bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-335. Environmental Impact of Contact Precaution Use for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) in Los Angeles (LA) County: Results of a Countywide Survey
Authors: Lee Pam , OYong Kelsey , LeBrun Michelle , Rubin Zachary A , Miller Loren G 
Published: January 2025

Abstract

Background
United States hospitals produce over 5.9 million tons of waste yearly. Disposable personal protective equipment (PPE) causes up to 70% of hospital municipal plastic waste. Contact precautions, often requiring disposable gowns and gloves, are frequently used to prevent MRSA/VRE transmission. We determined the scope and environmental impact of contact precaution use for MRSA and VRE in LA County.

Methods
We observed patient care at LA acute care hospitals to quantify PPE used for patients in MRSA/VRE contact precautions, as well as for patients with methicillin-susceptible Staphylococcus aureus (MSSA) and vancomycin-susceptible Enterococcus (VSE). We matched observations by hospital type (community, academic safety-net) and care location (intensive care, telemetry, ward). We conducted 24 observations for each organism.
To determine the extent of PPE used for MRSA/VRE, the LA County Department of Public Health surveyed acute care hospitals for the average daily number of hospitalized patients in 2023 in MRSA/VRE contact precautions. We modeled the county-wide solid waste and carbon dioxide (CO2) emissions from MRSA/VRE contact precautions.

Results
Mean gown use was higher for MRSA vs. MSSA (2.33 vs. 0.17 gowns/hour, p&lt; 0.01) and VRE vs. VSE (2.50 vs. 0.59 gowns/hour, p&lt; 0.01). Glove use did not vary between MRSA vs. MSSA (5.08 vs. 4.33 gloves/hour, p = 0.45) or VRE vs. VSE (5.88 vs. 5.46 gloves/hour, p = 0.50).
In total, ∼3% of LA County hospitals’ licensed beds are occupied by patients in contact precautions for MRSA and VRE. In our model this level of occupancy equaled 7.3 million gowns per year for MRSA and VRE contact precautions, which generate 461,400 kilograms (kg) of plastic waste and 2.27 million kg of CO2 emissions annually.

Conclusion
We found that care for patients in MRSA/VRE contact precautions requires significantly more gown use than for patients with MSSA/VSE. Glove use did not differ between patients with antibiotic-resistant infections vs. their antibiotic-sensitive counterparts. LA County’s MRSA/VRE PPE causes abundant plastic waste and greenhouse gas emissions equal to 5.8 million miles driven in an average car. Routine MRSA/VRE contact precautions need to be reconsidered given the paucity of supporting evidence as well as their potential harm to the environment.

Disclosures
Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
P-336. Validation of a Badge-Based Automated Hand Hygiene Monitoring System
Authors: Patel Palak , Steele Molly , Incesti Jennifer , Chu Vera , Marrs R , Zuccaro Patricia D , Bartlett Allison H , Landon Emily 
Published: January 2025

Abstract

Background
Hand Hygiene (HH) is the cornerstone behavior in preventing healthcare-associated infections (HAIs) yet accurately monitoring HH remains a challenge. We present the validation process and results for a popular badge-based automated monitoring system in the setting of existing aggregate, automated HH monitoring.
Accuracy of Unique Actions of Biovigil Monitoring System by Unit
Accuracy of Biovigil monitoring system compared to observation by IPC Team in behavioral validation phase by unit

Methods
University of Chicago Medicine Hyde Park Campus (UCM) is an 800 bed academic medical center and Ingalls Memorial Hospital (IMH) is a 200 bed community hospital. The Biovigil HH monitoring system (Ann Arbor, MI) was trialed on 4 units: IMH 35 bed med/surg unit (MS1), IMH 8 bed cardiac care unit (CCU), UCM 36 bed med surg unit (MS2), and UCM 19 bed Pediatric intensive care unit (PICU). Validation utilized planned path and behavioral validation techniques previously reported by the authors (Landon ICHE 2016). Participation by employees was voluntary.
Accuracy of Unique Actions of Biovigil Monitoring System by Event
Accuracy of Biovigil monitoring system compared to observation by IPC Team in behavioral validation phase by event

