bluuebunny/crossref_metadata_2025_split huggingface dataset:
1167. Dialysis-Related Bloodstream Infections: A Pre- and Post-ClearGuard HD Cap Conception Study
Authors: Li William , Otto Caitlin , Nakeshbandi Mohamed , Augenbraun Michael 
Published: October 2019

Abstract

Background
25% of patients on hemodialysis receive therapy via a tunneled dialysis catheter (TDC). Bacteremia is one of the most feared complications with an all-cause mortality rate of 12–25%, Medicare spending costs amounting nearly $600 million annually and average hospital length of stay of 12 days per episode. The ClearGuard HD chlorhexidine impregnated catheter (ClearGuard cap) has recently shown potential to significantly reduce rates of bacteremia.

Methods
Retrospective review of 150 patients receiving hemodialysis at a single outpatient center in Brooklyn, NY from January 1, 2015 to January 31, 2019. As of February 1, 2019, the ClearGuard cap was implemented for all patients. Poisson regression was used to estimate crude event rate for both pre- and post-intervention periods, with 95% Wald-based confidence intervals (CI). Follow-up for pre-intervention cases terminated at the date the intervention was introduced. A likelihood ratio test of difference in incidence pre vs. post-intervention was conducted. A Kaplan–Meier (K-M) plot of time from the first dialysis since January 2015 to first infection was constructed (pre-intervention cases only). Subsequent subgroup analyses distinguished TDC vs. other patients. The log-rank test was used to test differences between subgroups; Bonferroni corrections to P-values were applied to address the multiple testing problem.

Results
Median total tracking period (including post-infection follow-up) was 1.75 years (range 0.02–4.26) for pre-intervention cases; 0.19 years (range 0.08–0.21) for post-intervention cases. Event rate was estimated as 9.7 events per 100 person-years (95% CI 6.7, 14.1) for pre-intervention cases; zero (95% CI 0.0, infinity) for post-intervention cases (P = 0.318 for pre- vs. post-comparison) with a clear limitation being lack of power given recent implementation date. We found a statistically significant risk for infection in patients with TDC (P < 0.001).

Conclusion
In an underserved, poorly health literate, largely foreign-born, socioeconomically challenged population such as ours, we not only established a significant risk of bacteremia with TDC’s but preliminary post-ClearGuard cap conception data currently being followed is promising for a significant reduction in catheter-related bacteremia.

Disclosures
All authors: No reported disclosures.
1173. Expanding the MAGIC: Engagement of Frontline Nursing Staff in Device Stewardship
Authors: Linsenmeyer Katherine , Gupta Kalpana , Mosesso Suzanne , House Christine , Strymish Judith 
Published: October 2019

Abstract

Background
Nearly 40% of all peripherally inserted central catheter (PICC) placements may be inappropriate. Validated appropriateness criteria (Michigan Appropriateness Guide for Intravenous Catheters or MAGIC) were developed to improve patient safety and decrease adverse events from PICC line use. Recent studies have demonstrated the impact of MAGIC implementation with success but involve multimodal interventions that may not be sustainable. We evaluated the effect of a nursing-driven MAGIC-derived triage tool online utilization.

Methods
We conducted a quasi-experimental before and after study evaluating the effect of a MAGIC-derived triage tool including all patients for whom a PICC consult was ordered. The triage tool was implemented January 1, 2018 as part of the consult order and required providers to identify an indication for placement. All consults were reviewed by the IV Team Nurses who collaborated with ID providers when warranted. Providers were contacted if MAGIC criteria suggested alternate access was more appropriate and encouraged to either place a mid or peripheral line or to consider an oral medication. Rates of line utilization and line infections pre-intervention and post-intervention were compared.

Results
Overall, 242 consults for PICC lines were placed during the one year intervention period January 1, 2018 to December 31, 2018. Indications included: antibiotics (54%), TPN/chemo (21%) difficult access (17%), no response (8%). Thirty-five PICCs were averted directly related to the intervention. Appropriate indication of PICC placement with the tool was 88%. During this same time period, the line utilization ratio (lines/1,000 patient-days of care) decreased from a mean of 3.8 (range 3.3 to 4.2 for years 2015–2017) to 2.6, a 32% reduction (IIR 0.72; P < 0.05). Central line bloodstream infection rates (infections/1,000 line days of care) also decreased from a mean of 0.81 (range 0.56 to 1.18 for years 2015–2017) to 0.37, a 54% reduction (IIR 0.4; P = 0.10).

