bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of dry hydrogen peroxide on Candida auris environmental contamination
Authors: Sanguinet Jennifer , Marshall Gerard , Moody Julia , Sands Kenneth 
Published: September 2023

Background:Candida auris is an emerging pathogen that exhibits broad antimicrobial resistance and causes highly morbid infections. Prolonged survival on surfaces has been demonstrated, and standard disinfectants may not achieve adequate disinfection. Persistent patient colonization and constant environmental recontamination poses an infection risk that may be mitigated by no touch disinfection systems. We evaluated the efficacy of continuous dry hydrogen peroxide (DHP) exposure on C. auris environmental contamination. Methods: The study was conducted in a large tertiary-care center where multiple patients were identified as either infected or colonized with C. auris. DHP-emitting systems were installed in the ventilation systems dedicated to the adult burn intensive care and children’s cardiac intensive care units. Composite surface samples were collected in a sample of patient rooms and shared clinical workspaces among units with current C. auris patients, before and after installation of the DHP system, and from areas with and without exposure to DHP. The samples included “high touch” surfaces near the patient, the general area of the patient room, shared medical equipment for the unit, shared staff work areas, and equipment dedicated to individual staff members (Table 1). Presence of C. auris was determined by polymerase chain reaction (PCR). Association between DHP exposure and C. auris contamination was determined using the Fisher exact test. Results: In the presence of C. auris patients, 5 baseline samples per unit were taken before DHP was installed, and then 5 samples per unit were taken on days 7, 14, and 28 after installation. Prior to initiation of DHP, 7 (70%) of 10 samples were PCR positive for C. auris. After DHP installation, a statistically significant decrease to 5 (16.7%) of 30 samples (P <.05) was observed. In total, 20 samples (5 before installation and 15 after installation) were collected from units without DHP on the same days. At baseline, 2 (40%) of 5 samples were PCR positive for C. auris. During subsequent periods, 4 (27%) 15 samples were positive (P = .66). No adverse effects were reported by patients, visitors, or personnel in association with the operation of the DHP systems. Conclusions: These findings suggest that DHP is effective in reducing surface C. auris contamination in a variety of patient and healthcare worker surfaces.Disclosures: None
An infection prevention and control program established in the wake of the Ebola epidemic: Where are we, and how well are we doing?
Authors: Fofanah Bobson , Conteh Christiana , Katawera Victoria , Kamara Ibrahim Franklyn 
Published: September 2023

Background: Infection prevention and control (IPC) is a clinical and public health discipline based on a scientific approach and practical preventive and control measures. During the 2014–2016 West African Ebola outbreak, the high number of healthcare worker infections was attributed to inadequate IPC in Sierra Leone. This stimulated the establishment of national and subnational IPC programs. Since then, IPC has remained a priority to improve the health systems and strategic interventions during public health emergencies. Therefore, we conducted a detailed review to assess the status of the IPC programs. Methods: A descriptive analysis of the status of IPC programs in Sierra Leone was done using data from IPC assessments conducted in 2022 by the national IPC team, reviews of reports on program implementation, and experts’ objective opinions. Results:Performance. The national IPC assessment revealed strengths in 4 of 6 WHO IPC core components, with an overall score of 61% positioned at the ‘intermediate’ level of implementation. The best-performing component was ‘IPC guidelines’ (92%) with evidenced-based guidelines being developed and implemented over the years. Secondly, ‘Education and training’ (71%) made progress in basic and advanced IPC training, including the development of a preservice training curriculum. Also, ‘monitoring and audit and feedback’ (69%) and ‘IPC program’ (61%) met the basic requirements of an established Monitoring & Evaluation (M&E) system. Similar progress was made at the healthcare facility level, but with major gaps in ‘workload, staffing, bed-occupancy’ and ‘safe or built environment.’ Sustainability efforts. Evidence-based data on IPC have always been scarce due to a limited capacity to conduct IPC research. The Structured Operational Research and Training Initiative (SORT-IT) on antimicrobial resistance has helped promote evidence-informed decisions and build OR capacity that is relevant to improving program performance. In 2019, Sierra Leone instituted in-country production of alcohol-based handrub and liquid soap as a strategic intervention for providing hand hygiene products for use in healthcare facilities. This intervention was essential during the peak of the COVID-19 pandemic. Although most aspects of IPC implementation are government led with strong leadership support, stable funding and sustainability planning are yet to be achieved and will be crucial for long-term success. Conclusions: Most aspects of the IPC core components have been well implemented at the national level since the establishment of the IPC program. However, the program should continue improving the scope and quality of implementation and focus on the development of long-term plans to sustain existing gains and further improve on gap areas at the national level and especially the healthcare-facility level.Disclosures: None
Whole-genome sequencing cluster analysis reveals complex healthcare-associated COVID-19 dynamics
Authors: Rader Theodore , Snyder Graham , Harrison Lee , Srinivasa Vatsala Rangachar , Griffith Marissa , Pless Lora , Chung Ashley 
Published: September 2023

Background: Identifying and interrupting transmission of severe acute respiratory syndrome coronavirus 2 and resulting disease (COVID-19) in acute-care settings can be challenging due to incubation period, asymptomatic infection, and prevalent community disease. To elucidate routes of infection and interrupt COVID-19 outbreaks with uncertain epidemiological chains of transmission, UPMC utilized reactive whole-genome sequencing (WGS) of viral specimens. Methods: UPMC infection prevention teams identified healthcare-associated COVID-19 clusters with uncertain transmission pathways among patients and/or healthcare personnel (HCP) in acute-care hospitals. Nasopharyngeal samples preserved in viral transport media were obtained for genetic analyses. Nucleic acids were extracted and WGS libraries were prepared by targeted enrichment or multiplex PCR methodologies. Resulting sequencing reads were aligned to the Wuhan-1 reference genome, followed by identification of single-nucleotide polymorphisms (SNPs) among the genomes and construction of a phylogenetic tree. Specimens were considered genetically similar if there were ≤2 SNP differences between viral genomes within a cluster. Results: Between May 2020 until August 2022, infection prevention teams requested WGS for 17 healthcare-associated clusters of COVID-19 involving 182 individuals across 8 UPMC facilities (median outbreak size, 9 individuals; range, 2–26). Of the 182 individuals, 36 lacked clinical specimens and 30 did not pass WGS quality-control criteria of ≥95% of the reference genome with a minimum of 10× coverage. Of the 116 sequenced genomes, 94 (81%) had virus genetically similar to ≥1 other specimen, including 87 (83.6%) of 104 patient viruses and 7 (58.3%) of 12 HCP viruses, comprising 22 clusters (Fig. 1). The remaining 22 (20.6%) specimens were genetically unrelated. In total, 16 (94.1%) of the 17 epidemiologically identified clusters had 2 or more individuals with a genetically similar virus. Also, 7 (41.1%) of these clusters had genetically similar viral genomes for every individual within each cluster. Also, 9 (52.9%) clusters contained both genetically related and unrelated specimens: 5 of these had more complex genomic profiles (including 4 clusters containing 2 distinct subclusters of ≥2 genetically related viruses) and 1 cluster contained 3 subclusters of ≥2 genetically related viruses. In the outbreak with 3 clusters, 3 SNPs separated specimens from 2 temporally proximal clusters, suggesting possible propagation between clusters (cluster B-3 in Fig. 1). Conclusions: WGS can complement traditional epidemiological investigations of healthcare-associated COVID-19 outbreaks, revealing complex transmission dynamics. Future investigations will characterize the impact of WGS on determining specific transmission pathways in acute-care facilities.Disclosures: None
Aeromonas nosocomial cluster: Investigation review of possible modes of transmission
Authors: Bisht Anjali , Gray Hannah , Caldera JR , Yang Shangxin , Uslan Dan 
Published: September 2023

