bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-247. Skills in Managing Vascular Catheters: Differences Between Self-Perception and Assessment by an External Auditor
Authors: Paes Lima Valeria , Cardoso Regiane , Silva Sheila , Cláudia Fernandes Ana , Andrade Rafael , Ramos André Augusto , Ramos Marcelo , da Silva Cristiane , Garbero Rodrigo 
Published: January 2025

Abstract

Background
Implementing prevention strategies can be challenging for health services, and it is useful to know new assessment and teaching methods so that educational interventions are more effective.
Adherence to the intravenous medication administration checklist through self-assessment

Methods
Seventy-eight nursing professionals from a inpatient unit were invited to carry out an assessment of skills in intravenous medication administration. Initially, professionals completed a self-assessment questionnaire, in which they were asked to accurately report what corresponds to their usual practice. Then, the same professional administered the medication in a simulated environment while being observed by a trained professional, who filled out a standardized checklist. The observers were clinical nurse educator, an infection control nurse and a vascular access reference nurse. At the end of the procedure, the observer provided individual feedback to the professional on the positive aspects and non-conformities. Then, the professionals answered a questionnaire to evaluate this training modality.
Adherence to the intravenous medication administration checklist by an external observer

Results
In the self-assessment questionnaire, the professionals attributed unsatisfactory practice to 4%, increasing to 19% in the evaluation of the process by an external observer. The average time to respond to the self-assessment questionnaire was 8 minutes and 48 seconds, and to observe the procedure was 11 minutes and 26 seconds. The results are shown in figures 1 and 2.
The difference in the assessment of hand hygiene drew attention: professionals attributed it to be 99% adequate, and external observers, 70.9%. The main non-conformities observed were the failure to apply hand hygiene in the 5 recommended moments, the use of incorrect or incomplete technique and the length of the nails or the presence of dirt. The assessment of catheter insertion was carried out by only 67.9% of professionals.

Conclusion
The difference between self-perception and external assessment indicates the need for more innovative training methods with practical implementation, rather than the simple exposition of technical content. There was a good response from professionals to this method, and we consider the opportunity to provide individualized feedback in a safe environment very valuable.

Disclosures
All Authors: No reported disclosures
P-250. Identifying the Risks Associated with Increased Tissue Expander Infections Amongst Patients Undergoing Mastectomy with Immediate Tissue Expander Placement
Authors: Koplyay Courtney , Ngo Madeline , Davidson Tessy , Sopirala Madhuri 
Published: January 2025

Abstract

Background
Tissue expander (TE) infections are increasingly common in patients undergoing mastectomy with immediate TE placement. Post-mastectomy TE infections prolong recovery time, delay second-stage reconstruction, and confer a significant socioeconomic burden on the patient. In this study, we aim to identify modifiable risk factors associated with TE infections following TE manipulation and assess the infection risk associated with different TE implants (Mentor™ vs. Sientra™).
Univariate Analysis of Modifiable Risk Factors
Univariate analysis of modifiable risk factors associated with the development of tissue expander (TE) infection.

Methods
We identified several lapses in sterile technique during TE manipulation procedures performed at the plastic surgery clinic of a large safety net hospital. We conducted a retrospective review of all adult patients who underwent mastectomy with immediate TE placement and expansion from 2019-2022, collecting demographic, co-morbidity, and infection surveillance data. Cases were defined as patients who developed an infection after a clinic-based TE manipulation procedure and controls as patients who did not develop an infection after a clinic-cased TE manipulation procedure.
Multivariate Logistic Regression of Modifiable Risk Factors
Multivariate logistic regression analysis of modifiable risk factors associated with tissue expander (TE) infection.

Results
Of 292 cases, 16 developed a TE infection after TE manipulation. The total post-manipulation TE infection rate is 6.1 per 100 procedures. The type of implant did not influence infection rates on multivariate analysis (p=0.23). Patients who developed an infection after TE manipulation were more likely to have private insurance than those who did not develop an infection (p&lt;0.01). There was no significant difference in the presence of hypertension, diabetes, obesity, and tobacco use in patients who developed a TE infection compared to those who didn’t develop a TE infection.

