bluuebunny/crossref_metadata_2025_split huggingface dataset:
700. LOFI: Preliminary Analysis of Intervention Fidelity of a Cluster Randomized Trial Evaluating Universal Gloving to Reduce C. difficile Acquisition within VA Hospitals
Authors: McKinley Linda , Ray Cara , Keating Julie , Dixon Jonah , Moriarty Helene , Zhao Jiwei , Evans Charlesnika T , Foliaki Malini , Gelman Michael , Ndakuya-Fitzgerald Florine , Pfeiffer Christopher D , Sheeti Ahmed , Weintrob Amy , West Katelyn , Williams Maeve , Safdar Nasia 
Published: November 2023

Abstract

Background
Prevention of Clostridioides difficile infection (CDI) is a priority. Infection control measures to prevent CDI target symptomatic (infected) patients. These patients are placed on contact precautions (CP), requiring hand hygiene and use of gloves and gowns. However, asymptomatic (colonized) patients may be a reservoir for cross contamination, and evidence is scarce regarding prevention measures with this population. To address this gap, our study evaluates the effect of universal gloving (UG) for all patient contact to prevent transmission from these patients. However, the gloving intervention involves complex behavioral practices with wide variations in compliance; thus, data on intervention implementation provides critical context. Here we provide a preliminary analysis of intervention fidelity.

Methods
A cluster randomized trial (CRT) is being conducted in ten VA hospital patient units; 5 units randomized to standard of care (CP) and 5 units to the intervention (UG plus CP). A secondary outcome of the study is intervention fidelity (gloving compliance). This analysis includes monthly observation data on hand hygiene (HH) and gloving compliance for UG and HH, gloving, gowning for CP in both groups using a standardized observation tool. Compliance was calculated using the total number of compliant observations divided by the total number of observations.

Results
1012 Observations were conducted between May 2022 and April 2023. HH, gloves and gown compliance for CP did not differ between groups (Table 1). Gloving compliance with UG was lower than expected and significantly lower than gloving compliance for CP in the intervention group (Table 2). Table 3 compares HH and gloving between UG (intervention group) and CP (both groups). Gloving compliance was significantly higher with CP than with UG.
Results Tables
Table 1 - 3

Conclusion
Intervention fidelity is critical to support rigor of the CRT, but our results showed lower than expected compliance for both gloving and HH despite the UG intervention. A pilot interview identified the healthcare worker requirement for practicing both HH and gloving as a barrier. Additional investigation into barriers to gloving and HH compliance within the context of a UG intervention is ongoing.

Disclosures
All Authors: No reported disclosures
710. Burden of Clostridioides difficile Infection (CDI) in Flint, Michigan (MI): Association of Race and Gender with Mortality
Authors: Younas Mariam , Amin Hina , Ragheb Elio , Mahgoub Abdullahi , Karki Bibek , Upadhyay Manoj , Bakeer Mohammad , Armor Anthony , Newell Ann , Ríos-Bedoya Carlos F 
Published: November 2023

Abstract

Background
Flint, MI faces an increased vulnerability to health disparities as compared to other communities in MI. Flint & Genesee County’s most critical health needs is informed upon in-part by data provided by the three community hospitals, serving Genesee County, MI, and its urban core, the City of Flint. This cross-sectional study aims to describe our experience with CDI in Flint, MI; and determine 30-day mortality among CDI cases based on gender and race.

Methods
Hurley is a 443-bed premier public teaching hospital (largest in the region). Using National Healthcare Safety Network (NHSN) surveillance Laboratory Identification (Lab ID) events, 926 CDI cases, ≥ 18 years of age were identified among patients hospitalized at Hurley Medical Center from 01/2015 to 07/2022. A positive stool C. difficile test was regarded as a “CDI case” for purpose of this study. NHSN surveillance definitions were used to describe the incident, recurrent cases and determine the epidemiologic categories.