Results
During the planned path, investigators performed 336 unique actions and observations to test functionality. This identified issues with installation of soap use detectors on one unit. Once these were adjusted, overall accuracy was 99.7% (MS1 100%, MS2 100%, CCU 100%, PICU 98.8%). During behavioral validation, investigators observed 259 unique behaviors and compared with system raw data found an overall accuracy of 91% (MS1 95%, MS2 97%, CCU 84%, PICU 87% with 95% CI) as shown in table 1. Accuracy for detecting entry or exit was 91% (95%CI 86-94%), sanitizer use 97% (95%CI 94-99%), and soap and water use 92% (95%CI 62-98%) as seen in table 2. Monthly HH rates measured by the existing monitoring system (only UCM) before and during the trial system validation are shown in table 3.
Monthly HH Rates
Monthly HH rates measured by the existing monitoring system (only UCM) before and during the trial system validation

Conclusion
The trial HH monitoring system was more accurate on floor units than intensive care units but performed similarly and adequately across two different types of hospitals. There is insufficient data to evaluate for accuracy in measuring soap and water compliance. While HH compliance as measured by the existing system increased initially after installation of the trial system, this was not sustained and may be related to attrition in badge wearing for the trial system.

Disclosures
Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant
P-340. Evaluating the Efficacy of Nasal Iodophor Antisepsis in Reducing Candida auris Nasal Carriage in Nursing Home Residents
Authors: Gussin Gabrielle , Singh Raveena D , Saavedra Raheeb , Nguyen Eric , Shimabukuro Julie A , Bittencourt Cassiana E , Huang Susan 
Published: January 2025

Abstract

Background
Candida auris is an emerging drug-resistant yeast that is spreading rapidly in U.S. healthcare facilities, particularly in nursing homes. Like MRSA, C. auris is commonly found in the nose, raising questions about whether nasal iodophor application can reduce carriage.

Methods
We evaluated the impact of iodophor on C. auris nasal carriage at two nursing homes. Nasal carriers were identified from point prevalence sampling of bilateral nares of residents for both C. auris and MRSA conducted at each nursing home.
Nasal iodophor was given to carriers according to a 5-day twice-daily decolonization protocol. Nasal swabs for C. auris and MRSA culture were collected on Day 1 (pre-iodophor), Day 5 (last day of iodophor administration), and Day 9 (4 days after iodophor cessation). Bioburden was assessed on an ordinal scale (none = 0, few =1, 1+ = 2, 2+ = 3, 3+ = 4, and 4+ = 5). Paired t-tests compared C. auris and MRSA bioburden between timepoints.

Results
Twenty-two residents with C. auris nares carriage completed the evaluation. Seven (32%) also harbored MRSA. Between Days 1 and 5, mean nares bioburden decreased from 3.6 to 2.8 for C. auris (P=0.03) and from 4.3 to 2.3 for MRSA (P=0.02) (Figure). Comparing Day 9 to Day 1, mean C. auris bioburden at Day 9 was 2.8 (P=0.01) and mean MRSA bioburden at Day 9 was 3.1 (P=0.14).

Conclusion
Five days of nasal iodophor antisepsis appeared to suppress both C. auris and MRSA carriage. Rebound growth four days after iodophor discontinuation was seen for MRSA but not C. auris, although numbers were small. Nasal iodophor may be an effective strategy for reducing nasal carriage in high-risk settings. The value of repeated antisepsis for sustained bioburden reduction was not evaluated in this study.

