bluuebunny/crossref_metadata_2025_split huggingface dataset:
1266. Multifaceted Infection Control Strategies to Control Multidrug-Resistant Acinetobacter baumanii in Adult Intensive Care Unit in a Tertiary Hospital in Eastern Region, Saudi Arabia
Authors: Gammal Ayman 
Published: November 2018

Abstract

Background
Multidrug-resistant Acinetobacter baumanii (MDR-AB) has emerged globally as a significant pathogen in hospitals. During 2010, our hospital experienced an increase of MDR-AB in Adult intensive care unit (ICU). Our adult ICU is consists of 10 acute care beds. The hospital is a tertiary institution located in Eastern region of Saudi Arabia. Multidisciplinary team was formed to implement and determine the effect of multifaceted strategies in controlling MDR-AB.

Methods
Active surveillance culture (ASC) was initiated to determine the prevalence rate of MDR-AB per 1,000 patient-days (PD). Using ASC, which was done during admission in ICU, after 48 hours of admission and every week for all patients if there is a positive MDR-AB case, acquisition rate of MDR-AB was calculated per 1,000 PD. Average daily colonization pressure was also monitored. In addition, a multifaceted infection control strategies were carried out. These include hand hygiene, contact isolation, cohorting of patients, Chlorhexidine bath, and environmental cleaning and disinfection. Compliance with hand hygiene was observed using direct observation method. We use the Fluorescent Gel Method for evaluating the thoroughness of disinfection and cleaning for environmental surfaces.

Results
Hand hygiene compliance of HCWs initially was 89%, in 2017 was increased to 98%. Daily Chlorhexidine bath was adopted for all patients in ICU. Initially, the compliance for thoroughness of disinfection and cleaning is 84.6% it was increased to 92% in 2013–2017. Prevalence rate of MDR-AB was 20.7/1,000 PD in 2010, it was decreased by 50% in 2011–2012. In 2017, declined to 0.9/1,000 PD. MDR-AB acquisition rate was 11.8/1,000 PD in 2010, it was decreased by 57% in 2011–2012. In 2017, dropped to 0.6/1,000 PD. Average daily colonization pressure was 0.21 in 2010. In 2011–2012, it was decreased by 31%. In 2017, it was reduced to 0.02. Death rate among MDR-AB patient in 2010 was 25.7%. It was decreased to 14% in 2011–2012. In 2017, an enormous drop to 0% was achieved.

Conclusion
Implementing these multifaceted strategies help in controlling MDR-AB in our hospital. The commitment and adherence of the HCW to all infection control strategies are essential in sustaining low prevalence rate and acquisition rate of MDR-AB.

Disclosures
All authors: No reported disclosures.
1267. Nonventilator Hospital Acquired Pneumonia (NV-HAP) Prevention Initiative in Colombia, Bogotá
Authors: Valderrama Sandra , Miranda Claudia Janneth Linares , Soto Maria Juliana , Mckinley Estefania , Morcillo Juan Pablo , Alarcon Juan Pablo , Gonzalez Angela Patricia , Gamba Leidy 
Published: November 2018

Abstract

Background
Pneumonia is the second most common healthcare-associated infection worldwide. Non ventilator – Hospital Acquired Pneumonia (NV-HAP) affects more people than VAP, has a comparable mortality rate (18.7% vs. 18.9%), and has higher total costs ($156 million vs. $86 million), respectively. The objective of this study was to describe the result of the implementation of a bundle of measures for the prevention of NV-HAP in adult patients in a University Hospital in Colombia.

Methods
Descriptive study. In a period of 2 years, a care bundle for prevention of NV-HAP was implemented in adult patients in a university hospital that consisted of: (1) identification of patients at risk (patients over 60 years of age, or with altered consciousness, or swallowing disorder, or patients with tracheostomy), (2) marking the patient with a sticker on the head of the bed, and (3) implementation of the following measures: head of the bed elevation to 30°–45°, oral care every 12 hours, chlorhexidine oral rinse decontamination every 12 hours and aspiration of secretions as needed. In the first 6 months, training was carried out for all staff, the monthly adherence to the strategy was measured.

Results
During 2016, 1,045 patients were included, with 10,011 observations, bundle adherence during the first year was 33%. in the second year, 1,400 patiens were included, with 13,198 observations, the bundle adherence increased to 90% throughout the hospital. The rate of NV-HAP decreased from 4.2 (96 cases) to 3.4 (89 cases) per 1,000 patient-days, in the second year compared with the previous intervention year.

