bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-284. Effect of Different Disinfection Methods on Hospital Sink Drain Disinfection
Authors: Ahmed El-Imam Ibrahim , O’Hara Lyndsay M , McClintock Christopher , French Indira , Paszkiewicz Gwen , Robinson Gwen , Thomas Amber R , Johnson J Kristie , Leekha Surbhi 
Published: January 2025

Abstract

Background
A commercially available foaming disinfectant containing hydrogen peroxide, peracetic acid, and octanoic acid is EPA-registered for biofilm disinfection in sink drains, but recolonization occurs quickly. We evaluated the impact of adding physical removal of bioburden to foaming disinfectant use on bacterial colonization in sink drains.

Methods
We conducted a longitudinal study in a level-IV neonatal intensive care unit (NICU) at an academic medical center in Baltimore, MD. The NICU has 52 single-patient rooms with sinks with removable drain plug covers. We included 20 unique rooms to investigate the effect of foaming disinfectant alone and coupled with physical removal of biofilm through (1) mechanical cleaning with a brush, and (2) replacement of drain cover (Figure 1). In addition, we sampled 10 room sinks as control (no intervention). Samples were collected from 2 inches below the sink drain and underside of the drain cover using a polyester tripped swab (Puritan ESK environmental sampling kit with neutralizing buffer) at baseline (day 0) and days 1, 3, 5, and 7 post-intervention. Samples were serially diluted, plated on MacConkey II agar (Becton Dickinson), and incubated for 24 hours at 35+2°C. Colony-forming units (CFU) of total gram-negative bacilli (GNB) were calculated. The primary outcome was the difference in GNB burden (mean log CFUs) from baseline at each time point, for each intervention strategy, compared using paired t-test.

Results
Baseline counts for all groups including control were similar. On day 1, we found significant reductions from baseline for each intervention strategy, with differences from baseline becoming smaller over time. There was no significant change in GNB counts for the control group at any time point (Figure 2, Table 1). Strategies with mechanical cleaning (vs without) performed better for sinks, whereas sink cover change (vs without) resulted in greater log reductions in the cover bioburden through day 7 (Figure 2, Table 1).

Conclusion
Physical bioburden removal improved the effect of a foaming disinfectant on GNB counts in hospital sink drains. The impact of this strategy on hospital-acquired infections needs to be studied.

Disclosures
J Kristie Johnson, PhD, D (ABMM), biomerieux: has given presentations/speeches for the company listed above
P-287. Risk factors for Pseudomonas aeruginosa in ICU-Related Respiratory Infections. An analysis from the European Network for ICU-Related Respiratory Infections (ENIRRIs) study
Authors: Serrano-Mayorga Cristian C , Olivella-Gomez Juan , Torres Antoni , Martin-Loeches Ignacio , Reyes Luis Felipe F 
Published: January 2025

Abstract

Background
Nosocomial low respiratory infections (nLRTIs) represent a significant complication prevalent among patients who require admission to the intensive care unit (ICU). Gram-negative microorganisms are related to nLRTIs, such as ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU-acquired pneumonia (ICU-HAP), and hospital-acquired pneumonia (HAP). Pseudomonas aeruginosa (PA) is frequently identified among nLRTIs; however, not all patients with nLRTI may require antipseudomonal treatment and this is not clear in the literature. This study aims to describe the characteristics and principal outcomes of patients with confirmed PA nLRTI.
Table 1. Characteristics of patients with Pseudomonas aeruginosa identification Vs Non-Pseudomonas aeruginosa identification.

