bluuebunny/crossref_metadata_2025_split huggingface dataset:
780. Carbapenem-resistant Enterobacteriaceae (CRE) Contamination of In-room Sinks in a New Bed Tower
Authors: Warren Bobby G , Addison Bechtler S , Nelson Alicia , Barrett Aaron , Graves Amanda M , Lewis Sarah S , Smith Becky A , Anderson Deverick J 
Published: December 2021

Abstract

Background
Time from opening of a new bed tower to CREcontamination of patient room hospital sinks is poorly understood.

Methods
A 26-bed patient care unit in a new bed tower was opened on 7/18/2020. Patients admitted to this unit underwent weekly rectal cultures to survey for carbapenemase-producing (CP) CRE. Additionally, infection preventionists performed routine surveillance of all clinical cultures for CP-CRE. In-room sinks were located opposite the patient headwall in each patient room and were cultured monthly beginning 9/14/2020 for 3 months. Samples were obtained from the drain cover, handles, and top of bowl using sponges soaked in neutralizing buffer and processed using the stomacher technique. The tailpipe was sampled using a flocked mini-tip swab soaked in neutralizing buffer; the p-trap water was sampled with sterile tubing attached to a 50mL syringe. All samples were plated on HARDYCHROM-ESBL and KPC Colorex medias and incubated at 37°C for 24 hours. Carbapenem resistance genes (NDM1, KPC, IMP, VIM and OXA48) were detected by multiplex PCR and species were confirmed using MALDI-TOF. Environmental pathogens with intrinsic carbapenem resistance and no detected carbapenem-resistance genes were excluded.

Results
Generally, patients admitted to study rooms were similar across samplings (Table 1). No CP-CRE-positive patients were identified from weekly screening or clinical cultures from the opening of the unit through the end of the study. On the first sampling we discovered KPC-positive Enterobacter cloacae complex on a drain cover (1,400 CFU) and two environmental pathogens housing IMP or KPC genes. On the second sampling we discovered five environmental pathogens housing IMP or KPC genes. On the third sampling we discovered two environmental pathogens housing the IMP gene in p-traps (Figure 1).
Table 1. Patient Characteristics

Figure 1. Bacterial species and carbapenem-resistance genes found over time

Conclusion
In a new bed tower open for 58 days with no evidence of CRE positive patients, CRE and CRE genes were discovered in in-room sinks in clinically important (KPC) and environmental pathogens (KPC, IMP). We observed transient colonization of sink drains with potentially important pathogens during a short observation period. Observation over longer time is required to determine transient versus persistent colonization and risk factors for persistent drain colonization.

Disclosures
All Authors: No reported disclosures
781. Antiviral Effectiveness of Different Disinfectants on Surfaces Contaminated with Surrogate Non-enveloped Viruses
Authors: Gerges Bahgat , Rosenblatt Joel , Raad Issam I 
Published: December 2021

Abstract

Background
Contamination of surfaces with virions remains an important medical issues because they can serve as fomites for viral transmission. Long acting disinfectants are important because viruses can remain viable for extended durations. Here we assessed the anti-viral efficacy of various environmental spray disinfectants against F specific coliphage MS2, and Feline Calicivirus (FCV) as surrogate non-enveloped viruses.

Methods
MS2 was grown and titrated according to Environmental Protection Agency method 1601 and counted as plague forming unit per milliliter (PFU/mL.). Strain F9 of FCV was propagated and titrated in monolayers of Crandell-Reese Feline Kidney cells. Commercially available and an experimental disinfectant based on a biguanide combination were tested. The disinfectants, both wet and as dried residues, were compared on silicone surfaces for reduction of viral loads following 1-minute exposure to high viral load challenges (106-107 PFU/ml). Sterilized deionized water was used as a control.

Results
Results (as log10 reduction relative to sterilized deionized water control) are tabulated below for the disinfectants in wet and dry states following 1-minute viral challenges. Log10 reductions of MS2 and FCV viral loads following 1-minute exposures to disinfectants in wet and dry residue states.