Conclusion
There were no identifiable modifiable risk factors associated with increased rates of TE infections following TE manipulation. We found that private insurance was not protective against the development of a TE infection. Suboptimal sterile access to TEs may independently contribute to post-mastectomy TE infections. Implementation of a new sterile technique has yet to confer a significant decrease in TE infection rates. We will continue refining our standardized sterile protocol as we monitor TE infection rates.

Disclosures
All Authors: No reported disclosures
P-263. Sodium dichloroisocyanurate: A promising candidate for the disinfection of resilient drain biofilm
Authors: Martin Abbbie , Rohde Rodney E , O’Mahony Tom , Doyle Natasha 
Published: January 2025

Abstract

Background
Biofilms are complex multicellular communities of microorganisms which can lead to a variety of human diseases and infections. Biofilms consist of microbes which are contained within a protective extra polymeric substance layer, resulting in increased resistance to disinfectants. From an economic perspective, it is estimated that potentially deadly biofilms, which cause 1.7 million hospital acquired infections (HAIs) each year in the US, can result in costs of $11.5 billion in treatment. Biofilms thrive in a variety of diverse environments, including hospital sinks and drains, which can pose a significant threat to patient safety. Sink drains maintain one of the highest burdens of antibiotic resistant bacteria amongst all other surfaces, with Pseudomonas aeruginosa consistently being the most prominent species found within ICU sink drains. Studies have shown that by completely removing sinks from patient rooms, there is a significant reduction in the colonisation of gram-negative bacteria, a leading cause of HAIs.

Methods
The aim of this study was to determine if three hospital-grade disinfectants were capable of killing biofilm, and as such, if they could be used as potential drain disinfectants. Disinfectants were comprised of Sodium Dichloroisocyanurate (NaDCC), Peracetic acid and bleach-based disinfectants. Pseudomonas aeruginosa biofilms were cultivated using the CDC biofilm reactor, a standardised method for determining biofilm efficacy within the United States.

Results
The NaDCC product was successful in completely killing the biofilm (using a one-minute contact time), resulting in a total 8.70 log reduction. Peracetic acid reduced biofilm by 3.82 logs, followed by bleach, which had the lowest reduction at 3.78 logs.

Conclusion
Drain disinfection is critical to ensure patient safety and reduce the instances of HAIs. This experiment can help in predicting the effectiveness of three hospital disinfectants for drain applications. NaDCC could provide a reliable solution for drain applications and subsequent patient safety.

Disclosures
Abbbie Martin, BsC, Kersia Ireland: Employee Tom O'Mahony, PhD, Kersia Ireland: Employee Natasha Doyle, PhD, Kersia Ireland: Employee
P-264. Fournier-transform Infrared spectrometry is a quick, reliable and economical method used to determine clonality and nosocomial transmission of an extended Spectrum β-lactamase E.coli contaminated endoscope
Authors: De Jager Stephen A , Moonen Carolyn , Visser Marit 
Published: January 2025

Abstract

Background
Nosocomial transmission of bacteria via contaminated endoscopes is known to occur due to inadequacies in the complex cleaning process of multi-channel endoscopes. At our institution we do regular surveillance culture screening of endoscopes. Upon receiving positive cultures with an Extended Spectrum β-lactamase producing (ESBL) E.coli we alerted our hospital hygiene unit. After screening potentially exposed patients we determined clonality of ESBL E.coli isolates from 4 patients with expensive en specialized molecular diagnostics, at our local academic hospital using Amplification Fragment Length Polymorphism (AFLP). We were testing the BiotyperIR (Bruker Daltronics) in our laboratory and wanted to see how de FTIR compared to AFLP in our small peripheral hospital setting.
BiotyperIR 3D scatterplot
Cluster of endoscope isolate and exposed patient isolates with 2 non related patient control isolates