Methods
This prospective cohort was conducted in 12 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of nLRTI’s patients admitted to the ICU were collected. All patients were tested to find microbiological-causing agents. Patients with confirmed isolation for PA were compared to patients with non-PA isolation. The Mam Whitney and Chi-squared were used to compare the group's proportions depending on their distribution.
Table 2. Bivariate analysis for risk factors associated with Pseudomonas aeruginosa

Results
1059 patients with nLRTIs who underwent testing for microbiological diagnosis were included, 14.4% patients had confirmed infection by PA. 74% were male with a median age of 64 (49-73) years old. The principal diagnosis among patients with PA was VAP. The principal comorbidities were diabetes and heart disease, followed by COPD. The most frequent complication was septic shock, followed by acute kidney injury. There were differences among the comorbidities, complications and outcomes among the groups (Table 1). However, there were no differences in mortality (Table 1 - Figure 1). VAT and VAP diagnosis, COPD Gold D and AKI on the 1st day were associated with a high risk of infection by PA (Table 2).
Figure 1. Sankey diagram showing mortality outcome. Pseudomonas aeruginosa Vs. Non-Pseudomonas aeruginosa LRTI-diagnosed patients who were admitted to the ICU.

Conclusion
This multi-country study found some important risk factors associated with PA in nLRTI patients. Differences among groups were notorious; diabetes and COPD comorbidities are more frequent among PA nLRTI patients. Finally, PA infection increases the length of stay of patients. Further studies are needed to confirm these findings.

Disclosures
All Authors: No reported disclosures
P-311. Shifts in Methicillin-Resistant Staphylococcus aureus Types in Bloodstream Infections: Nationwide and Regional Influences and Their Impact on Mortality
Authors: Kaku Norihito , Ishige Masaki , Yasutake Go , Sasaki Daisuke , Ota Kenji , Mitsumoto-Kaseida Fujiko , Kosai Kosuke , Hasegawa Hiroo , Izumikawa Koichi , Mukae Hiroshi , Yanagihara Katsunori 
Published: January 2025

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) is the leading cause of bloodstream infections (BSI). In the USA and Japan, the New York/Japan clone (ST5-II) was historically prevalent, but recent studies in Japan have shown a shift towards ST8-IV and CC1-IV as the dominant strains. The extent to which these trends are mirrored in individual facilities and the variation in patient backgrounds across different MRSA types remains unclear.

Methods
We analyzed MRSA strains from blood cultures collected at Nagasaki University between 2012 and 2019. Whole-genome sequencing was utilized to determine sequence types, SCCmec, spa types, and resistance and virulence genes, complemented by phylogenetic analysis using core-genome MLST. Data were compared with earlier studies from 2003-2011 at the same hospital.

Results
Between 2003 and 2019, SCCmec type II decreased from 79.2% to 15.5%, whereas type IV increased from 18.2% to 65.5%. Severity and outcomes also changed: SOFA score decreased from 5.8 to 3.1, while in-hospital mortality decreased from 39.8% to 15.5%. No changes in the patient background, such as age, sex, or underlying diseases, were observed (Table 1). Further, the percentage of intravascular device-related BSI increased significantly from 18.1% during 2003–2007 to 46.6% during 2016–2019.
The most common SCCmec type IV detected between 2012 and 2019 were ST8-IV and CC1-IV (Fig. 1A). ST8 was the predominant ST in both 2012–2015 and 2016–2019, but CC1 was detected only during 2016–2019 (Fig. 1B). In ST8-IV, MRSA/J and ST8-IV with spa type t5071 were identified, with MRSA/J being predominant. The detected MRSA/J, ST8-IV with spa type t5071, and CC1-IV subtypes were similar in terms of drug resistance, molecular characteristics, and phylogenetic features to those detected in the nationwide surveillance (Fig. 2). Patient characteristics across major MRSA types (ST8-IV, CC1-IV, ST8-I, ST5-II) revealed no significant differences, with lower SOFA scores and in-hospital mortality for CC1-IV (Table 2).

Conclusion
The evolving nature of MRSA types in bloodstream infections, correlating with improved outcomes over time and influenced by changes in nationally and regionally circulating strains, is highlighted.

