bluuebunny/crossref_metadata_2025_split huggingface dataset:
First Environmental Investigation of Toxigenic Clostridium difficile at a Large Hospital in Bangladesh
Authors: Alam M Jahangir , Begum Khurshida , Rashid Tasnuva , Hasan Irtiza , McPherson Jacob , Hossain Feroz , Miranda Julie , Garey Kevin W 
Published: October 2017

Abstract

Background
Toxigenic Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients in the developed world and an emerging pathogen in developing countries due to increased use of broad-spectrum antibiotics. Although likely ubiquitous worldwide, the prevalence of toxigenic C. difficile spores in the hospital environs of developing countries is poorly understood. The objectives of the study are to isolate and characterize C. difficile from the hospital environs of a large hospitals in Dhaka, Bangladesh.

Methods
As part of our environmental surveillance effort, we collected 330 shoe-bottom swab samples from hospital employees, patients, and visitors inside of a large hospital in Dhaka, Bangladesh. Samples were analyzed for C. difficile using anaerobic enrichment culture and molecular methods. Suspected colonies from cycloserine cefoxitin fructose agar (CCFA) plates were identified by PCR (tcdA, tcdB, cdtA, cdtB and tpi genes) and strain typed using fluorescent PCR ribotyping, and MLVA methods.

Results
A total 149 of 333 (44.7%) shoe-bottom swab samples were culture positive for C. difficile of which 19.8% samples were toxigenic (tcdA and tcdB) C. difficile. A total of 11 distinct ribotypes were identified from 58 toxigenic C. difficile isolates tested. Predominant ribotypes were F053-163 (24.1%), F017 (20.7%), F106 (19.0%), F014-020 (17.2%). Other ribotypes were R001, F005, F010, F018, F054, F216, and FP407. No R027 and R078 C. difficile isolated. A broad MLVA diversity has been seen among the tested strains.

Conclusion
We identified a high prevalence of toxigenic C. difficile with diverse ribotypes from hospital environmental shoe-bottom swabs in Bangladesh. This is the first hospital environmental report of C. difficile from Bangladesh.

Disclosures
All authors: No reported disclosures.
Enhanced Cleaning and Education to Prevent Transmission of Clostridium difficile in Pediatrics
Authors: Aslam Anoshé , Melendez Giselle , Wang Min , Stell Frederic , Kelly Paulette , Killinger James , Dannaoui Aimee , Riedman Scott , Lopez Ruben , Ackerman Jill , Chou Alexander , Wexler Leonard , Smith David , Sanchez Stacy , Robilotti Elizabeth , Kamboj Mini , Eagan Janet 
Published: October 2017

Abstract

Background
Transmission of healthcare-associated Clostridium difficile infection (HA-CDI) has been shown to occur directly or indirectly through a contaminated environment. At a tertiary-care cancer center, HA-CDI rates were higher for pediatric units than for other general oncology units. To address the problem, a multidisciplinary team, including Infection Control, Nursing, and Environmental Services (EVS), was convened and identified refusals and room clutter as barriers to proper cleaning of rooms on the unit.
Aim: The aim of this study seeks to reduce HA-CDI in the inpatient pediatrics setting through environmental and educational interventions.

Methods
In the first phase of the study from February to April 2016, a baseline assessment of prevalent environmental disinfection practices was made among Nursing, EVS, Physicians, and Patient Representatives. Based on this feedback, the following were implemented during Phase 2, from June through October 2016: 1) Unit-wide disinfection with bleach twice a day including common and high traffic areas; 2) Initiation of a “preferred time for cleaning” program to engage families; 3) Enhanced visitor and family education on PPE use; 4) Creation of a communication plan in case of refusal to clean rooms; and 5) Dedicated use of diaper scales.

Results
During the first phase of the study, the following barriers to cleaning were identified: 1) High refusal rate as cleaning was perceived as inconvenient by families due to timing; 2) Common perception among EVS staff that multiple requests for cleaning the room may appear intrusive to the families; 3) Excessive clutter in the room; 4) Lack of education regarding PPE use; and 5) Shared equipment for diapers. To overcome these barriers, several interventions as outlined in methods were implemented. In Phase 2, there were 0 cases of HA-CDI identified in pediatric patients starting in July through October, 2016.

