bluuebunny/crossref_metadata_2025_split huggingface dataset:
1431. Dosing Matters – Consistency Analysis of Touch-Free Automatic Hand Hygiene Dispensers
Authors: Arbogast James W , Smith Nicole M , Bansaghi Szava , Chen Nanshan , Neal Travis B , McNulty John J , Haidegger Tamas P 
Published: November 2023

Abstract

Background
Touch-free automatic alcohol-based hand rub (ABHR) dispensers are used extensively in healthcare settings to facilitate hand hygiene (HH). U.S. Centers for Disease Control and Prevention and the World Health Organization HH guidance suggests ABHR dosing per use should be enough to cover the whole hand and keep hands wet for at least 15-20 seconds. Leapfrog 2022 guidance states each activation needs to produce at least 1.0 ml liquid volume. The objective of this study was to determine mean dose volumes and dispensing consistency for five leading US foam ABHR dispenser systems and to assess design impact on dosing variability.

Methods
In total, over 15 dispensers and 32 distinct refills were tested, with &gt;10,000 dispenses analyzed for each of the five systems. Automated testing used computer programming and custom mechatronics to activate the dispensers and capture weights at predetermined delay patterns. Low, medium and high usage patterns of 7x, 48x and 100x activations per day were set with dispense delay patterns based on cluster analysis of actual ABHR dispenser usage patterns from time stamped HH monitoring. In another laboratory, measurements were carried out manually; 50 doses were rapidly collected and weighed within an hour for each refill. Density values were used to calculate dispensed volumes. A linear mixed effects model was fit, and total variance components were compared using a 2-Sample Variance Test.

Results
Three of the dispenser systems had mean ABHR output &gt;1.0ml, and two were &lt; 1.0ml (see Table 1). Test results are compiled into histograms (Figures 1 & 2) to visually display the large differences in average dose and consistency between doses. Dispensers #A & #B have significantly greater variability (p &lt; 0.001), which is driven by pump design used to foam the ABHR.

Conclusion
Testing patterns (timing delays between dispenses) impacts dosing performance. The dispenser design and engineering cause significant differences in volume dispensed and consistency across dispenses. Using enough ABHR to cover hands completely and keeping hands wet long enough to significantly reduce pathogens is an important requirement. Facilities should assess ABHR dispenser outputs and consider consistent dosing as an essential performance criterion for effective HH policies and practices.

Disclosures
James W. Arbogast, PhD, GOJO Industries, Inc.: employee Nicole M. Smith, n/a, GOJO Industries, Inc.: employee Szava Bansaghi, n/a, GOJO Industries, Inc.: Grant/Research Support Nanshan Chen, n/a, GOJO Industries, Inc.: Grant/Research Support Travis B. Neal, n/a, GOJO Industries, Inc.: employee John J. McNulty, n/a, GOJO Industries, Inc.: employee Tamas P. Haidegger, PhD, GOJO Industries, Inc.: Grant/Research Support
1442. Use of a Spaced-Education Platform to Assess Hand Hygiene Auditor Competency
Authors: Vaughan-Malloy Ana M , Lehane Renee , Wells Mary , Sandora Thomas J 
Published: November 2023

Abstract

Background
Hand hygiene reliability is a top priority in healthcare. Infection Prevention and Control (IPC) programs often rely on clinical personnel to audit hand hygiene performance. Interrater reliability among auditors is critical to ensuring data validity. We evaluated whether spaced education, which increases long-term knowledge retention, could be integrated into auditor competency assessment.

Methods
113 trained hand hygiene auditors were enrolled in a 13-month online spaced-education platform to assess their mastery of knowledge needed for the role. We delivered 46 unique questions (3 per week, with 2 weeks between repeat delivery of a question) followed by rationale; we retired questions after 3 correct answers. A 10-item survey consisting of 9 Likert-scale questions and one free-text comment was emailed to gauge participant satisfaction with the competency program. Frequencies and percentages were used to summarize Likert responses, and themes were elicited from comments.