Conclusion
Even in a setting of low line infection and line utilization rates, further reductions in potential device harm can be achieved using point of care feedback tools. This intervention empowers nursing involvement in device stewardship, thus expanding the range of their involvement in stewardship activities.

Disclosures
All authors: No reported disclosures.
1177. A Spectrum of Infectious Complications in Continuous-Flow Ventricular Assist Devices: A Single-Center Longitudinal Cohort
Authors: Roberts Scott C , Rich Jonathan D , Pham Duc T , Harap Rebecca , Stosor Valentina 
Published: October 2019

Abstract

Background
Infections remain a frequent complication of patients (patients) with ventricular assist devices (VAD). We evaluated the epidemiology and outcomes of VAD infections at our center over a 10-year period.

Methods
We performed a retrospective cohort study of continuous-flow VAD recipients from July 2008-September 2018. VAD-specific and -related infections were characterized according to 2013 ISHLT definitions. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0.

Results
433 VADs were implanted into 375 patients. A total of 86 VAD infections occurred in 79 patients, with a mean incidence of 0.19 episodes/VAD and 0.20 episodes/pt. Patients with infections were predominantly male (73.3%) and Caucasian (54.6%), and had mean age of 52.7 years, nonischemic cardiomyopathy (58.1%), and VAD as bridge to transplant (53.5%, n = 46). Types of VAD included 43.0% axial (n = 37) and 57.0% centrifugal flow (n = 49). 78% of patients with infections were colonized with at least one multidrug-resistant organism (MDRO) such as MRSA (29%), VRE (73%), and ESBL (24%).
Notably, 15% of infections (n = 13) occurred within 60 d of VAD implantation, with mean time to onset 36 d (5–60 d) post-VAD. Early infections (<60d) involved driveline exit site (DLES) (n = 4), pocket (n = 3), and pump (n = 7) with 7 VAD-related blood stream infections (BSI), 6 infective endocarditis (IE), and 2 mediastinitis. Early infections involved Gram-positive (GP) bacteria (84.6%, n = 11), Gram-negatives (GN) (45.5%, n = 5), anaerobes (23.1%, n = 3), fungi (30.8%, n = 4), MDRO (61.5%, n = 8) and 32 pathogens (69.2%, n = 9). 85% of infections occurred late (n = 73) with mean time to onset 338 d (69–1215 d). In late infections (>60d), impacted sites included DLES (n = 38), pocket (n = 7), and pump (n = 40), with 42 BSI, 36 IE, and 2 mediastinitis. Pathogens were 68.5% GP (n = 50), 37.0% GN (n = 27), 2.7% anaerobes (n = 2), 2.7% fungi (n = 2), 17.8% MDRO (n = 13), and 26.0% polymicrobial (n = 19).

Conclusion
In this longitudinal retrospective cohort of patients supported with VADs, a majority of infections occurred >9 months post-implantation. GP pathogens predominated at all time-points. GN bacteria, including MDROs, anaerobes, and fungi are increasingly encountered. The vast majority of patients were colonized with ³1 MDRO during the course of VAD implantation.

Disclosures
All authors: No reported disclosures.
1181. Significant Reduction of Non-Ventilator Hospital-Acquired Pneumonia (HAP) with a Prevention Bundle and Clinical and Leadership Feedback in a Large Integrated Healthcare System
Authors: Naik Sejal , Lacerna Cristine , Kevorkova Yulia , Galin Jessica , Patey Donna , Block Lawrence , Parker Melanie , Betts Robin , Parodi Stephen , Witt David J 
Published: October 2019

Abstract

Background
Non-Ventilator Hospital-acquired Pneumonia (HAP) is a prevalent healthcare-associated infection with mortality of 21%. HAP prevention literature is scant. We developed a definition enabling accurate surveillance to support this effort and implemented a prevention bundle based on available literature and characteristics of our high-performing centers.

