bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-339. Infection Control Link staff program that involves all professionals improves the quality of infection control in hospitals
Authors: Shirano Michinori , Nakagawa Hidenori , IIida Ko , Asaoka Tomohiro , Fukuoka Risa , Morita Ryo , Yamaguchi Naoki , Nanri Sumiyo , Imasaki Mika , Yamaguchi Naomi , Goto Tetsushi 
Published: January 2025

Abstract

Background
Collaboration among all medical staff is essential to improve the quality of infection control. However, it is not easy to fully disseminate infection control knowledge to all. The purpose of this study was to evaluate whether the implementation of the Infection Control Link staff program organized in our hospital improved the quality indicator (QI) of infection control.

Methods
Our hospital's link staff program is unique in that it is composed of all healthcare professions, including not only physicians and nurses, but also laboratory technicians, pharmacists, radiologists, and physical therapists. The program was launched in 2012. Various lectures and hands-on learning experiences (hand hygiene compliance audit experience, personal protective equipment (PPE) donning and doffing training, etc.) were conducted at monthly meetings, and each department was asked to take the training home and put it into practice. As QI for infection control included the number of new hospital-acquired cases of Methicillin-resistant Staphylococcus aureus (MRSA) infection, the percentage of MRSA among all S. aureus detected in culture, the number of blood culture tests per 1000 patients/day, two sets of blood culture collection rate were used as indicators to evaluate efforts; QI data through 2020 were used for evaluation due to activity limitations imposed by COVID-19.

Results
In terms of indicators related to MRSA, the nosocomial incidence of MRSA infections was 3.4‰ in 2011, but gradually decreased to 1.1‰ in 2020. The MRSA/S. aureus detection rate also declined from 47.0% to 33.4% during the same period (Fig. 1). On the other hand, the number of blood culture tests per 1000 patients/day decreased from 14.1 in 2011 to 37.3 in 2020, and the collection rate of 2 sets of blood cultures improved from 42.5% to 93.7% during the same period (Fig. 2).

Conclusion
Bundling of various initiatives is important to improve the quality of hospital infection control. Although the Link Staff Program was not the only factor that improved quality, it is believed that this initiative was successful in providing knowledge and increasing awareness of infection control to all staff in all professions.

Disclosures
All Authors: No reported disclosures
P-352. Resistance of the Public Health Threat Emerging Pathogen Candida Auris from Multiple Sources to Antifungal Agents (ARIA 2020-2022)
Authors: Hawser Stephen , Monti Federica , Olari Sara , Kothari Nimmi 
Published: January 2025

Abstract

Background
As highlighted by the Centers for Disease Control (CDC), resistance to antifungal therapies leads to high morbidity and moderate to severely high mortality. In recent years, infections caused by Candida auris have been extremely difficult to treat and C. auris is now labelled as a public health threat. ARIA is a global surveillance initiative collecting yeast and fungal isolates from worldwide sources designed to determine resistance to antifungal agents and trends over time. The current study reports C. auris isolates from the ARIA project and outlines the susceptibility of these isolates to clinically used antifungal agents.

Methods
A total of 62 clinical isolates of C. auris were collected between 2020 and 2022. These originated from specific hospital sites in Germany (1), India (26), Kuwait (5), Panama (20) and the United Arab Emirates (10). All isolates were non-consecutive non-duplicate isolates. Isolates were identified via MALDI-TOF mass spectroscopy and susceptibility testing was performed in line with Clinical Laboratory Standard Institute (CLSI) guidelines using amphotericin B, anidulafungin, caspofungin, fluconazole, isavuconazole, micafungin, posaconazole and voriconazole. As there are no accepted breakpoints for C. auris, CDC tentative e breakpoints were adopted.

Results
MIC distributions with respect to CDC tentative breakpoints specific for C. auris are shown in the Table. 14 of the 62 isolates (23%) were resistant to amphotericin B, 1 isolate (1.6%) resistant to caspofungin, 53 isolates (85%) resistant to fluconazole and 1 isolate resistant to micafungin. Notably, all amphotericin-B resistant isolates were also fluconazole-resistant.

