bluuebunny/crossref_metadata_2025_split huggingface dataset:
1220. Effective, Novel, Handheld, UV Technology for Surface Disinfection While Patients or Staff Are Nearby
Authors: Gergen-Teague Maria , Garrett Kurt , Semenysheva Svetlana , Weber David J 
Published: October 2019

Abstract

Background
The battle against nosocomial infections is ongoing, and the role the environment plays in these infections has been well established. Because only 50% of the items in a patient’s room are adequately cleaned at the time of discharge, many hospitals are turning to “no-touch” systems to supplement their manual cleaning and disinfection protocols. Lumagenics introduces a safe, novel, handheld, low heat-generating Cool UV™ technology that can be used on a daily basis, while the patient is in the room.

Methods
Templates were drawn on Formica surfaces and inoculated with known amounts of epidemiologically important pathogens (EIP’s) (i.e., MRSA, VRE, CRE Klebsiella pneumoniae, multidrug-resistant Acinetobacter baumannii, and Clostridioides difficile spores). After drying, each surface was exposed to the Cool UV™ at varying times and distances. After exposure, each surface was cultured with a Rodac plate and incubated according to standard microbiological procedures. Following incubation, all growth was quantitated and log10 reductions were calculated.

Results
Without an organic load, vegetative EIP’s were reduced by an average of 3.63–5.08 log10 for 1 and 5 sec., respectively, at 1 inch and by an average of 2.10–4.08 log10 for 1 and 5 sec., respectively, at 5 inches (Table 1). C. difficile spores were reduced an average of 1.84–3.18 log10 in 10–60 secs from a distance of 1 inch, and an average of 1.21–2.58 log10 at 5 inches (Table 2). With an organic load (10% fetal calf serum), the log10 reduction for C. difficile spores was reduced ~0.94 log10, but the reduction achieved for the vegetative EIP’s remained relatively unaffected.

Conclusion
Lumagenics’ Cool UVTM technology, with short exposure times, reduced EIP’s by levels similar to “no touch” room disinfection UV devices and may be a useful adjunct to daily cleaning and chemical disinfection.

Disclosures
All authors: No reported disclosures.
1221. Comparison of the Antimicrobial Efficacy of Mobile Ultraviolet Light Devices in a Simulated Patient Room
Authors: Boyce John M , Cotton Margaret , Donlan Alice , Larochelle John , Hardwick Matthew 
Published: October 2019

Abstract

Background
Multiple mobile ultraviolet (UV) light devices are available for disinfection of hospital rooms, but few data are available on the relative ability of devices to reduce surface contamination and ease of use. The objective of the present study was to compare the antimicrobial efficacy of several devices in a laboratory setting.

Methods
Using a modification of the ASTM International method E2197, spores of Clostridioides difficile(ATCC strain BAA-1870) suspended in phosphate-buffered saline (PBS) with 5% fetal calf serum were inoculated onto 20 mm stainless steel disks and dried. Disks were attached to right and left bedrails, under bed, call button, chair armrest, floor near device, table top, table bottom, floor far from device, toilet seat and grab bar and sink handle in a mock 6.4 × 4.1-meter hospital room with a 1.5 × 2.4-meter bathroom. Disks were exposed using cycle times and device placements recommended by device manufacturers. Spores from exposed disks and unexposed control disks were recovered in PBS with Triton X-100, enumerated using dilution plating, and log10reductions were determined by comparing the number of spores recovered from exposed and control disks. Times for set-up, treatment and resetting the space were recorded for each device. Results were expressed as mean log10reductions and percent reduction/minute of room vacancy. Results were compared using Kruskall-Wallis nonparametric analysis.

Results
Mean log10reductions, percent reductions, run times for patient rooms and bathroom, setup/reset times, total room vacancy times, and percent reduction/minute of room vacancy are shown in the Table. There were no significant differences in percent reductions between different locations for each device. There were, however, statistically significant differences between microbial reductions between the different machines (P < 0.05 for all comparisons).

Conclusion
There are many factors to consider in selecting a UV device. These considerations should include mean log10reduction, total vacancy times and percent reduction achieved/minute of room vacancy.

