bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multi-Pronged Approach to Control Healthcare Facility-Onset Clostridium difficile Infection in a Tertiary Care Community Hospital
Authors: Chinn Raymond , Wyatt Jennifer , Wells Pam , Fox Tracy , Daley Jacqueline , Willon Judy , Magdaluyo Patty , Mabalot Shannon , Kramer Janie , Tarrac Shauna , Vasina Logan , Angus Gene , Guerra Tony , Rodean Kathy , Stiles Geoffrey , Woerle Cathy , Knier Susan , Tomac Chris , Gutierrez Katherine 
Published: October 2017

Abstract

Background
Clostridium difficile infection (CDI) contributes to significant increases in healthcare-associated morbidity and mortality. Multiple strategies have been promulgated to accurately diagnose and to control healthcare facility-onset (HO) CDI. Sharp Memorial Hospital is a 438-bed tertiary care community hospital. In 2014, the standardized infection ratio (SIR) CDI was 1.406 (2006–2008 baseline) with a p value of 0.0005. We report the results of a multi-disciplinary approach that has reduced our HO-CDI SIR. The National Healthcare Safety Network definitions and methodologies were used throughout the study.

Methods
Various multi-disciplinary interventions were implemented over a 12 month period from April 2015 through March 2016 that included enhanced administrative support and the creation of a multi-disciplinary CDI Steering Committee (Figure 1). A Lean Six Sigma approach was launched that included a two-day rapid process improvement (RPI) workshop in July 2015 with participation of an interdisciplinary team of frontline staff, leaders from the 2 units with high CDIs, Infection Prevention, and Environmental Services. Subsequently, lessons learned from the RPI were disseminated throughout the hospital. The laboratory and information technology staff and the antimicrobial stewardship program also contributed.

Results
Compared with the intervention period, the post intervention period (April 2016 through March 2017) documented a significant increase in the number of samples submitted for CDI testing ≤ 3 days after admission and a significant decrease in the number of samples submitted &gt; 3 days after admission. There were significant decreases in the HO-CDI SIR from 0.947 to 0.676 (p value 0.0485) and in quinolone days of therapy from 265 to 246 (p value 0.0001).

Conclusion
We have demonstrated a significant decrease in our HO-CDI using a multi-pronged approach that highlighted a return and reinforcement of back to basics infection prevention. High HO-CDI SIR in previous years might indicate missed community-onset, community-onset healthcare facility-associated cases. We did not employ other technologies such as the hands-free disinfection devices. Sustainability remains a future challenge.

Disclosures
All authors: No reported disclosures.
A Successful Strategy to Reduce Hospital-Onset Clostridium difficile
Authors: Bruno-Murtha Lou Ann , Osgood Rebecca , Alexandre Casey , Mahmood Rumel 
Published: October 2017

Abstract

Background
Our goal was to reduce the rate of hospital-onset (HO) C. difficile (CD) by prompt testing in patients with diarrhea on hospital day (HD) 1–3 using a nurse-driven testing protocol (NTP) with PCR and improve identification of disease after HD 3 using a combined toxin/antigen assay (TAA).

Methods
An automated best practice advisory/NTP was developed in Epic, triggered by documentation of diarrhea during HD 1–3, to facilitate prompt stool collection, testing and initiation of contact precautions. Education was provided. The NTP was fully implemented at 2 community-teaching hospitals mid-February 2016. The TAA was adopted 7/27/16 for testing after HD 3.

Results
In 2016, the standardized infection ratio (SIR) at Cambridge and Everett was 0.43 (P = 0.009) and 0.5 (P = 0.017), respectively, reflecting a 48–61% decrease from 2015. There was a 14–28% improvement in identifying cases as community-onset. The TAA led to a further decline in HO-CD by 10–61%. Refer to the graph for quarterly SIRs before and after implementation. Despite a 26% increase in testing volume, costs are less with the current strategy.

Conclusion
Prompt identification of CD improves care and prevents inflation of HO-CD. This strategy has enhanced our efforts to reduce our SIR (observed/expected cases) and resulted in a substantial incentive payment for CHA.

Disclosures
All authors: No reported disclosures.
Alcohol-based Hand Rubs Are Effective for Reduction of Multi-Drug Resistant Candida
Authors: Edmonds-Wilson Sarah , Yeik Alyssa 
Published: October 2017

Abstract

Background
Hand hygiene is one of the most important measures for preventing the spread of infection. However as new, multi-drug resistant organisms emerge there is the question as to whether marketed products are effective against them. Multi-drug resistant Candida auris(MDRCA) was first reported as an infectious agent in humans in 2009 and has since been implicated in a growing number of infections. In June 2016 the US CDC issued a clinical alert to healthcare facilities warning of the potential for MDRCA transmission and infection within healthcare facilities and the importance of infection control measures. To date, data on the effectiveness alcohol-based hand rubs (ABHRs) against MDRCA has been lacking. The objective of the study was to test the fungicidal efficacy of three commercial ABHRs against MDRCA.