Results
From November 2021 to December 2022, a total of 12,120 questions were attempted, and 32 of 113 auditors (28%) completed the competency. Auditors answered 70% of questions correctly on the first attempt and 83% on the final attempt. 30 of 113 auditors (27%) responded to the survey. The majority agreed the number and complexity of questions were appropriate (57% and 67%, respectively). 87% reported the platform easy to navigate, 63% reported the spaced-education model worked, and 77% agreed adequate time was provided for completion. 30% of respondents reported the individual competition as enjoyable. Time and effort required for completion was the most common theme identified among auditor comments; several respondents recommended fewer questions at a narrower spacing interval over a shorter time frame due to competing work demands; 5 individuals expressed a preference for an annual computer-based module.

Conclusion
A spaced education competency program improved hand hygiene auditor knowledge in the short term. Completion rate was low and participants expressed a desire for fewer questions over a shorter time frame. This study offers insight into ways to optimize spaced education as a potential tool for hand hygiene competency assessment.

Disclosures
Ana M. Vaughan-Malloy, MD, MPH, Asana: Stocks/Bonds|Aurora: Stocks/Bonds|Ayr Wellness: Stocks/Bonds|Bionano Genomics: Stocks/Bonds|Butterfly Network: Stocks/Bonds|Canopy Growth: Stocks/Bonds|Cresco Labs: Stocks/Bonds|CRISPR Therapeutics: Stocks/Bonds|Cronos Group: Stocks/Bonds|Curaleaf Holdings: Stocks/Bonds|Editas Medicine: Stocks/Bonds|Green Thumb Industries: Stocks/Bonds|High Tide: Stocks/Bonds|Iovance Biotherapeutics: Stocks/Bonds|Jushi Holdings: Stocks/Bonds|Moderna: Stocks/Bonds|Organigram Holdings: Stocks/Bonds|Pacific Biosciences of California: Stocks/Bonds|Personalis: Stocks/Bonds|Pfizer: Stocks/Bonds|SNDL Inc: Stocks/Bonds|Terrascend: Stocks/Bonds|Tilray Brands: Stocks/Bonds|Trulieve: Stocks/Bonds
1444. Candida auris Outbreak in a COVID-19 Hospital: Detection and Containment
Authors: Baylon-Valdez Victor , Aguirre-García Gloria Mayela , Guajardo-Lara Claudia E , Aleman-Bocanegra Mary C , Martínez-Reséndez Michel F 
Published: November 2023

Abstract

Background
Candida auris has become an important nosocomial infection in ICU patients. The difficulty in isolating and detecting this pathogen, its inherent multidrug resistance, and rapid transmission make it a menace to public health. The present work details the first C. auris outbreak in Mexico and containment techniques used in a Tertiary Care Center that underwent restructuring due to COVID-19.

Methods
We performed a single-center, retrospective, descriptive study from June 2020 to February 2022 at Hospital San Jose TecSalud, Monterrey, including hospitalized COVID-19 patients with detection of Candida auris by MALDI-TOF. After identifying the first cases, the exposed patients were screened twice weekly by skin (armpit/groin) swab culture. Those who tested positive were classified as colonization. Patients with clinical signs of infection were tested from sterile sites (blood/urine), and if the culture came back positive they were classified as cases. Finally, we described the interventions for containment.

Results
During the study period, 4,025 patients were hospitalized due to COVID-19; 971 were critically ill patients admitted to the ICU. 160 patients tested positive for Candida auris, 131 colonizations, and 29 cases (Figure 1). Of the total, 83% were male, mean age ± SD = 56.96 ± 13.29. The most common sites of infection in the cases group were urinary tract infections (55.17%) and bloodstream infections (44.81%; from this, 23% were catheter-associated). The first case was detected on June 4th, 2020, in July 2020, we transitioned to a single patient-per-nurse model and implemented disinfection validation via ATP bioluminescence. Also, to control the increase in cases, by the end of 2020, we standardized chlorine cleaning and de-escalated PPE, and implemented hydrogen peroxide vapor and reinforcement of hand-washing techniques (Figure 2).Figure 1.Patient’s Demographics.Figure 2.Outbreak.