Conclusion
The data from the ARIA study further emphasize the threat posed by C. auris considering its ability to resist commonly used antifungal agents. Continued monitoring of C. auris susceptibility is essential.

Disclosures
All Authors: No reported disclosures
P-361. Outcome of Candida auris Point Prevalence Survey in a Tertiary Care Hospital in Southeast Michigan
Authors: Malik Ambreen , Shallal Anita , Ruby Abigail , Malm Jessica , Mclenon Jennifer , Shanahan Clare , Chami Eman , Alangaden George J , Suleyman Geehan 
Published: January 2025

Abstract

Background
C. auris, an emerging multi-drug resistant organism associated with nosocomial outbreaks, is becoming more prevalent in Southeast Michigan due to interfacility healthcare transfer. The CDC recommends contact isolation and screening of epi-linked healthcare contacts of newly identified C. auris patients to prevent spread and assess potential transmission. We describe our institution’s experience with C. auris point prevalence surveys (PPS).

Methods
PPS was conducted at an 877-bed academic, tertiary care center consisting of private and semi-private rooms in Detroit. In collaboration with Michigan Department of Health and Human Services, we performed PPS by swabbing the axilla and groin of all patients on the implicated unit when a C. auris index case was incidentally identified from June-Dec 2023. In addition, potentially exposed roommates were flagged in the electronic health record for future screening. When additional cases were identified, 2 negative PPS conducted biweekly were required to stop PPS.

Results
Six C. auris index cases were identified during the 6-month period. We performed 18 PPS on 9 units and screened 430 patients (Table); 5 refused and 14 were discharged prior to screening. Four (22%) of the PPS resulted in identification of new cases; 2 PPS yielded 1 case each, 1 PPS yielded 3 cases, and the final PPS yielded 2 cases. Of those screened, 7 (1.6%) tested positive on 4 units. Nosocomial transmission was implicated in 4 patients across 2 units after an epidemiologic investigation. Terminal cleaning was performed on units implicated in nosocomial transmission, in addition to ancillary areas visited by the affected patients. Infection Prevention emphasized the importance of adhering to hand hygiene, appropriate PPE use, and cleaning and disinfection of the environment and shared equipment.

Conclusion
Controlling the spread of C. auris is a public health priority. However, only 1.6% of cases were detected with intense PPS. Despite considerable effort and healthcare resources being utilized to identify additional cases and mitigate possible nosocomial transmission, C. auris continues to spread in our region. Alternatively, healthcare facilities should consider active surveillance of high-risk patients at the point of hospitalization to mitigate the need for PPS.

Disclosures
All Authors: No reported disclosures
P-373. The VREy Resistant Enterococcus: Retracing VRE Transmission and Contamination Events in Healthcare Settings
Authors: O’Sullivan Tierney , Brazelton William , Khader Karim , Leecaster Molly , Tanner Windy , Rubin Michael , Samore Matthew H , Keegan Lindsay T 
Published: January 2025

Abstract

Background
Healthcare associated infections (HAIs), particularly those involving antibiotic resistant bacteria, are some of the most common, deadly, and preventable adverse events affecting patients in the clinical setting. Lowering HAI transmission rates would reduce the clinical burden to patients, economic burden to healthcare systems, and could help slow an alarming trend toward antimicrobial resistant organisms. However, determining definitive routes of transmission within healthcare facilities (HCFs) of HAIs is difficult and costly. Since HAIs are common in settings with little direct patient-patient contact, discerning the role of fomites in transmission pathways is critical, either via health care workers (HCWs) or from direct patient contact with contaminated surfaces.