Methods
Three test products, two ABHR foams and one gel, each containing 70% ethanol, were evaluated for fungicidal activity against MDRCA (AR-Bank #0390) using an in vitrotime kill method (ASTM E2783-11). Reductions of the microorganism were determined following exposure to test products for 15 and 30 seconds.

Results
Each of the three ABHR achieved complete reduction, 6.7889 log10(≥99.9999%) of MDRCA at the 15 and 30 seconds exposure times.

Conclusion
Health care workers should continue to use ABHRs as indicated for preventing the transmission of infection. This data indicates these products effectively kill MDRCA, and further highlights the importance of compliance with hand hygiene guidelines in healthcare settings.

Disclosures
S. Edmonds-Wilson, GOJO Industries: Employee, Salary
Comparison of Two Glove-Sampling Methods to Discriminate Between Study Arms of a Hand Hygiene and Glove-Use Study.
Authors: Blanco Natalia , Robinson Gwen L , Otieno Linda , Johnson J Kristie , Li Shanshan , Chanyasubkit Soraya , Harris Anthony D , Thom Kerri A 
Published: October 2017

Abstract

Background
Our group will be assessing in a randomized trial whether the use of alcohol-based hand rub (ABHR) to clean non-sterile gloved hands (instead of performing hand hygiene (HH) and changing gloves) for the WHO 5 Moments of HH during a single patient encounter is an efficient and effective practice. In preparation for this future study and in the absence of a well-established gold standard, this pilot study aimed to identify an effective glove-sampling method with the ability to detect a difference between our two study arms.

Methods
Healthcare workers (HCWs) entering Contact Precaution rooms were recruited and randomized into the intervention arm (HCWs directed to clean gloves with ABHR at each opportunity) or the usual care arm (HCWs behavior is silently recorded at each opportunity). In both arms, HCWs individual gloved hands were randomized then sampled, using both sponge stick and direct imprint methodology (Fig 1–2). The outcome of interest was total bacterial colony forming units (CFUs). A Wilcoxon rank-sum test was performed to compare the median distribution of CFUs recovered by each sampling method between study arms. Sampled gloved hands were also categorized by level of bacterial detection (0 CFUs vs. more than 0 CFUs). For each sampling method, the proportional difference between categories was analyzed using a Fisher exact test.

Results
42 unique HCWs participated in the study (25 intervention, 17 usual care). For each HCW interaction an average of 3 HH moments were recorded. Using the direct imprint technique, the median CFUs in the intervention arm compared with the usual care arm were 2 vs. 31, P &lt; 0.01. Using the sponge stick technique, the median CFUs were 1 vs. 6, P = 0.25. (Fig 3). Using the agar method, bacteria was detected on 16/25 (64%) of gloved hands in the intervention arm compared with 17/17 (100%) in the usual care arm (P &lt; 0.05). Using the sponge-stick method, bacteria was detected 16/25 (64%) of gloved hands in the intervention arm and on 15/17 (88%) in the usual care arm (P = 0.15).

Conclusion
The direct imprint method is an effective method to discriminate between our intervention arms. In addition, this method is more affordable and less work-intensive in the lab and as a sampling method than the sponge-stick method.

Disclosures
A. D. Harris, CDC Epicenter Program: Grant Investigator, Grant recipient; K. A. Thom, AHRQ: Grant Investigator, Grant recipient
Patients’ Family Empowering to Increase Hand Hygiene (HH) Compliance in Health-Care Workers (HCW) from a Hematology-Oncology Ward in Mexico City
Authors: Molina-Jaimes Aaron , Cueto Fuensanta Guerrero Del , Roman-Lopez Cristina , Sandoval-Hernández Silvia , Garcia-Pineda Bertha , Compte Diana Vilar 
Published: October 2017

Abstract

Background
HH is a key component to decrease infections in hospitals, but compliance in HCW remains low. We present a six-month strategy to empower patients’ caregivers on HCW HH compliance.