Background:Aeromonas is a gram-negative rod known to be present in water, sewage and soil which may cause infections especially in immunocompromised hosts. Cases of Aeromonas gastroenteritis have been associated with warmer weather. In total, 3 patients with extensively drug resistant (XDR) Aeromonas were identified at our facility between August and September 2022 on 2 intensive care units (ICUs). Our infection prevention, microbiology, and facility teams investigated these cases to determine whether a common source could be the mode of transmission. Methods: To first determine whether patients’ Aeromonas specimens were related, whole-genome sequencing (WGS) of the clinical isolates from 3 patients was performed using the Illumina DNA Prep Kit and Illumina MiSeq. Sequencing analysis was performed using CLC Genomics Workbench for de novo assembly, single-nucleotide polymorphisms (SNP) calling, and tree generation, Geneious Prime for reference-based assembly, annotation, and quality assessment, KmerFinder for reference identification, and the Comprehensive Antibiotic Resistance Database for resistance gene detection via protein homology. Chart review revealed that patients occupied multiple rooms between 2 ICUs (Fig. 1). Because water is a known source of Aeromonas, facility records were reviewed for water intrusion events. This analysis identified several cases in the affected patient and surrounding rooms. Sinks and faucets from 10 rooms were swabbed followed by direct plating on blood, MacConkey agar, and Aeromonas-selective cefsulodin-Irgasan-novobiocin (CIN) agar plates. Lastly, the city temperatures before and after positive cases were reviewed to identify whether any correlation could be shown between temperature and timing of infection. Results: WGS analysis revealed that the 3 Aeromonas isolates (all identified as A. hydrophila) were not directly related (minimum distance, 934 SNPs) and harbored between 4 and 19 unique antimicrobial resistance genes, including co-occurring carbapenemases VIM-2 and KPC-3 in 1 isolate and OXA-232 in another. Of the 20 environmental samples, few gram-negative nonfermenting bacteria and no Aeromonas isolates were detected (Fig. 1). Elevated city did loosely proceed patient cases of Aeromonas, suggesting a possible role of higher temperature, which may have promoted the growth of Aeromonas during the periods of the 3 cases and thus may contribute to the nosocomial infections (Fig. 2). Conclusions: Although our investigation did not reveal a definitive cause for the Aeromonas cases, it did show the importance prompt identification and investigation can have on mitigating the spread of a cluster. Our facility has not identified any additional nosocomial cases. Monitoring water intrusion events and plans for remediation continue to be a priority.Disclosures: None
Association of postnatal age with neonatal hospital-onset bacteremia in a multicenter, retrospective cohort
Authors: Prochaska Erica , Xiao Shaoming , Colantuoni Elizabeth , Mukhopadhyay Sagori , Flannery Dustin , Kalu Ibukun , Zerr Danielle , Adler Amanda , Milstone Aaron 
Published: September 2023

Background: Prevention of hospital-onset bacteremia (HOB) in all settings is a healthcare priority. The CDC is developing a neonatal-specific HOB quality metric, but the epidemiology of neonatal HOB is poorly understood. Our objective was to validate a prior single-center finding that HOB risk varies by birthweight and postnatal age in a multicenter cohort. Methods: We performed a multicenter, retrospective cohort study of neonates admitted to 4 neonatal intensive care units (NICUs) for ≥4 days between July 1, 2016, and July 1, 2021. HOB was defined as a positive blood culture for bacteria or fungi on day ≥4 of admission. The first HOB event in the hospitalization was counted per neonate. Repeat HOB events during a neonate’s admission were excluded. Poisson regression models with robust variance estimates were used to estimate the incidence rate (IR) of HOB, expressed as HOB events per 1,000 patient days and IR ratios (IRRs), within strata defined by CDC birthweight categories and 4-week postnatal age intervals, adjusting for central venous catheter (CVC) presence at time of HOB and study site. Results: The analysis included 9,267 neonates, contributing 191,295 patient days and 470 HOB events, with an unadjusted IR of 2.46 per 1,000 patient days (Table 1). Of 477 infants born ≤750 g, 153 (30.1%) had a HOB with an IR of 13.3 (95% CI, 10.5–16.0) events per 1,000 patient days in the first 4 weeks after birth (Fig. 1). After adjusting for CVC presence and study site, infants ≤750 g had a higher HOB rate in the first 4 weeks of life (IRR, 7.45; 95% CI, 3.81–14.56) compared to infants ≥2,500 g. After 8 weeks of life, there was no difference in HOB rate in the 2 groups (IRR, 0.8, 95% CI, 0.3–2.7). Conclusions: Neonates born ≤750 g were at highest risk for HOB within the first 4 weeks after birth; however, risk for HOB was not consistent over time. Postnatal age should be considered in a neonatal HOB quality metric.Disclosures: None