Methods
We present preliminary results of a model of who-infected-whom using densely sampled data from ICU units in two HCFs over 13 weeks. We combine daily microbiologic samples from three patient body sites, HCW hands, three zones within patient room environments, and shared environmental surfaces with epidemiologic data on HCW movement. Microbiologic samples were whole genome sequenced (WGS) for all distinct cultures. We developed a Bayesian transmission model that incorporates genomic and epidemiologic information to reconstruct probabilistic estimates of transmission routes to estimate who-infected-whom and rule out unlikely transmission or contamination events.

Results
This poster focuses on results for the vancomycin-resistant enterococci (VRE) samples (N=44). We characterize the relationship between overlapping and non-overlapping patient stays, HCW hands, and environmental surfaces, and their roles in transmission and contamination within the two HCFs.

Conclusion
Ultimately, these results provide further evidence on pathogen movement in HCFs and provide insights for developing and improving interventions to minimize transmission in HCFs.

Disclosures
All Authors: No reported disclosures
P-379. Timing Variations for Surgical Prophylaxis Within One Hour Pre-Incision: Impact on Surgical Site Infections in Elective Colorectal Surgery Procedures
Authors: Collins Curtis D , Hartsfield Eric , Cleary Robert K , Veve Michael , Brockhaus Kara K 
Published: January 2025

Abstract

Background
The optimal timing of surgical infection prophylaxis (SIP) is generally recommended to be given 60 minutes, or in some cases 120 minutes, prior to incision. Conflicting results have hampered further optimization of prophylaxis timing within this timing window. This study aimed to assess the impact of alternative prophylaxis timing on surgical outcomes, particularly surgical site infections (SSIs).

Methods
A large, validated database of elective colorectal surgeries in Michigan was used to perform a multi-center, retrospective cohort study. Cohorts included patients who received SIP within 0-15 minutes and 16-60 minutes prior to incision. Adult patients who received colorectal surgeries spanning from July 2012 to June 2021 were included. Emergent or urgent surgeries, missing follow-up and antibiotic information, and patients who did not receive all prophylaxis prior to incision were excluded. The primary outcome was incidence of SSIs. A multivariable logistic regression model analyzed the impact of timing and other confounding variables on SSIs.

Results
A total of 21,061 procedures were included. Of these, 6,405 patients (30.4%) received prophylaxis 0-15 minutes pre-incision and 14,656 (69.6%) received prophylaxis within 16-60 minutes. Cohorts were generally similar with differences in patients receiving β-lactam prophylaxis (97.1% vs 96%; P = &lt; 0.001), mechanical and oral bowel preparation (64.5% vs. 67; P = 0.023), and adherence to recommended dosing (82% vs. 83.7%; P =0.002). There was no difference between cohorts in total SSIs (6.8% vs. 7.1%, P = 0.419) or CDI (1.1% vs. 1%; P =0.324); however, deep SSIs were increased in the 16–60-minute cohort (0.8% vs. 1.1%; P = 0.032). Multivariable logistic regression showed no association between prophylaxis timing and SSIs (adjusted odds ratio (aOR) 0.98; 95% CI 0.86-1.13; P = 0.817).

Conclusion
Timing differences (0-15 minutes vs. 16-60 minutes pre-incision) did not significantly impacts overall SSIs incidence in elective colorectal surgeries.

Disclosures
Robert K. Cleary, MD, FASCRS, FACS, Intuitive Surgical, Inc: Honoraria
P-395. Clinical and Demographic Characteristics of Community Associated (CA) Clostridioides difficile
Authors: Hawco Adam J , Myers christopher J , Dahhan Runda , Hurley Christine , Dumyati Ghinwa 
Published: January 2025

Abstract

Background
The incidence of community associated Clostridiodes difficile infections CDI (CA CDI) increased over the last decade; with antibiotic use recognized as a risk factor for infection. In 2017, we noticed an increase in the number of CA cases occurring without recent antibiotic exposure. Our aim was to characterize CA CDI cases both with and without prior antibiotic use to better understand this emerging trend.

