bluuebunny/crossref_metadata_2025_split huggingface dataset:
1214. Microbiological and Clinical Effectiveness of Pulsed-Xenon Ultraviolet Disinfection of the Patient Room in the ICU
Authors: Morikane Keita , Suzuki Shoko , Yoshioka Jun , Yakuwa Jun , Nakane Masaki 
Published: October 2019

Abstract

Background
Contact precautions do not necessarily control transmission of MDROs as other route of transmission such as patient environment may be significant. No-touch environmental disinfection has been highlighted in the past several years to control transmission of MDROs. The effectiveness of portable Pulsed Xenon Ultraviolet (PX-UV) device has been examined and demonstrated in US healthcare settings. However, its effectiveness outside the US healthcare setting is seldom reported.

Methods
This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. The ICU has six rooms and beds. In the baseline period (August 2016 to January 2018), all rooms were manually cleaned after every patient transfer/discharge. In the intervention period (February 2018 to February 2019), PX-UV disinfection was added after the manual cleaning. In both periods, all patients were screened for MRSA and two drug-resistant Acinetobacter baumannii (2DRA) to detect acquisition of those pathogens in the ICU. For microbiological evaluation, surfaces were selected for sampling by contact plates before/after manual cleaning and after PX-UV. After overnight incubation, colonies on the plates were counted.

Results
The incidence of newly acquired MRSA declined over time (1.40 per 1,000 patient-days in the baseline period to 0.95 in the intervention period, relative risk (RR): 0.68, 95% confidence interval (CI): 0.12–3.70). The incidence of newly acquired 2DRA further declined (4.91 to 1.90, RR: 0.39, 95% CI: 0.13–1.18). Notably, no new acquisition of 2DRA was observed since August 2018 for more than 7 months, not only in the ICU but also throughout the hospital. The total count of colonies in the sampling of 140 sites after 17 patient discharges were 3,540 (before manual cleaning), 669 (after manual cleaning, before PX-UV) and 261 (after PX-UV). The percent reduction of microbiological burden by manual cleaning was 81%, but a further 61% reduction was achieved by PX-UV.

Conclusion
PX-UV is effective in further reducing the microbial burden even after through manual cleaning, which presumably led to termination of transmission of 2DRA in our hospital. The effectiveness of PX-UV in controlling MDROs in the non-US healthcare settings is suggested.

Disclosures
All authors: No reported disclosures.
1223. Endoscopic Retrograde Cholangiopancreatography (ERCP)-Associated Carbapenem-resistant Enterobacteriaceae (CRE) Before and After Implementation of Ethylene Oxide (ETO) Sterilization of Duodenoscopes
Authors: Bonisa Kathleen , Neelakanta Anupama , Layell Jessica , Mclain Jessica , Lana Haecherl , Betts Wendy , Kester Shelley , Passaretti Catherine 
Published: October 2019

Abstract

Background
Reusable duodenoscopes utilized for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures are challenging to clean thoroughly. Outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) have been associated with the use of duodenoscopes even when no clear breaches in manufacturer-recommended manual cleaning and high-level disinfection have been found. We evaluate the impact of implementation of ethylene oxide (ETO) sterilization on rates of ERCP-associated CRE.

Methods
The charts of all patients who developed CRE colonization or infection between 2012 and 2018 in a large tertiary care teaching hospital were reviewed to determine whether the patient had an ERCP in the 90 days prior to the CRE culture date. Rates of CRE acquisition per 100 ERCPs performed were calculated and compared pre (ERCP performed January 2012 through February 2015) and post-implementation (ERCP performed March 2015 thru December 2018) of routine ETO sterilization of duodenoscope following high-level disinfection (HLD) with an automatic endoscope reprocessor (AER) rather than HLD alone.

