bluuebunny/crossref_metadata_2025_split huggingface dataset:
1419. Evaluation of a vaporized hydrogen peroxide sterilization technology for duodenoscopes
Authors: Varghese Martin M , Cadnum Jennifer , Memic Samir , Torres-Teran Maria M , Rutala William , Donskey Curtis 
Published: November 2023

Abstract

Background
Current methods for reprocessing duodenoscopes, including double high-level disinfection, are not effective in eliminating bacterial contamination. Thus, there is a need to develop effective and safe sterilization technologies for duodenoscopes.

Methods
We examined the effectiveness of a new hydrogen peroxide gas plasma sterilizer designed for terminal sterilization of flexible endoscopes. The technology directs vaporized hydrogen peroxide into all internal endoscope channels with a short exposure time and includes a sterilization container that facilitates sterile storage after processing. Test organisms included Bacillus atrophaeus and Clostridioides difficile spores, Escherichia coli, Enterococcus faecium, and Candida auris inoculated on steel wires or dispersed throughout the internal channels with 5% fetal calf serum.

Results
The technology reduced &gt;108 colony-forming units (CFU) of the vegetative organisms to undetectable levels. B. atrophaeus and C. difficile spores on steel wires were eliminated by the technology ( &gt;6 log10 CFU reduction) and spores disperse throughout the channels were reduced by &gt;5 log10 CFU. No damage to the endoscopes was observed.

Conclusion
The sterilization technology was highly effective in reducing contamination of duodenoscopes in laboratory testing. Our results support further investigation of this technology in reducing contamination of in-use endoscopes.

Disclosures
William Rutala, MS, MPH, PhD, Ideate Medical: Advisor/Consultant|Ideate Medical: Stocks/Bonds|Kinnos: Advisor/Consultant|Kinnos: Stocks/Bonds|PDI: Advisor/Consultant|PDI: Honoraria
1420. Optimizing the detection of environmental fungal contamination by comparing sample collection and detection methods
Authors: Warren Bobby G , Graves Amanda M , Barrett Aaron , Nelson Alicia , Stiegel Matthew , Smith Becky A , Schwartz Ilan , Anderson Deverick J 
Published: November 2023

Abstract

Background
The use of environmental sampling to surveil the healthcare environment for invasive fungal species to prevent or respond to outbreaks is limited due to the absence of established threshold values and standard practices. This study aims to fill this gap by comparing sampling and detection methods in a controlled experimental setting.

Methods
We compared the sampling efficacy of commonly used healthcare sampling techniques and the detection efficacy of culture-based and qPCR quantification on common healthcare surface materials. The primary outcome was recovery of organisms, defined as total recovered CFU compared to known inoculum CFU.
Mock 10x10cm study surfaces (aluminum, formica, linen, and HEPA material) were inoculated with ∼104 CFU of Aspergillus fumigatus or Candida parapsilosis and allowed to air dry. Foam sponges and flocked swabs pre-moistened with neutralizing buffer were used to sample the complete surface area of surfaces. RODAC plates filled with species-specific media were pressed to the middle of the study surface and removed. Sponges were processed using the stomacher technique and swabs were vortexed in PBS. Eluents from sponges and swabs were used for both culture-based quantification and qPCR using FungiQuant primers and probe for the fungal 18S rRNA gene.

Results
20 experiments were completed for each combination of species (n=2), study surface (n=4), sampling method (n=3) and quantification method (n=2) resulting in 960 total samples. Overall, median percent recovery for culture-based and qPCR-based detection methods were 6.4% (IQR: 2.8-12.9) and 26.7% (10.5-48.1), respectively, (p&lt; 0.01). Median percent recovery for sponges and swabs were 17.9% (11.4-30.0) and 3.8% (1.9-6.7) via culture (p&lt; 0.01) and 36.2% (25.7-78.4) and 10.5% (7.7-36.0) via qPCR (p&lt; 0.01). RODAC median percent recovery via culture was 3.4% (1.0-7.1).
Fungal Recovery Characteristics by Fungal Species and Sample and Detection Methodology

Conclusion
qPCR-based detection had the highest median percent recovery compared to culture-based detection overall, regardless of sample method or study surface. Sponge samples had the highest median percent recovery for both culture- and qPCR-based detection methods, overall. Future studies are needed to assess our study’s identified optimized sample collection and detection techniques in a real-world healthcare environment.