Methods
Active laboratory and population-based surveillance for CDI was performed in Monroe County, NY as part of the CDC Emerging Infections Program between 2017-2022. An incident CA CDI case was defined as a patient with a positive C. difficile assay with no prior positive assay in the previous 8 weeks and no evidence of an overnight stay in a healthcare facility in the preceding 12 weeks. Clinical, demographic and exposure data were collected through medical record review. Descriptive and bivariate analyses were then performed.

Results
The incidence of CA CDI increased from 72.6 in 2017 to 100/100,000 population in 2022 (Figure 1). Among CA cases that received antibiotics in the 12 weeks prior to their infection, the proportion receiving fluoroquinolones and clindamycin decreased over time (Figure 2). During this period, the proportion of CA CDI cases that did not receive any prior antibiotics increased from 33.7% to 46.9% (Figure 2). Compared to cases with prior antibiotics, cases without prior antibiotic exposure were more likely to be male, on immunosuppressants, have a higher Charlson comorbidity score, have underlying inflammatory bowel disease and prior CDI (Table 1). Prior proton pump inhibitor or H2 blocker use was not significantly different between the two groups.

Conclusion
The study observed an increase in the incidence of CA CDI over the study period, with a growing proportion of cases occurring without recent antibiotic exposure. Additionally, the use of high-risk antibiotics decreased over time. These findings suggest that other factors, beyond antibiotic use, may play a significant role in the development of CA CDI. Further research into these emerging risk factors is necessary to inform targeted prevention strategies and address the rising incidence of CA CDI.

Disclosures
All Authors: No reported disclosures
P-416. The Unexpected Costs of Cutting Costs
Authors: Patel Palak , Marrs R , Steele Molly , Chu Vera , Zuccaro Patricia D , Bartlett Allison H , Landon Emily 
Published: January 2025

Abstract

Background
Hand Hygiene (HH) is the cornerstone of preventing healthcare-associated infections, however maintaining compliance is challenging especially when staffing changes. Here we show HH performance as measured by an automated monitoring system before and after a reduction in force (RIF) affecting unit-based nursing leadership.

Methods
University of Chicago is a large 800 bed academic medical center with 30 adult inpatient units that monitors HH using the GOJO Smartlink System (Akron, OH) to track entries and exits (denominator) as well as soap and hand sanitizer dispenses (numerator) aggregated over a nursing unit. The adult inpatient units span across two buildings and aggregate compliance data by nursing unit from Jan 1, 2024 through Mar 30, 2024 is included. A 4% RIF that changed unit-based nursing leadership but not direct patient care staff took place on 2/1/2024. The paired t-test was used to compare data from before and after the RIF.

Results
Building 1 had HH rate 45.28% in January before the RIF and 40.91% after the RIF (p&lt; 0.01). For building 2, HH before the RIF was 61.27% before and 57.26% after the RIF (p&lt; 0.01). 10 units had a change in nursing manager (PCM) and 20 units had a 50% reduction in assistant manager (ACM) staffing. In univariate analysis, both units with a change in PCM (51.62% to 47.33%, p=0.05) and those without a change in PCM (58.46% to 54.78%, p&lt; 0.01) had statistically significant decreases in HH. Units with a decrease in ACM staffing also had a significant decrease in HH (56.46% to 52.67%, p&lt; 0.01) but those who kept their ACM staffing did not (55.04% to 51.47%, p=0.19).

Conclusion
Overall, HH performance decreased significantly after the RIF despite not affecting any direct patient care roles. A decrease in staffing of the Assistant Care Manager role may have a larger impact on HH adherence than PCM role.

Disclosures
Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant
P-428. Impact of Diagnostic Stewardship Interventions on Ventilator-Associated Event Rates
Authors: Garcia Zachary S , Troost Jonathan , Albin Owen 
Published: January 2025

Abstract

Background
Ventilator-associated events (VAEs) are CDC/NHSN surveillance definitions for monitoring nosocomial complications from invasive mechanical ventilation. In 2022, we executed the Diagnosis of Ventilator-Associated Pneumonia (DIVA) trial (NCT05176353), a quasi-experimental pilot/feasibility clinical trial of a VAP bundled diagnostic stewardship intervention (VAP-DSI) targeting the ICU respiratory culturing pathway. This VAP-DSI associated with a 20% rate reduction in positive respiratory cultures per 1000 mechanically ventilated patient days. In this post hoc analysis, we present a secondary data analysis evaluating the impact of a VAP-DSI on VAE surveillance rates.

