bluuebunny/crossref_metadata_2025_split huggingface dataset:
1193. Disinfection of the Sink Drains to Reduce a Source of Serratia marcescens During Infection Outbreaks in a Neonatal Intensive Care Unit
Authors: Bourdin Thibault , Benoit Marie-Ève , Charron Dominique , Bédard Emilie , Prévost Michèle , Quach Caroline , Déziel Eric , Constant Philippe 
Published: December 2022

Abstract

Background
Sink drains are known reservoirs of pathogens and have been associated with multiple nosocomial outbreaks. In this study, the distribution of Serratia marcescens was investigated within the sink environment of a NICU and in colonized or infected newborns. The effect of different types of drain disinfection on bacterial concentration and on the detection of Serratia marcescens in sink drains was also investigated.

Methods
Sink drains from a NICU were sampled: 20 drains sampled for 6 weeks in the first year and 28 drains sampled for 5 months in the second year. S. marcescens isolated from positive patients were collected. A high-throughput short sequence typing (HiSST) method was developed to identify S. marcescens and compare strains and environmental DNA from sink drains with 56 clinical strains from 5 nosocomial outbreaks. Five interventions were tested: self-disinfecting drains, hot water disinfection, chlorine disinfection, steam disinfection and hot tap water flushing. Bacterial concentration of samples was measured in culture and flow cytometry and the HiSST method was used to identify S. marcescens.

Results
During the first and second sampling campaigns, 40% and 60% of sink drain samples were positive for S. marcescens with a moderate genotype diversity (1 to 11 different STs). The genotype profile of the 56 clinical strains was heterogeneous (26 STs). Four distinct STs were retrieved in 8 sinks after detection in patients whereas 1 ST was detected in a sink before detection in patient. Some environmental and clinical strains were found in drains for up to a year after the first sampling campaign. Each tested drain intervention reduced culturable bacteria (4-8 log) and viable bacteria (2-3 log), except for chlorine. The self-disinfecting drains, hot water and steam disinfection were able to remove temporarily S. marcescens from the drains.

Conclusion
The high genotypic diversity of the clinical strains suggests diffuse sources of S. marcescens within the NICU likely to cause nosocomial infection outbreaks. The self-disinfecting drains, hot water and steam disinfection seem to be the best methods to reduce bacterial concentration in drains and eliminate S. marcescens in the short term, thus limiting the risk of pathogens spread from the sink environment to patients.

Disclosures
All Authors: No reported disclosures.
1574. Patient, Health System, and Clinical Encounter Characteristics Associated with Use Of Antibiotics Without A Prescription In The United States
Authors: Grigoryan Larissa , Paasche-Orlow Michael K , Alquicira Osvaldo , Barning Kenneth , Mahmood Hamad , Porter Thomas , Khan Fareed , Salinas Juanita , Raphael Jean , Fowler Michele , Street Richard , Trautner Barbara 
Published: December 2022

Abstract

Background
Use of antibiotics without a prescription (purchased in the United States (U.S.), purchased in other countries, or obtained from friends and relatives) is potentially unsafe and may increase the global risk of antimicrobial resistance. We evaluated the effect of patient, health system, and clinical encounter factors on intention to use antibiotics without a prescription.

Methods
Waiting room survey conducted from January 2020 and March 2021 in three continuity and three same-day public primary care clinics and two private emergency departments. Non-prescription use was defined as the consumption of antibiotics not prescribed for the individual’s current condition. Intended use was defined as professed intention to take antibiotics if feeling sick, without contacting a doctor, nurse, or clinic, in any of the following situations: 1) buying antibiotics without a prescription in the U.S., 2) buying antibiotics without a prescription in another country, and 3) getting antibiotics from friends or relatives. The effect of patient, health care system, and clinical encounter factors were studied using multivariate logistic regression.

