bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Patients with Prior Clostridium difficile Infection (CDI) a Potential Source of Transmission during Hospital Admissions?
Authors: Gonzalez-Orta Melany , Saldana Carlos , Cadnum Jennifer , Donskey Curtis J 
Published: October 2017

Abstract

Background
Many patients with Clostridium difficile infection (CDI) continue to shed spores asymptomatically after completion of CDI therapy. However, the duration of shedding and the potential for transmission during subsequent healthcare exposures is unknown.

Methods
During a 6-month period, we collected perirectal, groin, and skin (chest/abdomen and hands) cultures for toxigenic C. difficile from patients with a prior history of CDI who were admitted to the hospital. We calculated the frequencies of perirectal and skin shedding of C. difficile at the time of admission, stratified by the time since the prior CDI diagnosis.

Results
Of 28 patients with a prior history of CDI enrolled in the study, 10 (36%) had positive perirectal cultures for toxigenic C. difficile upon admission, and 6 of 10 (60%) had positive skin cultures. The figure shows the percentages of CDI cases with positive perirectal, groin, or skin cultures, stratified by the time since the prior CDI diagnosis.

Conclusion
Patients with prior CDI often shed spores asymptomatically during hospital admissions. Further studies are needed to determine whether these carriers contribute significantly to transmission.

Disclosures
All authors: No reported disclosures.
Hospital-Nursing Home Transfer Patterns and Influence on Nursing Home Clostridium difficile Infection Rates
Authors: Campbell Lauren , Bush Kristen , Dumyati Ghinwa 
Published: October 2017

Abstract

Background
Little is known as to how hospital C. difficile infection (CDI) may impact nursing home (NH) CDI, or how patient transfers may modify this relationship. This study aims to examine a possible association between hospital and NH CDI rates, and whether NH CDI rates are influenced by patient transfers from hospital to NH.

Methods
Patient transfers among the 5 hospitals and 34 NHs in Monroe County, NY were identified from the Minimum Data Set (MDS) 3.0 and Medicare Provider Analysis and Review files for 2011–13, and aggregated to the NH level. NH and hospital CDI rates were obtained from Emerging Infections Program CDI population surveillance and National Healthcare Safety Network data, respectively. Multivariate negative binomial regression modeled the association between hospital CDI rate (weighted by hospital-to-NH transfers/overall transfers among hospitals and NHs) and NH CDI rate, controlling for NH covariates from NH Compare and the Online Survey, Certification, and Reporting files. Patient transfer networks between hospitals and NHs were constructed, and basic network analysis of transfer patterns was conducted to confirm contributing factors to NH CDI rates from the multivariate model.

Results
When weighted hospital CDI rate increased by 1%, NH CDI rate increased by 18% (P = 0.016). Antibiotic and feeding tube prevalence were associated with a 4% and 8% increase in NH CDI rate, respectively (P≤0.014). Network analysis confirmed multivariate results and detected hospital-NH pairs with high edge weights (number of transfers) where NHs receiving patients from hospitals with high CDI rates had higher CDI rates. Network clustering methods were used to identify 2 sub-networks within overall annual networks and clusters of hospital-NH pairs for targeted intervention.

Conclusion
Hospital CDI rate, adjusting for patient transfers, is associated with higher NH CDI rates in multivariate and network analyses, suggesting that NHs with a large inflow of patients from hospitals may need to implement stricter infection prevention practices to reduce transmission among residents. By identifying regional sub-networks, network analysis can also be used to actively manage facility CDI and prevent spread to other healthcare facilities.

Disclosures
All authors: No reported disclosures.
Risk factors for Clostridium difficile infection in C. difficile colonized ICU patients
Authors: Zhou Yuan , Lewis Larissa , McIntosh Michelle , Fang Ferric C , Pergamit Ronald , Dellit Timothy , Lynch John B 
Published: October 2017

Abstract

Background
Clostridium difficile is a major cause of healthcare-associated infections leading to significant morbidity and mortality; however, data-driven interventions to decrease C. difficile infections (CDI) are lacking due to an incomplete understanding of disease transmission and risk factors. Asymptomatic C. difficile carriers may be an important source of nosocomial transmission and disease but few studies have examined colonized patients who later develop CDI. We describe risk factors for the development of CDI in a critical care population screened for C. difficile colonization.