Disclosures
All authors: No reported disclosures.
1226. Application of a Foam Disinfectant Enhances Sink Drain Decontamination in Hospital Sinks
Authors: Jones Lucas D , Cadnum Jennifer , Sankar Chittoor Mana Thriveen , Jencson Annette , Donskey Curtis 
Published: October 2019

Abstract

Background
Sink drainage systems are a potential reservoir for the dissemination of pathogens in healthcare facilities. Pouring of liquid disinfectants down drains may have limited efficacy due to inadequate contact time and suboptimal penetration into areas harboring biofilm-associated organisms. We hypothesized that a foam application of a disinfectant would enhance sink drain decontamination in comparison to pouring of the same disinfectant.

Methods
We compared the antimicrobial efficacy of 300 mL of a hydrogen peroxide-based liquid disinfectant applied to sink drainage systems (N = 30 sinks per treatment group) using a hand-pumped foaming device vs. poured down the drain. Swabs were used to collect quantitative cultures from the proximal sink drain to depth of 1 inch below the strainer before treatment and at 15 minutes and 1, 2, 3, and 7 days after treatment. We also investigated the efficacy of the foam when applied every 3 days for a 2-week period (N = 10 sinks).

Results
As shown in the figure, pouring the hydrogen peroxide-based disinfectant down the drain significantly reduced the bacterial load on day 0 and day 1, but the bioburden returned to baseline levels within 2 to 3 days. In comparison, the foaming application of the disinfectant resulted in significantly greater reductions in bacterial recovery on days 0, 1, 2, and 3 (P < 0.01). With repeated foam treatments every 3 days, there was a progressive decrease in the bacterial load recovered from sink drains. Application of the foam required ~3 minutes per sink.

Conclusion
An easy-to-use foaming application of a hydrogen peroxide-based disinfectant was effective in suppressing recolonization of the proximal drainage system of sinks for at least 3 days. Intermittent application of the foaming disinfectant could potentially reduce the risk for dissemination of pathogens from sink drains.

Disclosures
All authors: No reported disclosures.
1232. Potential Health and Cost Outcomes of Optimized Statistical Process Control Use for Surgical Site Infection Surveillance
Authors: Nehls Nicole , Ilieş Iulian , Benneyan James C , Baker Arthur W , Anderson Deverick J 
Published: October 2019

Abstract

Background
Surgical site infections (SSIs) are common (160,000–300,000 per year in the United States) and costly ($6,000–$25,500 per event) healthcare-associated infections with potentially lethal outcomes (2.1%–6.7% mortality rate). A prior analysis by our group suggested that statistical process control (SPC) can detect SSI outbreaks earlier than traditional epidemiological surveillance methods. This study aimed to quantify the potential impact of SPC surveillance on patient outcomes (prevented SSIs and deaths) and healthcare costs.

Methods
We retrospectively analyzed 30 SSI outbreaks occurring over a period of 8 years in a network of 50 community hospitals from the Southeastern United States. We applied 24 control chart variations, including 2 optimized for SSI surveillance, 6 with expert-defined pre-outbreak baselines (used in our pilot study), 4 with lagged rolling baselines (idem), and 12 common practice ones (using rolling baselines with no lag or fixed baselines). The charts used procedure-specific data from either the outbreak hospital or the entire network to compute baseline SSI rates. We calculated the average SSI rates during, before and after the outbreaks, and the months elapsed between SPC and traditional detection. We then used these values to estimate the number of SSIs that could have been prevented by SPC, and corresponding deaths avoided and cost savings (Figure 1).

Results
Optimized charts detected 96% of the outbreaks earlier than traditional surveillance, while pilot study and common practice charts did so only 65% (58%) of the time (Figure 2). Optimized charts could potentially prevent 15.2 SSIs, 0.64 deaths, and save $226,000 in excess care costs per outbreak. Overall, charts using network baselines performed better than those relying on local hospital data. Commonly used variations were the least effective, but were still able to improve on traditional surveillance (Figure 3).

Conclusion
SPC methods provide a great opportunity to prevent infections and deaths and generate cost savings, ultimately improving patient safety and care quality. While common practice SPC charts can also speed up outbreak detection, optimized SPC methods have a significantly higher potential to prevent SSIs and reduce healthcare costs.

Disclosures
All authors: No reported disclosures.
1236. Staphylococcus aureus Surgical Site Infection: Epidemiology in Europe (SALT)
Authors: Mellinghoff Sibylle , Bruns Caroline , Albertrsmeier Markus , Bassetti Matteo , Horcajada Juan P , Vehreschild J Janne , Liss Blasius J , Cornely Oliver 
Published: October 2019

Abstract

Background
We conduct a retrospective, multinational cohort study with a nested case–control (NCT03353532). Data from all patients undergoing any surgical procedure in 2016 are collected within the cohort, comprising more than 150,000 procedures. S. aureus SSI cases are documented in an electronic database and matched 1:1 to controls within each center. Criteria for matching include epidemiological data and type of procedure. Participating sites are 14 major surgical centers in France, Germany, Italy, Spain, and the UK. We here present preliminary data from the interim analysis.