Conclusion
The disinfectants were generally much less effective as dried residues than wet. The biguanide-combination and hydrogen peroxide-combination disinfectants were the most effective disinfectants tested in both wet and dry residue states. Both warrant further study for extended eradication of highly infectious viruses on surfaces.

Disclosures
All Authors: No reported disclosures
782. A Comparison of Four Different Sampling Methods Used to Recover Contamination from Environmental Surfaces
Authors: Thompson Sharon , Rutala William , Sickbert-Bennett Emily , DiBiase Lauren , Anderson Deverick J , Weber David J , Weber David J 
Published: December 2021

Abstract

Background
We hypothesized that sampling tools with the largest surface area would be the most efficient at recovering bacteria. To test this hypothesis, we evaluated four different sampling methods to see which was most effective at recovering bacteria from common environmental surfaces.

Methods
At UNC Medical Center, a 951 bed academic facility, we tested four collection methods: swabs, RODAC (replicate organism detection and counting) plates, Sponge Sticks with manual extraction and Sponge Sticks using extraction with the Seward Stomacher. Laminate and stainless steel surfaces (100 cm²) were used for testing. Known quantities of Staphylococcus aureus (SA) and Klebsiella pneumoniae (KP) were applied across the test surfaces, then allowed to dry prior to sampling. Swab samples were collected by rubbing a moistened swab over the test surface, followed by a dry swab. Both swab tips were broken into a tube of saline and mixed. An aliquot of each was inoculated to agar plates. Each RODAC agar plate was pressed onto a test surface. Sponge Stick samples were collected by rubbing a pre-moistened sponge over the test surface. Each sponge head was ejected into a bag containing saline. For manual agitation, each bag was kneaded by hand for 1 minute. For Stomacher method, bags were processed for 1 minute. The contents of each bag were poured into tubes, then centrifuged. The supernatant was removed from each tube. An aliquot of each was inoculated to agar plates. Plates were incubated at 35°C, then colonies were counted for each plate.

Results
Comparative recovery rates across surfaces, organism types and sampling methods are shown in the table.

Conclusion
Organism type, not sampling method, appeared to the most important factor in bacterial recovery. Recovery of SA was significantly higher than KP, likely because it was able to better withstand manipulation and the physical stress of drying on test surfaces. The sampling tool appeared to have the second largest impact. RODAC yielded the highest recovery, followed by swabs, then sponges. Knowing the variable recovery based on method, surface and organism is important for meaningful interpretation of environmental surveillance conducted during outbreak investigations or quality assurance monitoring.

Disclosures
William Rutala, MS, MPH, PhD, PDI (Professional Disposibles International) (Consultant) David J. Weber, MD, MPH, PDI (Consultant)
783. Impact of Universal Decolonization on Intensive Care Unit Bloodstream Infections
Authors: Dea Lauren , Kerkar Shubha , Mdluli Xolani , Vang Ger 
Published: December 2021

Abstract

Background
Interventions used to reduce the incidence of hospital-acquired infections (HAIs) include hand hygiene, isolation, and decolonization. The routine use of chlorhexidine gluconate (CHG) and nasal mupirocin ointment has been shown to be an effective universal decolonization option to reduce bacterial transmission and prevent HAIs. The objective of this study is to compare the pre- and post-intervention of universal decolonization among ICU patients at Desert Regional Medical Center, an acute care Level II trauma center.

Methods
The first part of this study is a retrospective chart review of all ICU patients from June 2020 to August 2020. The second part of this research is a prospective study from December 2020 to March 2021. The prospective study will include all patients admitted to the ICU who completed the decolonization regimen of mupirocin for 5 days and daily CHG baths. In the intervention phase, all ICUs patients will be decolonized with nasal mupirocin twice daily for 5 days and CHG baths daily for the entire ICU stay. The primary outcome is the number of ICU bloodstream infections (BSIs). Secondary outcomes include the number of ICU-related central line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator associated pneumonia (VAP). An infection attributed to ICU stay is defined as an infection onset occurring more than 48 hours after ICU admission. Fisher’s exact and chi square test was used for the statistical analysis.

