bluuebunny/crossref_metadata_2025_split huggingface dataset:
1393. Unveiling disease trends: a ten-year analysis of mandatory notification diseases in Brazil (2013-2022)
Authors: Nardo Beatriz Barraqui , Angelo Marco Aurélio Fagundes , de Vasconcelos Débora , Lima Naísses Zóia , Carvalho Walisson Ferreira , Ladeira Ana Paula , Couto Braulio 
Published: November 2023

Abstract

Background
Disease surveillance is crucial for timely detection and control of diseases. In Brazil, mandatory disease notification is required through the National System of Notifiable Diseases (SINAN). This paper aims to contribute to the understanding of disease burden and patterns in Brazil, a representative region of South America and other developing countries.

Methods
The study utilized a retrospective observational study design to conduct surveillance of 54 mandatory notifiable diseases over a 10-year period, from January 2013 to December 2022. The data was collected from a reference public hospital located in Belo Horizonte, a city with a population of approximately 3,000,000 inhabitants, located in the Minas Gerais State of Brazil. Monthly incidence rates were calculated for each disease by using the number of cases as the numerator and the total number of patients admitted to the hospital as the denominator. To estimate endemic levels, the 90th percentile was used for both the monthly incidence rate and the mobile yearly average rate, which provided a threshold for identifying unusually high disease incidence levels. Secular time trends were evaluated using linear regression analysis.

Results
Over 10 years, 37,081 notifiable diseases were diagnosed from 54 different diseases. Only five diseases accounted for 87% of cases: classical dengue fever, unspecified communicable disease, assault by unspecified means, toxic effect of unspecified substance, and work-related conditions (Fig. 1). Monthly endemic levels were estimated, revealing an increase in incidence for 15 diseases including HIV, Syphilis, and assault by unspecified means (Fig. 2). Analysis of pandemic phases showed consistent increase in diseases such as visceral leishmaniasis and tuberculosis between 2018 and 2022 (Fig. 3), emphasizing the need for continued vigilance and targeted interventions.Figure 1Pareto Chart illustrating the occurrence of 54 notifiable diseases over a 10-year period (2013-2022) in a reference public hospital in Belo Horizonte, Brazil.Figure 2Trend analysis of notifiable diseases with incidence changes over a 10-year period (2013-2022) in a reference public hospital in Belo Horizonte, Brazil.Figure 3Incidence rate of visceral leishmaniasis and respiratory tuberculosis during pre-pandemic, pandemic, and late-phase pandemic periods (2018-2022) in a reference public hospital in Belo Horizonte, Brazil.

Conclusion
This study provides valuable insights into the epidemiology and trends of 54 mandatory notifiable diseases in Belo Horizonte, Brazil, over a 10-year period. The findings of this study contribute to our understanding of the burden of these diseases in the study population and may inform public health strategies for disease prevention and control in the future.

Disclosures
All Authors: No reported disclosures
1405. Angel of Death - Tetanus and Rabies - Indian Experience
Authors: Srikanth V S 
Published: November 2023

Abstract

Background
Tetanus is an old-world disease and Rabies dated back to the Vedic period i.e 1500-500BC in ancient Indian scripture, Yama, the mythical God of Death. This is one of very few recent studies done in India on Tetanus and Rabies, the data available on Tetanus and rabies are less so we are trying to share our experience on these diseases, so it will help the physicians to get a better understanding.

Methods
This is a retrospective study, detailed 3 years case sheet review was done and the patient’s clinical presentation and prognosis was noted in pre designed format.Inclusion criteria – All diagnosed cases of tetanus and rabies,Exclusion criteria – patient already received treatment from local hospital.

Results
58 tetanus cases with average duration hospital stay 15 days, common occupation farmers(barefoot workers).The site of injury -foot in 65% cases followed by injuries to the fingers or the hand in 30% and 5%cases due to injury while tooth picking with pin, splinter removal using pins.Clinical symptoms -Trismus“Lock jaw”(41),difficulty in walking (2),limb pain/stiffness(17),back muscle, pain/stiffness(12,)Dysphagia (7) ,72% autonomic dysfunction.Opisthotonos position and riscus sardonicus developed after 7-8days of infection. 18% mortality was noted most cases were unvaccinated cases. 31 Rabies cases - age group of 35-45, most cases were unprovoked bite.Common site of injury lower limbs.68% grade 3, 32% grade.Symptoms from bite1 months High grade fever, anxiety were initial symptoms followed by hydrophobia and aerophobia. 20% cases had seizure. Minimum hospital stays 12 days,Mortality 100.