Methods
All patients admitted to our medical or trauma ICUs were screened for toxigenic C. difficile by PCR via rectal swab. Colonized patients were placed in contact enteric precautions for their entire hospitalization and monitored for signs and symptoms of CDI. Retrospective chart review assessed risk factors associated with development of CDI.

Results
868 rectal swabs were collected from 4/01/16 to 10/31/16. 40 patients were colonized with C. difficile on ICU admission and 20 developed symptomatic CDI (Table 1). Risk factors for CDI in colonized patients include enteral feeding and exposure to antibiotics (Table 2).

Conclusion
50% of C. difficile colonized ICU patients progressed to symptomatic CDI during their hospitalization. Antibiotic use was a significant risk factor for CDI. C. difficile carriers may be a particularly vulnerable population for CDI, warranting further investigation for early identification of colonized patients and strategies for infection prevention.

Disclosures
F. C. Fang, BioFire: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research support and Speaker honorarium; Cepheid: Collaborator, Consultant and Scientific Advisor, Consulting fee, Educational grant, Research support and Speaker honorarium
Watch Out! Syphilis Is Back – Case Series of Four Cases of Ocular syphilis
Authors: Awadh Hesham , Visweshwar Haresh , Kilgore Jacob , Willenburg Kara 
Published: October 2017

Abstract

Background
Syphilis is an ulcerative sexually transmitted genital infection caused by Treponema pallidum, which is a member of the order Spirochaetales, family Spirochaetaceae, and genus Treponema. The incidence rate of Syphilis has been steadily rising since 2000; from 2.1 cases per 100,000 population to up to 7.5 cases per 100,000 population in 2014–2015 (the highest rate since 1994). In the state of West Virginia, we have witnessed an increase in the number of cases from 0.5 cases per 100,000 population in 2011, to 5.9 cases per 100,000 population in 2015. Systemic symptoms can include cardiovascular and neurological manifestations. We report to your attention four cases of syphilis mainly with neurological and ocular manifestations.

Methods
We report a series of four cases of neurosyphilis we encountered between 2013 and 2016. Main presentation of all four cases was ocular; primarily redness and photophobia. Diagnosis was confirmed by standard ophthalmological examination with positive initial rapid plasma regain titers (RPR) and fluorescent treponemal antibody absorption testing (FTA-ABS). The cerebrospinal fluid venereal disease research laboratory test (CSF-VDRL) was positive in two of the four cases (in which lumbar puncture was performed). Two of the four cases suffered from an overt immunodeficiency (HIV and laryngeal cancer on chemotherapy) and subjects of all four cases confessed to high-risk sexual behaviors. All four cases were managed with continuous infusions of Penicillin G potassium 24 million International Units for 14 days with variable response.

Results
Response to treatment was variable in that initial complete resolution was achieved in one patient (Case #3), another (Case #1) was retreated in 6 months due to rising RPR titers on follow-up with subsequent improvement. Two patients were lost to follow-up (Cases #2 and #4).

Conclusion
Sir William Osler reportedly said: “He who knows syphilis knows medicine”. The steady rise in the incidence of Syphilis warrants that health care providers consider such a diagnosis in the evaluation of suggestive neurological and ocular manifestations in predisposed patients. We also stress on the importance of follow-up to detect failure of initial treatment.

Disclosures
All authors: No reported disclosures.
Decrease of Hospital-Onset Clostridium difficile through Enhanced Electronic Decision Support
Authors: Donatoni Gina , Mikolajczak Anessa , Lewis Steven , Daniels Mark , Haviley Corinne , Postelnick Michael , Sutton Sarah 
Published: October 2017

Abstract

Background
Literature supports appropriate testing as a key factor affecting hospital onset (HO) Clostridium difficile (CDIF). It was recognized that our institution was a significant outlier in HO CDIF with a standardized infection ratio (SIR) of 2.567 in the second quarter of 2016 compared with a national SIR of 0.997. A February 2015 – April 2015 line list of CDIF LabID events were pulled from the National Healthcare Safety Network (NHSN) and medical records were reviewed for test appropriateness based on CDC/IDSA guidelines. Of these, 50% were related to inappropriate testing. Infection Prevention and Quality identified this as an opportunity for improvement and Executives dedicated resources to reduction efforts.