Methods
We conduct a retrospective, multinational cohort study with a nested case–control (NCT03353532). Data from all patients undergoing any surgical procedure in 2016 are collected within the cohort, comprising more than 150,000 procedures. S. aureus SSI cases are documented in an electronic database and matched 1:1 to controls within each center. Criteria for matching include epidemiological data and type of procedure. Participating sites are 14 major surgical centers in France, Germany, Italy, Spain, and the UK. We here present preliminary data from the interim analysis.

Results
We determine overall and procedure-specific incidence of S. aureus SSI. To date, 619 cases have been documented with a mean age of 59.0 years, 50,7% male and 49.3% female. Chronic cardiovascular disease (23%), diabetes (22%), and solid tumors (18%) are the most frequent comorbidities. Overall length of hospitalization is 19 days. A total of 20% SSI cases were treated at the intensive care unit, 49% were readmitted to the hospital, and 47% patients needed revision surgery.

Conclusion
The study includes all surgical procedures at participating centers allowing us to determine the incidence for all common surgical procedures aiming to better understand the risk of certain procedures. Furthermore, the study will analyze the risk composition of the surgical patient population to enable the calculation of the number of patients at risk in the overall surgical population in Europe. Predictive factors for S. aureus SSIwill be analyzed and thus allow future investigation into targeted prophylactic strategies such as S. aureus vaccines.

Disclosures
All authors: No reported disclosures.
1238. Alcohol-Based Nasal Antiseptic as Part of a Bundle to Reduce the Incidence of Contact Precautions and Surgical Site Infections
Authors: Stegmeier Heather 
Published: October 2019

Abstract

Background
A 145-bed hospital embarked on a 12-month project to reduce contact precautions (CP) for colonized methicillin-resistant Staphylococcus aureus (MRSA) patients, and to reduce surgical site infections (SSI) for orthopedic patients. Prior to the project all high-risk patients were screened using nasal polymerase chain reaction (PCR) test for MRSA, and if positive, placed on CP. Orthopedic surgical patients were also screened for MRSA, and if positive, received preoperative chlorhexidine (CHG) bath and nasal mupirocin.

Methods
Starting in January 2017, all high-risk patients received twice-daily alcohol-based nasal antiseptic and a daily chlorhexidine (CHG) bath, in place of targeted screening and CP. In addition, an SSI prevention bundle was instituted, comprised of alcohol-based nasal antiseptic in place of mupirocin, retraining perioperative staff on skin preparation, and UV-C disinfection added to manual cleaning in the operating room. Preoperative CHG bathing was already in place and was continued. During this period, there was a total of 868 orthopedic surgery patients. Patients who remained in the hospital post-operatively received twice-daily nasal antiseptic and daily CHG bathing.

Results
There was a reduction in the incidence of CP from 16% to 10% per day, while maintaining a rate of zero MRSA bacteremia. Reduction of gloves, gowns and nasal PCR tests, resulted in an estimated total cost reduction of $200,000. Additionally, there was a statistically significant reduction in total hip SSI from a 2016 baseline of 1.15 infections per 100 procedures to 0.017 infections per 100 procedures (98% reduction, P = 0.014.), and the rate of zero SSI in total knee replacement patients was maintained.

Conclusion
Universal decolonization in place of targeted screening and CP for colonized MRSA patients, reduced costs without increasing MRSA bacteremia. Replacement of mupirocin with a nasal alcohol-based antiseptic, as one component of an SSI prevention bundle, resulted in a marked reduction in SSI after total hip procedures.

Disclosures
All authors: No reported disclosures.
1241. Marked Improvement in Post-Operative Craniotomy Wound Care Using 2% Chlorhexidine (CHG) Cloths for Blood Clots Removal and Hair Cleaning in a Photo-Documentation Survey
Authors: Lee Eunjung , Kovryga Kornick Mariya , Wilhelm Lisa , White Janice , Bancher JeanMarie , Gohil Shruti K , Paff Michelle , Hsu Frank P , Huang Susan S 
Published: October 2019

Abstract

Background
Post-operative wound care can be an important strategy to prevent surgical site infection (SSI) following craniotomy. Insufficient wound care, blood clots, and oily hair near the incision can increase SSI risk.