Conclusion
Tetanus and rabies are preventable diseases; if ignored can cost life .So Rabies vaccination and immunoglobulin should be administered on time

Disclosures
All Authors: No reported disclosures
1409. Understanding the Current Status and Barriers to Infection Prevention in Emergency Departments: A Survey of 71 Hospitals across the United States
Authors: Dasari Laya , Shum Julio Ma , Searle Eileen F , Boggs Krislyn M , Chen Olivia L , Sullivan Ashley , Camargo Carlos A , Shenoy Erica S , Biddinger Paul 
Published: November 2023

Abstract

Background
Infection prevention and control (IPC) is especially challenging in the emergency care setting due to ever-increasing emergency department (ED) crowding, boarding of patients, increasing rates of staff turnover, and other factors.

Methods
2022 IPC practices in the ED setting were queried between January and April 2023 using the National Emergency Department Inventories (NEDI)-USA survey, which is administered annually to all United States EDs. In a subset of EDs, the expanded survey assessed reported adherence to IPC policies, barriers to policy compliance, use of transmission-based precautions signage, disinfection of reusable medical equipment, use of personal protective equipment (PPE), hand hygiene (HH), staff education and training, and perceptions of safety concerning healthcare-associated infections (HAIs).

Results
Of 289 facilities surveyed, 71 (25%) have responded as of April 17, 2023, with 83% (59/71) located in suburban/urban settings (Table 1). Although compliance with IPC practices was high with 73% (49/67) reporting &gt; 80% compliance with HH (Table 2), notably, compliance with signage was identified as a significant gap, with 25% (18/71) of EDs reporting that they rarely or only sometimes post signs for patients who required them. This issue was more pronounced with patients placed in hallways or overflow treatment spaces, where, in applicable hospitals, 71% (25/35) of EDs never, rarely, or only sometimes post transmission-based precaution signs. Despite this, most ED leaders (67%, 47/70) felt neutral or did not perceive HAIs to pose a significant risk to patients relative to other patient safety issues in the ED (Table 3).

Conclusion
This ongoing survey suggests high perceived compliance with IPC practices in the ED, which is discordant with evidence of suboptimal adherence to basic IPC practices. The findings suggest that targeted interventions and educational efforts are necessary to address the gaps in knowledge and understanding of IPC failures and risk of HAIs. The findings illustrate the importance of improving IPC practices in the ED to enhance patient safety; further research is needed to investigate the apparent discrepancy between perceived and actual practices.

Disclosures
All Authors: No reported disclosures
1410. Improved Disinfection in the Operating Room through Hydrogen Peroxide Fogging
Authors: Davis Jennifer , Bair Tina , Lapolla Brian , Bigham Michael 
Published: November 2023

Abstract

Background
Hospital acquired infections (HAIs), including surgical site infections (SSIs), are a major contributor to morbidity. Environmental exposure is a contributing factor to HAIs. Environmental decontamination with hydrogen peroxide fogging has proven to reduce bacterial growth and bioburden in the hospital setting. We sought to 1) implement and test feasibility of an operating room (OR)-based hybrid hydrogen peroxide fogging program and 2) assess the impact of hydrogen peroxide fogging on SSIs.

Methods
At a large freestanding midwestern Children's Hospital with a surgical volume of over 17,000 annual surgeries, a hybrid hydrogen peroxide fogging program was implemented in a risk-stratified fashion. Baseline fogging was completed to establish a post-fogging time series for bacterial regrowth (measured by culture and bioburden) and to guide the implementation schedule. Based on time-series results, room-specific fogging parameters were established. ORs received fogging either every 2 weeks (neurosurgical, cardiac and spine ORs) or every 4 weeks (all other ORs).
The fogging program was administered using a third-party vendor beginning in September 2022. The feasibility assessment was designed to identify any safety events, interruptions in care or access to the ORs due to fogging. The time series outcomes were bioburden and bacterial cultures. The primary patient outcome measure was the rate of SSIs. This is depicted in both a P chart, showing a monthly rate, and a T-chart, showing days between events. SSIs for orthopedic, spine and neurosurgeries were tracked from January 2021 to present.

