bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Policies Versus Practices Utilizing the CDC Infection Control Assessment and Response Tool
Authors: Lloyd-Krejci Buffy , Ellingson Katherine , Coury Elias 
Published: November 2020

Background: The Infection Control Assessment and Response (ICAR) tool was developed by the CDC following the 2014 Ebola outbreak. Over a 3-year period, the CDC dispensed Funding: to all public health divisions in all 50 states to implement and promote the ICAR. The ICAR was developed as a self-assessment tool to evaluate policies, competencies, and practices across healthcare settings. The primary aim of the tool and associated Funding: was to guide quality improvement activities by addressing the identified gaps in infection prevention (IP). Independent of state funding, we sought to use the ICAR to evaluate whether there were differences in reported policies from observed practices related to hand hygiene (HH) and personal protective equipment (PPE) use in long-term care facilities (LTCFs), ambulatory surgical centers (ASCs), and outpatient pain clinics (OPCs). Methods: From November 2018 to August 2019, we conducted in-person ICAR assessments in 7 LTCFs in 3 states (Arizona, Utah, and Idaho), 2 ASCs in 2 states (Arizona, Indiana), and 5 OPCs in 1 state (Arizona). All on-site assessments were conducted with the ICAR tool by a board-certified infection preventionist. The paper form was converted to a mobile compatible digital audit tool utilizing Microsoft Forms on the Microsoft 365 platform. Once a survey was completed, it was sent to an Excel database and analyzed utilizing SPSS software. Results: All facilities (14 of 14, 100%) had a designated person responsible for coordinating and/or directing the IP program. Moreover, 4 of 7 LTCFs (57%), 2 of 2 ASCs (100%), and 5 of 5 OPCs (100%) reported having written IP policies that met evidence-based guidelines, regulations, or standards (eg, CDC/HICPAC). None of the 7 LTCFs (0%), 2 of 2 ASCs (100%), and none of the 5 OPCs (0%) reported active surveillance to monitor and document adherence to proper PPE selection and use. During direct observation of hand hygiene opportunities, compliance was 23% for LTCFs (7 of 31 opportunities), 37% for ASCs (7 of 19 opportunities), and (11 of 28 opportunities) 39% in OPCs. Conclusions: Our results indicate that the ICAR tool remains a useful resource for distinguishing between the reporting of IP polices from the actual implementation of evidence-based practices. Although all facilities had a designated role for IP and most had written evidence-based IP polices, this did not translate to the observation of recommended HH and PPE practices. By utilizing this tool, healthcare facilities can support their evidence-based IP polices and further promote patient safety by identifying and mitigating gaps in practices.Funding: NoneDisclosures: None
Bacterial Colonization of Waiting Rooms in a Newly Constructed Children’s Outpatient Clinic: Construction Through 6 Months After Opening In Waiting Rooms
Authors: Spratt Henry , Levine David , Woods Charles , Ledbetter Joel , Price Gary 
Published: November 2020

Background: Healthcare-associated infections (HAIs) represent an ongoing problem for all clinics. Children’s clinics have waiting rooms that include toys and activities to entertain children, possibly representing reservoirs for HAIs. This study focuses on a newly constructed children’s outpatient clinic associated with a teaching hospital. We studied waiting room bacterial colonization of floors and play devices from the last phase of construction through 6 months of clinical use. Methods: Waiting room areas on the first 2 floors of the facility were studied due to high patient volume in those areas. In total, 16 locations were sampled: 11 on floors and 5 on play items. Using sterile double-transport swabs, all locations were sampled on 5 separate occasions over 2 months during the last phase of construction and 13 times over 6 months after the clinic was opened. After collection swabs were placed on ice, transported to a microbiology lab, and used to inoculate Hardy Diagnostics Cdiff Banana Broth (for Clostridium difficile - Cdiff), CHROM MRSA agar (for methicillin resistant Staphylococcus aureus - MRSA), Pseudomonas isolation agar (for Pseudomonas spp and P. aeruginosa), and tryptic soy agar to detect Bacillus spp. Media were incubated for 48 hours at 37°C and were scored for bacterial presence based on observation of colonies or change in the medium. Results: During the construction phase, waiting-room-floor bacterial