Methods
A report was created using our data warehouse to track specimens that were not collected within 24 hours of an order, as well as patients that had testing done in the previous 7 days. Physician and nurse education was completed on appropriate testing for CDIF, including symptoms and timely specimen collection. An enhanced order set was launched which embedded the testing algorithm into a series of cascading questions and best practice alerts (BPAs) which prompt the provider to reconsider ordering if the patient has less than 3 episodes of diarrhea in a 24 hour period, and/or has alternative explanations for diarrhea, including tube feedings and/or laxatives. Any CDIF test results from the past 30 days appear on the order screen to further guide physician ordering.

Results
Based on our NHSN data, HO CDIF cases were identified from October 2015 – September 2016, resulting in a peak (SIR) of 2.567. Since the interventions in November 2016, we have decreased our SIR to 0.356 in the first quarter of 2017. This shows a 50% overall decrease in HO CDIF. The data warehouse report showed 99% compliance of specimens collected within 24 hours of an order and only 5% of patients with an order in the past 7 days.

Conclusion
By implementing targeted education and a sophisticated order entry process that includes decision support, as well as recent results and treatments in the electronic medical record, CDIF cases are being appropriately ordered and collected, ensuring appropriate classification within NHSN and a decrease in overall SIR

Disclosures
All authors: No reported disclosures.
Similar Sexually Transmitted Infections Prevalence Despite Lower HIV Prevalence Among Transgender Women Compared with Men Who Have Sex With Men in Thai Community-Based Test and Treat Cohort
Authors: Hiransuthikul Akarin , Prawepray Nanthika , Pengpum Supab , Reankhomfu Ratchadej , Panpet Phubet , Mahachokchai Nopparat , Sumalu Saman , Brutat Pornpichit , Sungsing Thanthip , Janamuaysook Rena , Pengnonyang Supabhorn , Jantarapakde Jureeporn , Trachunthong Deondara , Na Nakorn Panus Rattakittvijun , Charoenying Sutinee , Phanuphak Praphan , Vannakit Ravipa , Phanuphak Nittaya 
Published: October 2017

Abstract

Background
Men who have sex with men (MSM) and transgender women (TG) are at increased risk for sexually transmitted infections (STIs). To understand potential different characteristics, we assessed gender-specific, demographic data, behavioral risks and prevalence of STIs.

Methods
Thai MSM and TG aged ≥18 years from six community-based organizations in Thailand were enrolled into the Test and Treat cohort during 2015–2016. Baseline demographic and behavior risk assessment and HIV/STIs testing were done. Blood for syphilis serology and pharyngeal and anal swab, and urine for gonorrhea and chlamydia nucleic acid amplification testing were collected. Logistic regression was used to determine factors associated with gender-specific STIs prevalence.

Results
From 1862 MSM and 787 TG enrolled, 874 (33%) had STI and 402 (15.2%) were HIV-positive. Compared with MSM, more TG were single (79.7% vs. 71.6%), had lower education (23.6% vs. 40% with diploma or higher), had lower income (35.7% vs. 42.6% gained &gt;288 USD/month), had first sex at young age (20.1% vs. 12.8% at &lt;15 years old), and reported &gt;3 sexual partners in the past 6 months (32.9% vs. 24.6%) (all P &lt; 0.001). The overall STIs prevalence was similar between both genders (31.5% vs. 33.6%, P = 0.29), but TG had lower HIV prevalence (8.9% vs. 17.8%, P &lt; 0.001). TG had higher prevalence of pharyngeal and anal chlamydia (5.5% vs. 2.9%, P = 0.001 and 19.5% vs. 15.1%, P = 0.007, respectively), while syphilis prevalence was higher in MSM (9.9% vs. 3.6%, P &lt; 0.001). Among HIV-positive participants, MSM had higher prevalence of HIV and syphilis coinfection (26.2% vs. 8.6%, P = 0.001). STIs prevalence among TG was associated with HIV-positive status (adjusted odd ratio [aOR] 2.74; 95% CI 1.52–4.95, P = 0.001), having multiple sexual partners or refused to answer (aOR 2.36; 95% CI 1.31–4.24, P = 0.004 and 2.33; 95% CI 1.24–4.37, P = 0.009, respectively) and unprotected sexual intercourse (aOR 1.66; 95% CI 1.02–2.69, P = 0.041).

Conclusion
Almost one-third of TG enrolled into the Test and Treat cohort had STI. TG had lower HIV prevalence but similar STIs prevalence compared with MSM, despite practicing riskier sexual behaviors. Our findings signified the importance of studying TG sexual networks in Thailand to better strategize sexual health programs.