Methods
Kaiser Permanente Northern California is an integrated healthcare system providing care for 4.4 million patients at 21 medical centers. Discharge diagnoses of HAP cases were reviewed for accuracy and factors permitting programmatic confirmation. A natural language extraction program identified new and persisting imaging findings, providing specificity. No other surveillance factors added specificity. Surgery, altered mental status, sedation, albumin <3 g/dl and tube feedings were identified as predictive risks. Seven interventions became part of a new pneumonia prevention order set for automatically identified high-risk patients: aggressive mobilization, upright posture for meals, swallowing evaluation before feeding, sedation restriction, elevated head of bed, oral care and feeding tube care. The project was fully implemented in 2015.

Results
Results were reported by 1,000 admissions and by 100,000 members served, to address a rapidly growing population. HAP decreased from 5.92 to 1.79/1000 admissions and 24.57 to 6.49/100,000 members and HAP case mortality remained stable (18–19%) while overall HAP mortality decreased from 1.05 to 0.34/1000 admissions (4.37 to 1.24 /100,000 members) (Figure 1 and 2). Carbapenem, quinolone, aminoglycoside and vancomycin use all decreased significantly (Figure 3). Benzodiazepine use decreased from 10.4% of all inpatient-days in 2014 to 8.8% of inpatient-days in 2016.

Conclusion
HAP rates, mortality and broad-spectrum antibiotic use were all reduced significantly, despite the absence of clinical practice guidelines or strong supportive literature for guidance. Some interventions had limited support, but most augmented basic nursing care. None had risks of adverse consequences. This supports the need to examine practices to improve care despite absent literature and even more so supports a need to study these difficult nebulous areas of care.

Disclosures
All authors: No reported disclosures.
1182. Clinical Outcomes of Hospital-Associated Respiratory Virus Infections
Authors: Petrie Joshua G , Lauring Adam S , Kaye Keith S 
Published: October 2019

Abstract

Background
Influenza and respiratory syncytial virus (RSV) are recognized as important causes of hospital-acquired infection. Increased use of multiplex molecular diagnostic testing is shedding light on the incidence of other hospital-associated respiratory virus infections (HA-RVI). However, the incidence and clinical impact of HA-RVI are not well understood.

Methods
We identified hospitalized patients admitted between July 1, 2017 and June 30, 2018 who were clinically tested to diagnose respiratory virus infections. HA-RVI were defined as respiratory virus positivity beginning more than 48 hours after hospital admission. The clinical outcomes of HA-RVI were compared with respiratory virus infections that were not considered hospital-associated (non-HA-RVI).

Results
Respiratory virus testing was performed on 4,690 individuals during 5,942 inpatient encounters. At least 1 virus was identified in 1,871 (31%) encounters, and 229 (12%) were defined as HA-RVI (median hours from admission to positivity [IQR]: 154 [79, 308]). Among the patients with a respiratory virus infection, 56% were adults, 52% were male, 77% were non-Hispanic white, and the median Charlson score was 2 (IQR: 1, (4); HA-RVI patients were more likely to be male (59% vs. 51%, P = 0.01) and had higher median Charlson scores (3 vs. 2, P < 0.001). All 14 respiratory viruses in the diagnostic panel were positive for at least one HA-RVI (Figure 1), but rhino/enterovirus (99), influenza A (27), human metapneumovirus (22) and respiratory syncytial virus (20) were most common. Compared with non-HA-RVI patients, those with HA-RVI had longer post-infection lengths of stay (median: 9 vs. 4 days, P < 0.001) and were more likely to die during hospitalization (odds ratio [95% confidence interval]: 3.4 [2.0, 5.7]) (Table 1).

Conclusion
A substantial number of HA-RVI were identified during the 2017–2018 respiratory virus season, and they were associated with a striking number of severe outcomes. More in depth analyses are required to determine whether severe outcomes are a direct result of HA-RVI or whether HA-RVI are more common in critically ill patients and serve as a marker for severe morbidity. A broader understanding of HA-RVI transmission and prevention strategies is needed.

Disclosures
All authors: No reported disclosures.
1183. Effect of Chlorhexidine Bath on the Prevention of Ventilator-associated Pneumonia: A Meta-Analysis
Authors: Robles Mark Jay M 
Published: October 2019

Abstract

Background
Ventilator-associated pneumonia, defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation, represents one of the most important nosocomial infections in critically ill patients. Chlorhexidine, an antiseptic solution, is a safe and effective product with broad antiseptic activity. This meta-analysis would like to investigate if Chlorhexidine bathing significantly reduced the incidence of Ventilator-associated pneumonia.