Results
A total of 130 patients were included in this study. Universal decolonization resulted in a reduction in overall ICU infections in the baseline group vs intervention group using a p-value of 0.05 (ICU-BSI 5 vs 4, p=0.73; CLABSI 2 vs 1, p=0.56; CAUTI 4 vs 2, p=0.41; VAP 23 vs 17, p=0.25).

Conclusion
Patients in the intervention group had a lower incidence of ICU infections compared to the baseline group. These findings suggest that universal decolonization may be an effective strategy in reducing ICU incidence rates of BSI, CLABSI, CAUTI, and VAP. Further studies need to be conducted to validate this finding with a greater population enrolled to achieve adequate power.

Disclosures
All Authors: No reported disclosures
784. Efficiency of Quaternary Ammonium Disinfectants against SARS-CoV-2 and Coronavirus 229E
Authors: Gerba Charles P 
Published: December 2021

Abstract

Background
The recent pandemic of CoVid19 has increased our need to assess the impact of disinfectants on the inactivation of human coronaviruses. The goals of this study were 1) quantify the disinfection of SARS-CoV-2 and human coronavirus 229 inactivations by various quaternary ammonium formulations, and 2) demonstrate the impact of disinfectants on preventing fomite-to-finger transfer of coronaviruses.

Methods
We compared the inactivation of both SARS-Covid -2 and coronavirus 229E suspended in 5% fetal calf sera and dried on both metal and plastic surfaces. In addition, studies were conducted with a silinated quaternary ammonium compound that left a residual on the surface. Studies were also conducted on the finger transfer of coronavirus from various surfaces. The virus was allowed to dry on the surface for 30 minutes, then a transfer was conducted by placing the finger pad directly onto the contaminated surface. The finger was tested for the virus. The study was then repeated with virus-contaminated porcelain surfaces that were sprayed with a quaternary product or placed on a surface with a quaternary ammonium compound that left a residual.

Results
Several readily available quaternary ammonium formulations were evaluated and proved to be effective with greater than a 99.9% reduction in titer after drying on both metal and plastic surfaces. In addition, a silinated quaternary ammonium compound that left a residual on the surface was capable of inactivating SARS-CoV-2 for at least seven days after application. Studies on the finger transfer of coronavirus from various surfaces showed that the amount of virus transfer to the finger varied from 0.46 to 49.0% depending upon the surface. Little or no virus transfer occurred from treated surfaces compared to the untreated controls. In addition, coronavirus 229E appears to be a good model for use in disinfection assessments for SARS-CoV-2.

Conclusion
Our results demonstrate that various quaternary ammonium disinfectant formulations are effective against human coronaviruses. Finger transfer tests showed that transmission of coronavirus from surfaces can be prevented, reducing the risk of fomite transmission. Coronavirus 229E appears to be a good model for use in disinfection assessments for SARS-CoV-2.

Disclosures
Charles P. Gerba, Ph.D., Allied Biosciences (Grant/Research Support)Behr (Grant/Research Support)Corning Inc. (Grant/Research Support)PPG (Grant/Research Support)Procter and Gamble (Other Financial or Material Support, donation)Rickett and Coleman (Grant/Research Support)
788. Enterobacter cloacae Infection Characteristics and Outcomes in Military Personnel who Sustained Trauma in Iraq and Afghanistan
Authors: Bennett William N , Yabes Joseph , Mende Katrin , Beckius Miriam , Rahman Azizur , Tribble David 
Published: December 2021

Abstract

Background
Enterobacter cloacae is a Gram-negative rod with chromosomally-induced Amp-C β-lactamase with multidrug-resistant potential. Joint Trauma System guidelines for treating combat wounds include prophylaxis with cefazolin and ertapenem, potent inducers of Amp-C. We evaluated clinical characteristics, antibiotic utilization, and outcomes associated with battlefield-related E. cloacae infections.

Methods
All initial solitary (those with single isolates) and serial E. cloacae isolates (≥24 hours from initial isolate from any site) were collected from the Trauma Infectious Disease Outcomes Study (6/2009-12/2014). Inclusion required E. cloacae isolation from a clinical infection. Amp-C-inducing β-lactams were classified based on induction potential and lability to the Amp-C β-lactamase as Amp-C induction levels.