Results
After implementation of the program there was a significant decrease in SSI rates from 3.38% to 0.68% and is represented by a center-line shift in the P chart. The days between SSIs moved in a favorable direction, increasing to 238 days, the longest since January 2021. The time series evaluation indicated return to baseline bacterial bioburden between 3 and 4 weeks post-fogging. The feasibility assessment identified no safety events, delays, interruptions or decreases in OR utilization.
Surgical Site Infections (Spine, Cardiac, Neurosurgical)
Since fogging began in September of 2022, we have experienced a centerline shift demonstrating a reduced rate of surgical site infections from 3.38% to 0.68%, the longest stretch between surgical site infections since January 2021.
Days Between Surgical Site Infections
Since fogging began in September of 2022, we have experienced the longest stretch between surgical site infections since January 2021

Conclusion
Hydrogen peroxide fogging is a feasible form of disinfection and reduces SSI rates when applied in the OR of a Children’s Hospital with a moderate to large surgical volume.

Disclosures
Michael Bigham, MD, ForTec Medical: Advisor/Consultant
1417. Continued Success of Legionella Water Screening for a Large Veterans Affairs Campus in Long Island, New York
Authors: Bailey Lisa , Rahman Mahfuz , Belanger Debra , Thorne Monique , Ford Florence M , Gouch Mark , Psevdos George 
Published: November 2023

Abstract

Background
Legionella is found in all natural water sources & has been linked to waterborne environmental outbreaks of pneumonia. Environmental surveillance in healthcare facilities is of paramount importance to prevent Legionella overgrowth and acquired infections. This can a be a challenging task for our large 268-acre Veterans Affairs campus with its own water supply wells and water distribution system, 10 buildings housing acute care, outpatient clinics, residential and nursing homes. While the COVID 19 pandemic absorbed resources & time, water testing was not neglected. We report our experience of Legionella water testing during the pandemic

Methods
Water Legionella sample testing is done quarterly involving 180 faucets & showers throughout the facility, ice machines and 4 cooling towers (CT). Cultures are performed in a reference laboratory. Annual cost $100,000. A positive detection is defined as 1 colony forming unit (CFU)/mL from faucets and 10 CFU/mL from CT. Every positive detection is managed as follows: remediation by hyperchlorination, resampling, disinfection of cooling towers, and removal of equipment (ice machines)

Results
In fiscal Years 2020-22 4853 Veterans were hospitalized and 455 were tested for Legionella via urinary antigen; 3/455 patients had legionellosis, all were community-related, & 1 had a concurrent coinfection with COVID-19. 2221 water samples were collected. Table 1 shows detections and locations. All detections were remediated by localized chlorine disinfection & then resampled. Retreatments with increased disinfectant dosage was implemented in repeat positive detections. In few instances up to 3 retreatments were required to achieve negative growth. For repeat positive detections for CTs remediation utilized addition of a 2nd biocide No employee/patient case of Legionella pneumonia has been associated with exposure to positive water testing
Table 1
Positive Legionella detections
Figure 1
Facility Diagram location of buildings and Cooling Towers

Conclusion
Preventing Legionella water overgrowth in a large Veteran Affairs campus can be a tedious and costly endeavor. L. pneumophila and non pneumophila species were detected in various locations including the CTs, nevertheless remediation protocols were immediately followed and proved successful. There were only 3 cases of Legionella pneumonia in the study period, but none were facility associated

Disclosures
All Authors: No reported disclosures
1418. The Effect of Dry Hydrogen Peroxide on Environmental Contamination with Candida auris in an Adult Burn Unit
Authors: Sutton Jared Alan , Dotson Nychie , Nagy Jaquelyn , Moody Julia , Sands Kenneth E 
Published: November 2023

Abstract

Background
Candida auris (C. auris) is an emerging multi-drug resistant pathogen that is a health threat for hospitalized patients. C. auris may survive on surfaces where standard disinfectants may not achieve adequate disinfection. Continuous dry hydrogen peroxide (DHP) reduces microbial bioburden on surfaces and may reduce the risk of C. auris transmission in the clinical care setting. This study reviews the efficacy of DHP exposure, coupled with routine environmental cleaning, on reducing microbial burden of C. auris on surfaces.