Methods
We searched PubMed and Cochrane Central Register database to check for all published studies related to the reduction of VAP with the application of chlorhexidine bath vs. control. Various study designs such as randomized controlled trials, Before-and-After study were included in this meta-analysis.

Results
This meta-analysis analyzed eight studies. One hundred Thirty-nine (139) events developed in the chlorhexidine group over 33,030 patient-days which were significantly lower compared with 183 in the soap and water group over 35,213 patient-days. The overall incidence of Ventilator-associated Pneumonia (VAP) with the application of chlorhexidine was significantly reduced by 23% with a pooled Risk Ratio (RR) of 0.77 with 95% Confidence Interval (CI): 0.62–0.96; I2 = 52%. In the subgroup analysis, a more significant outcome was observed using Before-and-After study as the research design (pooled RR 0.63, 95% Confidence Interval (CI): 0.48–0.83, I2 = 31%). Daily chlorhexidine bath generated a more favorable outcome, compared with every other day application as evident on the pooled RR 0.78, 95% confidence interval (CI): 0.62–0.98, I2=59%

Conclusion
This meta-analysis clearly favors the use of daily chlorhexidine bath in the prevention of ventilator-associated pneumonia.

Disclosures
All authors: No reported disclosures.
1194. Gender Differences in Psychosocial Determinants of Hand Hygiene Among Doctors
Authors: Park Sunghee , Lee Eunjung , Yoon Park Se , Lee Eunyoung , Park Jung-wan , Nae Yu Shi , Kim Tark , Hyok Jeon Min , Ju Choo Eun , Hyong Kim Tae 
Published: October 2019

Abstract

Background
Hand hygiene (HH) is essential in the prevention of hospital-acquired infections. It is known that there are differences in the compliance of HH between men and women but the reason for this phenomenon is unclear.

Methods
A survey on HH was conducted in July 2018 among healthcare workers at four different referral hospitals in South Korea. The differences between male and female doctors were then analyzed. The survey included a structured questionnaire with seven parts: (1) self-assessment of HH execution rate, knowledge, attitude, and behavior regarding HH, (2) internal motivation for better HH, (3) obstacles for HH, (4) emotional motivation, (5) the need for external supervision, (6) preference for alcohol gel, and (7) embarrassment due to supervision.

Results
Of the 1046 healthcare workers that replied to the survey, 201 (19.2%) were doctors, and of these, 129 (63.5%) were men. There was no significant difference between male and female doctors on the questionnaire related to knowledge, attitude, and behavior regarding HH. On the questions regarding internal motivation for better HH, male doctors had a higher tendency to agree that “I would be better at HH if it was related to getting a promotion,” but the results were statistically insignificant (5.08 vs. 4.69, P = 0.08). For the 14 questions about the obstacles for HH, the following five categories showed significantly higher results in men: (1) HH is difficult in emergency situations (4.87 vs. 4.51, P = 0.02), (2) time that could be spent on something more important is wasted on HH (3.12 vs. 2.67, P = 0.008), (3) HH is not a habit (3.26 vs. 2.58, P = 0.002), (4) I often forget about HH situations (3.60 vs. 2.89, P = 0.002), and (5) I do not perform HH because there is no disadvantage when I do not perform it (3.06 vs. 2.42, P = 0.008). In the category “HH causes pain and dryness of hands,” female doctors had a significantly higher tendency to agree (3.62 vs. 4.32, P = 0.003). Among the questions regarding emotional motivation, women had a higher tendency to agree that “Seeing a fellow employee perform bad HH angers me,” but there was no statistical significance (3.73 vs. 4.10, P = 0.07).

Conclusion
There was a significant difference between male and female doctors regarding obstacles for HH. A campaign for HH based on these results could be helpful for increasing HH compliance.

Disclosures
All authors: No reported disclosures.
1197. The Gloves Are Off: The State of Personal Protective Equipment (PPE) Use in Contact, Droplet, and Standard Precautions at a Major Teaching Hospital
Authors: Krishna Sneha , Ben-Aderet Michael , Cuzzolina Jennifer , Fanelli Isabel , Fawcett Sharon E , Garland Jennifer , Madhusudhan Meghan , Grein Jonathan 
Published: October 2019

Abstract

Background
PPE (gowns, gloves and masks) is used in standard precautions (SP) as well as for contact, droplet or airborne isolation. Improper PPE use can lead to self-contamination and transmission of infectious agents, and at our institution the quality of PPE use has not been well assessed. For quality improvement purposes, we conducted an evaluation of healthcare worker (HCW) PPE use and knowledge of SP.