Methods
We conducted a pre-post prospective cohort evaluation of a quality improvement intervention to address inpatient post-operative craniotomy wounds at an academic hospital. A post-op wound care protocol was jointly developed by neurosurgical wound care nurses, clinicians, and infection preventionists. The protocol began on postoperative day 1, and included use of soft ties to keep adjacent hair away from the incision, use of 2% CHG cloths to clean skin and hair within 2 inches of the incision as well as the proximal 6 inches of any surgical drain, and use of 2% CHG cloths to remove blood clots. Selection of 2% CHG cloths for blood clot removal was made following comparison to several concentrations of peroxide. A twice-weekly photo-survey of all inpatients undergoing craniotomy was undertaken during the baseline period (October–December 2018) and intervention period (March–April 2019), with feedback to wound care nurses occurring during the intervention period only. The proportion of redness, extensive blood clots (>50% incision), and oily hair near the incision were compared between the baseline period and the intervention period using Fisher’s exact tests.

Results
A total of 156 photo assessments were performed in 71 patients (101 assessments in 45 patients in the baseline period, and 55 photo assessments in 26 patients in the intervention period). Demographics, body mass index, emergent status, and prior craniotomy were similar across the baseline and intervention periods. The intervention was associated with significant reductions in redness (27.7% vs. 11%, P = 0.015), blood clots (33.7% vs. 10.9%, P = 0.002), and oily hair near the incision (76.7% vs. 28.6%, P < 0.001) (Figure 1).

Conclusion
The care of post-operative craniotomy wounds and adjacent hair was significantly improved through a standardized protocol to remove blood clots and ensure clean skin and hair adjacent to the incision during the post-operative inpatient stay. Photo documentation and feedback to wound care nurses helped ensure protocol adherence.

Disclosures
All authors: No reported disclosures.
1242. Evaluation of Risk Factors for Development of Total Hip Arthroplasty (THA) Surgical Site Infections (SSI)
Authors: Ingnam Sisham , Flaherty Jennifer , Lustberg Mark , Mangino Julie E , Day Shandra R 
Published: October 2019

Abstract

Background
THA is one of the most commonly performed surgeries for pathologic diseases of the hip. Multiple risk factors have been identified for SSI including: female gender, previous joint surgery, hematoma, joint dislocation, intraarticular glucocorticoid injection, rheumatoid arthritis, uncontrolled diabetes, anemia, malnutrition, and an immunosuppressed state. The objective of our study is to evaluate obesity (body mass index (BMI) >30) as an independent risk factor for THA SSI and identify other risk factors for SSI

Methods
A retrospective case–control (1:3) matched observation study was conducted from January 1, 2014–June 30, 2016. Patients with a THA SSI were identified using NHSN definitions and 3 controls were matched for sex and month of surgery for each SSI case. Patient information was extracted through chart review including BMI, revision surgery, chronic kidney disease (CKD), diabetes mellitus (DM), anemia, malnutrition, smoking, surgery duration, steroid use, pre-operative chlorhexidine (CHG) bathing and nasal povidone–iodine (PI) compliance. Multivariate analysis using a conditional logistic regression model was performed.

Results
Among 906 THA, 29 patients developed an SSI with 87 matched patients over the 2.5 years. The mean age in the SSI group was 61.0 years, and 37.9% were male. Mean age in the control group was 63.1, and 40.1% were male. In both groups, the most common indications for surgery were osteoarthritis followed by osteonecrosis and malignancy. Results of multivariate analysis identified five independent risk factors for SSI (see Table 1).

Conclusion
Obesity (BMI >30) was identified as an independent risk factor for THA SSI as well as CKD, steroid use and revision arthroplasty. While these risk factors are not easily modifiable, noncompliance with pre-operative CHG bathing and PI administration were also identified as significant SSI risk factor. These findings emphasize the importance of evaluating patients for SSI risk factors including obesity and improving compliance with all pre-operative SSI reduction measures.

Disclosures
All authors: No reported disclosures.
1249. Images vs. C-Reactive Protein Follow-up of Patients with Organ/space Surgical Site Infections
Authors: Garcia Allende Natalia , Freuler Cristina , Victoria Sanchez Ana , Ezcurra Cecilia , Mayer Wolf Micaela , Eliana Iglesias Debora , Paz Sandra , Antezana Trigo Ingrid , Risso Patron Agustina , Rodriguez Viviana Elizabeth 
Published: October 2019

Abstract

Background
End-of-treatment images of infections after intra-abdominal infection could increase costs. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used to define and predict the evolution of infectious diseases. The aim of this study was to describe clinical outcomes of adult patients with end-of-treatment images or CRP and ESR follow-up, during treatment of organ/space (OS) (intra-abdominal) surgical site infection (SSI).

