bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-309. Spread of SCCmec IV type Community-acquired MRSA in a Tertiary Care ICU in Japan
Authors: Kawamura Hideki , Okawa Daisuke , Niiyama Syuhei , Imuta Naoko , Nishi Junichiro , Kakihana Yasuyuki 
Published: January 2025

Abstract

Background
In recent years, community-acquired (CA) MRSA has become a problem, but there have been few reports of MRSA genotypes in the ICU. In our ICU, we have reinforced countermeasures such as screening for MRSA carriers using nasal specimens at admission and every week thereafter and decolonizing those who test positive for MRSA using mupirocin. This study aimed to investigate the prevalent strains of MRSA in the intensive care setting and their risk based on the genotyping of MRSA strains from patients admitted to our ICU.Figure 1.Comparison of the number of detections by POT1 value between Period A and Period B
Strains in Period A had more NY/Japan clones with a POT1 value of 93, while those in Period B had more community-acquired strains with a POT1 value of 106.

Methods
We examined two periods of increased nosocomial MRSA infections: 2013 to 2014 (16 strains in Period A) and 2021 to 2022 (23 strains in Period B). We evaluated changes in epidemic strains and assessed the possibility of transmission from ICU patients by genotyping of MRSA strains using PCR-based ORF Typing (POT).Figure 2.Epidemic curves by genotype in Period A and in Period B
There were three cases in Period A and two in Period B with the same genotype strain in hospitalized patients during the same period, all of which in Period A showed a POT1 value of 93.

Results
In Period A, 87.5% (14/16) of the strains showed a POT1 value of 93, presumed to be the NY/Japan clone; however, in Period B, the number of strains showing a POT1 value of 93 decreased to 4.3% (1/23) (p &lt; 0.001). In period A, 6.3% (1/16) of the strains showed a POT1 value of 106, presumed to be a CA strain. However, this increased to 39.1% (9/23) in period B (p = 0.01), and these strains were considered epidemic (Figure 1). There were no PVL-positive strains in Period A and Period B. There were three cases in Period A and two in Period B with the same genotype strain in hospitalized patients during the same period, all of which in Period A showed a POT1 value of 93 (Figure 2). Four cases (25.0%; three cases of pneumonia with bacteremia and one of surgical site infection) in Period A and 8 cases (34.8%; 6 cases of pneumonia (including 3 cases of bacteremia) and 2 cases of central line-associated bloodstream infections) in Period B developed infections.

Conclusion
The results suggest that CA MRSA strains are being brought into the ICU and causing infections, although the number of conventional nosocomial strains has decreased due to enhanced countermeasures. Monitoring of CA MRSA in ICUs is needed.

Disclosures
All Authors: No reported disclosures
P-317. Performance of nasal MRSA PCR screening test in pediatric patients admitted to hospital
Authors: Shrestha Rima , Sehra Amandeep , Gawelda Natalia , Bakir Mustafa 
Published: January 2025

Abstract

Background
Few studies reported Methicillin-Resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal screening as a tool for clinical stewardship in children.
This multicenter study evaluated the diagnostic test characteristics of the MRSA-PCR in predicting the presence of invasive MRSA infection in large number of pediatric patients admitted to hospital.

Methods
A retrospective cohort study is performed by chart review of children over 1 month of age admitted to OSF Health Care System, Illinois, between May 2013 and June 2022 and who has at least one MRSA-PCR nasal screening test and any subsequent culture of sterile body site performed. Data were validated, duplicates were removed, and missing or incomplete information related to screening results were removed before predictive values and post-test probabilities were calculated for MRSA infection in all patients as well as subgroup of high-risk, skin-soft tissue infections, and patients who were presented with respiratory symptoms or diagnosed with pneumonia.

Results
Overall, 373 (7.7%) of 4850 patients were tested positive with MRSA-PCR. Among patients screened positive, 91 (1.9%) had invasive MRSA infection. Sensitivity, specificity, positive and negative predictive value of screening test are 32.9%, 92.8%, 98.6%, and 8.0%, respectively. Table shows the screening test characteristics for various clinical diagnoses.

Conclusion
Large-scale nasal PCR screening test for MRSA in hospital-admitted pediatric patients shows very high negative predictive value, particularly in high-risk group. However, low prevalence of MRSA infection may not allow this screening tool to de-escalate antibiotic coverage in children admitted to hospital and suspected of invasive MRSA infection.