Disclosures
All authors: No reported disclosures.
Electronic Hand Hygiene Monitoring: A Tool to Drive Improvement and Measure Impact
Authors: Knepper Bryan , Miller Amber , Reese Sara , Kurtz Jennifer , Stella Sarah , Young Heather 
Published: October 2017

Abstract

Background
Hand hygiene (HH) is a basic principle of infection control, yet national HH adherence rates are only 40%. Challenges to improving HH rates include finding effective ways to promote and sustain change and collecting unbiased observations to measure the success of interventions. Our institution implemented an electronic HH (eHH) monitoring system on select hospital units with the goal of using this technology to both improve and measure HH rates.

Methods
In Apr 2016, Denver Health installed the HillRom Hand Hygiene Compliance Solution in 4 inpatient units (2 adult wards, 1 intensive care unit, and 1 progressive care unit). Sensors were installed on all HH dispensers and at the thresholds of patient rooms on the units. Registered nurses and certified nursing assistants wear badges that track HH upon entry and exit from the room. Appropriate eHH was defined as the use of waterless hand sanitizer or soap within 60 seconds before or after entering or exiting a room. Baseline data was collected for 2 months; a series of interventions, including public recognition of top performers, private individualized feedback, and posters emphasizing social pressures, were undertaken beginning in June 2016 (Figure 1). Descriptive statistics, chi-squared tests, and interrupted time series analyses were used to analyze the data.

Results
The median number of total daily observations was 4083 (IQR 3801–4437). The mean eHH adherence rate in the baseline period (Apr/May 2016) was 46% (IQR 44%-49%) and increased to 76% (IQR 75%-78%) in Mar 2017. Over the study period, there was a significant decreasing trend in the proportion of nurses with eHH rates &lt;50% (P &lt; 0.0001, Figure 2) and a significant increasing trend in the proportion of nurses with eHH rates ≥80% on all units (P &lt; 0.0001, Figure 3).

Conclusion
eHH provides thousands of objective observations per day. eHH rates improved over the study period both due to an increase in nurses with eHH ≥80% and a decrease in the proportion of nurses with eHH &lt;50%.

Disclosures
All authors: No reported disclosures.
Monitoring Hand hygiene Compliance among Healthcare Workers at a Tertiary Care Center: Use of Secret Observers Is the Way Forward
Authors: Krishna Amar , Navalkele Bhagyashri , Pervaiz Amina , Kotecha Aditya , Maroof Shahram , Stern Dale , Robinson Katia , Kado Jenna , Flanagan Elaine , Hussain Syed , Chopra Teena 
Published: October 2017

Abstract

Background
Hand-hygiene (HH) is known to be the most effective way to reduce healthcare acquired conditions (HACs). Despite being a simple answer to the complex HAC issue, compliance with HH practice has been abysmal with reported compliance rate of 40% among healthcare workers (HCWs). In 2015, compliance rate with HH at Detroit Medical Center (DMC) was reported to be 100% when direct observers were used to monitor compliance. In order to confirm the previously reported compliance rates, this study used secret observers to audit HH compliance and provide performance feedback to HCWs.

Methods
A prospective observational study was conducted at DMC from June 2016 to December 2016. Hand hygiene committee was established comprising of Infection Prevention and Hospital leadership members. Trained medical residents were appointed as “secret observers” to provide accurate HH reporting. HH auditing was performed using the smartphone app “Speedy audits” to survey and capture the 5 moments of hand hygiene among HCWs. Compliance reports based on different professions, hospital sites, unit locations and auditors were generated using online web portal and analyzed to determine HH compliance rate.

Results
During the 7-month study period when secret observers were used, a total of 1229 HCWs were observed. Overall, the HH opportunity compliance rate was 31% (916 complied opportunities /2939 opportunities). Hand hygiene compliance rates drastically fell when secret observers were used (31% compared with 100% in 2015 using direct observers). Based on two major before and after patient contact indications, 1022 compliances were observed from 3343 opportunities (30.5% compliance rate). The other compliance rates were 44% before aseptic procedure, 35% after body fluid exposure and 20% after patient environment contact [Figure 1]. Based on profession, compliance rates were lowest among nurses (613/2058; 30%) and medical students (36/169; 21%) when compared with physicians (445/957; 46%).

Conclusion
Hand-hygiene monitoring by secret observers with use of smartphone app is a feasible and accurate way for tracking HH compliance. The advantage of generating profession-based and unit-based reports for feedback will help to promote HH awareness and improve adherence rates.