Methods
HH compliance in HCWs was evaluated between June 1 and August 31, 2017 as recommended by WHO. Between September 1, 2016 and March 31, 2017 we undertook the empowering in the hematology-oncology ward (50 beds) from Instituto Nacional de Cancerologia, a cancer referral, teaching hospital in Mexico. To empower patients and their caregivers, a member of the team visited the patient and their relatives during the first 24h of hospital admission. Standarized information on HH and the importance of HCW compliance was given, along with a printed cartoon on HH opportunities (5 moments from WHO). Patients and their caregivers were trained to observe and record HH opportunties, an were invited to remind HCWs if HH omissions were observed. Data on HH compliance was collected monthly during the empowerment and 1 month after. Data was compared with the HH compliance from the 6 previous. We compared overall compliance and for each 5 HH moments before and after the empowering (chi 2 test).

Results
We empowered 82 caregivers (M: 25.6%) and F: 74.4%), mean age 44 years. 24.4% had completed primary education, and 13.1% had higher education. Mothers and spouses were the primary caregivers (28.1% and 36.6%). HH compliance increased in all 5 moments: Before touching a patient (M1) (B: 9.5%, A: 57.6%, P = 0.005); before a clean or aseptic procedure (M2) (B: 7.9%, A: 48%, P = 0.002); after body fluid exposure (M3) (B: 10%, A: 59%, P = 0.0005), after touching a patient (M4) (B: 7.4%, A: 57.9%, P = 0.0005), and after touching patient surroundings (M5) (B: 2.4%, A: 77.4%, P = 0.0008). Nurses achieved a higher increase on compliance compared with physicians. Caregivers recognition on HH increased for each opporunity, being more notorious for M2 (B:31.7%, A: 61.5%); M3 (B: 7.3%, A: 31.5%), and M4, (B: 36.5%, A: 68.7%). Perception on the importance of preventing health-care-related infections increased from 80.5% to 90.3%.

Conclusion
Empowering patients’ primary caregivers was an effective intervention to increase HCWs HH compliance at a hematology-oncology ward. The effect of this intervention remains to be evaluated on the long-term basis, but demonstrate the importance of involving patients and their relatives on health-care delivery.

Disclosures
All authors: No reported disclosures.
Persistence of Immune Response to an Adjuvanted Varicella-Zoster Virus Subunit Candidate Vaccine for up to Year 9 in Older Adults
Authors: Pauksens Karlis , Volpe Stephanie , Schwarz Tino F , Smetana Jan , Toursarkissian Nicole , Rombo Lars , Ravault Stéphanie , David Marie-Pierre , Bastidas Adriana , Oostvogels Lidia 
Published: October 2017

Abstract

Background
In the ZOE-50 and ZOE-70 clinical trials, the candidate herpes-zoster subunit vaccine (HZ/su; 50µg varicella-zoster virus glycoprotein E [gE] and AS01B Adjuvant System) demonstrated high efficacy against HZ, with limited waning over 4 years and consistent efficacy across age cohorts. In adults ≥60 years of age, the immune responses elicited by 2 HZ/su doses administered 2 months apart persisted for at least 6 years.1 Here we report immunogenicity and safety 9 years post-initial vaccination.

Methods
This Phase IIIB, open, long-term extension study (NCT02735915) followed 70 participants who received 2 HZ/su doses in the initial trial (NCT00434577). Blood samples to evaluate the persistence of cellular (intracellular cytokine staining) and humoral (ELISA) immune responses were taken at 9 years post-initial vaccination. Limited safety follow-up was performed (1 visit).

Results
All 70 participants (mean age at dose 1: 72.3 years; 61.4% female) were included in the according-to-protocol analysis. The fold increases over pre-vaccination in the frequency of gE-specific CD4+ T-cells expressing ≥2 activation markers plateaued after 4 years post-dose 1 (year 4: 3.4, year 5: 3.0, year 6: 3.4, year 9: 3.4). Anti-gE antibody geometric mean concentrations were also stable from year 4 onwards (Table 1) and remained above the pre-vaccination value of 1213.1mIU/mL. Cellular and humoral responses at year 9 were similar across age strata (60–69, ≥70 years). No vaccine-related serious adverse events nor suspected HZ episodes were reported.

Conclusion
In adults ≥60 years of age, HZ/su-induced cellular and humoral immune responses remained above pre-vaccination levels for at least 9 years post-initial vaccination, confirming immune persistence predictions2 based on 6-year data.

Disclosures
S. Volpe, GSK: Employee, Salary; T. F. Schwarz, GSK: Investigator and Scientific Advisor, Consulting fee; J. Smetana, GSK: Investigator, personal fees; &#x2028;S. Ravault, GSK: Employee, GSK shares and Salary; M. P. David, GSK: Employee, Salary and stock; A. Bastidas, GSK: Employee, Salary; L. Oostvogels, GSK: Employee and Shareholder, Salary and shares
Lymphogranuloma Venereum: a Croatian Case Report of a Patient with Proctitis and Concurrent Cervical Lymphadenitis
Authors: Gjurasin Branimir , Begovac Josip 
Published: October 2017

Abstract

Background
Lymphogranuloma venereum (LGV) can present with genital ulcers, proctitis, or femoral/inguinal lymphadenopathy with or without constitutional symptoms. There have been reports on the infection characterized by supraclavicular or cervical lymphadenopathy, although there is no published data on the detection of Chlamydia trachomatis (CT) in the affected lymph node.