Disclosures
All Authors: No reported disclosures
P-338. Impact of an Educational Program on Hand Hygiene Practice and Healthcare-Associated Infections in a Tertiary Care Hospital in Rural South India
Authors: Raju Jomel , Tom Maria 
Published: January 2025

Abstract

Background
Effective hand hygiene is pivotal in averting healthcare-associated infections (HAIs), especially in resource-limited settings. This study aimed to evaluate baseline hand hygiene practices among healthcare providers (HCPs) and the impact of an educational intervention on reducing HAIs in a rural South Indian tertiary care hospital.

Methods
Over a 12-week period, an observational study was conducted across internal medicine, neurology, pulmonology, urology, pediatrics, and general surgery departments. Hand hygiene compliance among HCPs was meticulously observed, while HAIs were monitored using CDC definitions. Subsequent to the baseline assessment, a targeted hand hygiene education program was initiated, focusing on enhancing compliance among 190 nurses.

Results
A total of 1817 inpatients were enrolled in the study, with 55% male and 45% female, and age ranging from 1 to 90 years (median age: 50 years).
Among the 1817 inpatients, HAIs exhibited varying incidence rates across departments. Notably, pneumonia was the most prevalent HAI in the internal medicine department (incidence: 1.8%), while urinary tract infections were prominent in neurology and pulmonology (incidence: 0.9%), and surgical site infections in urology (incidence: 0.7%). Hand hygiene compliance varied across departments, with internal medicine demonstrating the highest compliance (24.5%). Post-implementation of the education program, compliance significantly improved to 65.2%. Consequently, there was a notable decrease in HAI rates, with pneumonia cases in internal medicine decreasing by 30%, and urinary tract infections in neurology and pulmonology decreasing by 25%.

Conclusion
This study underscores the pivotal role of hand hygiene practices among HCPs in preventing HAIs, particularly in resource-limited settings. The implementation of targeted educational interventions resulted in a substantial improvement in compliance and a subsequent reduction in HAI incidence rates. These findings emphasize the ongoing need for concerted efforts to enhance hand hygiene practices and mitigate the risk of HAIs in rural healthcare settings. Further research and interventions are warranted to sustain these improvements and ensure optimal patient safety outcomes.

Disclosures
All Authors: No reported disclosures
P-344. Nursing Home Rates of Healthcare-associated infections Requiring Hospitalization by Facility Characteristics and Staffing Levels, October 2021 – September 2022
Authors: Walker Lindsey J , Hatfield Kelly M , Reddy Sujan , Currie Dustin , Jacobs Slifka Kara M , Fridkin Scott , Jones Heather N , Rodriguez Andrea , Lutgring Joseph D 
Published: January 2025

Abstract

Background
Healthcare-associated infections (HAIs) contribute to substantial morbidity among nursing home residents. The Centers for Medicare and Medicaid Services (CMS) tracks and reports a rate of HAIs requiring hospitalization per 100 resident stays (HAI rate) annually for nursing homes that is risk standardized by the health status and characteristics of the at-risk residents for each nursing home. We aimed to measure factors, including staffing, associated with nursing homes’ HAI rates.Figure 1.Description of nursing home characteristics among 11,431 nursing homes with a risk-standardized rate of healthcare-associated infections requiring hospitalization in fiscal year 2022. Estimated change in annual risk standardized rate of healthcare-associated infections requiring hospitalization per 100 residents (HAI rate) and p-values are calculated from parameter estimates in a multivariable linear regression model.

Methods
Nursing home characteristics and the annual HAI rate from October 2021 – September 2022 were extracted from Nursing Home Compare. We described the distribution of nursing home characteristics including type of ownership, number of beds, urbanicity, ventilator care capability, location within hospital, and the minority health-social vulnerability index (MH-SVI) of the surrounding county. We quantified nursing homes as meeting minimum staffing standards if they reported ≥0.55 registered nurse hours per resident per day (HPRD), ≥2.45 nurse aide HPRD, and ≥3.48 total nurse staffing HPRD to reflect newly finalized CMS rules. Multivariable linear regression models were used to identify characteristics associated with the HAI rate.

Results
The median annual HAI rate reported for 11,431 nursing homes was 6.79 hospitalizations per 100 residents (Q1-Q3: 5.93-7.87). In multivariable models, all characteristics were associated with the HAI rate (Figure 1). For-profit ownership was associated with 0.66 more infections per 100 residents (95% CI: 0.58, 0.73). Nursing homes located in counties in the highest MH-SVI quartile had 0.44 more HAIs per 100 residents per year (95% CI: 0.34, 0.54) than those in the lowest quartile. The 1,956 (17%) nursing homes that met minimum staffing standards had an estimated 0.44 fewer infections per 100 residents annually (95% CI: -0.52, -0.37) compared to nursing homes that did not, reflecting a 6% decrease in risk in an average facility.