Results
Between 2012 and 2018, 44 patients had first clinical culture with CRE within 90 days of ERCP (36% blood, 34% wound/surgical, 25% urinary and 7% respiratory sources). ETO sterilization of duodenoscopes following manufacturer recommended HLD was implemented March 2015. Rates of first CRE clinical culture within 90 days of ERCP decreased from 0.80 with HLD alone to 0.25 per 100 ERCP procedures with HLD plus ETO (unadjusted IRR 0.31 ETO vs. HLD alone, 95% CI 0.16–0.57, p-value < 0.001). This decrease occurred despite implementation of updated CLSI carbapenem breakpoints in July 2016. Figure 1 shows post ERCP CRE clinical culture trends over time

Conclusion
Implementation of ETO sterilization for duodenoscopes following HLD reduced our rates of post ERCP CRE in clinical cultures within 90 days of the procedure.

Disclosures
All authors: No reported disclosures.
1225. How Frequently Should Sink Drains Be Disinfected?
Authors: Ramos-Castaneda Jorge A , Faron Matthew L , Hyke Joshua , Buchan Blake W , Nanchal Rahul , Pintar Paula , Beth Graham Mary , Huerta Susan M , Bell-Key Dominique , Silvia Munoz-Price L 
Published: October 2019

Abstract

Background
New evidence shows the relevance of sink drains in the horizontal transmission of multidrug-resistant organisms. We recently demonstrated that a peroxide-based disinfectant (product B) was better than bleach at disinfecting sink drains; however, we did not determine the duration of this effect. In this study, we evaluate the duration of bacterial reduction in sink drains treated with product B and compared it to an enhanced hydrogen peroxide agent (product A).

Methods
Testing was performed in a 26-bed medical intensive care unit at a 566-bed tertiary care hospital in Milwaukee, WI. Two disinfectants were compared: product A (hydrogen peroxide, octanoic acid, and peroxyacetic acid; Virasept, Ecolab) and product B (hydrogen peroxide-based disinfectant; Peroxide Multi Surface Cleaner and Disinfectant, Ecolab). Sinks were randomly assigned to product A, product B, and control (no disinfection). On day 0, baseline cultures were obtained and disinfectant agents were applied. On post-intervention days 1, 3, 5, and, 7, samples from each drain were collected using E-swabs (Copan, Italy). Quantitation of Gram-negative burden was determined by serial dilution in saline plated to MacConkey agar and dilutions that contained 20–200 colonies were used for bacterial colony-forming units (CFU).
Multivariate multiple linear regression and analysis of variance were used to compare mean Ln(1+CFU) between groups using R v3.5.0. Environmental sampling, cultures, and statistical analyses were performed blinded to the disinfected used.

Results
All three groups had similar CFU counts at baseline (P > 0.05). On day 1, a statistically significant reduction in bacterial CFUs was observed in the group treated with product A compared with sinks treated with product B (P = 0.04) or the control group (P < 0.01). The same differences were observed on day 3 post-intervention. There were no significant reductions on days 5 and 7.

Conclusion
Product A was the most effective product at disinfecting sink drains but its effect disappeared at 5 days post-disinfection. These results suggest that treating sink drains every 5 days with a hydrogen peroxide mixture would be ideal for healthcare facilities dealing with sink drain contamination.

Disclosures
All authors: No reported disclosures.
1234. Mental Models of Surgical Site Infection Prevention Among Surgical Technicians and Nurses
Authors: Pop-Vicas Aurora E , Young Amanda , Knobloch Mary-Jo , Safdar Nasia 
Published: October 2019

Abstract

Background
Surgical site infections (SSI) are common and costly. Institutions have implemented complex prevention bundles to reduce SSI, but adherence remains challenging. Understanding clinicians’ mental models related to SSI prevention can help develop strategies to improve adherence.

Methods
We conducted focus groups with surgical clinicians at a tertiary care center. We used constructs from behavior change theories to analyze responses and identify relevant themes for SSI prevention.