Methods
We determined that a total of 16 patients had endoscopic investigations preformed with the contaminated endoscope. We were able to do rectal screening cultures for ESBL positive organisms using ESBL selective media from 11 of the 16 patients. We were unable to screen 5 patients. Of the 11 patients that were screened 4 were positive with an ESBL E.coli. Clonal testing was done on these isolates and 2 non outbreak ESBL E.coli patient isolates with AFLP and FTIR using the BiotyperIR. IR spectra were acquired from dried spots of bacterial suspensions in ethanol solution. Exploratory data analysis of the FTIR spectra was performed by Hierarchical Cluster Analysis (HCA) using Bruker’s updated software.
BiotyperIR dendrogram
Cluster of endoscope isolate and exposed patient isolates with 2 non related patient control isolates

Results
Both results from AFLP and the BiotyperIR showed that all 4 ESBL E.coli patient isolates were identical to the contaminated endoscope isolate and the 2 non outbreak patient control isolates were unrelated to the outbreak isolate. We concluded that there had been nosocomial transmission of an ESBL E.coli. Clonal typing using the BiotyperIR FTIR was done within 24 hours in our own laboratory compared to 2 weeks using AFLP which had to be sent to our local academic hospital.

Conclusion
The BiotyperIR FTIR spectrometry results were identical to molecular typing using AFLP to determine nosocomial transmission of a clonal ESBL E.coli. Results were obtained significantly faster and at a fraction of the cost of molecular AFLP.

Disclosures
Carolyn Moonen, PhD, Bruker Daltonics GmbH & Co. KG: Advisor/Consultant
P-266. Does routine use of sporicidal disinfectants for all post-discharge hospital rooms reduce environmental contamination with Clostridioides difficile spores?
Authors: Plumlee Sarah , Cadnum Jennifer , Varghese Martin , Bartles Rebecca , Memic Samir , Jencson Annette , Donskey Curtis 
Published: January 2025

Abstract

Background
Asymptomatic carriage of Clostridioides difficile is common in healthcare facilities. Routine use of sporicidal disinfectants for all post-discharge rooms has been proposed as a measure to address environmental shedding by carriers, but limited information is available on the effectiveness of this approach.
Recovery of C. difficile from CDI and non-CDI rooms in hospitals using sporicidal disinfectants only in CDI rooms versus in all post-discharge rooms

Methods
We conducted a culture survey to assess environmental contamination with C. difficile in patient rooms after cleaning and disinfection in 30 acute care hospitals, including 17 (57%) using sporicidal disinfectants (11 peracetic acid-based products and 6 chlorine-based products) for all post-discharge rooms and 13 (43%) using sporicidal disinfectants (1 peracetic acid-based product and 12 chlorine-based products) only for C. difficile infection (CDI) rooms. Cultures for C. difficile were collected from 10 rooms per hospital (up to 3 CDI rooms), including high-touch surfaces in the room (N=10 sites) and in the bathroom (N=10 sites). A mixed-effects logistic regression model was used to compare contamination in non-CDI (primary outcome) and CDI rooms in facilities using sporicidal disinfectants in non-CDI and CDI rooms versus only in CDI rooms.

Results
Of 595 total patient rooms and bathrooms cultured, 339 (57%) were in hospitals using sporicidal disinfectants for all post-discharge rooms and 256 (43%) were in hospitals using sporicidal disinfectants only in CDI rooms. As shown in Figure 1, there was a trend toward reduced C. difficile contamination in non-CDI and CDI rooms in facilities using sporicidal disinfectants in all post-discharge rooms versus only in CDI rooms, but the difference was not statistically significant (P&gt;0.62).

Conclusion
In a survey of 30 hospitals, use of sporicidal disinfectants for all post-discharge rooms was not associated with a statistically significant reduction in C. difficile contamination in non-CDI rooms. Additional studies are needed to determine if interventions to improve the effectiveness of sporicidal disinfectant application will reduce C. difficile contamination in real-world settings.