Conclusion
Meeting minimum staffing standards may reduce the rate of HAIs requiring hospitalization in nursing homes. Interventions and outreach efforts focused on increasing support for nursing homes in communities with high levels of vulnerability may also reduce inequities in the rate of HAIs which require hospitalization.

Disclosures
All Authors: No reported disclosures
P-355. Skin Lesions and the Use of Personal Protective Equipment in Healthcare Workers from Lima, Peru during the COVID 19 Pandemic
Authors: Coombes Carolina , Arribas-Garcia Paula , Llerena-Delgado Amira , Carrillo-Larco Rodrigo M , del Solar-Chacaltana Manuel Armando 
Published: January 2025

Abstract

Background
During the COVID-19 pandemic, healthcare workers relied on personal protective equipment (PPE) to mitigate COVID-19 infections. However, prolonged use of PPE led to a risk of developing skin lesions (SL). In our study, we evaluated the frequency, characteristics and factors associated with SL while using PPE.

Methods
We conducted a cross-sectional study to survey 219 healthcare workers in two hospitals in Lima, Peru between September 2020 and May 2021. The survey focused on reporting SL related to PPE use during their time as healthcare workers amidst the pandemic. Eligible participants were required to be hospital personnel that was actively working on-site and utilizing PPE.

Results
Most commonly used PPE items included N95 respirator (96.80%), disposable gown (80.37%), head cover (77.63%), eye gear (60.73%) and surgical masks (59.28%). 176 participants (80.37%) reported skin lesions while using PPE. The most prevalent SL were erythema (63, 36.42%), comedones (26, 15.03%) and erosions (25, 14.45%). Common locations for SL were the nasal bridge (93, 51.96%) and cheeks (43, 24.02%). Additionally, 91 (51.70%) participants reported seeking treatment, with self-medication (47, 51.65%) being the prevalent method. Among the participants, 80 (37.21%) reported using prevention methods being the most common, adhesive tape or bandages (46, 57.50%). SL were associated with being a medical intern (PR 2.46, p=0.014), medical attending (PR 2.35, p=0.019), medical resident (PR 2.69, p=0.006) and nurse (PR 2.44, p=0.014). Eye gear, shoe covers and overalls were found to be risk factors for SL (PR 1.16, p=0.048; PR 1.21, p=0.007; PR 1.15, p=0.031). Participants who had a history of previous skin conditions were 1.19 (p=0.008) times more likely to have SL. In the adjusted model, working in the ICU (PR 1.31, 95%CI 1.02-1.68, p=0.034), working more than 12 hours per day (PR 1.49, 95%CI 1.07-2.08, p=0.017), presenting a skin burning sensation and skin dryness (PR 1.21, 95%CI 1.03-1.42; p=0.021; PR 1.41, 95%CI 1.04-1.92, p=0.026) were associated risk factors.

Conclusion
By documenting the prevalence of skin lesions in healthcare worker due to PPE usage we underscore the need for biosafety monitoring, as the presence of lesions can lead to PPE misusage, increasing the risk of respiratory infections.

Disclosures
All Authors: No reported disclosures
P-356. Reduction of high-touch surface aerobic bacteria and fungi colony counts with the implementation of ActivePure continuous disinfection technology
Authors: Taylor Denise , Lynn Brittney , Trosch Kimberly , Marsh Daniel , Grier Laurie , Malek Alexandre 
Published: January 2025

Abstract

Background
As hospitals nationwide rebound from the effects of the COVID pandemic, reduced staffing and increased hospital-acquired infections (HAIs) are still challenges. Surface disinfection plays a pivotal role in the prevention of HAIs. To improve high-touch surface disinfection and remove the dependence on the human factor, ActivePure continuous disinfection technology devices were installed in the Medical Intensive Care Unit (MICU) HVAC system at Ochsner LSU Health Shreveport in October 2023. ActivePure is a novel technique that kills microbes in the environment by using an advanced photocatalytic oxidation particle.