Disclosures
All Authors: No reported disclosures
1435. A Comparison Study of Hand-Wash Rate of Medical Personnel Before and After Automatic Hand-Wash Detector Usage in Medical Intensive Care Unit
Authors: Mahapasuthanon Warinthip , Nilaratanakul Voraphoj 
Published: November 2023

Abstract

Background
Healthcare-associated infections affect patient safety and can lead to significant complications. Pathogens can easily spread to the surrounding environment and contaminate the hands of healthcare workers (HCWs) while performing routine activities. Hand hygiene (HH) has been emphasized as an important measure to prevent the spread of infections among patients. However, compliance with HH is still considered below acceptable thresholds.

Methods
This study utilized a quasi-experimental design to compare hand hygiene compliance among HCWs before and after the implementation of an electronic HH monitoring system. After system installation and test, we performed pre-intervention phase to measure baseline rates of HH episodes using the real-time location system (RTLS). HH compliance will be observed without real-time feedback and alarm.
Phase of the study
Model diagram of the medical intensive care unit (MICU) and the system

Results
The sensitivity and specificity of the system that capture HH actions were 90% and 100%, respectively. For capturing HH opportunities, the system showed 100% and 90% sensitivity and specificity, respectively. During the study period, a total of 30 participants were included. All were either nurses (n=21) or nurse assistants (n=9) working in the medical ICU. 93.3% of participants were female, and almost all (96.7%) had previous experience with HH workshops. After installing the system, HH compliance was observed, and the result showed that the mean HH compliance rate before patient contact was 56.19% (95%CI, 53.27-59.99%) while the rate after patient contact was 71.06% (95%CI, 67.45-73.85%). When we compared these rates with participants’ self- estimated HH compliance, we found that system-measured HH rates were lower, with a mean difference of -16.31 (95%CI, -22.61 to -11.07, p&lt; 0.001) and -18.94 (95%CI, -24.20 to -13.58, p&lt; 0.001) before patient contact and after patient contact, respectively.

Conclusion
We demonstrated a method to measure HH compliance through the implementation of an electronic HH monitoring system with real-time feedback via wireless technology. The preliminary results showed that the system based on ultra-wide bandwidth (UWB) can replace human observers. Further ongoing phases of the study will be necessary to determine whether the use of the monitoring system can effectively improve HH compliance in HCWs.

Disclosures
All Authors: No reported disclosures
2002. Infectious Diseases fellowship training on caring for people who use drugs: A national survey-based needs assessment
Authors: Vasishta Shilpa , Jawa Raagini , Kurz Sarah , Nolan Nathan 
Published: November 2023

Abstract

Background
Infectious complications of substance use are rising nationally among people who use drugs (PWUD), highlighting the need to integrate Infectious Diseases (ID) practice with addiction care. Training experiences among ID fellows, whose practice patterns are likely to be impacted by this syndemic, remain unknown. We conducted a national survey to understand U.S. ID fellows’ training, practices, and perspectives regarding care of PWUD.

Methods
An 18-item survey was developed to assess program characteristics, clinical practices, and perspectives regarding knowledge, comfort, and scope of practice. Recruitment was conducted via emails to fellowship programs, social media (Twitter, Mastodon), and IDSA platforms. Responses were collected over three weeks. Statistical analyses were conducted by chi square test. The study was deemed exempt from institutional review.

Results
196 U.S. ID fellows completed the survey (≅24% response rate), with representation from 9 of 9 geographic regions. All respondents cared for PWUD during their training. 49% had formal curriculum in their programs and 64% reported faculty advocates. 50% typically (in half or more encounters) counseled on harm reduction; 37% referred to outpatient resources and 33% recommended medications for opioid use disorders (MOUD) and naloxone. Respondents were unsure of community resources (e.g. syringe services, 48%; supervised consumption, 57%). 69% rated harm reduction counseling as extremely within scope of ID practice, versus 20% for the practice of recommending MOUD; 25% and 11%, respectively, reported feeling extremely comfortable with these skills. Engagement in discussions of harm reduction, MOUD, naloxone, and outpatient resources was significantly associated with presence of a faculty advocate (p&lt; 0.01 for all).
Self-reported engagement in clinical practices among Infectious Diseases fellows
Perspectives on comfort level and scope of practice among Infectious Diseases fellows
Availability and knowledge of resources at Infectious Diseases training sites

Conclusion
U.S. ID fellows frequently care for PWUD but infrequently engage in integrated care practices. Harm reduction counseling is seen as highly within ID scope of practice, however, comfort and knowledge are low. Both comfort and perception of scope are low for discussing MOUD, though this appears to be impacted by faculty modeling. Our findings highlight an opportunity to formalize training in ID fellowship to better address the need for integrated ID/addiction care nationally.