Disclosures
Hiroshi Mukae, M.D., Ph.D., AstraZeneca: Lecture fees|Gilead Sciences: Lecture fees|GSK: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Lecture fees|Shionogi & Co., Ltd.: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees
P-322. Transmission of Methicillin-Resistant Staphylococcus aureus to Healthcare Personnel Gloves and Gowns: a Cohort Study of VA Hospitals in 5 States
Authors: O’Hara Lyndsay M , Newman Michelle , Pineles Lisa , Rubin Michael , Khader Karim , Nelson Richard , Bahr-Robertson Mary , Baracco Gio , Goetz Matthew B , Evans Martin , Linder Kathleen A , Perencevich Eli N , Harris Anthony 
Published: January 2025

Abstract

Background
The aim of this study was to determine the rate of MRSA transmission to healthcare personnel (HCP) gloves and gown and to determine which patient care interactions and HCP roles are associated with greater transmission of MRSA.

Methods
Patients with a positive MRSA clinical or surveillance culture within the past 7 days were enrolled at 5 VA medical centers. Research team members observed 5 HCP in the room for each patient and recorded any items that were touched on a standardized data collection form. After completion of tasks and prior to room exit, HCP gloves and gown were cultured separately. The primary outcome was a surrogate measure for transmission defined as “yes” if a HCP glove or gown was contaminated with MRSA.

Results
We enrolled 799 patients and obtained 3,832 glove and gown cultures. Transmission of MRSA to gloves or gown occurred 713/3832 (18.6%) of the time while 589/3832 (15.4%) of interactions resulted in contamination of gloves and 319/3831 (8.3%) of interactions resulted in contamination of gowns. The gloves and gown of physical therapists and occupational therapists were most frequently contaminated with transmission occurring in 24/84 (29%) and 11/38 (29%) of observations respectively (Table 1). Any interactions that involved touching the patient (patient alone or patient and environment) resulted in glove or gown contamination in 622/2901 (21.4%) of observations, while touching only the environment resulted contamination in 91/931 (9.8%) of observations. Specific patient care activities with the highest rates of transmission included touching the endotracheal tube (12/35, 34%) and assisting the patient with bathing and hygiene (89/283, 31%). Specific environmental items touched with the highest rates of transmission included the call button (75/221, 34%) and the lift (31/125, 27%) (Figure 1).

Conclusion
Contamination of HCP gloves and gowns with MRSA occurs frequently when caring for Veteran patients particularly when there is direct patient contact. Hospitals may consider optimizing contact precautions by using fewer precautions for low-risk interactions and more precautions for high-risk interactions.

Disclosures
Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor
P-325. Lingering Effect of the COVID-19 Pandemic: Unnecessary Glove Use by Medical Trainees at a Large Academic Medical Center
Authors: Brown Breanna , Nolt Dawn , Guzman-Cottrill Judith A 
Published: January 2025

Abstract

Background
In 2023, medical students and house staff were observed wearing disposable gloves during pediatric patient encounters, including those in standard precautions. When asked about their rationale for glove use, students and house staff assumed that universal gloving was a component of standard precautions. We sought reasons for universal glove use, and if universal gloving for all patient care was followed beyond the Children’s Hospital.

Methods
Residents and fellows in all training programs at Oregon Health & Science University (OHSU) were surveyed. We created an electronic survey including questions about demographics, training level during the pandemic, hand hygiene habits, and facilities’ gloving policies where they worked during the pandemic. A free-text response was available to detail routine glove use. The survey was e-mailed by the Graduate Medical Education office in February 2024 and was open for one month. A reminder e-mail was sent 2 days before closure. The OHSU IRB reviewed the survey and determined it not to be human research.

Results
The survey was sent to 972 trainees, representing 95 programs. The response rate was 23% (n=226); not all questions required responses. Only 30 (25%) were pediatric trainees. In ambulatory settings, 3 (1%) respondents report never gloving, 66 (33%) sometimes, 75 (38%) often, and 55 (28%) always wear gloves as part of standard precautions. In inpatient settings, 1 respondent never wears gloves, 43 (22%) sometimes, 70 (36%) often, and 79 (41%) always wear gloves as part of standard precautions. Of the respondents in medical school during the pandemic: 64 (46%) were taught to wear gloves during all patient care, and 28 (20%) reported hospital policy requiring universal gloving. For those in residency and/or fellowship during the pandemic: 74 (55%) were taught to wear gloves during all care, and 17 (13%) reported policies that required gloving.

