the number of manual hours spent reviewing each admission case for pneumonia. A summary report is created each week and month for distribution to hospital staff and the Department of Health, respectively. Conclusions: The implementation of an automated pneumonia surveillance system proves to be a timelier, more cost-effective approach compared to manual pneumonia surveillance. By allowing an automated algorithm to review pneumonia, timely reports can be sent to infection prevention control staff, respiratory therapy providers, and unit staff about individual cases. Hospitals should leverage current technology to automate surveillance definitions because automated programs allow near real-time identification and critical review for infection and prevention activities.Funding: NoneDisclosures: None
Implementing an Electronic Screening Tool to Identify Patients at Risk for Candida auris
Authors: Silkaitis Christina , Arnold Lea Ann , Mikolajczak Anessa , Makula Elizabeth , Salim Asra , Stehlik Anne , Barnard Cindy , Dolgin Gina , Voss Heather , Qi Chao , Zembower Teresa 
Published: November 2020

Background:Candida auris is an emerging fungus that presents a serious threat to healthcare facilities. Because Chicago is a locus of high prevalence, the Illinois Department of Public Health (IDPH) released guidelines for acute-care hospitals to screen and isolate patients who are directly admitted from either a skilled nursing or long-term acute-care facility (SNF or LTAC) with a tracheostomy or on a ventilator. This project was undertaken to evaluate applicability of IDPH criteria to our inpatient population and to develop effective tools to implement a surveillance system. Methods: To assess IDPH criteria, we reviewed local case epidemiology and conducted a point-prevalence survey of all inpatients on May 22, 2019. To implement a new surveillance program, we convened a multidisciplinary team to assess the functionality of the electronic health record (EHR), to create clinician education, and to develop new electronic tools. Results: Between June 2018 and August 2019, 20 unique C. auris patients were admitted to our facility, and only 2 (10%) met IDPH criteria. During the point-prevalence survey, 609 inpatients were assessed, and only 7 (1%) met IDPH criteria (Table 1). Therefore, we created a new surveillance program tailored to our local epidemiology. To do this, we convened a multidisciplinary team with representatives from infection prevention, nursing informatics, patient care, microbiology and information technology (IT). The IT build took 5 months, and the work products included a screening questionnaire integrated into the nurse admission navigator, new microbiology laboratory orders for C. auris culture, a new internal isolation category that we deemed prior location-based isolation (PLI), and an electronic report to automatically aggregate data. To streamline workflow, best-practice alerts (BPAs) were designed to automatically order isolation and laboratory tests based on responses to the admission questionnaire (Fig. 1). Additionally, tools were created catch missed opportunities for isolation and to automatically update isolation status based on final culture results. Conclusions: Local epidemiology must be considered when designing C. auris surveillance programs. Stakeholder engagement and informatics were key to successful program implementation. The EHR must be nimble to address updated recommendations for organisms of concern. Data must be continuously evaluated to measure success of a targeted screening and surveillance program.Funding: NoneDisclosures: None
Important but Impractical: Hand Hygiene Among Operating Room Anesthesia Providers
Authors: Moseley Sadie Mae , Ankrum Andrea , Jimenez Normidaris , Guthrie Alyssa , Huang Felicia Scaggs , Schaffzin Joshua 
Published: November 2020

Background: Use of the WHO 5 Moments of Hand Hygiene (HH) by operating room (OR) anesthesia personnel has been called by some logistically unfeasible, despite evidence that HH can reduce patients’ risk of pathogen acquisition. We developed and implemented a set of 7 moments based on WHO guidance (Fig 1) with high adherence. We conducted this study 6 months later to determine whether the improvement was sustained. In addition, we sought to understand practices, beliefs, barriers, and perceptions among anesthesia providers regarding HH. Methods: We measured HH adherence by direct observation using locally developed 7 moments tailored to the anesthesia workflow during June–August 2019. Adherence was defined as the percentage of observed HH performed when a moment occurred. We used the theory of planned behavior (TPB) as a framework to conduct 11 individual interviews (8 attending anesthesiologists and 3 certified nurse anesthetists) with a semistructured instrument that included Likert scale and open-ended questions. Interview transcripts were reviewed and a codebook of themes was created through inductive thematic analysis. Resultant themes and Likert scale averages were grouped by the 3 key TPB variables. Results: In total, 294 HH moments were observed for 50 anesthesia providers during 36 cases. The average HH adherence was 21.1% with the highest adherence moment being after patient contact (61.7%). Interview participants stated universally that HH was important for patient care, but acknowledged barriers to performance. Barriers cited included interruption in workflow, a lack of evidence, lack of clarity of HH standard, and limited availability of product. Conclusions: Adherence to the 7 moments of HH for anesthesia providers was not sustained after 6 months. Providers identified numerous barriers to HH, including a lack of knowledge of a standard, as reasons for suboptimal adherence. These data suggest future interventions could be designed to address gaps in knowledge and remove barriers to improve HH adherence among OR anesthesia providers.Funding: NoneDisclosures: None
Imunocromatografic Tests Improving Point-of-Care Management of Respiratory Virus Infection in Children
Authors: Mendes Elisa Teixeira , Paranhos Hadassa Louback , Santos Isabela Cristina Moreira , Barbosa Nathália Reis Sartori , da Silva Raquel Vieira , Lima Maria Patelli Juliani Souza 
Published: November 2020

Background: Respiratory syncytial virus (RSV) and influenza virus (flu) contribute substantially to the overall burden of severe respiratory tract infection in children. However, the molecular etiological diagnostic methods of viral infection are still insufficiently accessible in public hospitals. Rapid immunochromatographic tests can add important information at the point of care, including antiviral or antibiotic indication, viral , and effective precaution measures to prevent outbreaks. The aim of this study was to evaluate this impact for pediatric patients under 5 years of age in our hospital. Methods: We conducted a retrospective, observational study of clinical outcomes of children under 5 years requiring hospitalization from 2013 to 2018 for viral respiratory disease, and who had positive RSV and/or flu immunochromatographic rapid test results. Results: In total, we identified 221 cases: RSV, 193; flu, 6; codetections, 19. (Table 1). The mortality rate was 1.8% (2 cases), and 88% of our patients were <1 year of age. Variables significantly associated with orotracheal intubation, the most intensive intervention, were younger age in months, comorbidities, RSV and flu codetection, and bacterial pneumonia diagnosis during hospitalization. Conclusions: In the multivariate analysis, RSV and flu codetection was associated with the least favorable clinical prognoses. Rapid test diagnosis may provide important information at the point of care, and molecular panels are not yet widely accessible in public hospitals. Hence, we believe that immunochromatographic rapid tests represent a valuable and feasible diagnostic alternative facilitating timely evaluation and treatment implementation.Funding: NoneDisclosures: None
Increasing Mupirocin Resistance Among MRSA Nasal Surveillance Isolates in the Chicago Area
Authors: Schora Donna , McElvania Erin , Sabatini Linda , Singh Kamaljit 
Published: November 2020

Background: In 2005, our healthcare system began universal admission screening for nasal colonization with MRSA and decolonization of MRSA positive patients with mupirocin. In 2010–2012, we studied the impact of nasal MRSA decolonization and concluded that it does not add benefit when contact precautions are used; plus, it resulted in increased rates of mupirocin resistance up to 9.4% in 2012. In September 2012 routine decolonization of hospitalized patients was discontinued. In the 2 years following discontinuation of mupirocin use for decolonization of MRSA carriers, the rate of mupirocin resistance gradually declined. We undertook a contemporary review of mupirocin resistance rates to ensure that the rates were stable. Methods: NorthShore University HealthSystem, Illinois, consists of 4 hospitals in the northern suburbs of Chicago, with 750 beds and 60,000 annual admissions. Admission nasal swab samples were collected from at-risk hospitalized patients based on a risk-adjusted algorithm. Nasal swabs were tested using the BD MAX MRSA assay. Positive samples were cultured onto BD BBL CHROMagar MRSA to recover the organism and were tested for the mupA gene, which confers high-level mupirocin resistance using an in-house PCR test. Data for mupirocin orders were provided by the pharmacy. Results: Mupirocin resistance rates and prescription orders are shown in Figs. 1 and 2. Conclusions: Mupirocin resistance rates plateaued between 2012 and 2014 and then increased from 9.1% in 2015 to 18.1% in 2019, despite discontinuation of routine decolonization of hospitalized patients. The reason for the increase is unclear; inpatient mupirocin orders were stable from 2015 to 2017.Funding: NoneDisclosures: None
Infection Control Center of Excellence Experience
Authors: Amer Hala , Alenizi Ahmed 
Published: November 2020

Background: In 2018, the Ministry of Health (MOH) in Saudi Arabia launched the Infection Control Excellence Center (ICEC) program among healthcare governmental institutions to create an exceptionally high concentration of expertise and resources within the infection prevention and control discipline to afford the best patient outcomes possible. King Saud Medical City (KSMC), one of the main healthcare institutions in Riyadh, was selected to be among the 10 facilities participating in ICEC 2019 competition. It is expected to qualify the facility to lead the Kingdom infection prevention and control as well as sharing expertise at regional and international levels. Methods: The infection control team at KSMCA used a business model canvas to present the project vision, resources, partners, values, and revenue streams (Fig. 1). All project stakeholders were engaged, including core infection control team, various hospital departments as internal partners, along with the MOH team as external partners. The ICEC program was presented at the KSMC executive council to earn leadership support. The following assessment areas were included in the presentation: (1) quality assurance and patient care through sustain basic infection control standards and improve key performance indicators (KPIs); (2) enhance the development and structure of the infection control team; (3) pursue innovative ideas in infection control practices. Overall, 17 projects arranged into 4 programs have been proposed (Fig. 2). Results: The institution successfully passed the eligibility criteria assessment in the first quarter of 2019. Infection control KPIs have been corporatized with KSMC strategic KPIs that support infection control improvement initiatives. The infection control team continues to grow in function and capacity. Also, 4 additional were awarded CIC certification in 2019 to reach total of 11 CICs, which represent 30% of the team (including 1 recertification). A dashboard designed by the project management office facilitates follow-up with the proposed projects in progress. Completion levels ranging between 30% and 100% have been achieved among these projects. A final evaluation was conducted in December 2019, including a field visit by the MOH ICEC team as well as a written MCQs exams and interviews with the core infection control team. Communication among the stakeholders and leadership involvement were considered among the assessment criteria. Conclusions: The ICEC supports and motivates investment in human capital and encourages innovative, cost-effective solutions in infection control field in Saudi Arabia. It is also aligned with Saudi Arabia healthcare transformation and the 2030 vision through integrated programs in healthcare facilities.Funding: NoneDisclosures: None
Investigation of Surgical Site Infection Outbreak Among Neurosurgical Patients
Authors: Ramos Luísa , Pessoa Jussara , Santos Leonardo , Starling Carlos , Couto Braulio 
Published: November 2020

Background: The infection control service of a private hospital in Belo Horizonte, Brazil, performs continuous surveillance of surgical patients according to the CDC NHSN protocols. In a routine analysis of the neurosurgical service, we identified a subtle increase in the incidence of surgical site infection (SSI): in 5 months (June–October 2018), 6 patients developed an SSI. From January 2017 until May 2018, there were no cases of infection in neurosurgery, which led us to suspect an outbreak. Methods: A cohort study was used to investigate the factors associated with risk of SSI. We investigated the following variables: ASA score, number of hospital admissions, age, preoperative hospital length of stay, duration of surgery, wound class, general anesthesia, emergency, trauma, prosthesis, surgical procedures, surgeon. Furthermore, 9 key steps were followed to investigate the outbreak: case definition (step 1), search for new SSI cases (step 2); confirmation of the outbreak (step 3); analysis of SSI cases by London Protocol (step 4); analysis of the cohort data (step 5); inspections in the surgical ward (step 6); qualitative and quantitative reports sent to the neurosurgical departments (step 7); continuing with active surveillance (stage 8); announcement of research findings (step 9). Results: The outbreak was confirmed: SSI incidence in the pre-epidemic period (January–May 2018) was 0 of 218 (0%); in the epidemic period (June–October 2018), SSI incidence was 6 of 94 (6.4%) (P < .001). We identified 3 SSI etiologic agents: 2 Klebsiella pneumoniae, 2 S. aureus, and 1 Serratia marcescens. It was unlikely that there was a common source for the outbreak. We identified the following risk factors: second or third hospital admissions (RR, 3.7; P = .041), and preoperative hospital length of stay: SSI patients (4.3±5.7 days) versus control patients (0.7 ± 2.1 days) (P = .048). None of the surgeons presented an SSI rate significantly different from each other. We used the London protocol to identify antibiotic prophylaxis failures in most cases. Conclusions: New cases of infections can be prevented if the length of preoperative hospital stay becomes as short as possible and, most importantly, if antibiotic prophylaxis does not fail.Funding: NoneDisclosures: None
Leveraging Local Expertise in Stewardship, Hospital Epidemiology and Public Health to Enrich Postgraduate Training in NYC
Authors: Cowman Kelsie , Ostrowsky Belinda , Seo Susan , Chen Victor , Bartash Rachel , Nori Priya 
Published: November 2020

Background: New York City is a gateway for emerging pathogens and global threats. In 2013, faculty from Montefiore Medical Center and Memorial Sloan Kettering developed a free half-day workshop for postgraduate trainees in antimicrobial stewardship (AS), infection prevention (IP), hospital epidemiology, and public health. This annual workshop, sponsored by the Infectious Diseases Society of New York (IDSNY), incorporates case studies and expert panel discussions on timely topics such as Ebola, Candida auris, Clostridiodes difficile, measles, nosocomial influenza, drug shortages, and AS/IP “big data.” Methods: From 2013 through 2017, the workshop involved 10–15 interactive AS/IP cases with audience response questions and panel discussions. In 2018–2019, based on feedback, the format was revised to emphasize breakout sessions in which participants actively practiced AS/IP tools, (eg, medication utilization evaluations, epidemiologic curves, and performance improvement devices). Examples of 2018–2019 cases are shown in Figure 1. A pre- and postseminar paper survey was conducted yearly to understand baseline training in AS/IP, desire for future AS/IP careers, and self-reported effectiveness of the workshop. Results: Initially, the primary audience was NYC ID fellows. From 2018 onward, we opened enrollment to pharmacy residents. Approximately 45 NYC ID fellows were eligible for the course each year. Results from 2013 to 2016 surveys were reported previously (Fig. 2). There were 32 attendees in 2018, 42 in 2019. The survey response rate was 88% in 2018 and 95% in 2019, with 68 (92%) total participants. Most participants had received previous training in IP (82%) and AS (94%) (Fig. 3). Most participants reported that the program was a good supplement to their ID training (98%) and that case studies were an effective means of learning IP (100%) and AS (98%). Furthermore, 92% stated they would like additional AS/IP training, and many since 2013 have requested a full-day course. Self-reported interest in future involvement in AS/IP increased after the workshop: IP, 68%–83% (P =.04) and AS, 88%–91% (P = .61). Conclusions: Most trainees reported satisfaction with the workshop and case-study learning method; interest in future AS/IP careers increased after the seminar. We intend to explore Funding: to expand to a full-day program for all NYC postgraduate trainees and AS/IP junior faculty. As such, we hope to obtain the endorsement of professional societies such as SHEA. This workshop could address a crucial educational gap in AS/IP postgraduate training and help sustain our future workforce.Funding: NoneDisclosures: None