Disclosures
Curtis Donskey, MD, Clorox: Grant/Research Support|Pfizer: Grant/Research Support
P-282. Cost Effectiveness Analysis of Ceftolozane/Tazobactam for the Treatment of Patients with Ventilated Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia in the Philippines
Authors: Uy Geovin Dexter c , Paredes Karlo , Camille Abello Gillian , Cameron Carolyn , Yang Joe 
Published: January 2025

Abstract

Background
Ceftolozane/tazobactam (C/T) was licensed by Philippine Food and Drug Administration for the treatment of ventilated hospital-acquired bacterial pneumonia (vHABP) and ventilator-associated bacterial pneumonia (VABP) last 2019. Increasing resistance rates to antibiotics available in the Philippine National Formulary (PNF) by Pseudomonas aeruginosa associated vHABP/VABP has concerned clinicians due to its overall morbidity and mortality. This study assessed the cost-effectiveness of C/T treatment compared with existing antimicrobials among adult patients with confirmed susceptibility profile of Pseudomonas aeruginosa associated vHABP/VABP.

Methods
An economic model was developed to compare the lifetime costs and quality-adjusted life-years (QALYs) associated with C/T and the currently listed antimicrobials (meropenem, aminoglycosides, colistin) in the PNF for the treatment of patients with Pseudomonas aeruginosa associated vHABP/VABP. A short-term decision tree was used for the in-hospital period, followed by a long-term Markov model to depict lifetime costs and outcomes.
Pathogen susceptibility was sourced from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database; clinical efficacy was obtained from the published literature. The model assumed a public payer perspective, capturing direct costs incurred by the health system, and direct health outcomes for treated patients. Discount rates applied followed local HTA methods guide.

Results
On treating Pseudomonas aeruginosa associated vHABP/VABP, C/T was associated with a higher absolute cure rate (17%) and lower absolute mortality rate (-3%) than meropenem. The incremental cost-effectiveness ratio (ICER) for C/T compared to meropenem, amikacin, and colistin were ₱267,396, ₱164,570, and ₱47,504 per QALY gained, respectively. C/T generated more QALYs than exiting antimicrobials at an increased cost per patient, but resulting in ICER less than one times the Gross Domestic Product (GDP) of ₱233,902 for amikacin, and colistin, and ∼ 1.2x GDP per capita for meropenem.

Conclusion
C/T represents a cost-effective treatment for payers and an important option to be listed in the PNF for clinicians treating patients with Pseudomonas aeruginosa vHABP/VABP in the Philippines.

Disclosures
GEOVIN DEXTER C. UY, RPh, MPH, MSD Philippines: employee|MSD Philippines: Stocks/Bonds (Private Company) Karlo Paredes, RN, MPH, PhD (cand), MSD Philippines: employee|MSD Philippines: Stocks/Bonds (Private Company) Gillian Camille Abello, MD, MSD Philippines: employee Carolyn Cameron, MPH, MSD Australia: employee|MSD Australia: Stocks/Bonds (Private Company) Joe Yang, PhD, Merck & Co., Inc: employee|Merck & Co., Inc: Stocks/Bonds (Private Company)
P-283. Epidemiology, clinical, phenotypic, and genotypic characteristics of multidrug, extensive and pan-drug resistant Acinetobacter baumannii from Qatar
Authors: Abdel Hadi Hamad 
Published: January 2025

Abstract

Background
Multidrug-resistant Acinetobacter baumannii-calcoaceticus complex is associated with significant morbidity and mortality with limited treatment options. The outlined study aimed to evaluate the epidemiology , clinical , phenotypic and genotypic characteristics of multidrug resistant (MDR) Acinetobacter species from Qatar between 2017-2020 .