Methods
A prospective study was conducted in the 19-bed MICU. Two weeks before device activation, 50 high-touch surface samples and 10 reservoir samples were collected by sterile sponge in situ and plated onto Nutritive (tryptic soy) agar for total aerobic microbial counts, Selective (Sabouraud dextrose) agar for total fungal counts, selective (MeReSa) agar for total MRSA counts, and CHROMagar selective for Carbapenem-Resistant Acinetobacter baumannii (CRAB). All agar plates were incubated at 30°C or 37°C (as applicable) for 48-96 hours. For evaluation, serial dilution plate counts were used to calculate the CFU per sponge for each media type. The detection limit was 10 CFU/sponge for each evaluation. After 4 weeks post-activation, 50 high-touch surface samples and 10 reservoir samples from the same pre-activation sample locations were collected and evaluated via the same methods, and the same was repeated at 9 weeks post-activation. Routine cleaning and disinfection protocols were unchanged during the entire study period.
Figure 2

Results
The mean aerobic bacterial and fungi surface CFUs were reduced over 99.78% (Fig 1). The mean MRSA surface CFUs were reduced by 99.99% and the mean CRAB surface CFUs were reduced by 99.75% (Fig 2). There was a 94% reduction in surfaces with greater than 500 CFUs/100cm2 of MRSA. There was a 100% reduction in reservoirs with greater than 500 CFUs/100cm2 of CRAB and 80% reduction in reservoirs with greater than 10 CFUs/100cm2 of CRAB.

Conclusion
The ActivePure continuous disinfection technology devices significantly reduced total aerobic bacteria, including MRSA, difficult-to-treat CRAB, and fungi surface colony counts on high-touch surfaces.

Disclosures
Kimberly Trosch, RN, BSN, ActivePure Technologies: Full time employee Daniel Marsh, n/a, ActivePure Medical: Advisor/Consultant
P-359. Healthcare Practitioners' Infection Prevention Strategies and Associated Factors in Primary Healthcare Facilities of Rohingya Refugee Camps in Bangladesh: A Qualitative Study
Authors: Hasan S M Murshid 
Published: January 2025

Abstract

Background
Healthcare-associated infections (HAIs) pose significant challenges to both patients and healthcare providers. Rohingya refugee camps in Bangladesh are the most densely populated in the world. In the primary healthcare facilities of Rohingya refugee camps, healthcare-associated infections pose major barriers to safe and high-quality healthcare delivery among Rohingya refugees. The study's goal was to evaluate infection prevention strategies and associated factors among primary healthcare practitioners in Rohingya refugee camps.

Methods
In 2023, we conducted a qualitative study among primary healthcare practitioners identified from 15 primary healthcare facilities in 15 Rohingya refugee camps. We conducted 60 in-depth interviews and six focus group discussions with community healthcare providers. We reviewed the collected data, developed a coding system, analyzed the data, and summarized findings according to the study objectives and themes.

Results
Respondents were 60 % men and 40 % women, with a median age of 30 years, and 85% had higher secondary education. All respondents were employed for a median of 3 months (range,1-36 months). Only 42.5% of primary healthcare practitioners were knowledgeable about infection prevention strategies, and 37.2% practiced good infection prevention. Primary healthcare providers who had higher education and formal training in IPC were significantly more likely to have good infection prevention practices. Effective infection prevention practices were linked to the availability and accessibility of hand washing facilities and soap, proper use of personal protective equipment, appropriate cleaning and disinfection protocols, adherence to infection prevention guidelines, surveillance of healthcare-associated infections, and adequate knowledge of infection prevention measures of primary healthcare providers.

Conclusion
Effective infection prevention and control practices are crucial for minimizing the risk of HAIs. This study assessed the infection prevention knowledge and practices, and their associated factors among primary healthcare practitioners in Rohingya refugee camps which would help develop and implement effective interventions to reduce HAIs within Rohingya refugee camps.

Disclosures
All Authors: No reported disclosures
P-360. Impact of a tiered masking intervention on healthcare worker illness and absenteeism during respiratory viral season
Authors: Vergara-Mojica Stephanie , Zodo Alexandra , Niego Meghan , Ali Mirza , Mena Lora Alfredo J 
Published: January 2025

Abstract

Background
High community transmission of respiratory viruses can lead to employee illness, absenteeism, and the risk of spread to both patients and healthcare workers (HCWs). Masking in healthcare settings can mitigate these risks. Our hospital developed a policy to adjust the level of masking required based on current community transmission rates, intensifying or relaxing mandates as necessary. This study aims to evaluate the impact of our tiered masking policy on employee absenteeism.