Conclusion
The strategy of prevention of NV-HAP decreased the cases of nosocomial pneumonia in a university hospital, through the education a high adherence to the strategy was achieved. Studies with a better design should be done to confirm the findings.

Disclosures
All authors: No reported disclosures.
1272. A Routine, HIV and HCV Testing and Treatment Program in a Large, Multi-Campus Emergency Department Finds High Prevalence of Acute HIV and Chronic Hepatitis C
Authors: Anson Ryan , Hall Christopher , Ivans Erica , Vassily Kara , Shaieb Annette , Berrol Ronn , Potts Brian , Bures Erin 
Published: November 2018

Abstract

Background
One in seven people living with HIV in the United States are unaware of their serostatus. Approximately 11,280 annual HIV infections (30.2%) are caused by this subset of individuals (CDC, 2017). In addition, acute HCV infections have nearly tripled since 2011, with many states seeing a dramatic increase in incidence among younger people outside the birth cohort (CDC, 2017). Because many individuals still use emergency departments (EDs) for their healthcare needs, these institutions play an increasingly important role in screening patients for HIV and HCV and linking them to medical services. Routine, opt-out testing initiatives are particularly effective at identifying new cases of HIV and HCV that could have otherwise been missed by a risk-based approach to screening.

Methods
In early May 2017, physicians and advanced practice nurses from Sutter Health’s Alta Bates Summit Medical Center (ABSMC) and a nearby outpatient HIV clinic implemented a routine HIV and HCV screening program at the hospital’s large, two-campus ED system in Oakland, CA. ED medical directors created a Nursing Standardized Procedure (NSP) to allow registered nurses (RNs) to independently order both blood tests using an automated, best practice authority (BPA) screen in the electronic health record (EHR) of any patient who met CDC-defined age criteria for testing.

Results
Of the 6,315 people screened for HIV between May 1, 2017 and March 31, 2018, 43 (0.7%) patients tested positive. Twelve (57%) of the 21 patients found to have a new HIV diagnosis also had symptomatic, acute HIV infection (AHI). All 12 patients with AHI initiated anti-retroviral therapy (ART) within five to 96 hours of their preliminary positive test result. Of the 5,820 patients screened for HCV, 424 (7.3%) were anti-HCV positive, while 185 (3.2%) patients had chronic infection. Thirty-nine percent of chronic HCV cases were among younger patients born before 1965. All patients with HIV or chronic HCV were referred to medical care at East Bay Advanced Care (EBAC).

Conclusion
An automated, routine HIV-HCV testing program integrated into standard nursing workflow at a community ED resulted in the timely screening, diagnosis, and treatment of many patients with acute HIV, and identified a high prevalence of chronic HCV infections among younger patients.

Disclosures
R. Anson, Frontline of Communities in the United States (Gilead, Inc.): Grant Investigator, Grant recipient. C. Hall, Frontline of Communities in the United States (Gilead, Inc.): Grant Investigator, Grant recipient.
1277. Universal Screening Is Key: Identifying Gaps in Adolescent HIV Infection Diagnosis at Local Pediatric Health System When Compared With Regional Adult Hospital
Authors: Most Zachary , James Lorraine , Warraich Gohar , Costello Kathleen , Dietz Stephen , Evans Amanda 
Published: November 2018

Abstract

Background
Undiagnosed sexual partners with HIV infection may contribute to up to 30% of new infections annually. Routine HIV screening of high-risk populations has been shown to be effective and is recommended by the CDC. Despite this recommendation, many adolescents are not screened. The negative impact on the adolescent population from inadequate screening has not been fully quantified.

Methods
Through a retrospective chart review, the course prior to diagnosis of HIV-infected adolescents diagnosed at Children’s Medical Center Dallas (CMC) and Parkland Hospital (PH, the proximate adult county hospital with a universal HIV screening program) was reviewed. Subjects were included if they had a confirmed, positive HIV test between 13 and 21 years of age, and excluded if they had a previous HIV diagnosis. Inpatient, outpatient, and ED encounters at CMC and PH following the subjects’ 13th birthday and before their HIV diagnosis were quantified. Missed opportunity encounters (MOE) were defined as above encounters where there was no HIV screen performed that took place after the date 3 months following their most recent HIV screen. Data were collated by facility and compared.