Conclusion
Many trainees were taught universal gloving during the pandemic. These habits have continued. The concepts behind standard and transmission-based precautions must be highlighted during medical training. It is imperative that all GME programs educate their trainees about the concepts of standard precautions and appropriate glove use.

Disclosures
All Authors: No reported disclosures
P-327. Mitigating Colonization with Carbapenem-resistant Organisms among Neonatal Intensive Care Unit Admissions: Evaluating the Effectiveness of Infection Control Interventions
Authors: Chowdhury Fahmida , Mamun Gazi Md Salahuddin , Khan Sanzida , Mah-E-Muneer Syeda , Islam Md Aminul , Ahmed Dilruba , Sen Debashis , Harun Md Golam Dostogir , Oakley Lisa P , Parra Gemma , Styczynski Ashley R 
Published: January 2025

Abstract

Background
Antimicrobial resistance (AMR) is the global leading cause of death from infections, particularly affecting low- and middle-income countries. Colonization with carbapenem-resistant organisms (CRO) increases the risk of infections with CRO. In an interim analysis of a prospective cohort study, we found 77% (141/182) of neonates in a neonatal intensive care unit (NICU) of a tertiary-care hospital in Bangladesh were colonized with carbapenem-resistant Klebsiella pneumoniae (CR-Kpn), with 63% (89/141) acquiring colonization &gt;48 hours after hospitalization. We aimed to assess the impact of infection control (IC) interventions on CRO colonization among neonates admitted to the NICU.

Methods
From July 2023 to April 2024, we enrolled 604 neonates: 358 before the intervention and 246 after. Neonates were assessed for CRO colonization using rectal swabs collected on admission, days 3 and 7, and weekly thereafter. Swabs were plated on selective agar mSuperCARBA followed by confirmatory identification and susceptibility testing using VITEK® 2. Positive blood cultures collected from patients with suspected sepsis underwent testing using VITEK® 2. Our IC interventions targeted hand hygiene (HH) and environmental cleaning (EC), including staff training on proper HH techniques and more frequent cleaning of high-touch surfaces, as well as regular audits to measure compliance with HH and EC. We conducted descriptive analyses using Pearson’s Chi-square test.

Results
Compliance with HH improved from 13% to 28% following the interventions, while environmental cleaning improved from 9% to 43% based on fluorescent markers. Over the same time, CRO colonization decreased from 74% (265/358) to 63% (153/246) (p=0.002) and CR-Kpn colonization decreased from 65% (232/358) to 54% (134/246) (p=0.011). Overall bacterial blood culture positivity [54% (51/95) vs. 57% (30/53), (p=0.87)] and CRO rates [13% (12/95) vs. 21% (11/53), p=0.19] remained stable at pre and post intervention respectively.

Conclusion
After implementing IC interventions, we observed a decrease in CRO colonization among NICU patients, though blood culture positivity was unchanged. Results suggest that even modest improvements in IC practices may have a role in curbing CRO transmission in high-risk settings.

Disclosures
All Authors: No reported disclosures
P-329. Estimating changes in MRSA infection rates due to changes in facility MRSA precautions
Authors: Khader Karim , Haroldsen Candace , Evans Martin , Simbartl Loretta , McCauley Brian , Samore Matthew H , Rubin Michael 
Published: January 2025

Abstract

Background
The role of active surveillance (AS) and contact precautions (CP) in acute care settings for preventing transmission of endemic drug resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) remains unsettled. The emergence of SARS-CoV-2 led to a shift in VA policy in March 2020, when VA acute care facilities were allowed to suspend AS for MRSA and CP for patients with MRSA colonization or active infection, resulting in a partial and variable de-implementation of AS/CP across the VA (Figure 1). We evaluated the impact of this change on VA MRSA infection rates.