Methods
The DIVA trial operationalized a VAP-DSI using an interruptive clinical decision support tool and modifications to clinical laboratory workflows. Interventions included gatekeeping access to respiratory culture ordering, preferential use of non-bronchoscopic bronchoalveolar lavage for culture collection, and suppression of culture results for samples with minimal alveolar neutrophilia. We compared monthly VAE rates among study ICUs (those that utilized the VAP-DSI) and non-study ICUs over both a 5-year pre-intervention period (2017-2022) and the post-intervention period (2022-2023). Event rates were compared using a Z-test approximation for person-time rates.

Results
Figure 1 demonstrates monthly VAE rates stratified by ICU and pre- vs post-intervention time periods. Study ICUs demonstrated significant decreases in rates of VAEs, VACs, and PVAPs following VAP-DSI implementation. Conversely, non-study ICUs experienced no significant changes in VAE rates.

Conclusion
In this single-center pilot/feasibility clinical trial, diagnostic stewardship interventions targeting the ICU respiratory culturing pathway associated with significant reductions in VACs, PVAPs, and total VAEs. These findings suggest a potential impact of diagnostic stewardship interventions on VAE surveillance rates.

Disclosures
All Authors: No reported disclosures
P-434. Comparison of Cardiovascular Disease Risk Calculators in People Living with HIV in the US Military Natural History Study
Authors: Bettger Caitlin , Horn Mackensie , Aden James , Xu Xiaohe , Agan Brian , Blaylock Jason , Larson Derek , O’Connell Robert , Colombo Rhonda , Lalani Tahaniyat , Yabes Joseph , Markelz Ana E 
Published: January 2025

Abstract

Background
Primary prevention of atherosclerotic cardiovascular disease (ASCVD) is a vital component of care for people living with HIV (PLWH). Current guidelines recommend at least moderate intensity statin for low to moderate ASCVD risk and high intensity statin for high risk. Determining ASCVD risk in PLWH is difficult due to a paucity of precise risk calculators. We retrospectively compared available ASCVD risk calculators in a population who had known ASCVD events.

Methods
We included US Military HIV Natural History Study (NHS) participants between 2006-2019 who experienced a known ASCVD event as defined in Table 1. Participants missing data to perform all four calculators were excluded from the analysis. Four risk calculators: American College of Cardiology/American Heart Association Pooled Cohort Equation (PCE), Framingham Heart Study Risk Score (FRS), Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) model, and the newly published HIV-CARDIO-PREDICT (HCP) were applied for each participant at 10, 5, and 2 years prior to the ASCVD event. Proportion of participants categorized as high risk was determined for each calculator. Paired calculators were compared by Fisher’s exact or Chi-squared tests.

Results
A total of 134 participants met initial inclusion criteria (Table 2). Of these, 113, 75, and 42 were excluded from the 10, 5, and 2 year analyses respectively due to missing data. HCP had the highest percentage of high-risk participants at any given time interval (Table 3). PCE had the lowest percentage of high-risk participants across all intervals. Head-to head comparison of PCE versus HCP demonstrated a significant difference in proportion of participants classified as high risk at all time intervals (p &lt; 0.0001).

Conclusion
In this military study cohort of PLWH who had a known ASCVD event, HCP had the highest sensitivity in classifying participants as high risk at all intervals. PCE, which is guideline recommended for ASCVD risk analysis, had the worst sensitivity. Further understanding of these calculator scores including their driving components over time (especially for HCP), their correlations with outcomes when non-cases are included, and their predictive ability among younger participants are needed.

Disclosures
All Authors: No reported disclosures