Disclosures
Raveena D. Singh, MA, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raheeb Saavedra, AS, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Susan Huang, MD, MPH, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work
P-341. Multidrug-Resistant Organism Sharing Among Nursing Home Roommates
Authors: Gussin Gabrielle , Kleinman Ken , Singh Raveena D , Bui Justina , Gadia Gabriel , Tjoa Thomas T , Mitchell John , Saavedra Raheeb , Shimabukuro Julie A , Bittencourt Cassiana E , Huang Susan 
Published: January 2025

Abstract

Background
Nursing homes are high-risk settings for multidrug-resistant organism (MDRO) prevalence and spread. We investigated whether nursing home roommates were more likely to carry the same MDRO compared to non-roommates.

Methods
We conducted a secondary analysis of 44 nursing homes in two studies (Protect Trial-Miller NEJM 2023; SHIELD-Gussin JAMA 2024) involving universal chlorhexidine bathing and nasal iodophor. We used MDRO status from baseline (2016-17) and end-intervention (2018-19) visits where 50 residents were sampled at random at each nursing home. Sampling included bilateral nares swabs processed for methicillin-resistant Staphylococcus aureus (MRSA), and axilla/groin swabs processed for MRSA, vancomycin-resistant Enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producers.
We used generalized estimating equations with alternating logistic regressions to assess the odds ratio (OR) for each MDRO while clustering by nursing home. These ORs are the relative odds of one person being positive (outcome) given that the paired person is positive (exposure), divided by the odds of being positive if the paired person is negative. We estimated separate values when the two people are roommates and when they are non-roommates.
Models adjusted for age, gender, post-acute status, need for full care assistance, presence of an indwelling device, MDRO history, and baseline vs. decolonization period. Shared room assignments (cohorting) due to known history of the specific MDRO being modeled were excluded.

Results
The 44 nursing home sample included 4851 residents who were roomed in 180 single rooms, 1945 doubles, 874 triples, 93 quads, four 5-bed rooms, and six 6-bed rooms. The Table shows significantly higher ORs of concordant MDRO carriage among roommates than among non-roommates for each MDRO.

Conclusion
Roommates in nursing homes are significantly more likely to carry the same MDRO versus non-roommates, indicating potential transmission within shared rooms.

Disclosures
Ken Kleinman, ScD, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raveena D. Singh, MA, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raheeb Saavedra, AS, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Susan Huang, MD, MPH, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work
P-374. Bacterial Outbreak Investigations Associated with Drug Diversion by U.S. Healthcare Personnel, 1990-2023
Authors: Pierce Rebecca , Vazquez Deida Axel A , Perz Joe , Perkins Kiran M 
Published: January 2025

Abstract

Background
Diversion of injectable medications by healthcare personnel (HCP) is widely recognized as a source of bloodborne pathogen transmission. Drug diversion can also cause bloodstream infections (BSIs) but may not be identified as a transmission source due to the myriad of potential etiologies of bacterial outbreaks in healthcare settings. Here, we describe characteristics of drug diversion-related bacterial outbreaks to inform identification and control.

Methods
We searched PubMed using the key terms “outbreak” or “cluster” and “diversion” to identify outbreaks reported from 1990-2023. Publication references were reviewed to identify additional reports. We excluded outbreaks outside the US and those caused by non-bacterial pathogens. We compiled patient- and outbreak-level data, including infection type, pathogen, length of stay, healthcare setting, diversion mechanism, and epidemiologic investigation strategies.

Results
We identified six drug diversion-related bacterial outbreaks published between 1991-2019, involving 80 patients. 93% (n=74) of patients presented with BSIs; 93% (n=74) were identified after surgery or procedure; 24% (n=18) of patients with a BSI had a polymicrobial infection. Median outbreak duration was 119 days (range: 38-288). All outbreaks involved water-associated bacteria (Table) and four outbreaks reported BSI onset within 48 hours of admission for at least one patient. Outbreaks necessitated multiple epidemiologic strategies, including routine approaches (e.g., case-control study [n=4]) and techniques specific to medication tampering (e.g., medication concentration testing [n=4]). At least three patients (range: 3-24) in each outbreak had related isolates by molecular typing or whole genome sequencing. Four outbreaks reported tampering with opioids administered by patient-controlled analgesia (PCA) pumps.