Methods
We modeled monthly positive MRSA culture rate at the ward-facility level using (1) all positive MRSA cultures, and (2) only positive sterile-site cultures (to more closely capture ‘true infections’). Our primary outcome was HAIs (occurring ≥ 3d after admission), including those up to 30-days post-discharge. We used Poisson, Negative Binomial, and Poisson mixed-effects regression approaches, clustering within ward type (ICU/non-ICU) and facility. With each approach, 4 different models incorporated increasing numbers of covariates to evaluate the robustness of the results.

Results
Using Poisson regression, we found culture rate, discontinuing AS & CP, and discontinuing CP only for colonization are associated with an increased MRSA positive culture rate (Model 1, Table 1). Addition of the year prior infection rate (Models 2–4) nullifies the association between AS & CP and MRSA positive culture rate. Results were similar when modeling positive sterile site cultures only (not shown) and using Negative Binomial regression (Table 2). Facility-level use of AS & CP is not associated with MRSA positive culture rate when using Poisson mixed-effects regression (Table 3), suggesting that accounting for facility-level clustering eliminates (or reduces) the apparent effect of AS/CP.

Conclusion
The impact of de-implementing AS & CP is complex and difficult to discern. The inference that de-implementation of AS & CP increased MRSA infection rates was not robust to relaxation of simplifying assumptions. These findings combined with the existence of unobservable data (e.g., use of gowns/gloves during the pandemic), imply substantial challenges surrounding statistical interpretation.

Disclosures
All Authors: No reported disclosures
P-334. Comparing Observed with Self-Reported Hand Hygiene Adherence Among Bedside Nurses at Two U.S. Hospitals
Authors: Kulkarni Prathit A , Greene M Todd , Saint Sanjay , Fowler Karen E , Jacob Serene , Dillon Laura , Espiritu Michelle , Houchens Nathan , Trautner Barbara 
Published: January 2025

Abstract

Background
Hand hygiene is recommended for all clinicians at entry to and exit from patients’ rooms. Adhering to such recommendations remains suboptimal possibly due, in part, to cognitive biases among clinicians who believe they are more compliant with hand hygiene than they actually are. We observed actual adherence to hand hygiene at room entry and exit among bedside nurses and compared these observations to self-reported perceptions of hand hygiene adherence.

Methods
Hand hygiene observations of bedside nurses (during day and night shifts) were made during their normal workflow in six inpatient general medicine wards at two Department of Veterans Affairs academic medical centers in 2022. The frequency of hand hygiene being performed—with either alcohol-based hand rub or soap and water—was noted at entry to and exit from patient rooms. Nurses were also surveyed regarding how often they perceive they typically perform hand hygiene.

Results
The participating units employed approximately 160 nurses. Hand hygiene was performed in 1,397 out of 3,690 (37.9%) room entry and in 2,159 out of 4,012 (53.8%) room exit opportunities, for a total of 3,556 out of 7,702 opportunities (46%). Hand hygiene was performed for a mean duration of 8.3 seconds at room exit. Among 92 survey respondents, approximately one-third had been a nurse for more than 20 years, 91% were female, 47% were Asian, and 8% were Hispanic. Survey respondents reported that they believe they perform hand hygiene in 95.1% of situations in which it is recommended.

Conclusion
Our study reveals a stark disconnect between actual and perceived adherence to hand hygiene recommendations among bedside nurses in general medicine wards at two geographically distinct academic medical centers. Additionally, the mean duration for which hand hygiene was performed was less than the recommended duration of 20 seconds. Possible explanations for these findings include: social desirability bias and overestimation bias when answering survey questions; the need for multiple trips into and out of patients’ rooms to access medications or supplies located outside the room; and time pressures. Future approaches to improving hand hygiene adherence should ideally address cognitive biases among clinicians.

Disclosures
Barbara Trautner, MD, PhD, Abbott Laboratories: Stocks/Bonds (Public Company)|AbbVie: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Phiogen Pharma: Advisor/Consultant