Results
We had 19 participants (10 nurses, 9 surgical technicians) in 4 focus groups. We found the following SSI prevention challenges: (1) emphasis on rapid patient turnover, which impairs ability to complete all required infection control tasks; (2) OR crowding and traffic, with increased risk to sterile technique breaks; (3) poor compliance with OR attire, including wearing scrubs outside of the hospital; (4) inadequate OR cleaning between cases; (5) lack of emphasis on post-discharge wound care instructions. The following beliefs were commonly expressed: (1) belief that some SSI are inevitable, due to increased complexity and duration of surgical procedures in a referral center; (2) perceived lack of knowledge and training on OR sterile technique among medical and nursing students; (3) perceived incorrect techniques for applying skin preps among surgical residents, and, occasionally, attendings; (4) fear and hesitancy to bring up OR irregularities if individual involved is perceived as having a “difficult personality,” irrespective of social hierarchy; (5) feeling overwhelmed by too many requirements for SSI prevention, which frequently change; (6) belief that some policies originate from outside influences and are not relevant to frontline clinicians; (7) frustration to receiving SSI performance feedback that is not individualized and lacks actionable items; (8) feeling “blamed” for having SSI without knowing “how to fix it”; (9) belief that training rigor and dedication to patient care have decreased over time, and are lax among younger generations. Representative quotes categorized according to behavior change constructs are shown in Table 1.

Conclusion
Addressing clinicians’ perceptions of SSI prevention may help improve adherence to the process and reduce SSI incidence.

Disclosures
All authors: No reported disclosures.
1254. Association of Structural Stigma Due to Sexual Orientation and HIV Diagnosis/PrEP Use in the United States: An Ecological Analysis
Authors: Tran Nguyen K , Goldstein Neal 
Published: October 2019

Abstract

Background
Structural stigma has the potential to reduce engagement in HIV prevention and care, particularly for sexual and gender minorities (SGM) who account for the highest proportion of new HIV diagnosis in the United States. We considered if structural stigma related to sexual orientation, that is the social/cultural norms and institutional policies/practices that constrain the lives of the stigmatized, is associated with state-level HIV diagnosis and use of pre-exposure prophylaxis (PrEP).

Methods
We used a composite measure of structural stigma that was previously developed; components included proportion of same-sex couples, gay-straight alliances in public schools, policies related to discrimination of sexual orientation, and public perception toward homosexuality. Proportion of HIV diagnosis from 2008 to 2017 and PrEP use from 2012 to 2017 per 100,000 population were extracted from AIDSVu. To account for overdispersion and the hierarchical structure of our data, we used a Poisson model with robust standard errors using generalized estimating equations.

Results
States with higher (vs. lower) levels of structural stigma related to sexual orientation had lower rates of HIV diagnosis (β = −0.550; 95% CI: −0.628, −0.472) and PrEP use (β = −0.165; 95% CI: −0.203, −0.119), after adjusting for state-level covariates such as median age, percentage black race, and legislative majority party in 2013.

Conclusion
State-level stigma has been shown to reduce SGM visibility, therefore, restricting access to prevention services. These findings suggest that states with higher levels of structural stigma toward same-sex sexuality may also have lower rates of engagement in HIV prevention services.

Disclosures
All authors: No reported disclosures.
1256. Contemporary Evaluation of Racial/Ethnic Disparities in Survival and Disease Progression among People with HIV in the US Midwest
Authors: Khazanchi Rohan , Sayles Harlan R , Bares Sara H , Swindells Susan , Marcelin Jasmine R , Marcelin Jasmine R 
Published: October 2019

Abstract

Background
Combating HIV-related disparities is a major goal of the 2020 National HIV/AIDS Strategy. However, research on HIV disparities has primarily been conducted in urban settings. A 1997–2007 study of people with HIV (PWH) at our clinic noted significantly increased mortality among high-risk non-Hispanic (NH) Black PWH (73%) compared with NH Whites (88%). This study evaluated demographic disparities in survival and disease progression in a large Midwest clinical cohort.

Methods
We retrospectively reviewed records of 1,396 PWH receiving treatment at an HIV Clinic in Omaha, Nebraska from 2012 through 2017. We included patients over 19 years old with diagnosed HIV, a minimum of two visits, and no lapse in care >2 years. Patients were stratified into low-risk (CD4 >100 cells/mm3 and HIV viral load <250,000 copies/mL) and high-risk (all others) groups. Cox proportional hazard models and Kaplan–Meier curves with log-rank tests compared patient demographics and mortality. Generalized estimating equations modeled change in CD4 count over time.