Conclusion
Certain features of healthcare BSI outbreaks, including involvement of water-associated bacteria, post-surgical populations, or rapid infection onset, should prompt consideration of drug diversion as a potential route of transmission. Multifaceted strategies, including evaluation for medication tampering, are needed to identify outbreaks from drug diversion.

Disclosures
All Authors: No reported disclosures
P-383. Do Intraoperative Bile Cultures in Pancreaticoduodenectomy Change Antibiotic Management? A Retrospective Observational Study
Authors: Ndungu Elizabeth , Kofahi Ahmad , Zraik Lara , Jackson Morgan , Beal Eliza , Monday Lea 
Published: January 2025

Abstract

Background
Biliary stenting increases post-operative surgical site infections (SSIs) following Whipple procedure due to bactibilia. Intraoperative bile culture (IOBC) is performed to guide empiric therapy for SSIs; however, its utility and impact on antibiotic utilization is poorly studied.

Methods
We performed a retrospective cohort study of adult patients undergoing pancreaticoduodenectomy over a 3 year period (2021-2023). Patients with and without IOBCs were compared for pre and post-operative characteristics and complications. Post-operative antibiotic utilization was also compared between cohorts (Fig1).

Results
36 patients underwent Whipple’s procedure during the study period; 26 (72%) had IOBC obtained, while 10 (28%) did not. Cohorts were similar in terms of comorbidities, neoplasm, and surgical characteristics (Table 1). All 17 Patients with prior biliary stenting had IOBC obtained, but IOBC were also obtained in 9 patients who had not previously been stented (Table1). Post-operative fever, leukocytosis, SSI, bacteremia, and deep abscess were similar between cohorts, however, more biliary leaks occurred in the group that did not have IOBC (P=0.010)(Table 2a). Compared to the group without cultures, the IOBC group had longer median antibiotic duration (11 versus 3 days, P=0.52), and fewer short course antibiotics under 14 days (65% vs 100%, P=0.197), however these were non-significant trends (Table 2b). Patients in the IOBC group also trended toward more antipseudomonal, carbapenem, and antifungal use (P=0.068 to P=0.285, Table 2b). 10 of 22 (45%) of patients with growth on their IOBC did not have antibiotics adjusted based on that result. Patients whose antibiotics were adjusted did not differ in their microbiology results from those whose cultures were ignored (Figure 2).

Conclusion
Almost 3 / 4 of patients undergoing Whipple’s procedure had IOBC obtained; some not previously been stented. 45% of patients with positive IOBCs did not have their antibiotics adjusted to target them. Patients who underwent IOBC trended toward longer antibiotic durations and use of broader agents despite having lower rates of post operative biliary leak. These results indicate physicians may feel compelled to treat these cultures without a clinical indication.

Disclosures
All Authors: No reported disclosures
P-388. A Cluster of Pseudomonas Infections After Vascular Surgery
Authors: Patel Palak , Chu Vera , Enriquez Aurea , Marrs R , Landon Emily , Zuccaro Patricia D 
Published: January 2025

Abstract

Background
Deep surgical site infection after vascular surgery is a dreaded complication. In October 2023 a vascular surgeon raised concerns about an increase in post-operative Pseudomonas infections with the infection prevention and control team at the University of Chicago Medicine.

Methods
University of Chicago Medicine is an 800 bed tertiary academic medical center with an active vascular surgery practice. Investigation of the suspected cluster was conducted by the Infection Prevention and Control (IPC) team and included molecular analysis of clinical isolates, environmental cultures of shared equipment and supplies, observation of operative practices, and observation on daily bedside rounds. Available Pseudomonas strains from patients included in the investigation were sent to Mayo labs (Rochester, Minnesota) for sequencing and relatedness analysis.

Results
Between 10/3/2023 and 11/3/2023, a total of 5 patients with Pseudomonas groin infection after vascular surgery were identified. 2 isolates were available for sequencing and were not related. Inspection of the vascular surgery workroom and supply room yielded shared equipment and supplies that were cultured by the IPC team. Pseudomonas was not recovered in these cultures but items from a surgical supply bag grew various gram positive organisms and a black mold that was not further identified. OR observation of operative practices revealed inadequate prep time of moist sites, lack of glove change before closing, and high traffic/occupancy during the case. Observation of daily rounds revealed multiple instances of failure to clean shared equipment (like portable ultrasound machines) between patients, lack of compliance with PPE for contact precautions, and inadequate hand hygiene practices.

Conclusion
Although these cases were not clonally related, the shared organism sparked high concern on the part of the surgeon which led to swift investigation and faster remediation than would have been possible with routine surgical site infection surveillance timelines. The investigation was able to identify multiple opportunities to improve routine infection prevention practices in the care of vascular surgery patients at this hospital.

Disclosures
All Authors: No reported disclosures
P-413. Epidemiology of Clostridioides difficile and Bloodstream Infection in Belgium: Insights from 2014-2022 Data
Authors: Shodu Nathalie , Callies Milena , Vaes Louise , Mertens Karl , Catry Boudewijn 
Published: January 2025

Abstract

Background
Healthcare-associated infections (HAI), like bloodstream infections (BSI) and Clostridioides difficile (CDI), strain Belgian hospitals. Since 2014, national surveillance requires data on hospital-associated (HABSI) and central line-associated bloodstream infections (CLABSI). Although CDI surveillance was obligatory until 2014, hospitals must join a surveillance program since 2015. This study delves into BSI and CDI trends in Belgium from 2014 to 2022.
Mean incidence of central line-associated bloodstream infections,hospital-wide ans in intensive care, Belgium 2013-2022, (CLABSI,central line-associated bloodstream infections; CRBSI, catheter related bloodstream infection=Confirmed CLABSI)

Methods
Data from national surveillance programs were analyzed using negative binomial longitudinal regression models. Incidence changes in CLABSI between pre-pandemic (2013-2019) and 2020-2022 were assessed, along with CDI incidence calculations. Statistical analyses utilized SAS Enterprise Guide 7.13 and STATA 16. Insights into incidence and causative agents for both BSI and CDI were analyzed.
Mean incidence of central line-associated bloodstream infections, hospital-wide,Belgium 2013-2022 ( CLABSI, central line-associated bloodstream infections; CRBSI, catheter related bloodstream infection=Confirmed CLABSI)

Results
Results show stable BSI incidence from 2014 to 2019. The 2020-2022 incidence calculation included 97, 99, and 95 participating hospitals, respectively. Hospital-wide CLABSI incidence increased from 2.0 to 2.6 per 10,000 patient-days in 2019 and then declined to 2.4 in 2022. ICU-only CLABSI incidence rose from 11.77 to 18.78 in 2020 and declined to 15.50 in 2022. The predominant microorganisms observed in total CLABSI since 2014 were S. epidermidis and E. faecium. In 2022 there was a statistically significant increase of HA-CDI incidence per 10,000 hospital-days compared to 2021, from 1.31 to 1.62. However, even though this increase was observed, most characteristics remain stable, such as percentage of recurrent episodes, age group of patients with infection. Since 2014, the most detected strain remained BR014.
Mean incidence of HA-CDI/10, 000 Hospitalisation-days in hospitals, per region. Belgium, 2010-2022.

Conclusion
The analysis of BSI and CDI epidemiology reveals significant trends crucial for healthcare management. The impact of the COVID-19 pandemic on CLABSI rates underscores the importance of targeted interventions, while ongoing challenges in HA-CDI incidence highlight the need for continued surveillance improvement. Future efforts should focus on effective prevention and control strategies to mitigate HAIs in Belgian healthcare facilities.

Disclosures
All Authors: No reported disclosures