Disclosures
All Authors: No reported disclosures
1466. Povidone-Iodine Irrigation versus Saline Irrigation for Reduction of Surgical Site Infections in Patients Undergoing Total Knee and Total Hip Arthroplasty: a large retrospective, propensity matched cohort study
Authors: Simon Samantha , Grant Andrew R , Smith Eric , Hollenbeck Brian L 
Published: November 2023

Abstract

Background
Surgical site infection (SSI) after total hip and total knee arthroplasty (THA/TKA) is a serious surgical complication. Perioperative irrigation with antiseptic compounds such as povidone-iodine have been used and are recommended by the World Health Organization and the Centers for Disease Control to reduce this risk. However, evidence supporting its superiority relative to non-antiseptic substances such as saline has been inconsistent. Therefore, we aim to identify if irrigation with povidone-iodine in THA/TKA reduces incidence of SSI in patients compared to saline irrigation.

Methods
In this retrospective, cohort study of 21,482 patients who underwent TKA or THA, we compared SSI rates between patients who received povidone-iodine irrigation and saline irrigation. Univariate and multivariable analyses were performed to identify risk factors for SSI. We also performed a propensity matched analysis. Each patient’s propensity for receiving povidone-iodine irrigation was calculated using select patient and surgical variables. Standardized mean differences were calculated to confirm reduction of potential confounding between the matched groups.

Results
There were 8,486 patients given saline irrigation and 12,996 patients given povidone-iodine irrigation (Table 1). In the univariate analysis, we did not identify a difference between povidone-iodine and saline (p = 0.76). Multivariate analysis showed diabetes, general anesthesia, and a procedure time of 2-3 hours increased risk of SSI, but povidone-iodine irrigation was not significantly different from saline (OR 1.1; CI 0.6-1.9) (Table 2). After propensity score matching there were 21 (0.25%) SSI in the povidone-iodine group and 19 (0.23%) in the saline group. Standardized mean differences were below 0.2 for all selected variables (Table 3). Odds of SSI were no different between the two matched groups (OR 1.1; CI 0.6-2.1).Table 1.Overview of patient and surgical variables by irrigation solution.Table 2.Multivariable analysis adjusted for age, sex, diabetes mellitus, anesthesia type, and procedure time. Showing odds of developing a surgical site infection.Table 3.Graph of standardized mean differences before and after matching. Blue dots represent unmatched cohort. Orange dots represent matched cohort. Table shows odds of developing a surgical site infection for the matched cohort.

Conclusion
Our analysis indicates no difference between povidone-iodine and saline irrigation in reducing SSI after THA/TKA. In situations where financial cost may be a factor in determining whether to use saline or povidone-iodine, we conclude that saline irrigation is equally efficacious and therefore a reasonable choice.

Disclosures
Eric Smith, MD, Conformis: Advisor/Consultant|Depuy: Advisor/Consultant
1491. Life's Simple 7 (LS7) is Not So Simple in Newly Diagnosed People Living with HIV: Evaluating Associations Between HIV and LS7 in ART-Naive People Living with HIV in Tanzania
Authors: Khan Safah , Manyangu Gloria J , Peck Robert N , Praygod George 
Published: November 2023

Abstract

Background
People living with HIV (PLWH) have complex cardiovascular health (CVH) profiles due to a combination of traditional, HIV-specific and lifestyle factors. Thorough characterization is necessary to guide primary prevention efforts. Previous studies that evaluated CVH in PLWH were mainly done in those on stable antiretroviral therapy (ART) and data in newly diagnosed PLWH is scarce. Therefore, we applied Life's Simple 7 (LS7) to compare CVH in ART-Naive PLWH and HIV-uninfected adults in Tanzania.