Results
Of 653 E. cloacae isolates, 253 met inclusion criteria – 64 patients had only initial isolates, 54 patients had serial isolates. Patients were largely male (99%), median age 23 years (IQR 21-27), with injury severity score of 34 (IQR 24-45). Initial isolates were wound (70%), respiratory (22%), blood (7%), urine (1%), and other (1%). Patients commonly had blast injuries (89%), required ICU admission (95%), and had a median hospital stay of 57 days (IQR 39-82). Patients with serial isolates showed a trend towards earlier clinical infection (5 vs 8 days, P = 0.07). They were also less likely to receive carbapenems prior to E. cloacae isolation compared to those with only initial isolates (4% vs 38%) and more likely to receive 1st generation cephalosporins (79% vs 58%, P = 0.01). The serial isolate group received more days of 1st generation cephalosporins (median 6 days vs 2.5 days, P = 0.01). Cumulative antimicrobial therapy trended towards significance and was greater with the serial isolates (median 100 days vs 74 days, P = 0.08). There was no difference in number of surgical interventions between those with and without serial isolates (P = 0.54). Overall, 6 patients died.

Conclusion
E. cloacae infections after battlefield trauma were frequently encountered and associated with exposure to 1st generation cephalosporins. Serial infections did not correlate to worse patient outcomes but displayed a trend towards an overall greater duration of antibiotic use.

Disclosures
William N. Bennett, V, MD, Abbvie (Shareholder)Amgen (Shareholder)Nabriva (Shareholder)
790. Evaluation of an Enhanced CPE Screening Program in an Acute Care Hospital in South Korea
Authors: Park Sun Hee , Yi Yunmi , Ji Seul Ki , Han Seung Beom , Shin Soyoung 
Published: December 2021

Abstract

Background
Carbapenemase-producing Enterobacteriaceae (CPE) poses a great challenge in infection control in healthcare settings. A screening and contact precautions are recommended to prevent the spread of CPE among patients. However, screening strategies differ among countries and healthcare facilities.

Methods
In September 2018, we launched a CPE screening program at a 660-bed hospital in South Korea, which targeted previously colonized patients, patients with history of admission &lt; 1 month or transferred patients or ICU-admitted patients. Once patients were identified to have CPE, they were isolated in a single room. After a CPE outbreak in July-Aug 2019, the enhanced screening program was implemented, which included patients with additional risk factors (exposure to hospitals in the past 6 months, receipt of hemodialysis or invasive procedures or rehabilitation) combined with weekly screening in ICU-admitted patients. Screening methods changed from two consecutive rectal screening swabs with chromogenic agar to initial screening with Xpert-Carba-R PCR, followed by one or two consecutive tests with chromogenic agar. We compared the CPE incidence in screening and clinical cultures before and after the enhanced screening program introduction (Sep 2018-Nov 2020).

Results
A total of 14,318 (2,178 vs. 12,140) were screened among 49,980 admitted patients and screening compliance increased from 18.6% to 94.5%. The number of CPE detection increased from 44 to 154 cases and the proportion of CPE-positive screening per 1000 admissions increased 0.6 to 2.2. However, the number of clinical CPE cultures decreased from 11 to 3 (Figure). Among screened patients, time-to-positivity was markedly reduced by 1.9 days (2.96 vs. 1.02 days) during the post-period. Additional 70 patients were detected: 36 due to serial screening in the ICUs and 34 due to enhanced on-admission screening. Factors significantly associated with positive screening were previous exposure to hospital (OR 3.5; 95% CI 1.7-7.1) and receipt of hemodialysis (OR 4.3; 95%CI 1.9-9.2). CPE isolates and carbapenemase genes were diverse (Figure). Trends in CPE detection in screening and clinical samples (upper), and bacterial species with detected carbapenemase genes (lower).

Conclusion
The study results showed that the enhanced screening program enabled us to identify the previously undetected CPE colonized patients and to decrease clinical CPE cultures.

