bluuebunny/crossref_metadata_2025_split huggingface dataset:
1153. UV-C Technology Is an Effective Adjunct to Terminal Cleaning in Environmental Pathogen Reduction in a Tertiary Pediatric Hospital
Authors: Singh Prachi , Lucas Amanda , Singer Monica Nayakwadi 
Published: November 2018

Abstract

Background
Effective environmental surface cleaning plays a vital role in reducing transmission of hospital-acquired infections. There remains a paucity of data in the pediatric literature regarding environmental pathogen reduction utilizing UV-C light. The objective of this study was to evaluate the reduction of environmental pathogens using UV-C light (Clorox Optimum-UV) as an adjunct to terminal cleaning in a free-standing tertiary pediatric hospital.

Methods
Upon patient discharge, a subset of patient rooms were tested for pathogens. Surface swabs were collected from high touch surfaces (call button, telemetry monitor, door handle, flush handle of toilet, faucet, bed rail, phone, keyboard pad, mouse, side table, dresser, and light switch). After terminal cleaning of the room, per hospital protocol the Clorox Optimum-UV completed one or two cycles of 5 minutes each depending on the dimensions of the room. Post-UV-C surface swabs were obtained from the same high touch areas in the room. Total colony count was reported from each of the surfaces swabbed. Swabs were streaked onto non-selective agar and incubated at 30-35oC for 72–96 hours. Mean plate colony count was determined manually and reported as CFU/swab. Data analysis was performed in Minitab 18.1. Fisher least significant difference (LSD) test was used to describe the difference between total bacterial counts at each time point (Pre-clean: dirty room, Post-clean: pre-UV-C/post-terminal clean, Post-UV: post UV-C light cycle).

Results
Mean total colony counts prior to cleaning the room was 92.3 CFU (33 surfaces), Pre-UV-C light 45.6 CFU and post-UV-C light 5.8 CFU (64 surfaces). Total bacterial counts are represented in Graphs 1 and 2. Upon multivariate analysis, the time the sample was taken (preclean, postclean, or post-UV) was the single explanatory variable for the differences seen in the means of total bacterial counts (P = 0).

Conclusion
Our study demonstrates that UV-C disinfection is a highly effective adjunctive cleaning method with standard terminal cleaning to reduce bacterial burden from environmental surfaces.

Disclosures
A. Lucas, Clorox: Research Contractor, Grant recipient. M. Nayakwadi Singer, Clorox: Grant Investigator, Grant recipient.
1154. Comparison of Five Testing Modalities for the Assessment of Patient Environment Cleanliness
Authors: Salsgiver Elizabeth , Martin Elena , Callan Katrina , O’Hara Niamh B , Ounit Rachid , Westblade Lars F , Mason Christopher E , Simon Matthew S , Saiman Lisa , Furuya E Yoko , Calfee David P 
Published: November 2018

Abstract

Background
Microbial contamination of the patient environment has been associated with healthcare-associated infections. Objective assessment of environmental cleanliness is recommended by the CDC to identify improvement opportunities. Methods currently used to assess cleanliness and microbial dynamics differ in their sensitivity, specificity, cost, ease of use, and turnaround time. We compared five assessment methods to examine these characteristics.

Methods
The bedrail, overbed table, remote control, and toilet seat in occupied patient rooms were sampled and assessed with: adenosine triphosphate (ATP) luminescence technology (LT), Replicate Organism Detection And Counting (RODAC) plates, C diff Banana Broth™ (CDBB), conventional aerobic culture (CC) and antimicrobial susceptibility testing, and shotgun next-generation sequencing (NGS) and analysis using metagenomic software.

Results
One hundred forty surfaces from 35 rooms were sampled. Of 70 surfaces sampled by both ATP LT and RODAC, 42 (60%) had concordant “pass” or “fail” results. Of 28 discordant samples, 26 (93%) passed by RODAC but failed by ATP LT. CDBB testing identified Clostridioides difficile on two surfaces in one room; C. difficile was also identified by NGS in this room. NGS had 100% concordance with organisms identified by CC, and identified approximately 20 additional organisms not identified by CC per surface. 38% of organisms identified by NGS were potential pathogens, compared with 13% through CC. No correlations were found between the primary quantitative assessments (RODAC bacterial concentrations and ATP LT ATP concentrations) and quantitative components of CC (presence/absence of organisms) and NGS (read numbers).