Methods
DHP-emitting systems were installed on burn intensive care and burn stepdown units. After install, for each patient newly identified with C. auris, baseline surface sampling of the patient room and other unit areas was performed beginning on the first day of positive culture, defined as Day 0. The DHP systems were activated and surface sampling collected to include days 1, 7, and 14. Select surfaces were sampled using polyurethane foam neutralizing buffer swabs. Individual swabs were grouped into three composites: Inner Patient Halo, Outer Patient Halo, and Mobile Shared Equipment (Table 1). Bioburden was assessed through cultures of the swabs and the identification and enumeration of resulting colony forming units (CFU). A multivariate regression model was used to evaluate the potential relationship between duration of DHP exposure and the logarithmically transformed counts of C. auris yielded by the samples.Table 1:Sampling site locations included in each composite category

Results
Three patients were identified, resulting in collection of 36 composite swabs. C. auris CFU were obtained from all composite swabs, with observed decrease in count over time (Figure 1). In a regression model including included covariates for time, room and patient proximity, there was a statistically significant relationship between C. auris bioburden and exposure to DHP (Table 2, F(5,30)=6.999, p&lt; 0.001, adjusted R2=0.461), with duration of DHP exposure adding significantly to the relationship, p=0.Figure 1:Candida auris colony forming units enumerated from environmental surfaces.Table 2:Multivariate Regression Analysis of DHP’s Impact on Candida auris Bioburden

Conclusion
Continuous DHP, coupled with routine environmental cleaning, augments disinfection and is effective in reducing surface microbial bioburden in rooms of patients with C. auris colonization/infection. To fully understand the synergism between routine environmental cleaning and DHP, further research is needed.

Disclosures
All Authors: No reported disclosures
1429. Temperature and Humidity Variations in the Operating Room: A Risk Assessment
Authors: Usiak Shauna , Yan Judy , Reyes Michell , Martin Ann , Bubb Tania N 
Published: November 2023

Abstract

Background
The American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) recommends that hospital operating rooms (OR) are controlled for temperature and humidity with established ranges but does allow for exceedances for surgeons and surgical procedures. There is currently no clear consensus or established thresholds for out-of-range temperature and humidity ranges in relation to risk for surgical site infections (SSI). A study was performed at Memorial Sloan Kettering Cancer Center (MSKCC) to further examine if temperature and humidity deviations pose a patient safety risk.

Methods
The study included 5600 surgical procedures that were performed at MSKCC between September 2021 and January 2022 where temperature and humidity logs were available. Procedures were broken into groups based on in- (n=4419) and out-of-range (n=1187) temperatures and in- (n=5225) and out-of-range (n=381) humidity. SSIs following the procedure were identified using targeted positive microbiology cultures and within NHSN (National Healthcare Safety Network) surveillance periods. Chi-square and Fisher’s exact statistical tests were used to determine if there was a significant difference between groups where p &lt; 0.05.
Breakdown of eligible procedures and follow up
Table represents the total number of eligible procedures with environmental parameters and SSI follow up period.

Results
There was no significant impact on SSI for out-of-range humidity (p=0.15). There was a significantly higher SSI rate observed for out-of-range temperatures (p=0.04) more specifically low out- of-range temperatures (p=0.02). A sub-analysis was performed for low temperatures based on procedures by duration. Significance of the finding was lost when surgery duration was 4 hours or greater.

Conclusion
If there was a true correlation between SSI and low ambient temperature, we would have expected to see a strengthening of SSI risk with longer procedures. This study suggests that temperature and humidity deviations out of the recommended guidelines in the operating room do not pose additional risks for surgical site infections and limited exceedances can be permitted without risking patient safety.

Disclosures
All Authors: No reported disclosures
1436. Effect of Personal Protective Equipment Conservation Due to COVID-19 on Multidrug Resistant Organisms in a Hospital Group
Authors: Fox Josephine , Leone Carole , Gasama Heather , Grimes- Jenkins Lydia J , Satish Munigala , Wood Helen , Whalen Kenneth , Marschall Jonas , Warren David K 
Published: November 2023

Abstract

Background
Early in the COVID-19 pandemic many healthcare facilities experienced shortages of personal protective equipment (PPE), which required them to conserve and prioritize PPE. We wanted to determine the effect a gown conservation strategy had on nosocomial methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile (C.diff.) and infections with vancomycin-resistant enterococci (VRE).