Methods
A cross-sectional analysis was conducted on a cohort of ART-naive PLWH and HIV-uninfected adults recruited from HIV clinics in Mwanza, Tanzania (CICADA cohort). We applied modified Life's Simple Seven (LS7) definitions (Table 1) and compared the distribution of LS7 metrics between study groups. Each LS7 was dichotomized as "ideal" (1 point) and "not ideal" (0 points) to obtain a total LS7 score. Poisson regressions were employed to investigate associations between HIV status and count of ideal total LS7 components (0-7). Logistic regression was employed to investigate individual LS7 metrics. Regressions were adjusted for age, sex, education, income.

Results
Our study included 1,224 participants (860 PLWH, 364 controls). PLWH had higher total LS7 scores (4.16 vs 3.85, p=0.015) and higher prevalence of ideal overall CVH (40% vs 35%, Figure 1). This difference remained significant even after adjusting for potential confounding (coef=0.07 [95%CI= 0.007-0.13], p=0.028). Distribution of LS7 metrics varied between groups (Figures 2a and 2b). PLWH were more likely to have ideal BMI (aOR=3.27 [95%CI= 2.41-4.45], p&lt; 0.001), ideal blood pressure (aOR=3.35 [2.56-4.37], p&lt; 0.001) and ideal total cholesterol (aOR=1.67 [1.24-2.24], p= 0.001). By contrast, PLWH were less likely to have ideal smoking (aOR=0.40 [0.26-0.59], p&lt; 0.001), ideal blood glucose (aOR=0.39 [0.30-0.51], p&lt; 0.001).

Conclusion
Early HIV influences several key determinants of cardiovascular health encompassed in Life's Simple 7 score. Our findings indicate favorable cardiovascular health in newly diagnosed PLWH, driven by lower rates of metabolic risk factors. However, such patients would still benefit from primary prevention efforts prioritizing smoking cessation, diabetes screening to mitigate remaining CVD risk.

Disclosures
All Authors: No reported disclosures
1512. Stakeholder Perspectives on Universal HIV Screening in Philadelphia Emergency Rooms
Authors: Aitcheson Nancy , O’Brien Caroline , Momplaisir Florence 
Published: November 2023

Abstract

Background
Decreasing new HIV infections requires reaching populations at increased risk of acquiring HIV who do not access regular testing. Emergency Departments (EDs) provide a disproportionate amount of care for socially vulnerable populations and are often the only place uninsured patients obtain healthcare. In Philadelphia, where HIV prevalence is 1.2%, further investigation is needed to optimize EDs as HIV testing venues for vulnerable populations. This study sought to elucidate perceived barriers and facilitators to universal HIV screening in EDs among hospital system stakeholders across Philadelphia.

Methods
We conducted a qualitative study using semi-structured interviews with physicians, administrators, and care navigators across five health systems in Philadelphia. Participants were recruited using snowball sampling. An interview guide based on the Consolidated Framework for Implementation Research explored facilitators and barriers to HIV testing in EDs. Interviews were audio-recorded and transcribed verbatim. We analyzed interviews using a modified grounded theory approach to code interview transcripts. Interrater reliability was assessed between multiple coders.

Results
14 individuals were interviewed: 3 registered nurses, 1 social worker, 2 program managers, and 8 physicians. Participants reported EDs play a critical role in providing care to patients who otherwise do not engage with the health care system, who tend to be of lower socioeconomic status and multiply marginalized. The facilitator that most significantly increases ED provider buy-in is a non-ED provider to follow up on HIV test results. Barriers to robust HIV testing programs included competing priorities, lack of personnel, and lack of sustainable funding.

Conclusion
This contextual inquiry revealed shared barriers and facilitators to HIV testing across multiple health systems in a city with a high burden of HIV. The development of a dedicated staff position to deal with indeterminate and reactive HIV testing (removing this responsibility from ED) is the single most important intervention to facilitate HIV testing in EDs. This study provides a clear target for municipal funding in Philadelphia and may be generalizable to HIV testing implementation in EDs in other urban centers.

Disclosures
All Authors: No reported disclosures
1515. Implementing “Opt-Out” Screening to Identify and Link Patients to Care With HIV: Experience from Memorial Healthcare System
Authors: Eckardt Paula A , Niu Jianli , Piche Elizabeth J 
Published: November 2023

Abstract

Background
The program is an opt-out HIV testing program aiming to improve HIV screening and provide linkage to care for patients who test positive. Here we present project results of implementing opt-out” screening to identify and link patients to care with HIV in a large community hospital in South Florida.