Conclusion
Control of CDI on pediatric units poses unique challenges. Engagement of key stakeholders is essential to identify and meet these challenges and to devise effective strategies that will ultimately lead to reduced hospital-based transmission of CDI.

Disclosures
All authors: No reported disclosures.
Frequently Identified Infection Control Gaps Related to Hand Hygiene in Long-Term Care Facilities
Authors: Tyner Kate , Nailon Regina , Beach Sue , Drake Margaret , Fitzgerald Teresa , Lyden Elizabeth , Rupp Mark E , Schwedhelm Michelle , Tierney Maureen , Ashraf Muhammad Salman 
Published: October 2017

Abstract

Background
Little is known about hand hygiene (HH) policies and practices in long-term care facilities (LTCF). Hence, we decided to study the frequency of HH-related infection control (IC) gaps and the factors associated with it.

Methods
The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted in-person surveys and on-site observations to assess infection prevention and control programs (IPCP) in 30 LTCF from 11/2015 to 3/2017. The Centers for Disease Control and Prevention (CDC) Infection Prevention and Control Assessment tool for LTCF was used for on-site interviews and the Centers for Medicare and Medicaid (CMS) Hospital IC Worksheet was used for observations. Gap frequencies were calculated for questions (6 on CDC survey and 8 on CMS worksheet) representing best practice recommendations (BPR). The factors studied for the association with the gaps included LTCF bed size (BS), hospital affiliation (HA), having trained infection preventionists (IP), and weekly hours (WH)/ 100 bed spent by IP on IPCP. Fisher’s exact test and Mann Whitney test were used for statistical analyses.

Results
HH-related IC gap frequencies from on-site interviews are displayed in Figure 1. Only 6 (20%) LTCF reported having all 6 BPR in place and 10 (33%) having 5 BPR. LTCF with fewer gaps (5 to 6 BPR in place) appear more likely to have HA as compared with the LTCF with more gaps but the difference didn’t reach statistical significance (37.5% vs. 7.1%, P = 0.09). When analyzed separately for each gap, it was found that LTCF with HA are more likely to have a policy on preferential use of alcohol based hand rubs than the ones without HA. (85.7%, vs. 26.1% P = 0.008). Several IC gaps were also identified during observations (Figure 2) with one of them being overall HH compliance of &lt;80%. LTCF that have over 90% HH compliance are more likely to have higher median IP WH/100 beds dedicated towards IPCP as compared with the LTCFs with less than 90% compliance (16.4 vs. 4.4, P &lt; 0.05).

Conclusion
Many HH-related IC gaps still exist in LTCF and require mitigation. Mitigation strategies may include encouraging LTCF to collaborate with IP at local acute care hospitals for guidance on IC activities and to increase dedicated IP times towards IPCP in LTCF.

Disclosures
All authors: No reported disclosures.
Impact of Electronic Hand Hygiene Monitoring on Hospital-Acquired Clostridium difficile Infection Rates
Authors: Knepper Bryan , Miller Amber , Ruff Kevin , Van Winks Tina , Zoetewey Julie , Douglas Ivor , Hanley Michael , Young Heather 
Published: October 2017

Abstract

Background
Lower rates of hand hygiene adherence are linked to increased risk of nosocomial transmission of infectious pathogens, thereby increasing morbidity and mortality. Assessing true adherence is difficult using direct observation due to the low number of observations collected, heterogeneous observer training and bias, and the Hawthorne effect. We assessed whether radio frequency identification (RFID) hand hygiene monitoring resulted in changes to our hospital-onset Clostridium difficile (HO-CDI) rates. We also assessed whether electronically measured hand hygiene improved by the end of the intervention period.