Results
During the 7.6-year study period, 926 cases were identified. 46.7% of the cases were in men, with a 30-day mortality of 10.4% vs 7.3% in women (p-value 0.10) (Table 1). African American (AA) comprised 44.4% of the cases with 30-day mortality of 9.1% vs 8.1% in whites (p-value 0.78) (Table 2). There were 64 recurrent CDI cases with 30-day mortality of 6.3% as compared to 8.9% in incident cases (p-value 0.65). Mean age at specimen collection was 59.9 years (standard deviation (SD) 17.5) with 43% of the cases falling in the age group ≥ 65 years (Table 3). Hospital-onset (HO) and community-onset healthcare facility associated (CO-HCFA) CDI accounted for 42.8% (396/926) and 14.9% (138/926) of the cases respectively. 60.5% (237/392) of the CO CDI were associated with antibiotic use with in the past 90 days as compared to 95.9% (380/396) of HO and 94.9% (131/138) of CO-HCFA CDI (p-value &lt; 0.001).Table 1:CDI cases based on genderTable 2:CDI cases based on raceTable 3:CDI cases based on age groups

Conclusion
CDI caried a significant mortality in this high-risk cohort. Mortality was slightly higher in men and AA; though it was not statistically significant. Antibiotic use was the strongest predictor of CDI acquisition (p-value &lt; 0.001) and about half the CDI cases were CO.
Antimicrobial stewardship initiatives targeting unnecessary and inappropriate antimicrobial use in the community are as imperative as in the hospital setting.

Disclosures
All Authors: No reported disclosures
731. Factors Contributing to Long-Term Risk of Developing Multidrug-Resistant Pseudomonas Recurrence
Authors: Volker Scott , Vogler Andrew J , Fairman Kathleen A , Huang Vanthida 
Published: November 2023

Abstract

Background
Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is a significant healthcare concern in hospitalized patients with a mortality rate upward of 54%. Delayed initiation of appropriate antibiotics with MDR infections may lead to prolonged hospital stays and increased mortality. Previous studies investigated risk factors that contribute to MDR-PA and mortality; however, none evaluated factors leading to recurrence. Therefore, we sought to assess the risk factors contributing to the long-term recurrence of MDR-PA.

Methods
This was a retrospective case-control study of hospitalized patients at HonorHealth Network from January 2015-January 2023. Patients were included if they have ≥2 positive P. aeruginosa cultures in 1-year with MDR as first occurrence. Cases were patients with MDR-PA at second occurrence and controls were patients with no MDR-PA at the second occurrence. MDR-PA was defined as resistance to at least 1 antibiotic in ≥3 different antimicrobial classes. Risk factors associated with a secondary MDR-PA occurrence were evaluated using logistic regression backwards-stepwise analysis of clinical signs and symptoms, demographic, admission location, and number of days since the first MDR-PA occurrence.

Results
Of 8,140 hospitalized patients, 209 (n=132 case, n=77 control) met study entry criteria; 52% were female and 84.8% were Caucasian. Respiratory infections (OR 3.13, 95% CI 1.22-8.04), urinary tract infections (UTIs) (OR 4.51, 95% CI 1.82-11.16), intravenous antibiotic use within the past 30 days (OR 3.03, 95% CI 1.05-8.72), and a time period of 30-59 days since the initial culture positive for MDR-PA (OR 4.34, 95% CI 1.37-13.72) were associated with an increased risk of a secondary occurrence of MDR-PA within 1 year.

Conclusion
Our study revealed that there is an increased risk of subsequent recurrence between 30-59 days following the initial MDR-PA positive culture. However, further investigations are warranted in the future to be generalizable.

Disclosures
All Authors: No reported disclosures
743. Efficacy and persistence of 3M™ Skin and Nasal Antiseptic for reduction of S. aureus colonization ex vivo porcine tissue model
Authors: Laubach Isabel A , Peterson Marnie L , Parthasarathy Ranjani 
Published: November 2023

Abstract

Background
Surgical-site infections can result from nasal colonization of Staphylococcus aureus prior to surgery. Nasal decolonization with iodine-based products is a common way to combat this problem. The efficacy and persistence of nasal decolonization products is a crucial component for this presurgical protocol to be successful. An ex vivo porcine mucosal model allows for clinically relevant testing of formulations without the need for live animals.

Methods
Fresh porcine vaginal mucosa was processed to create 5 mm diameter explants. One group was left uninfected, and the other was infected with prepared methicillin-resistant S. aureus (MRSA) Xen30 to achieve 106 CFU/explant and incubated for 2h at 37 °C. After 2-hour incubation, explants were treated with formulation for 1h then gently washed with mucin and incubated for 24h at 37 °C. Uninfected explants were photographed prior to treatment, immediately post treatment, pre and post wash, and at hour intervals following mucin wash. Infected explants were collected into neutralizing solution at 24h, vortexed and sonicated to liberate bacteria then plated to enumerate CFU/explant. Additional infected explants were stained with LIVE/DEAD stain and imaged by fluorescence microscopy at 24h.

Results
Pictures of uninfected, treated explants showed that 3M™ Skin and Nasal Antiseptic (SNA) formulation persisted visually on the tissue up to 6h post wash while Betadine was no longer visible on tissue at 1h post wash. At 24h post wash, explants treated with Skin and Nasal had no recoverable colony forming units while explants treated with Betadine had regrown to ∼7 Log10 CFU/explant. This finding was confirmed by staining and fluorescent imaging. Fluorescent imaging showed that treatment of uninfected explants with SNA or Betadine did not compromise tissue viability compared to untreated control; however, infected explants treated with Skin and Nasal retained the most tissue viability.
Fluorescent images of porcine vaginal mucosa stained with LIVE/DEAD stain following 24h incubation with formulations.

Conclusion
The material properties of SNA prep allow it to remain on the tissue even after washing resulting in longer lasting activity against MRSA Xen30 than Betadine treatment over 24 hours. By persisting, the SNA treated explants showed reduced tissue damage by MRSA than was observed in the Betadine and untreated groups.

Disclosures
Ranjani Parthasarathy, PhD, 3M: Have patents|3M: 3M employee|3M: Stocks/Bonds
751. The success of an escape room activity on antimicrobial stewardship in achieving Doctor of Pharmacy Educational outcomes
Authors: Lee Yuman , Bradley Nicole 
Published: November 2023

Abstract

Background
ASP Escape Room was an activity created and conducted in the infectious disease elective for pharmacy students in their 3rd professional year. Students were assigned the CDC Core Elements of ASP as a pre-reading. During class, students worked in groups of 4 on tasks relating to the CDC Core Elements to decode various puzzles to advance through the activity in establishing an antimicrobial stewardship program. The goal of ASP Escape Room was to engage and motivate students to learn foundational antimicrobial stewardship concepts and challenge students to develop personally and professionally. The purpose of this study was to assess the impact of ASP Escape Room on achieving Doctor of Pharmacy Curriculum Outcomes and Entrustable Professional Activities (COEPA) 2022 and evaluate perceptions.

Methods
During the Spring 2023 semester, student feedback was anonymously collected via an electronic survey. Students evaluated the impact of ASP Escape Room based on the 3 domains of COEPA 2022 (Knowledge, Skills, and Attitudes) on a Likert scale from strongly disagree to strongly agree.

Results
39 students responded. Majority strongly agreed or agreed that ASP Escape Room allowed them to learn foundational knowledge (38/39, 97.4%), develop problem solving skills (37/39, 94.9%), improve effective communication skills (38/39, 97.4%), understand the role of a steward in optimizing healthcare (39/39, 100%), achieve shared goals on a team (38/39, 97.4%), and build/maintain trust among colleagues (39/39, 100%). Additionally, students enjoyed participating (38/39, 97.4%), reported the activity was an engaging way of learning antimicrobial stewardship (38/39, 97.4%), and that they would like to participate in future escape room activities as part of pharmacy course work (36/39, 92.3%). Most students ranked the activity’s difficulty as a 3 (61.5%) or 4 (30.8%) out of 5.

Conclusion
ASP Escape Room was positively received and provided an opportunity for students to expand beyond foundational knowledge, and develop on the and skills and attitudes domains, including building trust, effective communication, and supporting team goals. Opportunities like ASP Escape Room Activity are important in the education of pharmacy students to prepare them to practice at the highest level of the profession.

Disclosures
All Authors: No reported disclosures
757. Bridging the Gap: An Educational Intervention to Increase HIV PrEP Access in Resident Primary Care Clinics
Authors: Davis Jennifer M , Solomon Daniel A , Alexander Erik K , Ramani Subha 
Published: November 2023

Abstract

Background
HIV Pre-Exposure Prophylaxis (PrEP) is a safe and effective way to prevent HIV acquisition. Yet, in 2020, only 25% of individuals in the US and Puerto Rico who had an indication for PrEP received a PrEP prescription. While PrEP is accessible to primary care clinicians, many do not feel comfortable prescribing PrEP. Clinician education has been identified as a key opportunity to increase access and comfort in prescribing PrEP.

Methods
An educational intervention was designed aiming to increase PrEP knowledge and prescribing among residents and preceptors in the primary care clinics at Brigham and Women’s Hospital (BWH). The intervention followed the six steps described in Kern’s model of curriculum development (Figure 1). After formal needs assessment, an in-person interactive teaching session was designed and presented. This was supplemented by an online reference guide and note template dot phrases accessible in the electronic medical record (EMR). The curriculum was evaluated with pre and post intervention surveys. Survey data were analyzed using descriptive statistics and one tailed T tests.

Results
Of the approximately 30 residents and preceptors who participated in the intervention, 19 completed the pre survey and 9 completed the post survey. Only 37% (7/19) of pre survey respondents reported having had PrEP education in the past. 21% (4/19) had prior teaching during medical school, 21% (4/19) during residency, and 16% (3/19) in continuing medical education courses. Participants indicated that their comfort with prescribing PrEP increased overall after the intervention with a statistically significant increase in reported confidence in their ability to prescribe PrEP (mean Likert scale value of 3.88 vs 2.95, p = 0.03) (table 1).

Conclusion
PrEP is an underutilized modality in preventing HIV transmission, but many primary care clinicians do not feel comfortable prescribing PrEP even though it is accessible in primary care settings. Systematic PrEP education is lacking in the UME, GME, and CME settings. Targeted, interactive, multimodal educational interventions can be effective in increasing comfort with PrEP prescribing. Support from leadership and learner buy-in is critical for effective training.

Disclosures
All Authors: No reported disclosures
760. Multidisciplinary Education in Substance Use Disorder Centers Improves HIV Prevention Knowledge and Practice: BRIDGE PrEP: Building Bridges to Reach People Who Inject Drugs with the Goal of Employing PrEP for HIV Prevention
Authors: Glazar Amanda , Carney Becky K , Simpson Mara S , Daniels Susan , Felzien Gregory S 
Published: November 2023

Abstract

Background
Around 10% of new HIV infections in the US are attributed to injection drug use or male-to-male contact and injected drug use; syringe sharing is the second riskiest behavior for contracting HIV. For many, substance use disorder (SUD) treatment is the primary point of access for receiving HIV-related services. A 2021 survey showed gaps in HIV prevention knowledge and practice among SUD center staff but also interest in education (Fig 1). The BRIDGE PrEP program is a grassroots initiative designed to educate and motivate SUD center staff to increase their clients’ awareness of and access to HIV preexposure prophylaxis (PrEP) services.

Methods
Ten live continuing medical education (CME) meetings supported by an educational grant from Gilead Sciences, Inc were conducted at SUD centers between August 2022 and May 2023. The 1-hour meetings provided didactic information, real-world insights, faculty-learner interactions, local networking, and take-away print and online staff/patient-education resources (Fig 2). Program goals include:1.Increase HIV testing of people who inject drugs 2. Educate SUD center staff regarding PrEP harm-reduction practices and 3.Build linkages between SUD staff, PrEP providers, and HIV-care networks within local/regional systems. Moore’s Level 1-5 (self-reported) outcomes (Fig 3) were collected via pre-, post-, and 6-week follow-up surveys evaluating knowledge and self-reported frequencies of recommended HIV prevention practice behaviors.

Results
To date, there have been 154 participants representing a diverse multidisciplinary learner group extending beyond the clinician-only audience typical of many CME programs (Fig 4). Increases in knowledge were demonstrated across topic areas (Fig 5), and participants reported intent to improve HIV prevention-related practices following the activity (Fig 6). To date, follow-up surveys report specific actions taken on individual and system levels to improve HIV screening and prevention (Fig 7).

Conclusion
Positive outcomes related to HIV prevention knowledge and practice among SUD center staff have the potential to impact many at-risk individuals. Additionally, follow-up surveys suggest that improved awareness is prompting collaboration and system-level changes driven by participants (Fig 8).

Disclosures
All Authors: No reported disclosures
763. Infection Prevention Resource Physicians to Build On-Call Capacity
Authors: Hayes Ericka , Smathers Sarah , Townsend Sara , Le Goff Lauren , Plaras Marisse , John Audrey , Fatemi Yasaman , Sammons Julia 
Published: November 2023

Abstract

Background
The COVID-19 pandemic showed that infection prevention and control (IPC) human resources are critical and are stretched in prolonged crisis. There has also been a shift from experienced infection preventionists (IPs) during the pandemic and natural attrition to a less experienced cohort. Medical Director (MD) oversight of IPC programs is critical in providing clinical guidance and support for developing IPs. IPC and MD resources are required 24/7 to respond to urgent issues such as management of highly infectious exposures. Many IPC programs have a single MD with extensive on call periods stretching a limited resource and increasing potential for physician burnout. We report the impact of Infectious Diseases Resource Physicians (IDRP) to support IPC on call.

Methods
Our large pediatric health system had a gap in MD coverage from June 2022-October 2022. To support IPC on call, we developed a weekly rotating IDRP staffed by an inpatient ID physician with MD backup as needed. After a senior MD onboarded in October 2022, the IDRP rotation was expanded to other ID physicians on a voluntary basis. Education in management of common urgent/emergent IPC issues was provided to all IDRPs. Data was collected on time spent and themes by IDRPs.

Results
From October 2022-April 2023 we have had 11 IDRPs provide IPC support. Calls per week ranged from 0-5 with a median of 1. Time investment by IDRP weekly was a median of 10 minutes, range 0-60 minutes, spent supporting IPC questions. Common themes were communicable diseases such as tuberculosis, assessing symptomatic caregivers/parents and type of precautions needed. Feedback from the IPC team and IDRPs was positive as solicited through meetings, emails and individual inquiry.

Conclusion
We have successfully established ID physician support coverage for our IPs on call, building a bench of IPC expertise throughout our ID group and supporting the single senior MD. Additional capacity for the IPC program provides flexibility and support needed during critical times, such as pandemic response. IPs felt well supported by the IDRP with the additional benefit of strengthening relationships across the IPC team and ID division. Key factors in success include clear expectations, education, feedback, and support.

Disclosures
All Authors: No reported disclosures
773. The Role of Infectious Diseases Physicians in Postgraduate Antimicrobial Stewardship Education: A Nationwide Questionnaire Survey in Japan
Authors: Miwa Toshiki , Okamoto Koh , Okamoto Koh , Nishizaki Yuji , Tokuda Yasuharu 
Published: November 2023

Abstract

Background
To promote appropriate antimicrobial use, resident physicians’ understanding of antimicrobial stewardship (AS) is essential. While infectious disease (ID) physicians are expected to play a leading role in AS education, data are limited for the impact of ID physicians’ involvement. We aimed to evaluate the impact of direct interaction with ID physicians on resident physicians’ knowledge, perceptions, and attitudes regarding AS.

Methods
A cross sectional study involving the participants of the Japanese nationwide online examination for resident physicians in January 2023 was performed. The questionnaire with 29 items on their educational background as well as perceptions and attitudes regarding AS were distributed, collected, and analyzed in combination with the examination scores.

Results
Of 8,438 post-graduate year (PGY) 1 and 2 resident physicians participated in the examination, 4,051 (48.0%) from 577 institutions responded in the present study. A half (54.0%) worked at hospitals with an existing ID department (Table 1). A third (32.7%) did not receive any formal AS education during their residency program whereas 65.2% failed to understand the concept of AS, and 79.2% were less confident in choosing appropriate antimicrobials. Among respondents working at hospitals with an ID department, presence of bedside ID consultation service was associated with enhanced commitment to choosing narrow-spectrum antimicrobials, de-escalation, transition to oral therapy, and compliance of appropriate duration of therapy than ID consultation only based on chart review (49.6% vs. 42.6%, 51.4% vs. 41.6%, 76.3% vs. 66.3%, 66.7% vs. 55.7%, respectively [all of P &lt; 0.05]) (Table 2). Although there was no statistically significant difference in total test scores, respondents who had an ID rotation were more likely to review past antimicrobial exposure and colonization of resistant pathogens and try to choose narrow-spectrum antimicrobials than those who received lectures only (59.3% vs 39.0%, P &lt; 0.001) (Figure).

Conclusion
Resident physicians’ perceptions and attitudes regarding AS may improve through direct interaction with ID physicians. Our findings underscore the imperative role and value of ID physicians as key educators for future physicians.

Disclosures
All Authors: No reported disclosures