Conclusion
In the setting of the transition of Hospital San Jose into a COVID-19 Hospital in response to the high volume of patients, and the emergence of C. auris at the ICU; early detection and screening of the exposed population, multi-disciplinary coordination between healthcare teams, and the rapid installation of interventions were crucial for the containment and termination of the outbreak.

Disclosures
All Authors: No reported disclosures
1445. Public Health Containment Response Detects Possible Transmission of Echinocandin-Resistant Candida auris in a Long-term Acute Care Hospital
Authors: Brennan Brenda M , McNamara Sara E , Valley Ann M , Podzorski Diane , Lyman Meghan , Parnell Lindsay 
Published: November 2023

Abstract

Background
Candida auris is an emerging fungal pathogen which is often multidrug-resistant, can cause severe infections, and spreads readily in healthcare settings. While echinocandin resistance (ech-R) remains low in the United States (&lt; 5%), the number has been increasing, which is concerning because echinocandins are first-line therapy for C. auris infections. In May 2022, the first ech-R C. auris isolate in Michigan was detected at long-term acute care hospital (LTACH) A and enhanced lab surveillance was conducted to assess potential for ech-R transmission.

Methods
Upon detection of C. auris in a urine specimen at LTACH A in March 2022, a containment response was initiated, which included clinical surveillance and colonization screening of patients at LTACH A. C. auris colonization screening testing and antifungal susceptibility testing (AFST) was performed at Wisconsin State Laboratory of Hygiene and whole genome sequencing (WGS) by the CDC. Ech-R was determined using tentative breakpoints defined by CDC.

Results
From Mar 2022 – Sept 2022, 15 C. auris-positive specimens were detected from 12 patients at LTACH A (5 clinical specimens, 10 screening swabs). In May 2022, AFST on a blood isolate from a C. auris-colonized patient showed resistance to azole and echinocandin classes. This patient had no history of prior echinocandins use. AFST conducted on 12 available isolates (5 clinical, 7 screening) detected ech-R in 10 (83%) isolates (3 clinical, 7 screening); all isolates were resistant to azoles and susceptible to polyenes. WGS was performed on 4 isolates and revealed 3 closely-related clade III isolates (all ech-R), suggesting possible facility transmission, and 1 clade IV isolate (susceptible), suggesting a separate introduction.

Conclusion
Multiple ech-R C. auris isolates detected among patients overlapping in the same facility and with close genetic relatedness provide further evidence that echinocandin resistant strains can be transmitted among patients and raise concerns about spread to a larger population of patients without prior echinocandin use. Enhanced surveillance for C. auris detection and antifungal resistance, public health reporting, and robust infection prevention and control measures are critical to containing the spread of concerning resistance.

Disclosures
All Authors: No reported disclosures
1447. Cluster of Carbapenem-resistant Acinetobacter baumannii in the Context of Local Community Transmission
Authors: Darwish Malik , Desai Angel , Catalan Marinell , Wilson Timothy , McGlynn Colin , Suhd-Brondstatter Jennifer , Dow Allison , Kingsley Amy , Reilly Mary , Cohen Stuart H 
Published: November 2023

Abstract

Background
Carbapenem-resistant Acinetobacter baumannii is increasingly being recognized as a nosocomial pathogen of concern. We report on a cluster of infections at a tertiary-care hospital in the context of local community outbreaks.

Methods
Between July and October 2021, we identified an increase in carbapenem-resistant Acinetobacter baumannii infections at our medical center. We conducted epidemiological investigation followed by whole-genome sequencing of clinical isolates in tandem with the Public Health Department, who was monitoring ongoing regional long-term care facility outbreaks.