Methods
Patients aged 18-75 years entering the emergency departments (EDs) for medical care were screened for eligibility automatically utilizing an EPIC-based screening tool. The program data from its inception in June 2008 to the end of December 2022 were retrospectively reviewed. Data included demographics and HIV testing results with linkage to care information. All HIV positive results were confirmed by Broward County Department of Health to identify new versus previous HIV positive cases. Data was entered in a spreadsheet and then imported for descriptive statistical analysis.

Results
Of the 79,309 patients tested in the program between June 2018 and December 2022, 471 were identified as HIV positive with an overall rate of 0.6% (Figure 1). Of those tested HIV-positive, 134 (28.5%) were newly diagnosed. The majority of those newly diagnosed were male (64%), African American (66%), and 26-35 years of age (27.2%). 74.6% of the newly diagnosed patients were linked to care (Figure 2). Of those 337 previously diagnosed patients, 189 (56.1%) were confirmed in HIV care, 20 were known to have died, and 68 (53.1%) of 128 patients out of care at testing achieved care re-engagement (Figure 2). Additionally, the number of opt-out tests decreased from 22,092 in 2019 to just 10,359 in 2020 due to the COVID-19 pandemic. However, as the pandemic subsided in 2021 and 2022, the number of opt-out tests increased to 14,705 and 22,264 respectively (Figure 1).Figure 1.The FOCUS testing HIV data at MHS, June 2018−December 2022.Figure 2.Linkage to medical care in HIV-positive cases, June 2018−2022.

Conclusion
The results showed that the FOCUS program on HIV testing and linkage to care can be successfully integrated into a community healthcare system. The high rate of newly diagnosed HIV-positive cases in the program highlights the need for increased access to HIV testing and healthcare services. The rate of HIV re-engaged in care among those previously diagnosed also indicates the need for opt-out HIV testing in the community to increase reengagement in care.

Disclosures
All Authors: No reported disclosures
1518. Prevalence of Integrase Inhibitor Resistance within an Urban Clinic Network After Adoption as First-line Therapy
Authors: Januszka Jenna E , Drweiga Emily N , Badowski Melissa E 
Published: November 2023

Abstract

Background
Limited data outside of randomized controlled trials exist reporting the prevalence of integrase inhibitor resistance (INSTI-R) since the approval and recommendation of INSTIs as first-line treatment for HIV. National surveillance data in 2018 estimated INSTI-R to be 6.3% in people with HIV (PWH) who had never achieved viral suppression, with 0.8% attributed to transmitted drug resistance (TDR). The purpose of this study was to describe the prevalence of INSTI-R in patients from a single urban clinic network on INSTI-containing regimens. Prevalence amongst University of Illinois Chicago Community Clinic Network (UCCN) patients on INSTI-containing single-tablet regimens specifically was previously reported.

Methods
This was a retrospective study of adult PWH followed at UCCN prescribed an INSTI-containing regimen between September 2017 and September 2020 with &gt; two recorded HIV-1 RNA viral loads collected &gt; 12 months apart. The primary endpoint was the difference in INSTI-R in UCCN patients compared to national data. Other outcomes included development of virologic failure (VF), defined as &gt; 200 copies/mL in two consecutive HIV-1 RNA viral loads, and patient specific factors associated with VF. The primary endpoint was analyzed using a chi-square test. All other data are presented as descriptive statistics.

Results
Of 948 patients screened, 321 were included and followed an average of 30 months. Baseline characteristics are presented in Table 1. A total of 5 subjects had INSTI-R prior to switch resulting in a prevalence of 1.6%, which was significantly less than the national prevalence of 6.3% (p&lt; 0.001). Of note, all patients with INSTI-R were previously treated with first generation INSTIs and none were deemed TDR. Study-defined VF occurred in 26 subjects (8.1%). Seven subjects (26.9%) were not taking antiretrovirals for &gt; six weeks at the time of study-defined VF. Outcomes of patients with VF are outlined in Table 2. Subjects with a pre-treatment viral load &gt; 100,000 were more likely to experience VF (p=0.0485).

Conclusion
Among UCCN patients on INSTI-containing regimens, INSTI-R rates were lower than the estimated national prevalence; however, this comparison is limited due to the large proportion of subjects with viral suppression at baseline.

Disclosures
All Authors: No reported disclosures