Methods
The RFID system was installed in Apr 2016 in 2 medical/surgical units, a progressive care unit, and an intensive-care unit (study group). Registered nurses, certified nursing assistants, and selected physicians wore RFID badges to track hand hygiene adherence. Adherence is defined as washing with soap or alcohol-based hand rub within 1 minute before or after entering or exiting a patient’s room. A second set of rooms (1 ICU, 1 short-stay unit, and 5 medical/surgical units) without the system served as the control group. HO-CDI rates were tracked monthly for each group using NHSN definitions. HO-CDI trends were compared for 15 months before and 12 months after installation of the system using interrupted time series analysis. Average electronic hand hygiene adherence for the first two months and last two months of the intervention period was compared using the Wilcoxon rank-sum test. Other interventions aimed at reducing HO-CDI were consistently applied to both the study and control groups.

Results
One hundred and eighty-six HO-CDI occurred: 73 in the study group and 113 in the control group. In the study group, the trend in HO-CDI rates changed from increasing in the pre-intervention to decreasing in the post-intervention (P = 0.02) (Figure 1). HO-CDI rates in the control group demonstrated no change in trend (P = 0.69) (Figure 2). In the study group, electronically tracked hand hygiene adherence increased from a mean of 46% in Apr-May 2016, to 77% in Feb-Mar 2017 (P &lt; 0.0001).

Conclusion
Electronic RFID hand hygiene systems can have a tangible effect on hospital-acquired infection rates. This result strengthens the argument for using these systems to improve patient safety.

Disclosures
All authors: No reported disclosures.
Improving Hand Hygiene:Anonymously Validated Data Driven Approach Producing Sustainable Culture Change Utilizing “One and Up” Accountability Agents across a Healthcare System- a Cost-effective National Best Practice.
Authors: Ross Jack 
Published: October 2017

Abstract

Background
Inadequate hand hygiene is a major contributor to hospital infections worldwide. Before 2012, in our healthcare system, hand hygiene was monitored by unit managers, nurses, and infection control staff with reported compliance rates of &gt;90%. A five month independent audit by an anonymous observer revealed actual rates of 14–33%. This discordant result was typical of hospitals across the country then and now who have provided intensive education, used peer feedback, and maximized physical hand hygiene supplies. A commitment was made to rigorously improve hand hygiene utilizing validated data, social psychology with disciplinary consequence, and no additional expensive technology.

Methods
Employed dedicated “secret shopper”/anonymous observers were deployed across five hospitals, all units and all shifts, and all job roles to collect valid anonymous hand hygiene observations without local bias. Twice monthly hand hygiene data was shared by hospital, unit, shift, and job role to executive leadership and down to frontline unit staff for daily huddles. Additionally, over 100 “One and Up” Accountability Agents from management ranks were recruited, trained, and performed weekly standardized unit- based hand hygiene obervations openly, giving feedback real-time to non-compliant employess and medical staff; noncompliance was reported to the hospital epidemiologist; and emails on his behalf were sent to the employee’s manager, and the manager’s manager “One and Up”. A four step disciplinary process was begun. The same process was applied to the medical staff.

Results
Over 188, 000 anonymous secret shopper validation observations, and hundreds of thousands of Accountability Agent observations have been performed. Hand hygiene compliance has been &gt;94% for 22 months and ≥97 % for the last 6 months in all five hospitals. No employee or medical staff member advanced beyond the second disciplinary step.

Conclusion
This model represents a national best performance model, with validated and sustained results, accomplished with cultural change and aligned multitier accountability (not technology). It is truly a low cost blueprint for other healthcare systems that seek rapid, honest, and sustained hand hygiene improvement across all job roles, shifts, and different sized hospitals and cultures.

Disclosures
All authors: No reported disclosures.
How Many Patients Who Present to North Central Bronx Hospital with a Sexually Transmitted Disease (Chlamydia, Gonorrhea) Are Tested for HIV?
Authors: Yung Lok 
Published: October 2017

Abstract

Background
To determine whether an individual got infected with either Chlamydia trachomatis, N gonorrhea, or both infected, the HIV test was ordered or not.

Methods
Systematic review and data synthesis of STD and HIV testing results through Quardamed within the 1 month period of November, 2015. Percentage of patients with and without a STD (either Chlamydia trachomatis, N gonorrhea, or both infected) who had HIV test done.