Methods
We report a patient with pharyngitis, proctitis and cervical lymphadenitis, in whom LGV specific DNA was detected by polimerase chain reaction (PCR) in both the rectal swab and cervical lymph node fine needle aspirate.

Results
A 48-year-old Croatian HIV-positive male patient attended our outpatient HIV clinic complaining of a 10-day perianal pain, bloody rectal discharge with normal stool consistency and painful and enlarged cervical lymph node. On the first day he had fever, which subsided on the following day. Clinical examination demonstrated exudate on the right tonsil, painful, and enlarged right cervical lymph node (5 × 2 cm, Figure 1), perianal pain on palpation and rectal purulent discharge. During the preceding 10-year period, the patient was taking his antiretroviral therapy regularly and had an undetectable HIV RNA by PCR. We started treatment with ceftriaxone and doxycycline. The fine needle aspirate of the affected lymph node showed a pyogranulomatous inflammation. Indirect immunofluorescence assay on CT antibodies detected positive titers in IgG (&gt;512) and IgA (256) classes. LGV-specific DNA was detected in both the rectal swab and the cervical lymph node fine needle aspirate. Ceftriaxone was discontinued after 5 days and doxycycline therapy was continued for a total of 6 weeks because of the persistence of the cervical lymphadenopathy. The patient came to a full recovery.

Conclusion
We found six published case reports on LGV with associated cervical lymphadenopathy in which the infection with CT was established by serologic testing and/or by nucleic acid amplification tests of the pharyngeal and/or rectal swabs. Some of the mentioned reports demonstrated granulomatous inflammation present in the affected cervical lymph node, as was evidenced in our patient. To our knowledge, this is the first case report of a patient with CT infection in whom LGV-specific DNA was detected in the cervical lymph node.

Disclosures
All authors: No reported disclosures.
Agar Gradient Diffusion Susceptibility Testing for Neisseria gonorrhoeae: A Reliable Alternative to Agar Dilution?
Authors: Desjardins Michaël , Lefebvre Brigitte , Labbé Annie-Claude , Martin Irene , Mauffrey Florian , Longtin Jean , Fortin Claude 
Published: October 2017

Abstract

Background
Antimicrobial susceptibility testing by agar dilution, the gold-standard for determination of minimal inhibitory concentration (MIC) for N. gonorrhoeae, is a labor intensive technique usually performed in reference laboratories. Agar gradient diffusion is a simpler alternative to obtain MICs. However, correlation of N. gonorrhoeae MIC values obtained by the two methods is not well established. The objective of this study is to evaluate performance of agar gradient diffusion compared with agar dilution for N. gonorrhoeae.

Methods
Fifty strains of N. gonorrhoeae (34 isolates from clinical specimens; 14 WHO reference and two ATCC strains), all confirmed to be genetically distinct using molecular typing (NG-MAST), were selected. Isolates with known high MICs were targeted. Agar gradient diffusion MIC testing was done in a clinical laboratory on all strains for ceftriaxone, cefixime, and azithromycin while comparing two different commercial antimicrobial strips (bioMérieux, Alere) on three different culture media (BD, Oxoid, CLSI’s recommended medium). Agar dilution MIC testing according to CLSI was done at the Québec provincial reference laboratory on all strains. Performance of agar gradient diffusion was assessed by accuracy, using essential and categorical agreements, and by precision (reproducibility).

Results
When comparing agar dilution and agar gradient diffusion using bioMérieux strips on CLSI testing medium, essential agreements (within 1-log2 dilution) were 94, 88, and 82% for ceftriaxone, cefixime, and azithromycin, respectively. Categorical agreements were 100, 94, and 94%. Agar gradient diffusion, compared with agar dilution, had a tendency to under-estimate MIC for third-generation cephalosporins, not classifying 86% of isolates with decreased susceptibility (MIC 0.12–0.25 mg/l for ceftriaxone, 0.25 mg/l for cefixime) as such. Overall precision of agar gradient diffusion was 96%.

Conclusion
Agar gradient diffusion using bioMérieux strips on CLSI testing medium shows satisfactory accuracy compared with agar dilution for N. gonorrhoeae MIC testing of third-generation cephalosporins and azithromycin even in a carefully selected panel of strains.