colonies were dominated by Bacillus spp, and first-floor waiting rooms had nearly 7 times more colonies than those on the second floor (P < .05). A similar pattern was observed for C. difficile and MRSA. No Pseudomonas spp were observed during construction. Once patients were present, Bacillus spp contamination dropped for the first floor, but increased for the second floor. All other bacterial types (C. difficile, MRSA, Pseudomonas spp, and P. aeruginosa) increased on the second floor after the clinic opened (eg, from 23% to 42% for C. difficile and from 7% to 46% for MRSA; P < .05). The play devices showed small increases in bacterial load after clinic opening, most notably Pseudomonas spp. Conclusions: This study provides evidence that a shift from bacterial species associated with soil (eg, Bacillus spp) toward species commonly associated with humans occurred in waiting rooms after construction in this children’s outpatient clinic. Increases for MRSA, Pseudomonas spp, and P. aeruginosa were linked to patient presence. These data suggest that patients, their families, and clinic staff transport bacteria into clinic waiting rooms. This outpatient clinic environmental contamination may increase potential for HAIs and may represent a target for intervention.Funding: NoneDisclosures: None
Bronchoscope-Related Outbreaks and Pseudo-Outbreaks: CDC Consultations—United States, 2014–2019
Authors: Bardossy Ana , Novosad Shannon , Perkins Kiran , Moulton-Meissner Heather Adele , Arduino Matthew , Benowitz Isaac 
Published: November 2020

Background: Exposure to medical devices can be a risk factor for the development of healthcare-associated infections; bronchoscopes are a leading cause of device-associated outbreaks. We describe bronchoscope-related outbreaks and pseudo-outbreaks reported to the Centers for Disease Control and Prevention’s Division of Healthcare Quality Promotion (DHQP), and we summarize investigation steps and control measures. Methods: We identified bronchoscope-related consultations with state and local health departments between July 1, 2014, and September 30, 2019, in the DHQP database. We abstracted data on patient symptoms, clinical culture results, investigation findings, and subsequent infection prevention and control interventions. Results: We identified 15 consultations involving 150 patients (range, 3–31 patients per consultation). Each consultation involved at least 1 cluster of the same organism. Organisms associated with bronchoscope-associated clusters were nontuberculous mycobacteria (n = 7), Candida spp (n = 3), Exophiala spp (n = 2), Pseudomonas aeruginosa (n = 2), Enterobacter spp (n = 2), and Raoultella planticola, Stenotrophomonas maltophilia, Achromobacter spp, Mycobacterium tuberculosis, and Aspergillus spp (1 each; 2 consultations involved multiple pathogens). Procedures from which these patient specimens were collected included bronchoalveolar lavage, bronchial wash, bronchial brushing, sputum swab, and lymph node biopsy. For the 7 outbreaks in which clinical data were available, 5 did not have patients with clinical infections related to the pathogen recovered. Two consultations involved pseudo-outbreaks: one involved contamination of specimen collection tubes and the other involved contamination of cultures within the laboratory. Potential underlying pathogen sources included contaminated bronchoscopes (inadequate reprocessing or device damage) (n = 10, 67%), use of nonsterile ice, water, or saline during the procedure (n = 4, 27%), contaminated specimen collection tubes (n = 1, 7%), contaminated bronchoscope suite (n = 1, 7%), and clinical laboratory contamination (n = 1, 7%). The most common interventions included improvement of reprocessing procedures (n = 5), removal of possibly damaged bronchoscopes (n = 4), and eliminating nonsterile ice and water exposures in bronchoscopy (n = 3). Conclusions: Water-related organisms were the most commonly identified pathogens in bronchoscope-related consultations, highlighting the important role that exposure to contaminated water during bronchoscopy and bronchoscope reprocessing might play in bronchoscopy-associated outbreaks and pseudo-outbreaks. During bronchoscope-related outbreaks identifying a common pathogen could indicate problems in bronchoscope handling or reprocessing, device damage, or exposure to nonsterile water.Funding: NoneDisclosures: None
Carbapenemase Gene Profiles in Carbapenem-Resistant Enterobacteriaceae—United States, January 2018–August 2019
Authors: Huang Jennifer , Pettinger Amanda , Bantle Katie , Bhatnagar Amelia , Gilbert Sarah , Malik Sarah 