Methods
Two phases, direct observations and a survey, were completed between December 2018 and February 2019 in inpatient areas.
Direct observations of PPE use were done by Infection Prevention nurses (IPs) in contact and droplet isolation rooms during daytime hours using an internally developed observation tool (Figure 1). Observations focused on 3 stages of PPE use: donning, in room clean/dirty activities and doffing. A survey consisting of 15 questions was developed to assess staff knowledge of SP in specific clinical scenarios, perceptions of current practices and barriers to use. The survey was distributed by IPs to HCWs during their regular rounds. Data were recorded and tabulated using RedCap electronic survey tool.

Results
106 observations and 107 surveys were completed. Observations showed appropriate PPE worn in 84% (n = 83) and hand hygiene (HH) post doffing in 95% (n = 79). Common gaps included no HH pre-donning [33% n = 43], PPE not changed between dirty and clean tasks (29% n = 2), incorrect mask removal (20% n = 16) and doffing gloves post-gowns [19% n = 69]. In the survey, answers to SP questions suggest PPE is overused in patients with diarrhea or respiratory illness but underused in draining wound management (Figure 2). HCW felt more compliant than their colleagues in both HH and PPE (Figure 3). The largest misperception was that gowns should be doffed pre-gloves (40% n = 40). Reasons for not using PPE included time (26%, n = 27), and perception that PPE is unnecessary (16%, n = 10). 75% (n = 80) of HCW felt adequately educated about PPE.

Conclusion
At our institution, significant gaps still exist in HCW knowledge and use of PPE. Future QI work should focus on increasing HCW knowledge of standard precautions, HH pre-donning, changing PPE when appropriate in room as well as proper doffing order. The perception that HCW felt adequately educated despite significant gaps may be a barrier.

Disclosures
All authors: No reported disclosures.
1206. #HitMeWithYourFluShot: Consolidating a 3-Week Influenza Vaccination Program into a One-Day Drill
Authors: Drees Marci , Meyer Erin , Durst Ed , Mase Tabe , Ratnayake Hiran , Wetherill Samuel , Sharif Russel , Wroten Kathleen 
Published: October 2019

Abstract

Background
Since 2011 our health system has achieved >90% employee influenza vaccination via a 3-week intensive nonmandatory program offering entrance location vaccinations. We partnered with Emergency Management to consolidate this process into 1 day, fulfilling a dual purpose of conducting an emergency vaccination drill.

Methods
The health system comprises 2 hospitals (913-bed and 250-bed) and campuses, multiple off-campus clinical and nonclinical sites, and a free-standing emergency department, employing nearly 12,000 people in 4 states. A multidisciplinary team planned the drill, scheduled 4 am-9 pm at 3 locations in the 2 hospitals. In addition, roving vaccination teams visited all off-campus sites to either perform vaccinations or deliver supplies. Employees not scheduled to work were encouraged but not required to come in; all eligible employees working that day were expected to be vaccinated. Nonemployees (including physicians, volunteers and retirees) were also included. To promote the event, we developed posters and other communications using a #HitMeWithYourFluShot hashtag, and included radio stations, therapy dogs, photo booths and other activities. After the event we surveyed participants to elicit feedback.

Results
During the 1-day event we vaccinated 7267 (69%) employees, along with 1594 nonemployees, similar to prior 3-week campaigns (figure). Nearly 300 employees volunteered to vaccinate or perform other duties. The roving teams visited 81 practices at 42 separate locations, traveling >250 miles. Of those completing the post-event survey (n = 656), 79% found the event very convenient, and 61% of those who had participated in prior campaigns found this format somewhat or much better. Employee vaccination rates for the entire season was 92%.

Conclusion
This effort demonstrated that we could achieve high levels of employee flu vaccination in a single day in a large and geographically diverse healthcare system, using a mass vaccination drill format that included multiple sites of vaccination as well as roving vaccination and transport teams. We identified the lack of a master list with locations of all off-campus employees as the greatest opportunity. Participants favorably accepted the drill format and employee engagement was high.

Disclosures
All authors: No reported disclosures.