Disclosures
All authors: No reported disclosures.
What Psychological Theories of Behavior Change Can Teach Us about Improving Hand Hygiene Adherence: Do We Mean What We Say?
Authors: Corace Kimberly , Smith Jeffrey , MacDonald Tara , Fabrigar Leandre , Saedi Arezou , Quirk Jacquelyn , MacFarlane Sam , Valickis Debbie , Garber Gary 
Published: October 2017

Abstract

Background
Health care worker (HCW) hand hygiene is effective in reducing healthcare associated infections, yet hand hygiene rates are suboptimal. Psychological theories of behavior change can be used to improve and sustain hand hygiene adherence. While past research has examined HCW explicit attitudes towards hand hygiene (ie., self-reported attitudes), it is unclear if these explicit attitudes are consistent with implicit attitudes (ie., attitudes outside of one’s awareness). Understanding HCW explicit and implicit attitudes is important when designing effective interventions to improve hand hygiene rates. This study examined explicit attitudes towards HCW hand hygiene and compared these to implicit attitudes.

Methods
HCWs (N = 420) from 70 long-term care facilities in Ontario, Canada completed: (1) a survey tool based on psychological theories of behavior change to examine explicit attitudes towards hand hygiene, and (2) a computer administered implicit association test (IAT) and affect misattribution procedure (AMP) to evaluate implicit attitudes towards hand hygiene. Sociodemographics and self-reported hand hygiene adherence were measured. Factor analysis was performed to identify themes. Correlations were conducted between explicit and implicit measures.

Results
Factor analysis identified key explicit attitudes themes: (1) beliefs about consequences to self and others, (2) environmental resources, (3) time pressure and workload, and (4) social/professional role and identity. AMP and IAT results indicated that these procedures can be successfully applied to hand hygiene. While results suggested implicit positive attitudes towards hand hygiene, implicit test scores were neither correlated with explicit attitudes nor with self-reported hand hygiene adherence.

Conclusion
Explicit attitudes did not predict implicit attitudes. So, what we say is not always what we really think or do. Interventions have successfully targeted implicit attitudes to foster behavior change when targeting explicit attitudes alone did not work. This is yet to be explored in the hand hygiene arena, and is a key area for future research in order to guide the development of successful interventions to sustainably improve hand hygiene rates.

Disclosures
All authors: No reported disclosures.
Humoral and Cellular Immunogenicity of Zoster Vaccine within One Year after Herpes Zoster
Authors: Lee Eunyoung , Chun June Young , Song Kyoung-Ho , Choe Pyeong Gyun , Bang Ji Whan , Kim Eu Suk , Kim Hong Bin , Park Sang Won , Kim Nam Joong , Park Wan Beom , Oh Myoung-Don 
Published: October 2017

Abstract

Background
Herpes zoster vaccination is recommended to patients with a prior history of herpes zoster to prevent reactivation. However, the appropriate timing of vaccination is controversial. We compared immunogenicity of vaccine according to timing of vaccination after zoster illness.

Methods
In this prospective observational study, subjects were stratified into two groups by the vaccination timing since their zoster illness: 6–12 months (within-1 year group) vs. 1–5 years (after-1 year group). Blood samples were collected before and 6 weeks after vaccination of zoster vaccine live. Varicella-zoster virus (VZV)-specific IgG concentrations were measured by enzyme-linked immunosorbent assay. Interferon-gamma enzyme-linked immunosorbent spot (ELISPOT) assays were performed to assess VZV specific T-cell responses.

Results
A total of 59 patients (18 in the within-1 year group and 41 in the after-1 year group) were enrolled. Ages were not significantly different between groups. The baseline geometric mean titer (GMT) of VZV IgG was higher in the within-1 year group than in the after-1 year group (245.8 IU/mL vs. 124.9 IU/mL; P = 0.040). The geometric mean fold-rise (GMFR) of VZV IgG was lower in the within-1 year group than in the after-1 year group (1.42 vs. 2.46; P = 0.002). The GMT of spot forming cell (SFC) counts by ELISPOT at baseline and 6 weeks after vaccination were not significantly different between groups. The GMFRs of SFCs were also comparable.

Conclusion
Zoster vaccination within 1 year after zoster illness may have disadvantage in the aspect of humoral immune response (ClinicalTrials.gov number, NCT02704572).

Disclosures
All authors: No reported disclosures.