Results
204 subjects met inclusion criteria: 140 (69%) male, 155 (76%) black, and 87 (43%) followed by CMC. There were 412 total encounters (2.02 per subject) out of which 284 (1.39 per subject) qualified as MOE. Seventy-two subjects had at least one MOE. At the CMC ED, there were 6.7 MOE for every new HIV adolescent diagnosis, compared with PH ED where there were 0.9 (P &lt; 0.01) (Figure 1). Adolescents identified through the PH ED were older (PH, 18.8 years vs. CMC, 16.1 years, P &lt; 0.01) (Figure 2), and had a trend toward a lower CD4 count (PH, 337 cells/m3 vs. CMC, 449 cells/m3, ns). Three adolescents were identified with AIDS (CD4 &lt;200) through HIV screening at PH, vs. 1 at the CMC ED.

Conclusion
Missed opportunity encounters for HIV screening of adolescents are greater in number in pediatric emergency departments without universal screening programs, when compared with similar adult settings with such a program. Implementing a universal HIV screening protocol at pediatric EDs in HIV endemic areas may help to identify HIV-positive adolescents at younger ages and improve long-term outcomes.

Disclosures
All authors: No reported disclosures.
1279. Prevalence of HIV Among the Youth Aged 15–24 in Nigeria: A Need to Increase Access for Young Adolescents to HIV Counseling and Testing
Authors: Ezenekwe Ezinne , Uduak Nevis Essien , Nnamani Catherine 
Published: November 2018

Abstract

Background
Nigeria with a population of over 173 million people, HIV/AIDS remains a growing public health issue. The people living with the virus are about 3.2 million and it is observed that there is an increase of new infection among the adolescents and young people. We decided to study the prevalence of HIV among young people aged 15–24 in the country. The country was divided into six regions for the purpose of this study.

Methods
We adapted the secondary data that were collected from the report of the National HIV/AIDS and reproductive survey (NARSH 2012) on Prevalence of HIV/AIDS on adolescents and young people in Nigeria in 2012. Data collection on the survey were from the primary source documents in health facilities that offer HIV/AIDS services

Results
Among the six geopolitical zones, South–South zone has the highest (4.9%) prevalence rate of HIV infection among the adolescents and young people, more than the National median prevalence of 3.6%, while south -East has the lowest prevalence of (1.1%). Results showed that adolescent and young people, aged 20–24 had higher prevalence of 3.2% while ages 15–19 had prevalence of 2.9%. Results from the segregated data by sex showed that between the ages (15–24), the prevalence is higher (3.3%) with female gender than the male (2.4%) counterpart. HIV/AIDS in Africa and Nigeria in particular has a feminine face due to culture of silence, early child marriage and religious barriers that forbids female gender to discuss issues around sexuality or seek reproductive health services at age 15.

Conclusion
The age limit for access to HIV counseling and testing (HCT) should be adjusted to include young people who are sexually active as early as age 15. Findings revealed that the legal framework on access to HCT (HIV Counselling and Testing), of WHO at 18 years and above have created a barrier to young people who are below 18 and are active sexually to access HCT as the Health personnel would ask for the parental consent.

Disclosures
All authors: No reported disclosures.
1281. Emergence of a B/F1 HIV Recombinant in the Philippines: A Potentially New Circulating Recombinant Form
Authors: Schwem Brian , Dungca Nina , Arevalo Geraldine , Francisco Christian , Penalosa Christine , Leyritana Katerina , Destura Raul , Lim Jodor , Tactacan-Abrenica Rosario , Telan Elizabeth , Solante Rongene , Salvana Edsel Maurice 
Published: November 2018

Abstract

Background
The Philippines has one of the fastest growing HIV epidemics globally. This was accompanied by a switch from subtype B to CRF01_AE. With a large population of returning overseas workers, new subtypes are being introduced regularly. Because diagnosis of HIV in the Philippines is usually late, superinfections can occur and may give rise to new circulating recombinant forms (CRFs). We propose a new CRF from the Philippines.

Methods
Following institutional board approval, treatment-naive patients from two HIV treatment hubs (San Lazaro Hospital and the Philippine General Hospital) were recruited. Blood samples underwent Sanger sequencing of the PR and RT regions and next-generation sequencing (NGS) of near-full length genomes. Sequences were analyzed for recombination using the online tool jumping profile Hidden Markov Model (http://jphmm.gobics.de/).

Results
247 samples underwent Sanger sequencing of the PR and RT regions of the pol gene. Phylogenetic analysis indicated a clustering of four of the samples. Further analysis showed all four samples had the same breakpoints at nucleotides 2875, 2996, and 3001 (HXB2 numbering). All four patients were male, MSM, with a mean age of 28 years old (24–32), and &gt;10 sexual partners. Mean CD4 count was 464 cells/µL and median viral load was 2.67 × 104 copies/mL. Two patients had sex with foreigners. To get a better overall view of subtype composition, we performed NGS using Illumina HiSeq. NGS showed the majority of the genome to be subtype F1 with segments of subtype B inserted in the pol, vpu, and env genes. A blast analysis of the consensus sequence showed 8,932 out of 8,943 nucleotides (99%) matched a 1999 sample from Argentina. Phylogenetic analysis of these samples show clustering of the four B/F1 recombinants with some South American sequences. No drug resistance mutations were identified.

Conclusion
Mutation and recombination contribute to the extensive genetic diversity of HIV. Understanding this is important in choosing treatment regimens, developing future vaccines, and pursuing epidemiological investigations. The emergence of a new CRF in the Philippines underlies the importance of conducting routine surveillance for new HIV recombinant forms.

Disclosures
All authors: No reported disclosures.
1299. Iowa TelePrEP: Preliminary Experience with a Public Health-Partnered, Telemedical PrEP Delivery Model in a Rural State
Authors: Hoth Angela , Shafer Cody , Dillon Dena , Scheetz Constanza , Owens Seth , Edel Kathryn , Ohl Michael 
Published: November 2018

Abstract

Background
Access to HIV pre-exposure prophylaxis (PrEP) is often poor in small urban and rural areas due to long distances to PrEP providers and stigma. In 2017, the Iowa Department of Public Health (IDPH), University of Iowa (UI), and community representatives collaborated to develop a public health-partnered telemedical PrEP delivery model to overcome these barriers (TelePrEP). IDPH personnel working in five sexually transmitted infection (STI) clinics and partner services (PS) programs in Eastern Iowa screened clients for PrEP indications and referred those with need to TelePrEP pharmacist providers at UI. Via collaborative practice, pharmacists completed initial and follow-up PrEP home video visits with clients on smart phones and laptops. Clients obtained laboratory monitoring and STI screening in public health-affiliated and local laboratories in accordance with USPHS/CDC guidelines, and received PrEP medication by mail. PS personnel linked TelePrEP clients with newly-identified STIs to local treatment.

Methods
Using the PrEP continuum as framework, we used IDPH databases and UI medical records to conduct a retrospective process evaluation of the TelePrEP model (February 2017–April 2018).

Results
TelePrEP received 44 referrals from public health and 59 self-referrals via advertising. Pharmacists completed 84 initial visits (81% of referrals), including 37 visits (84%) with clients referred by public health. Most (94%) started emtricitabine/tenofovir after initial visits. Retention in TelePrEP at 6 months was 87%. 96% of guideline-indicated laboratory tests (HIV, creatinine, STI, hepatitis) were completed at baseline and follow-up. Rates of extragenital chlamydia and gonorrhea screening were lower (74 of 104 completed screens) due to variable availability of swabs at local laboratories. 15 clients were diagnosed with 20 STIs on screening (6 syphilis, four gonorrhea, 10 chlamydia) and one unrecognized pregnancy was identified. PS linked all clients with STIs on screens to treatment within 14 days (80% in 3 days).

Conclusion
Using telemedicine, healthcare systems can partner with public health administered STI clinics and PS programs to create virtual PrEP delivery models in rural settings. Public health partnerships enhance client identification and ensure linkage to care for new STI diagnoses in telemedicine programs.

Disclosures
A. Hoth, Gilead Sciences, Inc.: Research team member, Research support. M. Ohl, Gilead Sciences, Inc.: Grant Investigator, Research grant.
1303. Provider Knowledge and Attitudes Toward Antibiotic Prescribing and Antibiotic Stewardship in Outpatient Rural Clinics
Authors: Kufel Wesley , Mogle Bryan , Williams Karen , Jester James , Snyder John , Mastro Keri , Lubowski Theresa , Bohan KarenBeth 
Published: November 2018

Abstract

Background
Rural outpatient clinics serve the healthcare needs of many individuals, especially for acute sick visits and infectious processes. A better understanding of providers’ knowledge and attitudes toward antibiotic stewardship in the outpatient rural setting is needed to facilitate more effective education regarding appropriate antibiotic prescribing.

Methods
A cross-sectional, multi-center, 28-item survey assessing providers’ knowledge and attitudes toward antibiotic prescribing and antibiotic stewardship in the rural setting was distributed to providers from Guthrie and United Health Services primary care clinics in rural New York and Pennsylvania.

Results
Sixty-five providers participated (31% response rate) with 43%, 29%, and 28% of responses from physicians, resident physicians, and advanced practice providers, respectively. More than half of respondents practiced for ≤5 years since terminal training. The most significant barrier to improving antibiotic prescribing was patient demands (55%) followed by uncertain diagnosis of bacterial infection (22%) and short appointment visit times (11%). Providers that spent ≤20 minutes per visit were more likely to feel pressured to prescribe antibiotics for upper respiratory tract infections (URI) to ensure patient satisfaction than those who spent &gt;20 minutes (41% vs. 7%, P = 0.024). Additionally, providers who saw &gt;50 patients per week were more likely to feel pressured to prescribe antibiotics for URIs than those who saw ≤50 patients (50% vs. 18%, P = 0.009). Only 42% of providers selected the correct answer that 90–98% of URIs are viral. The majority of providers strongly agreed that antibiotics are overused (71%) and inappropriate antibiotic use can lead to resistance (82%). Thirty-eight percent of providers never heard the term antibiotic stewardship or heard the term but were unsure about the definition. However, more than 75% of providers strongly agreed or agreed that they were interested in receiving more education regarding antibiotic stewardship.

Conclusion
Variability exists among providers’ knowledge and attitudes toward antibiotic stewardship and antibiotic prescribing in rural outpatient settings. Increased educational efforts are warranted to increase consistency of these concepts and practices.

Disclosures
All authors: No reported disclosures.
1309. The Impact of Clinical Practice Guideline Using Educational Intervention for Improvement of Diabetic Foot Infections Treatment Outcomes
Authors: Phangmuangdee Mullika , Navanukroh Oranich , Koomanachai Pornpan 
Published: November 2018

Abstract

Background
Diabetic foot infections (DFIs) are important cause of lower-extremity amputation. The inappropriate empirical antimicrobial therapy for DFI was associated with amputation. We created the Clinical Practice Guideline (CPG) of empirical antimicrobial (ATB) therapy for in-patients with DFIs. The primary outcome of present study was to evaluate the intervention using educate and training the surgeons to adhere with CPG. The secondary outcome was the decreasing of unfavorable outcome (amputations).

Methods
A prospective study of CPG implementation for treatment in adult in-patients who had DFIs was conducted at surgical and orthopedics wards. The CPG was developed by the investigator team based on the data from our previous study (submitted to publish). CPG was presented monthly to train the orthopedic and vascular surgeons for 1 year. The empirical ATB regimens were prescribed by the responsible surgeon who was trained to use CPG. Demographics data, wound characteristics, microbiological data, ATB therapy, and clinical outcome were recorded. The appropriate empirical ATB treatment was determined by investigators weather CPG matched or microbiological matched. The adherence to CPG, the appropriate empirical ATB, and the unfavorable outcome were analyzed. All data were reported by descriptive and inferential statistics.

Results
A total of 85 DFIs patients were enrolled. The patients received the appropriate empirical ATB matched to CPG and matched to microbiological data, were 87% and 67%, respectively. The unfavorable outcome was 26% while previously was 72.4% (submitted to publish data) before CPG implementation. The independent factors associated with unfavorable outcomes were (1) an inappropriate ATB and (2) infections with drug-resistant pathogens (adjusted relative ratio; aRR 2.98; 95% CI: 1.36–6.55, P = 0.007 and aRR 1.90; 95% CI: 1.05–3.43, P = 0.034, respectively).

Conclusion
The current study demonstrated that mothly training of CPG resulting in the high adherence (87%) of CPG use and resulting in high rate of appropriate empirical ATB. Educational intervention insisted the responsible physician for administration the appropriate ATB with the improvement of unfavorable outcome in DFIs.

Disclosures
All authors: No reported disclosures.