Methods
Observational retrospective cohort. Hospitalized patients older than 16 years were included, who developed OS SSI after abdominal surgery, in a general hospital, from June 2014 to June 2018. Population variables: age, gender, comorbidities (cancer, diabetes mellitus, cirrhosis, chronic renal failure, tobacco, immunosuppressants, Charlson score and obesity), ESR, quantitative CRP, imaging study (tomography (CT)/ ultrasound), type of drainage route (surgical, percutaneous). Outcomes variables: antibiotic patient-days, time to infection (TTI), CRP and ESR at the time of diagnosis (TD) and at the end of treatment (TET), rate of relapsing infection. Statistical analysis: Description of variables sort by patients under images follow-up and patients under CRP and ESR follow-up. Fisher test of relapsing infection was calculated between groups.

Results
Included: 76 patients. Twenty-six were followed with CT or ultrasound and 50 were followed with CRP and ESR. Forty women, with a mean age of 55 years (19–91) and an average score of the Charlson of 3.64 (0–10). Forty patients had cancer before surgery (52.63%). Microbiological diagnosis: 70/76 patients, the majority was polymicrobial. Average of antibiotics patient-days was 24.4 days (14 days of intravenous therapy). TTI: 8.65 days. Average CRP at the TD was 87.5 mg/L and 17.5 mg/L at TET. No differences in ESR values (31.9 mm to 33.5 mm). Percutaneous drainage: 46 patients. Surgical procedure: 27. Relapsing infection: 11,5% in images group vs. 4% in no images group; P = 0.33.

Conclusion
Quantitative CRP monitoring was useful to guide the duration of antimicrobial treatment. No differences of relapsing infection between groups was found.

Disclosures
All authors: No reported disclosures.
1265. Monitoring of Human Immunodeficiency Virus (HIV)-Infection Using the Cepheid HIV-1 Qualitative Assay
Authors: Keizur Erin , Wood-Palmer Drew , Koussa Maryann , Ocasio Manuel , Jane Rotheram-Borus Mary , Klausner Jeffrey 
Published: October 2019

Abstract

Background
Human immunodeficiency virus (HIV)-1 RNA quantification is the primary method of monitoring response to antiretroviral therapy. In the U.S. viral RNA testing is recommended for all HIV-infected patients at entry into care, at initiation or modification of therapy, and on a regular basis thereafter. HIV-1 DNA testing may pose additional advantages. For example, proviral DNA may predict early loss of viral suppression. The Cepheid® (Sunnyvale, CA) HIV-1 Qualitative (HIV Qual) assay detects total nucleic acid for both RNA and DNA and provides a qualitative result (HIV detectable or undetectable).

Methods
We tested participants aged 14–24 years old from the Adolescent Trials Network (ATN) CARES study with known HIV infection in Los Angeles, California and New Orleans, Louisiana. We tested participants using the Cepheid® HIV Qual assay and the quantitative HIV-1 RNA, real-time PCR test using the COBAS P6800 system (Roche, Branchburg, NJ). We used 100 μL of whole blood for the HIV Qual assay and results were provided in 90 minutes. We sent the remainder of the whole blood from the same visit to a commercial laboratory for HIV-RNA PCR testing and results were reported as “detected,” “detected, <20 copies/mL plasma” or “not detected, <20 copies/mL plasma.” We compared HIV Qual and HIV RNA PCR test results from the same visit for each participant.

Results
Overall, 57 HIV Qual tests were performed with concurrent HIV RNA PCR tests. Of those, 9/15 tests were concordant with HIV viral RNA suppression while 39/42 tests were concordant with HIV viral RNA detection. In 6 cases, the HIV RNA was not detected at <20 copies/mL by the Roche PCR while the HIV Qual assay detected HIV DNA. Of those 6 cases, 3 had subsequent HIV RNA PCR testing. All 3 cases had detectable HIV RNA at their next testing date (214 copies/mL, detected <20 copies/mL, 2130 copies/mL).

Conclusion
The HIV Qual test is feasible for the monitoring of HIV-infection. Due to its detection of HIV DNA, it may predict future lack of HIV RNA suppression.

Disclosures
All authors: No reported disclosures.