Results
Of the 564 respondents, 247 (43.8%) reported prior use of non-prescription antibiotics; half of these instances involved penicillins (mostly amoxicillin). Overall, 177 (31.4%) of the respondents intended to use antibiotics without a prescription from one of the three sources (Figure 1). Younger age, lack of health insurance and high cost of doctor visits were predictors of intention to buy antibiotics without a prescription in the U.S. (Table 1). Predictors of intention to buy antibiotics without a prescription from other countries included younger age, being interviewed in Spanish, and reporting that a language barrier is a major problem for medical appointments. Lack of health insurance and high cost of physician visits were associated with the intention to use antibiotics obtained from relatives or friends.

Conclusion
Interventions aimed at reducing non-prescription antibiotic use should focus on addressing language barriers, ensuring health insurance coverage, and reducing financial barriers to primary care visits.

Disclosures
Larissa Grigoryan, MD, PhD, Rebiotix Inc: Grant/Research Support Michael K. Paasche-Orlow, MD, MPH, GlaxoSmithKline: Advisor/Consultant Barbara Trautner, MD, PhD, Genetech: Advisor/Consultant.
1200. Measuring the Contamination of Transport and Emergency Ambulances and Emergency Medical Service (EMS) Providers
Authors: Graves Amanda M , Schaps Diego , Isaacson Julia , Barrett Aaron , King Carly , Warren Bobby G , Anderson Deverick J 
Published: December 2022

Abstract

Background
Contamination of ambulances and EMS providers is poorly understood.

Methods
We conducted a prospective observational study to determine contamination of ambulances and EMS providers at two agencies in central North Carolina. Study ambulances and providers were enrolled and sampled prior to the start of day shift on each sampling day. Ambulances were then disinfected with bleach by a study member. Ambulances and providers were sampled again immediately following shift completion and before final disinfection.
Samples were obtained from ambulances and providers (Table 1). Cellulose sponges and flocked swabs used for sampling were pre-drenched with disinfectant neutralizing buffer. RODAC plates for clothing cultures were filled with disinfectant neutralizing agar. Sponges were processed using the stomacher method, swabs were plated onto media directly, and RODACs were read and worked up using standard microbiology techniques. All samples were plated on general and selective media for study pathogens. We calculated total colony forming units (CFU), total CFU for each sample area and proportions of samples harboring clinically important pathogens (CIPs), defined as MRSA, MSSA, and VRE. The Mann-Whitney U test was used to compare CFUs between samples, ambulances, and providers, and the Z score proportionality test was used to compare proportions of samples with CIPs. P &lt; .05 was considered significant. Table 1.Sampling Methods and Locations of Ambulance and EMS Providers

Results
10 emergency and 10 transport ambulances, and 40 providers were sampled from September 2021 - March 2022 resulting in 980 total samples. Transport and emergency truck CFUs (Table 2) were similar between sample 1 and 2 (p=0.1, 0.9, respectively). EMS providers CFUs were similar at sample 1 and 2 (p=0.2, 0.2, respectively). Before a shift, 100 samples harbored CIPs (19 MRSA, 66 MSSA, 15 VRE). Following the shift, 88 new CIPs were recovered (24 MRSA, 53 MSSA, 11 VRE). At Sample 1, 59 (59%) of CIPs were harbored on EMS uniforms, and 41 in ambulances. At Sample 3, 62 (70%) of CIPs were harbored on EMS uniforms. Other results can be seen in Table 2. Table 2.Median CFUs for Emergency and Transport Ambulances and EMS Providers by Sample, and Number of CIPs Recovered

Conclusion
Our data demonstrate provider uniforms were contaminated upon arrival and ambulances were contaminated when deemed ready for service. Further studies are needed to determine optimal disinfection procedures of ambulances and EMS uniforms.