Disclosures
M. Desjardins, bioMerieux: Research Contractor, Research support. BD: Research Contractor, Research support. Alere: Research Contractor, Research support. Oxoid: Research Contractor, Research support. C. Fortin, Alere: Research Contractor, Research support. bioMerieux: Research Contractor, Research support. BD: Research Contractor, Research support
Oxoid: Research Contractor, Research support
Healthcare Engagement among Persons with HIV: More Than Just Viral Load and Clinic Attendance
Authors: Okeke Nwora Lance , Clement Meredith , McKellar Mehri , Stout Jason 
Published: October 2017

Abstract

Background
The traditional definition of engagement in HIV care in terms of only clinic attendance and viral suppression provides a limited understanding of how persons with HIV interact with the healthcare system.

Methods
We conducted a retrospective analysis of patients with ≥ 1 HIV clinic visit at the Duke Adult Infectious Diseases Clinic between 2008 and 2013. Healthcare utilization was characterized by four indicators: clinic attendance in each half of the calendar year (yes/no), number of emergency department (ED) visits (0, 1 or 2+), inpatient admissions per year (0, 1, 2+), and viral suppression (never, intermittent, always). Healthcare engagement patterns were modeled using latent class/latent transition analysis, with model fit assessed using the Bayesian Information Criterion.

Results
The cohort included 2686 patients (median age 42.9 years, 72% male, 56% black). A three-class model best fit the data: “Adherent” “Non-adherent” and “Sick”. “Adherent” patients had high rates of clinic attendance in each half of the year (84%), rarely visited the ED (3.6% with ≥1 ED visit per year), and moderate rates of (54%) viral suppression. “Non-adherent” patients rarely attended clinic visits in both halves of the year (1.5%), used the ED more than “adherent” patients (10.3% with ≥1 ED visit per year), and had low rates of viral suppression (19%). “Sick” patients also had high rates of clinic attendance (75%), were frequent users of the ED (53% with ≥1 ED visit per year), and comparable rates of viral suppression to the “adherent” group (55%) viral suppression. Non-white race (OR 1.9) and age ≤ 40 (OR 3.76) were associated with membership in the “non-adherent” class. Movement between classes was dynamic, especially in the “sick” group (30–40% of whom moved to a different class the following year). Across all years, persons in the “non-adherent” class were more likely to completely disengage from care the following year than “adherent” persons (23.6% v. 0.2%, P &lt;0.001).

Conclusion
A broader definition of healthcare engagement revealed distinct and dynamic patterns among persons with HIV that would have been hidden had only clinic attendance and viral suppression been considered. These patterns may be useful for designing engagement-targeted interventions.

Disclosures
All authors: No reported disclosures.
High Correlation of Visual Inspection and a Smartphone-Based Electronic Reader of Two Dual Rapid Diagnostic HIV/Syphilis Assays
Authors: Allan-Blitz Lao-Tzu , Rivera Silver Vargas , Konda Kelika , De Cortina Sasha Herbst , Caceres Carlos , Klausner Jeffrey 
Published: October 2017

Abstract

Background
The HRDR-200 automated reader (Cellmic, LLC, CA, USA) is an opto-mechanical smartphone attachment that reads lateral flow-based rapid HIV/Syphilis combo assays. The reader may minimize human errors in interpreting rapid tests as well as provide a centralized data system for epidemiologic monitoring.

Methods
We enrolled men who have sex with men and transgender women &gt;18 years old seeking services at a sexually transmitted disease clinic in Lima between October 2016 and April 2017. Venous blood was tested using two dual HIV and Syphilis rapid tests (SD BIOLINE HIV/Syphilis Duo (SD), Republic of Korea; and First Response HIV 1 + 2/Syphilis Combo (FR), India). HIV infection was confirmed with fourth-generation EIA tests, while Syphilis was confirmed with RPR, TPPA, and TPHA titers. Clinic staff visually inspected rapid tests, after which the tests were read by the HRDR-200. To assess how well the reader results correlated with visual inspection we calculated negative and positive percent agreement, concordance, and kappa statistic.

Results
Of 283 participants, 34% were HIV-infected and 46% had treponemal antibodies (69% of whom had reactive RPR titers). The concordance of reader results with visual inspection was high for both antibodies and both rapid assays (see Table).

Conclusion
Given the high correlation of the reader with visual inspection, further investigation is warranted into the potential utility of the reader for epidemiologic monitoring as well as for improving HIV and Syphilis diagnosis in areas without technicians trained in visual inspection of rapid tests.

Disclosures
All authors: No reported disclosures.