Conclusion
ATP LT and RODAC plates both provide useful quantitative cleanliness data, although high ATP values did not always indicate the The presence of viable aerobic bacteria. CDBB may be a useful method for identifying C. difficile in the environment, but larger studies of the performance characteristics of CDBB are needed. CC and NGS provided useful organism identification information, but NGS had higher sensitivity for detecting potentially pathogenic organisms. The clinical implications of NGS results must be further studied and cost and technical expertise are important considerations.

Disclosures
N. B. O’Hara, Biotia: Board Member, Employee and Shareholder, Salary. L. F. Westblade, Accelerate Diagnostics: Grant Investigator, Grant recipient. Biomerieux: Grant Investigator, Grant recipient. Allergan: Grant Investigator, Grant recipient. Merck: Grant Investigator, Grant recipient.
1155. Excessive Movement, Unnecessary Contamination: Clostridium difficile Patients in the Hospital
Authors: Reese Sara , Knepper Bryan , Miller Amber , Young Heather 
Published: November 2018

Abstract

Background
The environmental contamination of Clostridium difficile in acute care hospital rooms is associated with increased risk of infection for subsequent patients. Patients that stay in a room following a patient with a C. difficile infection (CDI) have an increased risk of CDI compared with patients whose previous resident did not have CDI. The objective of this study was characterize the room movement of CDI patients in a Level 1 Trauma Medical Center.

Methods
A patient with CDI was defined as an inpatient with a positive C. difficile test through rapid serology, C. difficile polymerase chain reaction (PCR) or multiplex-stool PCR from March 2017 to March 2018. Patients were classified as either community-onset (CO, positive test &lt;4 days after admission) or hospital-onset (HO, positive test ≥4 days after admission). Additionally, the number of rooms each CDI patient resided in during one admission following a positive C. difficile test was determined and the proportion of patients who stayed in one to two rooms or at least three rooms per visit was calculated.

Results
There were a total of 244 CDI patients identified (172: CO, 72: HO) between March 2017 and March 2018. The mean time from admission to positive test was 12.4 hours post-admission for CO-CDI patients and 251.1 hours for HO-CDI patients. Almost 40% of HO-CDI patients (36.1%, n = 72) stayed in at least three rooms during their hospital admission compared with &lt;30% of CO-CDI patients (28.4%, n = 172).

Conclusion
The current state of room movement with CDI patients is suboptimal, resulting in increased infection risk for subsequent patients. A multi-faceted intervention to address this problem is essential to achieve an optimal goal of 1–2 rooms per hospital stay for a CDI patient. Quality improvement projects include (1) notification of patient movement to nursing leadership, (2) alerts to nursing supervisors of potential CDI patients before room transfer, and (3) earlier diagnosis of community-onset C. difficile.

Disclosures
All authors: No reported disclosures.
1159. Influenza Symptoms in Vaccinated Healthcare Workers in an H3N2-Dominant Season
Authors: Bartlett Allison , Ridgway Jessica P , Marrs Rachel , Henson Amanda M , Chu Vera , Enriquez Aurea , Murillo Cynthia , Runjo Demetria , Seguin Alexandra , Beavis Kathleen G , Guenette Caroline , Landon Emily 
Published: November 2018

Abstract

Background
Influenza vaccination of healthcare workers is an important component of keeping patients safe, but must be paired with exclusion of ill healthcare workers (HCW) from work. CDC recommends exclusion from work until afebrile for 24 hours, but not all HCW with influenza develop fever and may still be a risk for spreading. Half of HCW with influenza in an H1N1-dominant season (2013–2014) at our institution were afebrile.

Methods
From 1/31–4/24/18 (H3N2-dominant season), HCW with fever or cough were screened for influenza and respiratory syncytial virus by polymerase chain reaction of flocked nasopharyngeal swabs. Additional HCW were tested by their primary care providers. We collected influenza vaccination status and symptoms and calculated the proportion of influenza-positive HCWs with fever or cough. Infection control practitioners (ICPs) contacted each influenza-positive HCW to identify potential patient or HCW exposures 24 hours prior to symptom onset and offered oseltamivir prophylaxis to exposed patients and HCW.