Disclosures
All Authors: No reported disclosures.
1202. A Multi-Center Validation of the Electronic Health Record ‘Admission Source’ Field Against Clinical Notes for Identifying Hospitalized Patients with Long-term Care Facility Exposure
Authors: Goodman Katherine E , Taneja Monica , Magder Laurence , Resnik Philip , Sutherland Mark , Sorongon Scott , Klein Eili , Tamma Pranita , Harris Anthony 
Published: December 2022

Abstract

Background
A current or recent long-term care facility (LTCF) stay is a strong risk factor for antibiotic-resistant bacterial colonization and infection. However, most electronic health record (EHR) systems do not systematically record LTCF exposure. Absent manual chart review, which is resource-intensive and cannot be incorporated into automated screening algorithms, there is no definitive method for identifying LTCF-exposed inpatients. As a surrogate, researchers often use ‘Admission Source’ to identify LTCF transfers, but this EHR field has not been previously validated, and it may miss the unknown percentage of patients with recent, but not current, LTCF stays. This study evaluated the accuracy of ‘Admission Source’ in identifying LTCF-exposed inpatients.

Methods
This was a retrospective study of adult admissions from 2018 – 2021 across 12 hospitals in the University of Maryland Medical System. We extracted patient and encounter data and classified patients as LTCF-exposed by ‘Admission Source’ if they were LTCF transfers. For 315 randomly sampled admissions, M.T. and K.G. reviewed the admission ‘History & Physical’ note for mention of LTCF exposure (Fig. 1). Assuming an indication of LTCF in either the ‘Admission Source’ field or clinical note represented true exposure, we estimated each method’s sensitivity with 95% confidence intervals.

Results
Across 280,581 admissions, 9,476 (3.4%) had an ‘LTCF transfer’ admission source. In the validation sample, 26 (8.3%) were classified as LTCF-exposed by either ‘Admission Source’ or clinical note, of which 12 were identified in the ‘Admission Source’ field and 25 in the notes (Fig. 2). The sensitivity of ‘Admission Source’ for detecting LTCF exposure was 46% (29% – 65%) and for clinical notes was 96% (81% - 99%). Most (12/14) patients missed by ‘Admission Source’ were current LTCF residents (Fig. 3).

Conclusion
The EHR ‘Admission Source’ field misses the majority of inpatients with recent or current LTCF exposure, risking substantial misclassification in research studies and clinical algorithms that incorporate this variable. Automated techniques for analyzing free-text notes, such as natural language processing, could significantly improve detection of these patients to assist hospital epidemiology and infection control efforts.

Disclosures
All Authors: No reported disclosures.
1219. Outbreak Investigation of Burkholderia cepacia Linked to Contaminated Ultrasound Gel
Authors: Weyhmuller Carol , Lynch Caitlin , Maglio Michael , Milligan Sarah , Otero Sally , Sherman Eileen , Lindao Daniel H , Gilbert Brett , Chaparro-Rojas Fredy 
Published: December 2022

Abstract

Background
This presentation will highlight how a multiuse hospital product was determined to be contaminated with Burkholderia cepacia (BCC) in the summer of 2021. The investigation began when there was a cluster of inpatients at one campus with blood cultures growing BCC. A multidisciplinary team was quickly assembled to investigate these cases. Swift action by the system team identified the source of the contamination, removed the product from use, and implemented evidence-based guidelines for safe ultrasound gel use.

Methods
The investigation began with thorough chart reviews. An epi curve was created to visually display the outbreak. A literature review was conducted to review previous outbreaks of BCC. It was determined that all the patients had undergone ultrasound procedures. The team immediately focused on multiuse bottles of ultrasound gel.

Results
Initial case investigation revealed a cluster of 9 patients growing BCC. The specimen source was primarily blood, but 2 patients had cultures from other sources. Ultrasound was the only commonality found. 37 opened and unopened product samples of 9 different water-based products were sent to the lab for testing. BCC was identified in 8 samples of non-sterile ultrasound gel. Immediate action was taken to rapidly recall the product system wide. Supply Chain quickly purchased and distributed a replacement product at all campuses. The manufacturer was contacted, the Department of Health was notified, and Infection Prevention alerted neighboring health care systems.

Conclusion
Risk assessments were done to assess the use of ultrasound gel and the cleaning of transducers within the health care system. System wide education commenced for the proper use of ultrasound gel and equipment to prevent patient infections. A total of 11 patients were identified with BCC during the outbreak. Whole genome sequencing linked 10 of the patient isolates to a national outbreak associated with contaminated ultrasound gel. This investigation emphasizes both the need for rapid mobilization in the event of an outbreak to prevent additional morbidity and mortality and the importance of assessing appropriate use of non-sterile ultrasound gel and equipment within healthcare facilities.