Disclosures
All Authors: No reported disclosures
793. Rifabutin Use in Staphylococcal Prosthetic Material Infections: A Case Series
Authors: Monk Miranda , Elshaboury Ramy H , Nelson Sandra B , Bidell Monique R 
Published: December 2021

Abstract

Background
Bacterial biofilm formation is of clinical concern among patients with staphylococcal infections involving prosthetic material. While rifampin has in-vitro, animal and clinical data to support its adjunctive role in these types of infections, its potent induction of multiple cytochrome P450 enzymes and P-glycoprotein transport system proteins can pose significant drug-drug interactions. Rifabutin has comparable in-vitro anti-staphylococcal activity but less drug-drug interaction potential than rifampin. However, minimal clinical data exists to support rifabutin use as adjunctive treatment of prosthetic infections.

Methods
This case series describes 7 patients who received adjunctive rifabutin for staphylococcal prosthetic material infections between February 2018 and January 2021 at Massachusetts General Hospital. The primary outcome of infection recurrence was defined as need for surgical intervention for suspected or proven recurrence infection within 6 months after starting rifabutin therapy. Incidence of adverse effects was the main secondary outcome.

Results
Most patients (6/7) had methicillin-sensitive S. aureus (MSSA) and one patient had S. epidermidis infection. Three patients had spinal fusion hardware infection, one patient had hardware-associated spinal osteomyelitis/ diskitis with epidural abscess, two patients had prosthetic joint infection, and one patient had MSSA bacteremia with left ventricular assistance device involvement. All patients except one underwent surgical management prior to starting rifabutin. Infection recurrence was noted in one of seven patients who required surgical washout. Adverse events were uncommon (n=1 treatment-related nausea, n=1 leukopenia).

Conclusion
This small case series suggests favorable outcomes with use of rifabutin instead of rifampin for staphylococcal infections with prosthetic material involvement.

Disclosures
Sandra B. Nelson, MD, UpToDate (Other Financial or Material Support, author)
794. The Role of the Environment in Healthcare-associated Transmission of Vancomycin Resistant Enterococcus: A Proof of Concept Study
Authors: Linkneheld-Struk Amber L , Williams Victoria R , Mieusement Lorraine Maze Dit , Salt Natasha , Chan Adrienne , Leis Jerome A 
Published: December 2021

Abstract

Background
Transmission of Vancomycin Resistant Enterococcus (VRE) from environment to patient and patient to patient can both occur in healthcare settings. Due to the COVID-19 pandemic, a cohort of exposed patients on an inpatient unit with an extensive VRE outbreak needed to switch physical locations with a non-exposed patient population. By comparing outcomes of both cohorts, we aimed to determine the role of the physical environment (both direct and indirect contact) as compared to the patient population, in ongoing VRE transmission.

Methods
From 10 March to 21 April 2021, 41 new nosocomial acquisitions of VRE were detected as part of a VRE outbreak on a 34-bed acute care unit. Prior to the switch of units, extensive cleaning of the unit was conducted including electrostatic adjuncts to standard cleaning and environmental swabbing for VRE yielded no positive surfaces. The exposed cohort included 3 of 30 patients with VRE while the non-exposed cohort had 0 of 28 VRE positive patients based on prevalence testing on 21 April 2021. Following the physical relocation of both cohorts on 22 April, 2021, prospective VRE screening was performed on both units for one month including on admission, discharge and weekly prevalence screening. Hand hygiene compliance rates on both units was measured using group electronic monitoring.

Results
Figure 1 depicts the timeline and number of VRE cases before and after the unit switch. Following relocation of the VRE exposed cohort to the new unit, no further VRE transmission was detected (0/235 VRE screens; 0 VRE cases per 1000 patient days). Conversely, there were new VRE transmissions (3/99 VRE screens, 5 VRE cases per 1000 patient days) in the non-exposed cohort. When the units resumed their original location, one additional case of VRE was identified in the exposed cohort upon return to their original location. These transmissions occurred despite HH compliance of 94% (141,610/150,706) during the entire study period on the outbreak unit, which was consistently higher than on the non-outbreak unit (141,589/227,136, 62%).Figure 1.

Conclusion
The environmental reservoir for VRE may be more important in transmission than the patient reservoir. These findings underscore the importance of environmental cleaning to contain VRE outbreaks.

Disclosures
All Authors: No reported disclosures