Weekly respiratory viral metrics and employee influenza-like illness for 2022

Methods
Retrospective review of employee health data, public health respiratory virus surveillance metrics, and infection prevention masking requirements at a 151-bed safety-net hospital. Data from September to December 2022, when universal masking was in place, and September to December 2023, when our new masking policy was implemented was compared. In 2023, four masking levels were created: red always requires masks for HCWs and patients; orange requires them for HCWs; yellow requires masks for HCWs during patient contact; both orange and yellow recommends but doesn’t require masks for patients; green recommends but does not require masks for HCW and patients. Weekly public health respiratory surveillance data, masking requirements and employees reporting influenza-like illness (ILI) were tabulated and compared before and after our new masking policy.

Weekly respiratory viral metrics and employee influenza-like illness for 2023

Results
A total of 66 HCWs reported ILI during the 2022 respiratory viral season compared to 44 in 2023, a 33% reduction. Weekly respiratory viral metrics and HCW ILI is plotted in Figure 1 for 2022 and Figure 2 for 2023. When mask levels were raised to orange on October 6, HCW ILI slightly decreased. Masking changed to yellow on October 22 and correlated with a subsequent increase in ILI. Escalation to red on December 10 was followed by a decline in ILI.

Conclusion
A tiered masking policy in response to fluctuating community transmission appears to be an effective strategy in managing HCW absenteeism due to ILI. Despite higher percent positivity from multiple viruses, a 33% decrease in ILI occurred after implementation of the tiered masking policy, as compared the prior universal masking policy. A tiered masking policy based on percent positivity may be more effective than universal masking.

Disclosures
All Authors: No reported disclosures
P-363. Containing an Outbreak of Carbapenemase-producing Organisms in a Singapore Hospital
Authors: Beh Darius , Tan Glorijoy , Kum Jia Qi , Chia Gabrielle , Kui Huiru , Tan Joanna , Tang Ying Wei , Aung Aung Hein , Chow Angela , Poh Bee Fong , Ang Brenda 
Published: January 2025

Abstract

Background
Tan Tock Seng Hospital is a 1700-bed academic teaching hospital in Singapore. Active surveillance using rapid PCR for the detection of asymptomatic carriage of carbapenemase-producing organisms (CPO) is routinely performed (Fig. 1). Where available, identified carriers are cohorted or isolated under contact precautions. We describe a hospital-wide multispecies OXA-48-like and NDM outbreak, findings from epidemiological investigations and the subsequent infection prevention and control (IPC) measures.
Existing and intensified CPO screening strategies

Methods
Initial response included additional intensified contact tracing (Fig. 1), expansion of isolation bed capacity and audits of IPC practices. Case-control analysis involved 280 cases and 995 controls. Universal admission screening was conducted to validate the accuracy of existing high risk screening (HRS) criteria. Wards with high transmission underwent environmental sampling.

Results
The CPO screening positivity rate was observed to be on a steady increase during 2022/23, from a baseline of 1.3-1.7% in 2020/21, peaking at 6.5% in June 2023 (Fig. 2). Spot audits demonstrated a decrease in hand hygiene compliance, improper cleaning of shared equipment, and poor IPC practices especially during diaper changes. Isolates were predominantly Klebsiella pneumoniae and sequence type 307. OXA was the commonest carbapenemase, followed by NDM. Risk factors for acquisition were presence of an indwelling urinary catheter for OXA (adjusted odds ratio [AOR] 1.62, 95% CI 1.02-2.48, p = 0.028), exposure to third-generation cephalosporins for NDM (AOR 3.83, 95% CI, 1.86-7.92, p &lt; 0.001) and length of stay of 15-21 days for both (AOR 3.19, 95% CI, 2.05-4.96, p &lt; 0.001). 4.8% of OXA carriers developed clinical infection within a median of 17 days (Fig. 3). Sensitivity of HRS criteria was 70%, though compliance to screening was only 60-80%. Periods of higher transmission were associated with lower rates of CPO cohorting (Fig. 4). CPO was found in 6.9% (9/130) of environmental samples.
Rate and time to onset of clinical infection for asymptomatic carriers according to CPO genotype

Conclusion
Drivers of the outbreak were lower rates of CPO cohorting/isolation, a decrease in IPC standards, the inadequate compliance to HRS and the introduction of a highly transmissible bacterial clone. Early detection coupled with isolation remains a key strategy to control the spread of CPO.
Epidemiologic curve of the CPO outbreak in relation to cohorting efforts (%)

Disclosures
Darius Beh, MBBS (S'pore) MMed (Int Med) MRCP (UK), AstraZeneca: Conference Sponsorship|Gilead: Conference Sponsorship