Results
No significant difference in mortality was noted across race/ethnicity categories (P = 0.286). Several clinical and demographic characteristics, including CD4 counts <500 cells/mm3, were significantly associated with increased mortality (Figure 1). Compared with NH Whites, mean CD4 counts (Figure 2) were significantly lower for NH Blacks (P = 0.001), Hispanics (P = 0.006), and Others (P = 0.013). High-risk status was associated with mortality (P < 0.001), but no significant differences in mortality were noted across race/ethnicity categories after stratifying for patient risk status (Figures 3 and 4).

Conclusion
Significant racial/ethnic disparities in HIV disease progression among PWH at a Midwest HIV Clinic persist. However, in contrast to the 1997–2007 study, disparities in survival were not observed among high-risk PWH. As our patient demographics are essentially the same, the reduction of this disparity suggests needed investigation of whether these changes are the result of better antiretroviral efficacy or if social determinants of health in the region have improved. Systems-level interventions are needed to ensure all PWH benefit from continuing advances in HIV research and care.

Disclosures
All authors: No reported disclosures.
1268. Clinic Screening for Adverse Childhood Experiences among Persons with HIV: A Pilot Project
Authors: Anand Priyanka , Carter Bryce , Bronstein Abby , Schwartz Alexis , Harrington Brittney , Wilson Jennifer , Metzger David , Short William R , Torgersen Jessie 
Published: October 2019

Abstract

Background
Childhood trauma has long-lasting implications for adult health as prior work in the general population linked ≥4 adverse childhood experiences (ACEs) to multiple negative health outcomes in adulthood. History of childhood trauma is prevalent in people living with HIV (PLWH); however, screening for history of childhood trauma is not routinely performed in HIV clinical care.

Methods
We conducted a single-center, cross-sectional quality improvement pilot project to (1) define the prevalence of ACEs in PLWH engaged in care and (2) improve linkage with mental health resources. We hypothesized the prevalence of ≥4 ACEs in PLWH would be >21%, the prevalence previously reported in the local, general population. Patients were approached in the course of routine clinical care at an urban, academic HIV outpatient clinic between October 2018 and April 2019 and offered screening for ACEs, depression, and post-traumatic stress disorder (PTSD) using previously validated tools.

Results
Forty-nine patients completed the screening. Median age was 48 years [IQR: 37–55]; 69% were male and 53% were gay or bisexual. Most patients identified as black/African American (75%) and white (12%). Median ACEs score was 4 [IQR 1–6], with 51% (95% CI: 36–66%) reporting ≥4 ACEs (Figure 1), and most common ACE being guardian substance abuse (57%) (Figure 2). When compared with men, women had a higher median ACEs score (5 vs. 3, P = 0.04), history of childhood sexual abuse (67% vs. 26%, P <0.001), parent incarceration (53% vs. 24%, P = 0.04), and parental divorce or separation (73% vs. 41%, P = 0.04). Patients with ≥4 ACEs were more likely to have positive PTSD screens (56% vs. 21%, P = 0.02), moderate depression or greater (37% vs. 11%, P = 0.002), and were more likely to accept on-site mental health referral after screening (36% vs. 8%, P = 0.04). Acceptability of screening was deemed “very good” by patients, with median acceptability score 5 [IQR: 4–5] on a 5-point scale.

Conclusion
Over half of HIV+ patients screened in our clinic reported ≥4 ACEs, more than twice the prevalence of the general population. ACEs screening facilitated linkage of patients with high ACEs scores to mental healthcare. These results highlight the potential value of routine ACEs screening to enhance delivery of trauma-informed HIV primary care.

Disclosures
All authors: No reported disclosures.
1271. Pre-Exposure Prophylaxis (PrEP) Awareness and Uptake Between Men Who Have Sex with Men and Men Who Have Sex with Men and Women
Authors: Tao Jun , Montgomery Madeline , Sosnowy Collette , Nunez Hector R , Sowemimo-Coker Genoviva , Chu Christina , Nunn Amy , Chan Philip , Chan Philip 
Published: October 2019

Abstract

Background
Men who have sex with men are disproportionately impacted by HIV in the United States and may benefit most from pre-exposure prophylaxis (PrEP). However, differences may exist between men who only have sex with men (MSM) and men who have sex with both men and women (MSMW). MSMW may experience more barriers to accessing PrEP and may act as a potential bridge population for transmitting HIV to female sex partners. Differences in PrEP awareness and use between MSM and MSMW are unknown.