Methods
Prior to the pandemic, isolation gowns were required for patients colonized or infected with multidrug-resistant organisms (MDROs) at BJC Healthcare, a 15-site hospital group with &gt;3,000 acute care beds. In April 2020, we initiated a modified contact precautions (CP) strategy for acute care patients colonized with MDROs (identified via surveillance cultures or based on past MDRO infection). Healthcare workers were instructed to wear gloves and follow standard precautions when seeing patients on modified CP. Patients with active MDRO infection and C.diff. were excluded from modified CP. Rates of NHSN laboratory identified (LabID) MRSA bacteremia and C.diff., and nosocomial VRE from blood/urine cultures, were compared before and after the modified CP. The study period was divided into baseline CP (1/01/2019- 8/30/2019) and modified CP (1/01/2021-8/30/2021) periods.

Results
There was no difference in LabID MRSA bacteremia or LabID C.diff. rates in the baseline CP versus the modified CP period (MRSA: 0.069 baseline vs 0.062 modified CP per 1000 pt days, p=0.64, and C.diff.: 3.96 baseline vs 3.66 modified CP per 10,000 pt days, p=0.45), respectively. There was no difference in the nosocomial VRE bacteremia & bacteriuria combined rate (0.097 baseline vs 0.116 per 1000 pt days modified CP, p=0.37). There was no difference in the subsets of nosocomial VRE bacteremia (0.038 baseline vs 0.047 modified CP, p=0.51) or VRE bacteriuria (0.059 baseline vs 0.069 per 1000 pt days modified CP, p=0.54).

Conclusion
We limited gown use to cases of MRSA, VRE and C. difficile infection in a conservation effort, and no longer required it for MRSA or VRE colonization; this change was not associated with increases of MRSA or C.difficile LabID rates nor with nosocomial VRE cases. Our findings highlight the importance of monitoring and evaluating PPE conservation strategies to document their safety.

Disclosures
All Authors: No reported disclosures
1437. Successful Control of Candida auris Outbreak in a Tertiary Hospital Intensive Care Unit in Greece
Authors: Nikopoulou Anna , Skalisti Paschalia , Tselenkidou Sophia , Veleni Anastasia , Papoti Sofia , Karampatakis Theodoros , Katsifa Helen , Iasonidou Christina , Christaki Eirini , Sotiropoulos Damianos 
Published: November 2023

Abstract

Background
Candida auris is an emerging pathogen, which can spread efficiently and cause outbreaks in healthcare settings.The purpose of this study is to highlight the importance of strict infection control measures to prevent in-hospital C. auris transmission.

Methods
Single-center retrospective observational study in hospitalized patients at the 2nd Department of Intensive Care Medicine (ICU) of G. Papanikolaou General Hospital from 02-11-2022 until 28-02-2023. Patient outcomes and epidemiologic indices were recorded. In total 79 surveillance cultures in 18 patients (male: 75%, median age: 51 years) were performed, while 187 surface samples were collected.

Results
After C. auris isolation from the index patient, colonization screening was performed in all ICU patients. C. auris was detected in a neighboring patient, 24 hours later, and in another patient from a central venous catheter tip culture 2 months later. An environmental culture from a pulse oximeter, was also positive. Immediately, an epidemiologic investigation was conducted, and an intensive infection control program was implemented in the ICU. Measures included strict adherence to standard and contact precautions and hand hygiene, isolation of positive cases, dedicated staff to care for patients with C. auris, disposable or specialized equipment for patient care, and cleaning and disinfection of frequently touched surfaces and equipment. In addition, surveillance cultures were performed twice weekly for each patient and once weekly for the environment. Also, to control the transmission to other departments, patient transfer was limited. At the same time, ICU personnel was educated on the significance and implementation of infection control bundles. The above measures resulted in the control of transmission of Candida auris in our hospital.

Conclusion
Strengthening appropriate infection control interventions and increasing compliance to their implementation, combined with continued surveillance and healthcare worker engagement by education, can prevent the transmission of pathogens such as Candida auris in healthcare settings.

Disclosures
All Authors: No reported disclosures