Published: November 2020

Background: Carbapenem-resistant Enterobacteriaceae (CRE) cause significant morbidity and mortality each year in the United States. Treatment options for these infections are often limited, in part due to carbapenemases, which are mobile β-lactam-hydrolyzing enzymes that confer multidrug resistance in CRE. As part of the CDC’s Containment Strategy for Emerging Resistance, public health laboratories (PHLs) in the CDC Antibiotic Resistance Laboratory Network (AR Lab Network) have worked to characterize clinical isolates of CRE for rapid identification of carbapenemase genes. These data are then used by public health and healthcare partners to promote patient safety by decreasing the spread of resistance. We summarize carbapenemase gene profiles in CRE, by genus and geography, using data collected through the AR Lab Network from January 2018 through August 2019. Methods: CRE isolates were submitted to 55 PHLs, including those of all 50 states, 4 large cities, and Puerto Rico, in accordance with each jurisdiction’s reporting laws. PHLs performed phenotypic and molecular testing on isolates to detect targeted, emerging carbapenemase genes and reported results to submitters. Carbapenemase-positive (CP) isolates were defined as PCR positive for ≥1 carbapenemase gene tested: blaKPC, blaNDM, blaVIM, blaIMP, blaOXA-48–LIKE. PHLs submitted results to CDC monthly. Genera other than Enterobacter, Klebsiella, and Escherichia coli are categorized as other genera in this analysis. Data were compiled and analyzed using SAS v 9.4 software. Results: From January 2018 to August 2019, the AR Lab Network tested 25,705 CRE isolates; 8,864 of 25,705 CRE (34%) were CP. Klebsiella spp represented the largest proportion of CP-CRE at 68% (n = 6,063), followed by E. coli (12%, n = 1,052), Enterobacter spp (11%, n = 981), and other genera (9%, n = 768). Figure 1a shows the composition of CP-CRE carbapenemase genes by genus. The most common carbapenemase and genus profiles were blaKPC in Klebsiella (74%; 5,562 of 7,561 blaKPC-positive) blaNDM in E. coli (43%; 372 of 868 blaNDM-positive) blaVIM in Enterobacter spp (35%; 25 of 72 blaVIM-positive), and blaIMP among other genera (90%; 92 of 102 blaIMP-positive). Common CP-CRE genes and genera also varied by geography (Fig. 1b). Conclusions: The AR Lab Network has greatly enhanced our nation’s ability to detect and characterize CP-CRE. Our data provide a snapshot of the organisms and regions where mobile carbapenemase genes are most often detected in CRE. Geographic variation in CP gene profiles provides actionable data to inform local priorities for detection and infection control and provide clinicians with situational awareness of the genes and organisms that are circulating in their region.Funding: NoneDisclosures: In this presentation, the authors discuss the drug combination aztreonam-avibactam and acknowledge that this drug combination is not currently FDA-approved.
Catheter-Associated Symptomatic Urinary Tract Infections in Nursing Homes—National Healthcare Safety Network, 2013–2018
Authors: Mungai Elisabeth , Edwards Jonathan , Eure Taniece , Anttila Angela , Rowe Theresa , Stone Nimalie , Bell Jeneita 
Published: November 2020

Background: Catheter-associated symptomatic urinary tract infections (CA-SUTIs) are a common adverse healthcare event in nursing homes and have been the focus of multiple prevention strategies.1 In 2012, the CDC launched the NHSN Long-Term Care Facility (LTCF) Component, which nursing homes, the CDC, and prevention collaborators can use to monitor nursing home CA-SUTI incidence and prevention progress.2 The objective of this analysis was to compare CA-SUTI rates and reporting patterns of nursing homes between 2013–2015 and 2016–2018. Methods: We analyzed CA-SUTI data from nursing homes reporting to the NHSN during 2013–2018. Consistent reporters submitted ≥6 months of complete data in any calendar year during the period. To potentially confirm patterns in CA-SUTI rates, we defined “consecutive” reporters, as nursing homes that submitted data for ≥6 months each year during 2013–2018. CA-SUTI incidence rates were calculated as the number of CA-SUTI events divided by the number of catheter days multiplied by 1,000. Likelihood ratio tests using negative binomial regression were used to compare CA-SUTI rates from 2016–2018 and 2013–2015 among both consistent and consecutive reporters. Results: During 2013–2018, the number of nursing homes submitting at least 1 month of CA-SUTI data to NHSN increased from 60 to 120 (Fig. 1). Among these