Team-based infection preventionist review improves interrater reliability in identification of hospital-acquired infections
Authors: Castillo Alyssa , Totten Sarah , Pisney Larissa 
Published: September 2023

Background: The University of Colorado Health (UCHealth) metropolitan region is composed of 4 hospitals. Therein, 10 infection preventionists (IPs) retrospectively review all cases of potential central-line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection (SSI) to adjudicate whether each case meets the NHSN definitions for hospital-acquired infection (HAI). In August 2021, the UCHealth IP team structure transitioned from a subject-matter expert model (in which each IP reviewed a specific HAI) to a unit-based model (in which each IP reviewed all HAIs and SSIs on their assigned units) to create redundancy in knowledge and skill. The IP team subsequently instituted a weekly meeting to review all potential cases of HAI. We hypothesized that this review structure would result in increased consistency in the application of NHSN definitions across the UCHealth hospitals and units. Methods: From August 17, 2022, through March 3, 2023, the UCHealth IPs, managers, and medical directors met weekly for 1 hour via teleconferencing. Each IP presented key details for all near-miss and confirmed cases of SSI or HAI on their respective units and received questions and feedback from their peers and medical directors. Case determination was based on team discussion and consensus. If there was discordance in the interpretation of an NHSN case definition, a formal inquiry was sent to resolve the uncertainty. The number of cases reviewed, case determinations changed, and formal inquiries to NHSN were tracked. Results: During the study period, the IP team convened weekly meetings and reviewed 248 patient cases—of which 208 (83.9%) were confirmed HAIs. Based on collaborative team discussion, 14 cases (5.6%) were changed from reportable to nonreportable. Three cases (1.2%) originally thought to be nonreportable were changed to reportable. The HAI determination of a reportable case (eg, revision of a “superficial” SSI to “deep” SSI) was changed for 9 (6.0%). Following team discussion, 13 formal inquiries were sent to the NHSN to clarify case definitions, and these responses were collated for future reference. Conclusions: Team-based IP review of HAI cases improves consistency in application of NHSN case definitions and highlights areas of uncertainty in their interpretation. This team-based model of case review is a useful educational and practical tool to increase interrater reliability in case adjudication across large teams of IPs, to create a systematic way to query NHSN, and to ensure that knowledge gained is disseminated for future benefit.Disclosures: None
Quality improvement approach for surgical-site infection prevention in a Philippine provincial hospital
Authors: Abustan Anthony , Hogan Unarose , Winn Julie , Pagaran Paul , Littlefield Joan , Miles Ted 
Published: September 2023

Background: Globally, the 30-day cumulative incidence of surgical-site infections (SSI) was 11% (95% CI, 10%–13%) based on the systematic review and meta-analysis derived from 57 studies. SSIs are poorly studied in the Philippines. Americares and its hospital partner, Camarines Norte Provincial Hospital, Philippines, sought to reduce SSIs through (1) establishing SSI surveillance in the hospitals’ surgical departments, (2) implementing quality improvement processes, and (3) developing and implementing an SSI prevention care bundle. Methods: A quality improvement methodology was used to introduce SSI surveillance and care-bundle checklist in partnership with Americares. Using paired t tests, pre- and posttest scores of the SSI care bundle training were analyzed. SSI surveillance was established based on the adapted CDC criteria. All clean surgeries were monitored except orthopedic surgeries. The number of surgeries performed, monitored, and SSIs identified were documented using the surveillance forms and plotted using Microsoft Excel software. A care bundle based on WHO evidence-based interventions for SSI prevention was designed and