Methods
A prospective study was conducted between 2017-2020 for all clinical isolates of Acinetobacter species. Microbial identifications and antimicrobial susceptibility tests were performed using automated MALDI-TOF MS and BD PhoenixTM system according to the manufacturer’s recommendations while additional ASTs were performed with E test . Genomic tests were performed using whole genome sequence

Results
Out of 536 isolates, 62 (11.5%) resistant isolates were identified showing decremental trend over the study period with dominance of sequence types: ST2 (71 %), ST 25 % (8%) and ST 164 (8%). Main age of acquisition was 64 year (38-70). Isolate sites were urinary (42 %), respiratory (29%), bloodstream (16%), skin and soft tissues (13%) mainly acquired at hospitals (97 %). Existing multiple comorbidities and previous antimicrobial exposure were present in most cases. Multiple antimicrobial regimes for management were dominated by colistin, meropenem, amikacin, cotrimoxazole and tigecycline with 30-day mortality of 16 %. Microbiological evaluation demonstrated extensive resistance ranging between 85-100 % for active agents including meropenem and ampicillin-sulbactam at 97.4 % as well as for novel agents: ceftazidime-avibactam (100%), ceftolozane-tazobactam, meropenem-vaborbactam and imipenem- relebactam at 97.4 %. All ST2 isolates carried class D blaOXA-23 and blaOXA-51 family, that confer resistance to carbapenems, as well 7 isolates carried class B MBL blaNDM-1.

Conclusion
Acquisition of resistant Acinetobacter baumannii is infrequent with decremental trend dominated by ST 2, mainly isolated from the elderly with multiple comorbidities and risk factors. Predominant isolation sites are urinary, respiratory, bloodstream, skin and soft tissues. Extensive resistance profiles limit treatment options for conventional and novel agents pointing towards urgent needs for alternative therapy.

Disclosures
All Authors: No reported disclosures
P-307. Antibiotic Exposure and Community Resilience Shape Colonization Resistance to Vancomycin-Resistant Enterococci: Effects of Prior Antiboitics on Colonization Re-emergence
Authors: Treat Ben , Hobeika Joseph , Margolis Ellie 
Published: January 2025

Abstract

Background
For life-threatening healthcare-associated vancomycin-resistant enterococci (VRE), gut colonization is a prerequisite for infection and is not predicted by prior Vancomycin treatment, indicating other selective forces are important. Host characteristics, strain variation and other microbial selective forces determine whether a patient's microbiome resists or permits VRE colonization.

Methods
Two preclinical models study VRE colonization resistance using fluorescently labeled clinical VRE strains. First, human microbiome stool communities were anaerobically cultivated in defined media, resulted in reproducible complex communities retaining 72-89% of microbial members. They are challenged with clinical VRE strains (10^3 cfu) to assess microbiome's role in resistance. Second, BL6 mice were pre-treated with PO Vancomycin, IP Cefepime+ IP Vancomycin, IP Meropenem, IP Pipercillin/Tazobactam, PO Metronidazole, or PO Clindamycin for one week. Post-treatment, they are inoculated with clinical VRE and clearance time was monitored. After a week without VRE detection in stool culture and by FACs, mice resume PO Vancomycin to observe re-emergence.

Results
When complex human stool cultivated microbiomes are exposed to clinical VRE strains, some prevent colonization while others facilitate it. Intriguingly, both the VRE strain and the community composition influence colonization (fig 1). In mice treated with anaerobic-active antibiotics, consistent VRE colonization occured. However, duration varied significantly (e.g. PO Vancomycin cleared in 14-22 days, IP Pipercillin/Tazobactam in 20-54 days). After VRE clearance, re-challenge with antibiotics lead to VRE re-emergence in all previously colonized animals.

Conclusion
Within human microbiome communities there is redundancy and variation in the members that can create a bacterial community barrier to VRE colonization. In mice, previous antibiotic use affects both how long VRE colonizes and its likelihood of returning after further disturbance. This may explain varying findings in studies on factors influencing MDRO colonization.

Disclosures
Ellie Margolis, MD PhD, ICLR: Stocks/Bonds (Private Company)