Results
Of 186 HCW tested by UCM, 49 (26%) tested positive for influenza (35 with influenza A; 14 with influenza B) and 11 (6%) tested positive for RSV. Forty-eight HCW (98%) received influenza vaccination. Fever was reported in only 19 (54%) HCW with influenza A and three (21%) HCW with influenza B. Cough was present in the majority of HCW (34 (97%) with influenza A and 12 (86%) with influenza B). An additional 55 HCW were diagnosed with influenza by their primary care providers. ICPs performed contact investigations for 43 HCW who reported exposure to patients or other HCW between 24 hours before symptom onset through the time of diagnosis. Occupational medicine provided 138 courses of prophylactic oseltamivir to HCW.

Conclusion
Afebrile influenza illness is common; current workforce guidelines are insufficient to prevent exposure in the healthcare setting. Expanding employee influenza screening to include fever OR cough doubled the number influenza positive HCW identified. Despite excellent influenza vaccination rates, vigilance is critical to prevent influenza transmission in the hospital. HCW screening for influenza based on fever OR cough, exclusion from work, and identification of potential exposures can help keep patients and colleagues safe.

Disclosures
All authors: No reported disclosures.
1161. Infection Control After Debridement of Brucella melitensis Hardware Infection
Authors: Novack Amanda 
Published: November 2018

Abstract

Background
Brucellosis is the most common laboratory-acquired bacterial infection, according to the Centers for Disease Control and Prevention (CDC), despite the rare incidence of Brucellosis in the population at large. A 34-year-old man presented with pain and swelling of the left leg, where he had previously sustained an open tibia fracture 1 year prior. After the initial injury, he underwent four corrective surgeries (including bone graft and internal-fixation) and was asymptomatic for 6 months before these new symptoms developed. MRI revealed a 6.5 × 5.1 × 2.7 cm abscess and tibial osteomyelitis. Surgical staff performed an aggressive incision and drainage (I&D) with saucerization of the tibia, to treat what seemed to be a routine hardware infection. Five days later, tissue cultures grew Brucella melitensis. Upon further questioning, the patient described butchering a wild boar 10 days prior to symptom onset.

Methods
The CDC provides guidance on serological testing and post-exposure prophylaxis (PEP) for persons exposed to Brucella in the laboratory setting. Upon identification of this patient’s Brucella isolates, infection control staff identified all laboratory workers that met CDC criteria for “high risk” exposure, as well as other healthcare workers (HCW) exposed to aerosolized infectious material (including those workers in the operating room during pulse lavage of the abscess).

Results
Staff identified 34 HCW with presumed high-risk exposure, including 19 laboratory personnel, 13 operating room personnel, and two patient care technicians. Baseline serology was obtained on all 34 HCW, and PEP with rifampin and doxycycline was prescribed for each. Nine of the exposed employees changed PEP therapy due to intolerance, and follow-up serology was obtained on 32 of the 34 healthcare workers, with zero seroconversions found.

Conclusion
Brucellosis is a rare disease in clinical practice, so a high index of suspicion is necessary to enact appropriate precautions before widespread exposures. When exposure is identified after the fact, efficient protocols should be in place to identify all susceptible individuals. Due to the low infectious dose of Brucella melitensis, CDC guidance should be expanded to include aerosolizing procedures outside of the laboratory.

Disclosures
All authors: No reported disclosures.
LB14. Safety and Immunogenicity of High-Dose Quadrivalent Influenza Vaccine Administered by Intramuscular Route in Subjects Aged 65 Years and Older
Authors: Chang Lee-Jah , Meng Ya , Janosczyk Helene , Landolfi Victoria , Talbot H Keipp ,   QHD00013 Study Team
Published: November 2018

Abstract

Background
Older adults (≥65 years of age) remain at increased risk of influenza because they do not respond to standard dose influenza vaccines as well as younger adults. A high dose, inactivated trivalent influenza vaccine, IIV3-HD, containing four times the antigen content (60 µg hemagglutinin per influenza strain) of standard-dose influenza vaccines has been available in the United States since 2010. Two distinct B influenza lineages (Victoria and Yamagata) have co-circulated for over a decade, making it difficult to predict which will predominate the next season. IIV4-HD has been developed to address the frequent influenza B strain mismatches by incorporating a strain from each B lineage. This pivotal Phase III study evaluated the safety and immunogenicity of IIV4-HD as compared with two IIV3-HD vaccines.

Method
A randomized, modified double-blind, multicenter study (NCT03282240) was conducted in 2670 healthy subjects in the United States, who were randomly assigned to receive IIV4-HD, a licensed IIV3-HD, or an IIV3-HD with the alternate B influenza strain. Using the hemagglutinin inhibition (HAI) assay at baseline and 28 days after vaccination, post-vaccination geometric mean titers and seroconversion rates were measured. Safety data were collected through 6 months post-vaccination.

Result
IIV4-HD was noninferior to the licensed IIV3-HD and the investigational IIV3-HD (containing the alternate B strain) for all four influenza strains as assessed by HAI GMTs and seroconversion rates. Moreover, IIV4-HD induced a superior immune response (HAI GMTs and seroconversion rates) compared with the immune response induced by the IIV3-HD that does not contain the corresponding B strain. Reactogenicity profiles were comparable across all study groups. Most unsolicited adverse events were of Grade 1 or Grade 2 intensity. One serious adverse event considered related by the Investigator was reported in the IIV4-HD group.

Conclusion
Vaccination of adults 65 years of age and older with IIV4-HD was found to be noninferior to two IIV3-HD vaccines with a similar safety profile. The addition of a second B lineage strain does not adversely affect the safety or immunogenicity profile of IIV4-HD compared with IIV3-HD.

Disclosures
L. J. Chang, Sanofi Pasteur: Employee, Salary. Y. Meng, Sanofi Pasteur: Employee, Salary. H. Janosczyk, Sanofi Pasteur: Employee, Salary. V. Landolfi, Sanofi Pasteur: Employee, Salary. H. K. Talbot, Sanofi Pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.
LB19. Progress Toward a Vaccine for Maternal Immunization to Prevent Respiratory Syncytial Virus (RSV) Lower Respiratory Tract Illness (LRTI) in Infants
Authors: Fries Louis , Thomas D Nigel , Smith Gale , Plested Joyce , Piedra Pedro , Patel Nita , Cho Iksung , Glenn Greg 
Published: November 2018

Abstract

Background
RSV is the leading cause of infant LRTI and hospitalization worldwide. The greatest burden of severe disease is in term infants &lt;5 months old. Novavax is developing an aluminum-adjuvanted RSV F nanoparticle vaccine for use in the third trimester of pregnancy, with the goal of preventing medically significant infant RSV LRTI in the first 3–6 months of life via transplacental transfer of maternal antibodies.

Method
After dose-finding studies in 1,050 women, we studied vaccine safety and immunogenicity in a Phase 2 trial in 50 healthy third trimester pregnant women. Safety was assessed in mothers and infants, focusing on pregnancy and peri-partum outcomes. We measured binding and functional RSV antibodies in mothers at baseline, day 14, delivery, and days 35 and 180 post-partum, in cord blood, and in infant sera on days 14, 35, 60, and 180 of life. Anti-F antibody specificities were probed with biolayer interferometry and monoclonal antibodies (mabs) to known epitopes.

Result
In Phase 2, RSV F nanoparticle vaccine was immunogenic, safe, and well-tolerated in pregnant women. Anti-F IgG and neutralizing antibodies were elicited. Increases in antibodies competitive with mabs to neutralizing epitope sites Ø, VIII, II, and IV, and also the p27 domain displayed by the pre-fusogenic F protein, were present in maternal and infant sera of vaccinated subject pairs. Transplacental transfer of RSV antibodies was more efficient (110 to 120%) in women immunized &gt;30 days before delivery compared with those vaccinated later; RSV antibody t1/2 ranged from 30 to 41 days in infants. We have subsequently enrolled 4,636 pregnant women and their infants in a global observer-blind, randomized, placebo-controlled Phase 3 trial assessing efficacy against medically significant RSV LRTI. In November 2017, an informational analysis performed by an independent statistician, the sponsor remaining blinded, yielded a posterior probability of ≥90% that efficacy was &gt;0%.

Conclusion
RSV F nanoparticle vaccine is immunogenic in pregnancy, and neutralizing antibodies, including those competing for pre-and post-fusion F epitopes, are transferred efficiently transplacentally. An analysis of Phase 3 efficacy against medically signifcant infant RSV LRTI is projected for Q1, 2019.

Disclosures
L. Fries, Novavax: Employee and Shareholder, Salary. D. N. Thomas, Novavax: Employee, Salary. G. Smith, Novavax: Employee and Shareholder, Salary. J. Plested, Novavax: Employee, Salary. P. Piedra, Novavax: Collaborator, Consultant, Research Contractor and Scientific Advisor, Consulting fee, contract fees for immunologic assays and Research support. N. Patel, Novavax: Employee and Shareholder, Salary. I. Cho, Novavax: Employee and Shareholder, Salary. G. Glenn, Novavax: Employee and Shareholder, Salary.
Experimental Pain Is Alleviated by Manual Traction Itself Rather than Subjective Bias in the Knee: A Signal Detection Analysis
Authors: Shigetoh Hayato , Osumi Michihiro , Morioka Shu 
Published: November 2018

Abstract

Background
Manual traction is used for pain relief, but it is not clear whether the pain relief effect of manual traction is due to sensitivity or to subjective bias. The differences between manual traction and touch have also been unclear.

Objectives
We used signal detection theory to investigate whether manual traction and touch were effective for pain relief, and we compared the pain relief effect between manual traction and touch.

Design
Repeated measures and single blinding.

Methods
Twenty healthy adult volunteers performed an intensity judgment task immediately before and after each intervention. The intervention was either manual traction or touch for 10 minutes. We measured the intensity judgment task’s signal detection measures of hit rates, false alarm rates, sensitivity (d'), and response bias (C) in an Aδ fiber–mediated pain condition and C fiber–mediated pain condition.

Results
Manual traction did not provide a significant level of change, but its effect sizes differed. In our comparison of the effect sizes, manual traction tended to reduce the hit rate and altered the sensitivity value rather than the response bias in Aδ fiber–mediated pain. There was no significant difference in the amount of change in the hit rate between touch and manual traction regarding Aδ fiber–mediated pain and C fiber–mediated pain.

Conclusions
In terms of effect sizes, manual traction was effective for the pain relief of the first pain by producing a change in pain sensitivity rather than by subjective bias. Manual traction reduced the first pain, whereas touch reduced the first pain and second pain.
Feasibility and acceptability of a faith-based mind-body intervention among African American adults
Authors: Mama Scherezade K , Bhuiyan Nishat , Chaoul Alejandro , Cohen Lorenzo , Fagundes Christopher P , Hoover Diana S , Strong Larkin L , Li Yisheng , Nguyen Nga T , McNeill Lorna H 
Published: November 2018

Abstract
Physical activity reduces cancer risk, yet African American adults remain insufficiently active, contributing to cancer health disparities. Harmony & Health (HH) was developed as a culturally adapted mind-body intervention to promote physical activity, psychosocial well-being, and quality of life among a church-based sample of overweight/obese, insufficiently active African American adults. Men and women were recruited to the study through an existing church partnership. Eligible participants (N = 50) were randomized to a movement-based mind-body intervention (n = 26) or waitlist control (n = 24). Participants in the intervention attended 16 mind-body sessions over 8 weeks and completed a physical assessment, questionnaires on moderate-to-vigorous physical activity (MVPA) and psychosocial factors, and accelerometry at baseline (T1), post-intervention (T2), and 6 week follow-up (T3). Eighty percent of participants (94% women, M age = 49.7 ± 9.4 years, M body mass index = 32.8 ± 5.2 kg/m2) completed the study, and 61.5% of intervention participants attended ≥10 mind-body sessions. Participants self-reported doing 78.8 ± 102.9 (median = 40.7, range: 0–470.7) min/day of MVPA and did 27.1 ± 20.7 (median = 22.0, range: 0–100.5) min/day of accelerometer-measured MVPA at baseline. Trends suggest that mind-body participants self-reported greater improvements in physical activity and psychosocial well-being from baseline to post-intervention than waitlist control participants. HH is feasible and acceptable among African American adults. Trends suggest that the mind-body intervention led to improvements in physical activity and psychosocial outcomes. This study extends the literature on the use of mind-body practices to promote physical and psychological health and reduce cancer disparities in African American adults.