implemented. Compliance with the SSI care bundle was documented using Microsoft Excel. The relationship between the use of a care bundle and SSIs was analyzed using the Pearson correlation coefficient. Results: An online SSI care bundle training session was conducted. Overall, 150 participants had a mean pretraining test score of +6.46. After the training was conducted, the same participants had a mean posttraining test score of + 1.76). a statistically significant increase of 5.29 (95% CI). Thereby, the mean score difference after training showed that knowledge increased overall. These findings show an average of 90.43% compliance with the SSI care-bundle checklist over the 18-month window from May 2021 to November 2022. From a baseline of 0%, compliance increased from 80% upon its introduction in May 2021. Lastly, the SSI incidence rate from May 2021to November 2022 averaged 1.89%. The days between reported SSIs averaged 16.85. No baseline was available for comparison prior to the introduction of the surveillance and care bundle. A Pearson r data analysis (n = 1,850) was used to determine the relationship between the use of the care bundle and SSIs. The data illustrated a moderate negative correlation (r = −.31). Therefore, higher care-bundle compliance yielded fewer SSI cases. Conclusions: The use of an evidence-based care bundle paired with a local quality improvement process significantly improved SSI prevention and surveillance. Future studies are needed that include clean-contaminated, contaminated, and dirty surgical cases to test the degree of SSI reduction possible.Disclosures: None
Tecovirimat use among patients with monkeypox (mpox) in Alameda County, California, June–October 2022
Authors: Ouyang Megan , Shemsu Munira , Marusinec Rachel , Pena April , Trivedi Kavita , Dunne Eileen , Yette Emily , Moss Nicholas , Bayard Paul , Edmunds Magdalen , Lai Sunny , Nguyen Mychi , Rajagopal Sumanth , Slome Sally , Tang Michele , Ayala George , Chitnis Amit 
Published: September 2023

Background: Tecovirimat (TPOXX) is an antiviral drug only available via an Expanded Access Program (EAP) investigational new drug protocol and is recommended for treatment of select patients with monkeypox (mpox) infection. Alameda County Public Health Department prioritizes health equity but does not have a dedicated public health clinic. Therefore, we partnered closely with local healthcare providers that serve communities disproportionally impacted by mpox to ensure there was access to TPOXX. Using data collected during the outbreak we assessed whether populations in Alameda County most affected by mpox received treatment. Methods: We describe Alameda County patients with confirmed or probable mpox who received TPOXX during June–October 2022. Data were collected from case investigation interviews with patients and state-wide reportable disease database(s), which included demographic, clinical, and behavioral information. Confidence intervals (CIs) were calculated using the exact method for Poisson counts. We compared characteristics of mpox patients who received and did not receive TPOXX using the Pearson χ2 or Fisher exact test. P < .05 was considered significant. Results: Mpox case rates in Alameda County were highest among Black or African-American residents (35.6 per 100,000, 95% CI, 26.7–46.4) and Hispanic or Latinx residents (25.2, 95% CI, 20.2–31.0) compared to Asian residents (3.9, 95% CI, 2.3–6.1) and white residents (10.4, 95% CI, 7.7–13.9) residents. Among 242 mpox patients, 69 patients (28.5%) received TPOXX. The distribution of demographic and clinical characteristics among patients who received TPOXX was not significantly different than among those who did not, including residents aged 31–40 years (36.2% vs 34.7%), Black or African-American residents (20% vs 26.3%), Hispanic or Latinx residents (38.5% vs 41%), male residents (89.9% vs 95.3%), gay, lesbian, or same-gender loving residents (67.2% vs 67.4%) in the city of Oakland (63.2% vs 61.5%), or residents with human immunodeficiency virus infection (43.5% vs 36.6%). Conclusions: During the Alameda County mpox outbreak, nearly one-third of patients received TPOXX. Demographic and clinical characteristics were similar among TPOXX recipients and nonrecipients. A proactive approach to obtaining TPOXX in Alameda County and strong relationships with local providers may have allowed for treatment to be accessible to mpox patients. Regular review of outbreak data can inform public health activities, ensure health equity, and help refine local response efforts.Disclosures: None