Results
804 patients were tested for gonorrhea or chlamydia by GC probe during November 2015. Thirty-three of 804 (4.1%) individuals were infected with Chlamydia trachomatis. Of those 20 were tested for HIV by rapid oral test. Six of 804 (0.7%) participants who were infected with N gonorrhea had five HIV rapid test done. Two of 804 (0.3%) participants were infected with both diseases and one patient was tested for HIV. Most patients with a confirmed STD were diagnosed in ED (43.4%) followed by OB/GYN (37.3%). Seventy-two percent of patients who were either infected with chlamydia, gonorrhea or both were tested for HIV. In the ED, 48% had an HIV test vs. 80% in OB/GYN (including family planning).

Conclusion
The majority of patients were tested for HIV. More patients were tested in OB/GYN compared with the ED likely because an HIV counselor is readily available during clinic hours. Increase in education and training of health care providers and nurses to become more comfortable in testing patients for HIV may increase the number HIV testing when patients present with STDs.

Disclosures
All authors: No reported disclosures.
Hand hygiene: Knowledge and Practices of Clinical Teachers in Selected Teaching Hospitals in Kenya
Authors: Ndegwa Linus , Nyoni Champion 
Published: October 2017

Abstract

Background
Healthcare-associated infections lead to substantial morbidity and mortality worldwide, and adequate hand hygiene (HH) in the clinical setting is essential for prevention. Clinical teachers are central to the training of healthcare workers (HCW) as they teach and model safe practices in the clinical environment. However, there is limited research on the knowledge and practices of clinical teachers related to HH in teaching hospitals, particularly in African settings. We describe the knowledge and practices of HH amongst clinical teachers in selected teaching hospitals in Kenya.

Methods
Data were collected through self-administered standardized questionnaires with basic demographic, knowledge and practices about HH from clinical teachers employed at two teaching hospitals. Participating clinical teachers were anonymously audited for HH practices using an adapted World Health Organization tool. The audits consisted of 20–30 minutes observations in each ward

Results
Among 57 participants overall, 42 (73.7%) were nurses, 8 (14.0%) clinicians, and 5 (8.8%) therapists. Twenty-one (36.8%) of the participants had knowledge regarding the minimum time needed to practice HH using alcohol based hand rub, 14 (24.6%) knew that hand washing and hand rubbing should be performed in sequence. The combined knowledge score for each individual ranged from 0% to 94.1% with a mean of 50.1% (SD=20.1, Cl 95% 44.7- 55.4%). Hand hygiene compliance significantly varied by clinical instructor’s type; nurses (42.7%) and therapists (38.0%) had the highest adherence and clinicians had the lowest 33.7% (P = 0.0001).

Conclusion
Clinical teachers in this study demonstrated knowledge gaps and poor practices related to HH. Since they serve as role models for future generations of healthcare workers, clinical teachers must recognize the importance of HH in preventing hospital-acquired infections, including when and how HH should be performed while following recommended practices.

Disclosures
All authors: No reported disclosures.
Performance of Zoster Vaccine Live (Zostavax): A Systematic Review of 12 years of Experimental and Observational Evidence
Authors: Dooling Kathleen , Guo Angela , Leung Jessica , Belongia Edward , Harpaz Rafael 
Published: October 2017

Abstract

Background
One in three people in the U.S. will develop herpes zoster during their life. Zoster Vaccine Live (ZVL or Zostavax™), has been licensed in the U.S. since 2006 to prevent herpes zoster. ZVL protection has been shown to wane with time and estimates of effect can be imprecise. We performed a systematic review of the duration of efficacy and effectiveness of ZVL against herpes zoster (HZ).

Methods
We systematically searched PubMed, Embase, Cochrane, and clinicaltrials.gov for vaccine efficacy or effectiveness (VE) studies of ZVL. Two authors independently screened each title and abstract, and potential VE studies were reviewed in-depth. Eligibility criteria included original data on ZVL prevention of HZ in a general population of immunocompetent recipients ≤ 60 years old. Selected articles were abstracted, independently reviewed, and discrepancies adjudicated. We attempted to locate relevant unpublished work and contacted authors for additional data, where necessary. Measures of association were illustrated on a forest plot and converted to VE (1-hazard ratio or risk ratio or odds ratio).