nursing homes, 194 (88%) were consistent reporters. The pooled CA-SUTI rate of 1.77 per 1,000 catheter days in 2016–2018 was significantly lower than the pooled CA-SUTI rate of 2.45 per 1,000 catheter days in 2013–2015 among consistent reporters by ~24% (Table 1). Also, 50 consecutive reporters submitted CA-SUTI data during 2013–2018. Among these consecutive reporters, the pooled CA-SUTI rate of 2.11 per 1,000 catheter days in 2016–2018 was significantly lower than the rate of 2.53 per 1,000 catheter days in 2013–2015 by ~21% (Table 1). Conclusions: This analysis suggests that nursing homes using NHSN for CA-SUTI surveillance have made progress in prevention efforts. During 2013–2018, evidence showed that CA-SUTI incidence rates declined among consistent reporters between the 2 reporting periods. This decrease was verified among consecutive reporters. Additional study is needed to determine which factors account for varying reporting patterns and differential CA-SUTI incidence.Funding: NoneDisclosures: None
CAUTIs in Patients With Thoracic Epidurals
Authors: Seidelman Jessica , Lewis Sarah , Smith Becky 
Published: November 2020

Background: The Surgical Care Improvement Project 9 (SCIP 9) mandates the removal of urinary catheters within 48 hours following surgery to reduce the risk of catheter-associated urinary tract infections (CAUTIs). Although patients with thoracic epidurals are not exempt from SCIP 9, these patients may be inherently different from other surgical patients. Early removal of Foley catheters may cause urinary retention and recatheterization, which in turn can lead to CAUTI or urethral trauma. Our hospital’s current policy is to allow Foley catheters to remain in place until the thoracic epidural is removed. The goal of our study was to identify and compare the rate of CAUTI in patients with thoracic epidural catheters to the rate of CAUTI in patients without thoracic epidural catheters Methods: We performed a retrospective cohort study of patients with and without thoracic epidurals who had Foley catheters during hospitalization from July 1, 2017, to May 31, 2019. We used descriptive statistics to compare CAUTI rates based on unit between the 2 groups of patients. Results: We identified 1,834 unique patients with thoracic epidurals and urinary catheters during the study period. We found 4 CAUTIs of 9,896 catheter days (0.4 CAUTIs per 1,000 catheter days) in patients with epidural catheters and 43 CAUTIs of 36,809 catheter days (1.17 CAUTI per 1,000 catheter days) in patients without thoracic epidurals for a rate ratio of 0.346 (95% CI, 0.1242– 0.9639; P < .03). We conducted a sensitivity analysis on a subset of patients admitted under the cardiothoracic service and compared the patients with Foley catheters with and without thoracic epidurals. In this subset, we found 1 CAUTI in 5,890 catheter days (0.17 CAUTI per 1,000 catheter days) in patients with thoracic epidurals and 4 CAUTIs in 9,429 catheter days (0.42 CAUTIs per 1,000 catheter days) in patients without thoracic epidurals), for a rate of 0.4002 (95% CI, 0.0447–3.5808; P < .39). In this subgroup, 7.0% of patients with thoracic epidurals required a second Foley catheter compared to 16.9% of patients without thoracic epidurals who required a second Foley catheter (P < .01). Conclusions: Although patients with thoracic epidurals maintain Foley catheters beyond 48 hours, the CAUTI rate in these patients is lower than in patients without thoracic epidurals. Therefore, removing Foley catheters within 48 hours of surgery in patients with thoracic epidurals may not reduce the risk of CAUTI and, in fact, could be harmful. Further evaluation of confounding variables is warranted.Funding: NoneDisclosures: None
Challenges in Identification of Candida auris in Hospital Laboratories: Comparison Between HIC and LMIC
Authors: Sengupta Sharmila , Marimuthu Kalisvar , Stewardson Andrew , Harbarth Stephan , Durante Amanda , Singh Sanjeev 
Published: November 2020

Background:Candida auris is an emerging nosocomial fungal pathogen causing invasive illness and outbreaks worldwide. A major issue regarding C. auris is that it can be misidentified unless appropriate technology is used. We conducted a survey of available methods for identification of C. auris in 21 hospital laboratories in India regarding their protocols for prevention of C. auris infection. Methods: The survey was an adaptation of a similar survey conducted for the Connecticut Laboratory Response Network in 2017. We mailed the survey to 30 microbiologists and ID physicians, and 21 of them from 12 states responded. All respondents were from private acute-care and teaching hospitals. The responses were analyzed and compared to the Connecticut study. Results: Of 21 hospitals, 19 (90.5%) can identify C. auris in house. Also, 18 (85.7%) have identified C. auris in the past 18 months. Species level identification was done only for blood cultures in all hospitals. Only 5 (26%) laboratories speciated Candida spp isolated from other sites such as respiratory and urinary specimens. Automated systems were used like Vitek 2 in 16 (84.2%), Phoenix BD in 2(10.5%) and Microscan in 1(5.26%) laboratory. MALDI-TOF MS and PCR for identification were used in 2 laboratories. Antifungal susceptibility testing is done in-house in 19 (90.5%) laboratories. Only 10 (52.6%) responding hospitals from India had infection prevention protocols for C. auris, and 9 (47.4%) of them isolated patients. The major challenges for infection prevention with C. auris are absence of screening in high-risk patients (66.7%), misidentification by automated systems (84.2%), and inability to speciate from nonsterile sites underestimates the prevalence (100%). Conclusions: There is an urgent need to enhance the capacity of hospital laboratories to detect C. auris early, and to implement infection prevention measures. In both studies early detection is the key and as suggested by the US authors, challenges can be overcome through collaboration between hospitals and referral laboratories when resources are limited. This optimizes laboratory capacity and prevents global spread through colonized patients. The limitation of this study is that data from public hospitals are unknown and larger studies are needed.Funding: NoneDisclosures: None
Changes in the Prevalence of Methicillin Resistance Among Healthcare-Associated Staphylococcus aureus Infections, 2009–2018
Authors: Weiner-Lastinger Lindsey M. , Soe Minn M. , Edwards Jonathan R. , Dudeck Margaret A. 
Published: November 2020

Background:Staphylococcus aureus has long been an important cause of healthcare-associated infections (HAIs) and remains the second most common HAI pathogen in the United States. Often resistant to several antibiotics, S. aureus infections are difficult to treat and can leave patients at risk for serious complications such as pneumonia and sepsis. HAI pathogens and their antimicrobial susceptibility testing (AST) results have been reported to NHSN since its inception in 2005. Previous NHSN surveillance reports have presented national annual benchmarks for antimicrobial resistance phenotypes, such as methicillin-resistant S. aureus (MRSA). Whether there have been any significant changes over time in the prevalence of methicillin resistance among S. aureus infections reported to NHSN has not been previously assessed. Methods:S. aureus AST data from central-line–associated bloodstream infections, catheter-associated urinary tract infections, and inpatient surgical site infections reported from acute-care hospitals between 2009 and 2018 were analyzed. S. aureus was defined as MRSA if it was reported as resistant to oxacillin, cefoxitin, or methicillin. A national percentage resistant (%R) was calculated for each year as the number of resistant pathogens divided by the number of pathogens tested for susceptibility multiplied by 100. A generalized linear mixed model with logistic function was created to evaluate annual changes in the percentage resistant. Several patient-level and hospital-level characteristics were assessed as potential covariates. To account for differential baseline %R values between individual hospitals, specification of random intercept and slope were used during model creation. Differences in the trend of %R between HAI types were assessed using interaction terms. Data were analyzed using SAS v 9.3 software, and P < .05 was considered significant. Results: Overall, 3,317 hospitals reported at least 1 S. aureus pathogen tested for susceptibility between 2009 and 2018. The national unadjusted %R decreased from 49.2% (2009) to 41.2% (2018), with similar decreases seen in each HAI type (Table 1). After adjusting for significant covariates, a statistically significant annual 3% decrease in the prevalence of resistance was observed (Fig. 1). Significant differences between HAI types did not exist. Conclusions: The percentage of healthcare-associated S. aureus resistant to oxacillin, cefoxitin, or methicillin has declined consistently over the past 10 years. Continued efforts in infection prevention and antimicrobial stewardship are vital to sustaining this decline.Funding: NoneDisclosures: None