Results
Of 9 patients with carbapenem-resistant Acinetobacter baumannii isolates, 8 were sent for whole genome sequencing (WGS) which revealed two clonally related groups; Clone 1 accounted for four cases, Clone 2 accounted for two, and the remaining two were unrelated to the other isolates. Half of the Clone 1 cases and all of the Clone 2 cases presented from the same two long-term care facilities, likely reflecting a known regional outbreak. The other two Clone 1 cases presented from the community and were suspected to be healthcare-acquired prior to WGS confirmation, although no definite route of transmission was ultimately identified. In response, we performed audits on the affected wards to improve targeted infection prevention practices, including enhanced cleaning and disinfection of respiratory therapy equipment. Concurrently, we initiated a surveillance system to screen all patients upon admission from long-term care facilities for colonization via rectal swabs cultured on Acinetobacter-selective media. Subsequent point prevalence testing revealed no additional healthcare-associated infections.

Conclusion
We identified a cluster of carbapenem-resistant Acinetobacter baumannii cases that predominantly reflected ongoing outbreaks at long-term care facilities in the community. Two likely healthcare-associated cases were also identified through whole genome sequencing, prompting infection prevention measures and targeted screening. Our experience highlights the necessity of a robust surveillance system and mitigation efforts to prevent transmission of healthcare-associated infections.

Disclosures
All Authors: No reported disclosures
1455. Cluster of Methicillin-Susceptible Staphylococcus aureus (MSSA) Infections at an Outpatient Surgery Center
Authors: Bailey Allison , Kennedy Idamae , Ansorg Henning , Doohan Noemi C , Robles-Davis Shellie , Stoltey Juliet , Epson Erin , Siegel Jane D 
Published: November 2023

Abstract

Background
In February 2023, a local health department (LHD) notified the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program of 3 patients hospitalized for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and/or abscess following sacroiliac (SI) joint injections for pain at an outpatient surgery center. Two recovered after treatment and one expired 9 days after the injection. CDPH-HAI and the LHD conducted an investigation.

Methods
LHD and CDPH infection preventionist staff went on site to evaluate infection control (IC) practices. Whole genome sequencing (WGS) was performed on all available MSSA isolates at the CDPH Microbial Diseases Laboratory.

Results
Initial investigation revealed single-dose vials of one product had been used for multiple patients; this practice was discontinued. WGS found the 3 patient isolates were identical (0 single nucleotide polymorphism (SNP) difference). The same healthcare personnel (HCP) team had performed the procedures for all 3 infected patients. A site visit identified gaps in IC and injection safety practices. One HCP who provided care to all 3 patients had visible skin lesions on their hands, wore bracelets, and was unaware of a facility policy to report if they were unable to perform adequate hand hygiene. MSSA screening cultures were collected from 3 involved HCP and were positive in only the HCP with skin lesions. WGS showed that the HCP MSSA isolates were highly related to the patient isolates (0-2 SNP difference). We advised the facility to develop an IC program tailored to the procedures performed, including adverse event surveillance, adherence monitoring of hand hygiene and environmental services practices, and attention to injection safety. The MSSA colonized HCP was referred for treatment of their skin condition and decolonization and was restricted from patient care until their skin condition improved.
Phylogenetic tree for MSSA

Conclusion
A combination of injection safety and hand hygiene lapses led to MSSA transmission from an HCP to 3 patients. This cluster underscored the importance of IC programs in outpatient clinics and the risk of transmission of infectious agents from HCP to patients with gaps in IC practices. It also highlighted the contribution of WGS in investigating HAI outbreaks.

Disclosures
All Authors: No reported disclosures
1456. Outbreak of Elizabethkingia anophelis on a Pulmonary Medicine Unit
Authors: Weber Rachel , Barajas Grace , Reiner Sandra , Malczynski Michael , Qi Chao , Zembower Teresa 
Published: November 2023

Abstract

Background
Elizabethkingia species are multidrug-resistant emerging pathogens that have caused outbreaks in healthcare settings and are associated with high mortality rates (20-40%) among infected patients. We experienced an increased number of E. anophelis isolates on our high-risk pulmonary medicine unit (PMU) in October 2022. An outbreak investigation was performed.

Methods
The outbreak investigation consisted of review of clinical and microbiological data, evaluation for potential laboratory contamination, water and medical equipment sampling, staff interviews, and pulsed-field gel electrophoresis (PFGE) to characterize clinical and environmental isolates.