Results
We screened 1302 articles; 17 underwent full text review and 8 met inclusion criteria and were abstracted for this review. Selected studies included 1 phase III randomized controlled trial, 2 quasi experimental and 5 observational studies. One experimental and 5 observational studies estimated VE during the period from vaccination up to 4 years following vaccination; estimates across studies ranged from 33%-55%. Two quasi experimental and 3 observational studies estimated VE for ≥ 4 years following vaccination; estimates ranged from 19%-40%; the median estimate was 24% (Figure). Pooled VE was not calculated due to heterogeneity in length of follow up, age distribution of study subjects, as well as adjustment for factors such as underlying medical conditions.

Conclusion
Most experimental and observational studies estimate VE just above 50% during the 3 years following receipt of ZVL. Beyond 3 years, ZVL protection wanes, with most studies estimating a VE of ≤24% after 4 years. Information on overall efficacy and duration of protection from ZVL will guide policy decisions regarding its use.

Disclosures
E. Belongia, Novavax: Investigator, Research support
Immune Senescence Factors Associated with the Immunogenicity of a Live Attenuated Zoster Vaccine (ZV) in Older Adults
Authors: Weinberg Adriana , Schamder Kenneth , Johnson Michael , Popmihajlov Zoran , Tovar-Salazar Adriana , Caldas Yupanqui , Pang Lei , Cho Alice , Levin Myron 
Published: October 2017

Abstract

Background
ZV confers protection against herpes zoster by increasing the cell-mediated immunity (CMI) to varicella-zoster virus (VZV). ZV immunogenicity and protection decrease with increasing age. We investigated effects of age and immune senescence on ZV immunogenicity.

Methods
399 adults ≥50 years had VZV T-cell helper 1 (Th1) CMI measured by ex vivo VZV-stimulated IL2/IFNg ELISPOT and blood T-cell nonspecific immune senescence by flow cytometric characterization of FOXP3, CD25, IL10, TGFb, PD1, CD28, CD57 and CD31 expression before and at 1, 6 and 52 weeks after ZV. In a subset of 95 vaccinees, VZV-stimulated T cell expression of CD107, Granzyme B, FOXP3, CD25, IL10, TGFb, CD39 and PD1 were also measured. Multivariate regression analysis was used to identify independent effects of age and immune senescence on VZV Th1 CMI (P &lt; 0.025).

Results
IL2+ and IL2+IFNg+ Th1 memory VZV CMI peaked at 6 weeks after ZV and remained elevated at 1 year. Effectors, including VZV-specific IFNg+ Th1, and CD8+CD107+% and CD4+/CD8+Granzyme B+% cytotoxic T lymphocytes (CTL), peaked at 1 week, but only the IFNg+ Th1 effectors remained elevated at 1 year. There was also a transient increase in blood CD8+PD1+% exhausted T cells 1 week after ZV. Independent positive effects on peak memory Th1 VZV CMI included the baseline CMI and negative effects included blood CD4+FOXP3+% T regulatory (Treg) and CD8+PD1+% T exhausted cells. Independent positive effects on peak effector Th1 VZV CMI included baseline CMI and negative effects included blood CD8+CD25+FOXP3+% Treg. Age did not have an independent effect on peak CMI. Independent positive effects on persistent (1 year) memory Th1 included baseline CMI and negative effects included age, blood CD4+FOXP3+% Treg and CD8+PD1+% T exhausted cells. Persistent effector Th1 CMI was negatively affected by age only.

Conclusion
ZV generated VZV-specific Th1 and CTL responses. The early increase of CD8+ exhausted T cells in blood suggested that CTL responses to the vaccine virus may be compromised by immune senescence. The negative of age on VZV Th1 CMI was fully mediated by immune senescence at peak response, but age had a negative effect on CMI persistence that was independent from the markers of immune senescence included in this study.

Disclosures
A. Weinberg, merck: Grant Investigator, Research grant K. Schamder, merck: Grant Investigator, Research grant Z. Popmihajlov, Merck & Co., Inc.: Employee and Shareholder, Salary L. Pang, Merck: Employee and Shareholder, Salary M. Levin, merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant