bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying risk factors for pediatric central-line–associated bloodstream infections
Authors: Conrad Paula , Murphy Julie , Audain Pascale , Connors Michelle , Hopkinson Christopher , Yuen Jenny Chan , Ormsby Jennifer 
Published: September 2023

Background: Pediatric patients often require central venous catheters (CVCs) for a variety of clinical indications, including medication administration, parenteral nutrition, and venous blood sampling. Patients with CVCs are at risk for central-line–associated bloodstream infections (CLABSI). These hospital-acquired infections are often preventable and may lead to increased morbidity and mortality. Clinicians at a 477-bed, freestanding pediatric academic hospital completed a quality improvement project to identify factors that place pediatric patients at increased risk for CLABSI and to outline strategies aimed at CLABSI reduction for our highest-risk patients. Methods: Project leaders completed a literature review to evaluate current research on the topic and then assembled a project team. The team completed a retrospective analysis and categorization of CLABSI cases and reviewed internal CLABSI root-cause analysis data. The group then completed a case–control analysis to identify risk factors in patients with CVCs who developed CLABSIs, compared to patients with CVCs who did not develop CLABSI. Following this analysis, the team created a CLABSI risk-factor tool for use by bedside nurses. This tool described patients with CLABSI risk factors and outlined best practices for CLABSI prevention. Results: Based upon literature review, root-cause analysis data, and retrospective CLABSI case review over the period from 2017 to 2021, an initial list of 9 potential CLABSI risk factors was compiled. A case–control analysis was performed comparing 97 CLABSI cases with 103 matched controls. Univariate, multivariate, and additional covariate analyses were employed to identify 3 factors placing pediatric patients at increased risk for CLABSI. These included (1) multiple enteral devices (ie, 2 or more devices, including gastrostomy tube, jejunostomy tube, gastrostomy or jejunostomy tube, ostomy, and peritoneal drain); (2) multiple CVC entries (ie, CVC used for medications and venous sampling); and (3) long-term CVC plus parenteral nutrition (CVC in place for >21 days and receiving parenteral nutrition and/or intralipids). Conclusions: Pediatric patients with central venous access are vulnerable to CLABSI, and certain patients may be at increased risk. Frontline clinicians may be able to identify these patients and adopt best practices to prevent infection. A tool for use by bedside nurses can be a useful adjunct to existing CLABSI prevention practices.Disclosures: None
Inpatient remdesivir versus nirmatrelvir-ritonavir in the progression of COVID-19
Authors: Patel Dimple , Mccoy Christopher , Donohoe Kendall , Lee Matthew , Gold Howard , Chapin Ryan 
Published: September 2023

Background: Nirmatrelvir-ritonavir received emergency use authorization (EUA) for the prevention of progression of COVID-19 in December 2021. Most data supporting this authorization are limited to the outpatient setting in unvaccinated patients, and high-quality head-to-head comparisons to other antivirals such as remdesivir are lacking. Patients at high risk of disease progression, such as advanced age, smokers, and those with cardiovascular disease, diabetes, obesity, or cancer continue to be admitted to acute-care settings for various indications, and some are incidentally found to have mild COVID-19. The objective of this project was to compare rates of progression of mild-to-moderate COVID-19 for inpatients treated with remdesivir versus nirmatrelvir-ritonavir. Methods: This study was a single-center, retrospective cohort study that included patients aged ≥18 years with PCR-confirmed SARS-CoV-2 infection who were initiated on nirmatrelvir-ritonavir within 5 days or remdesivir within 7 days of symptom onset between June 2022 and August 2022. The primary outcome was the worsening of symptoms via the WHO ordinal clinical severity scale for COVID-19. Secondary outcomes included escalation of care or readmission due to COVID-19, discharge prior to treatment completion, and any adverse drug reactions (ADRs). Within our institutional guidelines, prior approval is needed for COVID-19 treatment through collaboration between the primary team and antimicrobial stewards. Nirmatrelvir-ritonavir is the preferred agent for both in- and outpatients unless the patient had drug interactions or lack of enteral access, in which case remdesivir was considered. Results: In total, 58 patients were screened and 50 patients were included, 25 patients in each arm. Most were non-Hispanic, white males with at least 1 comorbidity. Compared to the remdesivir arm, the nirmatrelvir-ritonavir arm had more patients with at least a primary COVID-19 vaccine (44% vs 34%). Also, 88% of patients in each arm had a baseline ordinal score of 4, and 12% had a score of 5. Ordinal score changes between the start and end of therapy were similar between groups, and neither had an increase in oxygen requirements (Fig. 1). No readmissions were due to COVID-19, and both medications were well tolerated. Refer to Fig. 2 for secondary outcomes. Conclusions: Nirmatrelvir-ritonavir and remdesivir showed similar safety and efficacy in the treatment of hospitalized patients with mild-to-moderate COVID-19. Current evidence-based guidelines and treatment costs favor nirmatrelvir-ritonavir for patients who can receive this drug.Disclosures: None
Decolonization of hospital patients may aid efforts to reduce transmission of carbapenem-resistant Enterobacterales
Authors: Singh Brajendra K. , Paul Prabasaj , Gowler Camden D. , Reddy Sujan C. , Slayton Rachel B. 
Published: September 2023

Background: Multimodal approaches are often used to prevent transmission of antimicrobial-resistant pathogens among patients in healthcare settings; understanding the effect of individual interventions is challenging. We designed a model to compare the effectiveness of hand hygiene (HH) with or without decolonization in reducing patient colonization with carbapenem-resistant Enterobacterales (CRE). Methods: We developed an agent-based model to represent transmission of CRE in an acute-care hospital comprising 3 general wards and 2 ICUs, each with 20 single-occupancy rooms, located in a community of 85,000 people. The model accounted for the movement of healthcare personnel (HCP), including their visits to patients. CRE dynamics were modeled using a susceptible–infectious–susceptible framework with transmission occurring via HCP–patient contacts. The mean time to clearance of CRE colonization without intervention was 387 days (Zimmerman et al, 2013). Our baseline included a facility-level HH compliance of 30%, with an assumed efficacy of 50%. Contact precautions were employed for patients with CRE-positive cultures with assumed adherence and efficacy of 80% and 50%, respectively. Intervention scenarios included decolonization of culture-positive CRE patients, with a mean time to decolonization of 3 days. We considered 2 hypothetical intervention scenarios: (A) decolonization of patients with the baseline HH compliance and (B) decolonization with a slightly improved HH compliance of 35%. The hospital-level CRE incidence rate was used to compare the results from these intervention scenarios. Results: CRE incidence rates were lower in intervention scenarios than the baseline scenario (Fig. 1). The baseline mean incidence rate was 29.1 per 10,000 patient days. For decolonization with the baseline HH, the mean incidence rate decreased to 14.5 per 10,000 patient days, which is a 50.2% decrease relative to the baseline incidence (Table 1). The decolonization scenario with a slightly improved HH compliance of 35% produced a relative reduction of 71.9% relative to the baseline incidence. Conclusions: Our analysis shows that decolonization, combined with modest improvement in HH compliance, could lead to large decreases in pathogen transmission. In turn, this model implies that efforts to identify and improve decolonization strategies for better patient safety in health care may be needed and are worth exploring.Disclosures: None
Developing a statewide infection prevention program assessment service for dialysis settings using a six-sigma framework
Authors: Ludington Chelsea , Brum Renee 
Published: September 2023

Background: Due to the need for recurrent and direct access to the bloodstream, patients who require hemodialysis are at higher risk of developing healthcare-associated infections. Failure to assess gaps in systems and processes impedes the implementation of quality and performance improvement initiatives. In Michigan, there is no consultative service offered to dialysis units to assist with infection prevention practices, and no statewide dialysis data are being utilized. The Michigan Department of Health and Human Services developed a consultative, nonregulatory service dedicated to providing a comprehensive assessment of dialysis-based infection prevention programs. Methods: A multidisciplinary team created an infection prevention dialysis evaluation program using the six-sigma define–measure–analyze–design–verify model. These elements included content within the dialysis-specific Infection Control Assessment and Response (ICAR) Tool from the CDC with supporting program assessment items. From August 2021 through August 2022, the team completed 17 inpatient dialysis assessments within our cohort’s 17 hospitals. Data were analyzed using descriptive statistical analysis, and the final analysis included 1,086 observations from the developed assessment tool. Observations were grouped into 7 infection prevention categories: appropriate use of single and multiuse devices and supplies, aseptic technique, bloodborne pathogen prevention, cleaning and disinfection, hand hygiene, personal protection equipment (PPE) use, and storage of devices and supplies. Detailed summary reports were provided to the participating facilities after each site visit that included identified gaps, recommendations for improvement, and evidence-based resources. Results: Deficiencies were grouped into 7 major infection prevention categories among the 17 assessments, including cleaning and disinfection (n = 17, 100%), hand hygiene (n = 9, 53%), PPE use (n = 9, 53%), appropriate use of single and multiuse devices and supplies (n = 6, 35%), bloodborne pathogen prevention measures (n = 6, 35%), aseptic technique (n = 5, 29%), and storage of devices and supplies (n = 4, 24%). Conclusions: Our program’s prototype has been successful at detecting gaps in dialysis-based IP programs. By conducting data analyses of assessment findings, we have been able to assist the organization in establishing priorities for quality and performance improvement. Based on the results, comprehensive and robust systems to assess infection prevention programs, including those in dialysis settings, are necessary to enhance infection prevention operations across the continuum of care.Disclosures: None
Some like it hot: Variable impact of a tailpiece heating device on different gram-negative bacteria
Authors: Park Stacy , Kotay Shireen , Barry Katie , Carroll Joanne , Attai April , Guilford William , Mathers Amy 
Published: September 2023

Background: Transmission of multidrug-resistant bacteria to patients from colonized hospital sink drains has prompted attempts to interrupt transmission through a variety of interventions directed at the wastewater environment. We previously found that use of a heating device designed to disrupt biofilm formation between the P trap and the sink drain, which is the major point of dispersal of bacteria to the patient-care environment, was associated with reduced risk of detectable gram-negative organisms on hospital sink drains. However, there was no observed effect on some important pathogens, including Pseudomonas aeruginosa and Stenotrophomonas maltophilia. We hypothesized that heating to a higher temperature would provide additional efficacy in preventing drain colonization. Methods: As part of a previous randomized study, 54 tailpiece heaters were installed in 3 intensive care units in an academic hospital and 2 acute-care units in an associated regional hospital; half of these devices were shams (ie, no heat). The devices were programmed to heat for 1 hour every fourth hour. Prior to this study, a device update increased the heating temperature (during the previous study the median heated temperature was 65.9°C). Sink drains and P traps were sampled monthly. Samples were assessed for semiquantitative growth of gram-negative bacteria on MacConkey agar, looking especially for P. aeruginosa and S. maltophilia. Frontline personnel were blinded to device assignment. Results: The mean heated temperature reached was 74.4°C. Based on proportional odds logistic regression (wherein the odds ratio reflects the likelihood of a given sample falling in a lower microbiologic burden level versus the levels above it), the heating device was associated with increased likelihood of lower microbiologic burden at the drain level for general growth on MacConkey agar (OR, 2.47; 95% CI, 1.11–5.51) and for growth of S. maltophilia (OR, 5.39; 95% CI, 2.20–13.18). The device did not have an effect on burden of Enterobacterales (OR, 1.38; 95% CI, 0.58–3.24). For P. aeruginosa, there was a trend toward decreased likelihood of lower microbiologic burden (OR, 0.41; 95% CI, 0.18–1.07) that did not reach statistical significance at the drain level, and the heating device was associated with decreased likelihood of lower microbiologic burden of P. aeruginosa at the P-trap level (OR, 0.20; 95% CI, 0.10–0.39). Conclusions: Heat disruption of biofilm between the P trap and sink may be a promising strategy for prevention of hospital sink drain colonization; however, the impact is variable across different bacterial species. Further understanding of the dynamics of the microbiome within wastewater is needed.Disclosures: None
Healthcare worker perceptions about infection prevention and control processes and practices in Latin America
Authors: Fabre Valeria , Beccar-Varela Pilar , Herzig Carolyn , Reyes-Morales Guadalupe , Rock Clare , Quiros Rodolfo 
Published: September 2023

Background: The burden of hospital-associated infections (HAIs) and antimicrobial resistance (AMR) in Latin America is high. Improving engagement by healthcare workers (HCWs) in infection prevention and control (IPC) may lead to better patient outcomes; however, little is known about HCW perceptions of IPC in the region. We sought to understand HCW perceptions of IPC processes and practices. Methods: During August–September 2022, HCWs from 30 hospitals with IPC programs in 4 Latin American countries (Panama, Guatemala, Ecuador, and Argentina) were invited to participate in an electronic, voluntary, anonymous survey about their perceptions of IPC at their hospitals. Physicians, nurses, and environmental care (EVC) personnel were prioritized for recruitment. All respondents were asked 18 questions; IPC team members were asked 5 additional questions about specific activities implemented by IPC programs, how data are used, and how IPC could be improved. Answers with 5-point Likert scale responses were categorized into 2 groups (eg, strongly agree or agree vs neutral, disagree, or strongly disagree) for analysis. Results: Of 1,252 HCWs who completed the survey, 181 (14%) were IPC team members, 1,095 (87%) had direct patient contact, and 1,156 (92%) worked >20 hours per week. Figure 1 shows participant characteristics. Most participants (56%) rated their IPC program as very good, 38% rated it as good, and 6% rated it as bad. Physicians were less likely to give a favorable rating. Compliance with prevention bundles and hand hygiene (HH) by colleagues was rated as poor by 28% and 22% of HCWs, respectively; however, only 11% and 5% indicated that their own compliance was poor, respectively. Also, 25% of participants reported not receiving or only occasionally receiving HH compliance data. Similarly, 41% of participants reported not receiving HAI data on a regular basis, and 19% of IPC nurses reported not receiving data despite being responsible for conducting surveillance. Furthermore, 41% of respondents indicated not receiving or only occasionally receiving IPC training or education relevant to their role. When asked about the safety climate, 16% of participants reported not feeling appreciated. In addition, 22% of IPC nurses and 37% of individuals in the “other” category (eg, health technicians and therapists) were more likely to report this. When IPC team members were asked how frequently specific activities were conducted (Fig. 2), several opportunities for improvement were identified, including improving HCW access to HH data and development of strategic plans. Conclusions: Improving HCW access to training on IPC and to data on HAI burden and compliance with HH and prevention bundles should be emphasized in Latin American hospitals.Disclosures: None
Oregon Project Firstline: A needs assessment of healthcare personnel infection prevention knowledge and training preferences
Authors: Ida Nicholas , Guzman-Cottrill Judith , Tammer Roza , Pierce Rebecca , Tran Dat 
Published: September 2023

Background: Infection prevention and control (IPC) competency is critical for healthcare personnel (HCP) and patient safety. In collaboration with the CDC new national IPC training collaborative called Project Firstline, the Oregon Health Authority’s (OHA) Healthcare Associated Infection (HAI) Program established a state-level program in 2021. The goal of Oregon Project Firstline is to provide relevant, accessible, and engaging IPC training materials for our state’s HCP. We assessed the IPC learning needs of Oregon’s healthcare workforce, and to understand the preferred methods and formats of training across the various HCP roles. Methods: OHA’s HAI program recruited HCP by distributing electronic surveys through multiple healthcare, regulatory, and public health partners’ email listservs and HCP-targeted newsletters. Survey responses were recorded from September 23 to December 10, 2021. The HAI program assessed respondents’ IPC knowledge, online and in-person job training preferences, frequently used training devices, and trusted sources for IPC information. An individual’s understanding of an IPC topic was categorized based on their self-assessed confidence in their knowledge and ability to teach the topic to others. In total, 6,382 surveyed responses were analyzed. Results: The average understanding among HCP was lowest in IPC topics relating to triage and isolation of contagious patients and fit testing of respiratory protection devices. For these topics, 3,208 HCP (66.21%) and 3,657 HCP (75.48%) HCP, respectively, did not understand the topic well enough to teach others (Fig. 1). The highest number of HCP (n = 2,512, 39.36%) requested additional training in methods on how to educate others about IPC topics (ie, “train the trainer”). Surveyed respondents most frequently used personal computers for job trainings in both work and at-home settings (n = 4,603, 72.12%) and 3,437 HCP (53.85%) were open to either in-person or remote formats for job education. The CDC and OHA were the most frequented and trusted IPC sources among surveyed HCP: 4,124 HCP (64.62%) and 3,584 HCP (56.16%), respectively. Conclusions: IPC is a critical topic in HCP training across all healthcare facility types and employee roles. Effective educational planning includes understanding the learners’ knowledge needs and preferred methods of learning. Our learning needs assessment identified important IPC knowledge gaps and will help ensure that our training courses will be offered in effective educational formats for Oregon’s diverse HCP. Future training will include appropriate triage of potentially infectious patients, respiratory fit testing, and general IPC “train the trainer” sessions. Additionally, we will offer both in-person and remote options.Disclosures: None
How COVID-19 spread varied by resident length of stay and resident–staff transmission pathways over time in US nursing homes
Authors: Healy Jessica , Paul Prabasaj , Singh Brajendra , Stone Nimalie , Slifka Kara Jacobs , Slayton Rachel 
Published: September 2023

Background: Pathogen transmission among staff and residents in nursing homes can vary depending on their interactions and by the amount of time a resident receives care in the facility. Understanding the relative differences in transmission rates between and among staff and residents can identify the pathways that contributed most to the spread of SARS-CoV-2 in US nursing homes. Further exploring relative differences by categorizing facilities by residents’ lengths of stay can identify priority categories for intervention. Methods: Using US National Healthcare Safety Network (NHSN) surveillance data on resident and staff cases, vaccination, and resident deaths during June 2020–June 2022, we estimated SARS-CoV-2 transmission among and between residents and staff. We used a Bayesian inversion of a susceptible–exposed–infected–removed–virus–death (SEIRVD) compartmental model to produce the estimates. The facilities were divided into those with median length of stay (LOS) among the residents of 10 weeks. Additional inputs included the incidence and vaccination levels of the county where each facility was located. For the compartmental model, all data were averaged to form a representative facility for each category. Transmission was estimated separately for 3 periods: (1) June 2020–March 2021 as before the SARS-CoV-2 delta variant, (2) April 2021—October 2021 during SARS-CoV-2 delta variant dominance, and (3) November 2021—June 2022 during the prevalence of the SARS-CoV-2 omicron variant. Results: Regardless of facility category, transmission was highest from staff to residents or resident to resident (Fig.). These estimates of transmission were highest during the pre–SARS-CoV-2 delta variant phase. Transmission in that phase was highest in the facilities with LOS >10 weeks from staff to residents at 0.88 per week (95% credible interval [CrI], 0.06–1.85), in the facilities with LOS 6–10 weeks from staff to residents at 0.68 per week (95% CrI, 0.03–1.78), and in the facilities with LOS <6 weeks between residents at 0.47 per week (95% CrI, 0.02–0.95). Conclusions: Staff-to-resident or resident-to-resident transmission were the dominant pathways of spread of SARS-CoV-2 across the periods or the facility categories. Facilities with LOS 6 weeks or longer had higher median transmission estimates across the periods and transmission routes compared to facilities with LOS less than 6 weeks, implying that when prioritization of intervention resources is needed, facilities caring for populations with longer stays could be prioritized.Disclosures: None