Results
Between October and December 2022, E. anophelis was identified from respiratory cultures of five colonized patients on our high-risk PMU. None developed clinical infection. By PFGE, three isolates were identical, one was possibly related and one was distinct and not considered part of the outbreak. Laboratory contamination was ruled out when rounds identified no sources and repeat tracheal aspirate cultures processed manually grew E. anophelis. Between 10/23/22-10/31/22, all four patients had tracheostomy collars and received respiratory care on overlapping days on PMU. 144 environmental samples were obtained on PMU and three other units where patients had received care: 75 water fixture, 45 water, 15 respiratory equipment, and 9 other medical equipment. 3/144 (2%) environmental samples were positive, all from water fixture samples from PMU. These were distinct from each other and patient isolates. Rounds and interviews identified supplies stored in splash zones, excessive splashing of sinks, and potential misuse of tap water (i.e. rinsing nebulizers). Additionally, PMU had medical equipment needs which resulted in increased sharing of equipment between patients.

Conclusion
Although a definitive source for this outbreak was not found, the investigation concluded that transmissions likely occurred due to tap water misuse coupled with suboptimal infection prevention practices during respiratory procedures. Rapid identification and investigation of this outbreak, including swift awareness, education, and participation of frontline staff, likely contributed to the timely end of this outbreak.

Disclosures
All Authors: No reported disclosures
1457. Carbapenem-resistant Acinetobacter baumannii in an Intensive Care Unit during the COVID-19 pandemic: An Outbreak Investigation Utilizing Whole Genome Sequencing
Authors: Williams Samantha , Thompson Kolawole Rochelle T , Navalkele Bhagyashri , Grubb Melinda , Fletcher Sheila , Ware Daphne , Robinson Ashley 
Published: November 2023

Abstract

Background
Infections due to carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with increased mortality, length of hospital stay, and cost. Due to the high patient volume during the Delta wave of the COVID-19 pandemic, one of the parking garages at our institution was converted into overflow ICU space that lacked institutional Infection Prevention (IP) oversight. Shortly afterwards, we experienced an outbreak of CRAB. Here we describe our outbreak investigation utilizing whole genome sequencing.

Methods
After five cases of CRAB were noted in a ten-day period, enhanced IP measures were implemented, and an outbreak investigation was initiated (Figure 1). A hospital-onset (HO) CRAB case was defined as CRAB isolated from any specimen collected on or after hospital day three from August to September 2021 in patients without prior CRAB infection. A line list of HO CRAB cases was created. CRAB isolates underwent WGS and analysis (PA) (Figure 2). Location mapping was then performed on cases involved in the outbreak to assess potential transmission pathways.

Results
Nine cases of HO CRAB were initially identified. Eight of these underwent WGS and analysis (Figure 3). Based on WGS, six of the eight isolates were determined to be genetically related and were strains from global cluster 2 with intrinsic (OXA-51 family) and acquired (OXA-23) carbapenemases. Further investigation revealed the two unrelated isolates (C and H) had prior community-onset (CO) CRAB colonization, and they were excluded from the outbreak. One additional HO case was identified later during the outbreak and did not undergo WGS. A total of eight cases were labeled as HO CRAB. Location mapping of HO cases was performed. Multiple overlapping locations were noted among HO cases, with five of the eight cases notably having been located in the makeshift garage ICU during their stay (Figure 4). Patient demographics, clinical data, and outcomes are described in Table 1.
Based on results of WGS and analysis, isolates C and H are not related to other isolates. C has &gt;1100 single nucleotide polymorphisms (SNPs) and H has &gt;265 SNPs with other isolates. The remaining 6 isolates are closely related to each other with &lt;20 SNPs.

Conclusion
Our study demonstrated the use of location mapping and utility of WGS to identify outlier cases and the strains involved in the CRAB outbreak. Our findings also highlight the need for IP involvement at the time of addition of new patient care areas to provide guidance on practices to help prevent outbreaks.

Disclosures
Ashley Robinson, PhD, Pfizer: Grant/Research Support