Methods
We evaluated all MSM and MSMW presenting to the Rhode Island Sexually Transmitted Diseases (STD) clinic and PrEP clinic from 2013–2017. Demographics and behavioral information were reviewed. Bivariate analyses were performed to present distributions of demographic and behavioral characteristics by sexual behavior. Logistic regression was conducted to explore associations between PrEP awareness/use and sexual behavior. Confounding variables were identified using the directed acyclic graphs (DAGs) and a priori.

Results
Of 1,795 male individuals, 84% (1,504) were MSM, and 16% (291) were MSMW. The median age of our study population was 29 (interquartile range [IQR]: 23–42). When compared with MSM, MSMW were more likely to be non-White (33% vs. 28%), uninsured (54% vs.46%), self-report more sexual partners in the past 12 months (median 6 [IQR: 3–9]: vs. 4 [IQR:2–10]), use intranasal cocaine (21% vs. 12%), and engage in selling (6% vs. 2%) or buying sex (12% vs. 4%, all P < 0.05). MSMW were also less likely to have a previous HIV test (77% vs. 89%) compared with MSM. MSMW were 59% (adjusted odds ratio [aOR]: 041, 95% confidence interval [CI]: 0.31–0.55) less likely to be aware of PrEP and 17% (aOR: 0.83, 95% CI: 0.41–1.66) less likely to report ever using PrEP after adjusting for age, race/ethnicity, and self-reported HIV risk.

Conclusion
Despite engaging in higher risk behaviors, MSMW were significantly less likely to be aware of or use PrEP compared with MSM. Future PrEP interventions are needed to target this potentially high-risk bridge population.

Disclosures
All authors: No reported disclosures.
1273. Reasons for Disengagement in Care among Individuals Receiving Pre-Exposure Prophylaxis (PrEP) from a Sexual Health Clinic
Authors: Zucker Jason , Theodore Deborah , Carnevale Caroline , LaSota Elijah , Richards Paul , Gordon Peter , Cohall Alwyn , Sobieszczyk Magdalena 
Published: October 2019

Abstract

Background
Pre-exposure prophylaxis (PrEP) effectively reduces HIV acquisition, but its efficacy depends on continued engagement through periods of high and low risk. Persistence in HIV prevention care has been low in real-world settings. In our program, 32% of patients are lost to care after their first visit and only 35% of patients are retained at their planned third visit. Reasons for low persistence in care are poorly described.

Methods
We identified all MSM who started PrEP between July 2015 and June 2018 at a sexual health clinic in an urban academic medical center in New York and had not had a visit in ≥6 months. We called patients between July 2018 and January 2019; those who were English speaking were given the option to complete an online questionnaire about current PrEP status, reasons for disengagement, and social and behavioral determinants of health (SBDH).

Results
Up to 710 patients were eligible for the study; over 700 calls were made. 125 participants agreed to participate and 57 (46%) completed the questionnaire. 24 patients (42%) were still actively taking PrEP. The most common reasons for starting PrEP were fear of getting HIV (58%), high self-perceived HIV risk (28%), and recommendations from friends (26%). Among those no longer taking PrEP, the most common reasons for discontinuation were cost/insurance issues (32%), lower perceived HIV risk (18%), concern about long-term side effects (12%), and trouble attending every-3-month appointments (12%). For those stopping due to lower perceived risk, 40% were in a monogamous relationship, 60% were less sexually active, and 20% always used a condom or did not engage in receptive anal intercourse. 56% of patients had at least 1 major life event in the preceding 3 months, including loss of a job (25%), breakup with a partner (12%), illness or death of a family member (11%), or unstable housing (8%). 47% used drugs or alcohol before sex in the past month including 39% not on PrEP.

Conclusion
Reasons for engagement, disengagement, and re-engagement are highly variable at the individual level. Cost and insurance issues were common in spite if clinic resources available to cover the cost of visits and medications. Life trauma was common. Individualized interventions to address SBDH may be required to engage and retain individuals in HIV prevention care.

Disclosures
All authors: No reported disclosures.