Disclosures
Brett Gilbert, D.O., F.A.C.O.I., Pfizer: speaker bureau.
1225. The Perfect Storm: A Hardy and Lethal Pathogen and a Unit Filled with Immunocompromised Patients with Large Open Wounds. Troubles with Candida Auris in a Burn Intensive Care Unit
Authors: Moore Riley , Lie Louise , Pua Herminia , Slade David H , Rangel Sharon , Davila Anthony , Carson Joshua S , Parada Jorge Paiva 
Published: December 2022

Abstract

Background
C auris is an emerging often multidrug resistant pathogen capable of causing severe morbidity and mortality. C auris has been increasingly isolated from patients in skilled nursing facilities and hospitals, and has been associated with facility outbreaks. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and readily colonizes the environment posing an especially great risk to immunocompromised patients with large open wounds and long lengths of stay.

Methods
From 7/1/21 - 8/30/21 we noted a cluster of 4 patients with C auris in clinical cultures from the Burn ICU (BICU). A multidisciplinary team involving infection prevention, nursing/medical directors, health and safety, engineering, environmental services, and hospital leadership investigated the cluster as a potential outbreak. Mitigation measures involved a multi-modal response of C auris admission screening, weekly point prevalence testing of all BICU patients, environmental surface cultures, enhanced room cleaning, staff education, hand hygiene and personal protective equipment usage audits.

Results
11 cases of C auris were identified on our BICU from 7/1/21 - 2/28/22. 5 (45.5%) cases from clinical isolates, 1 (9.1%) from a BICU point prevalence screen on 12/15/21, 5 (45.5%) as a part of weekly point prevalence screens started on 1/1/22. 6 (54.5%) patients were admitted for burn related injuries, 2 (18.2%) for Steven Johnson Syndrome, 2 (18.2%) for necrotizing wounds, and 1 (9.1%) for COVID-19 pneumonia. Cases occurred in 6/10 rooms in the Burn ICU. One (9.1%) patient expired during this outbreak (not deemed to be from C auris infection).

Conclusion
Resilient infections like C auris pose a risk of nosocomial transmission and potential high morbidity and mortality to burn patients with impaired immune defense and large open wounds. A multidisciplinary team using targeted interventions including screening, education, enhanced cleaning eradicated the outbreak in our BICU. As of 5/1/22, we went 13 + weeks without identifying a new case. The last patient with C auris was discharged 3/16/22. To prevent future outbreaks, we created a standardized response plan and instituted a universal screening protocol for C auris targeting all patient admissions from skilled nursing facilities and admissions to all ICUs.

Disclosures
Jorge Paiva Parada, MD MPH, Shionogi: Honoraria.
1238. Evaluation of Children Exposed to Perinatal Hepatitis C in the US : A Literature Review
Authors: Saleh Ezzeldin , Rodriguez Marcela , Chaudhary Subhash 
Published: December 2022

Abstract

Background
Incidence of Hepatitis C virus (HCV) infection is rising in the United States (US), largely due to the ongoing opioid epidemic. In children, perinatal transmission is the most common route of HCV infection, which is almost always asymptomatic. Therefore diagnosis is confirmed by HCV antibody testing by ≥18 months due to persistence of maternal antibodies. Identification of HCV-infected infants is critical as up to 80% develop chronic HCV infections with significant morbidity and mortality. In this review, we examine studies evaluating appropriate testing for perinatal HCV.

Methods
We performed a systematic literature review with PubMed and Embase (through April 2022) for studies evaluating optimal testing of children exposed to perinatal HCV in the US. Full text articles in English were included and conference proceedings were excluded.

Results
We analyzed 13 articles; all were published in the last decade with study periods spanning from 1993 to 2018 [Table1]. Most of the studies were retrospective, except for one prospective and two before-and-after intervention. Rates of optimal HCV testing showed vast regional differences and varied widely, with rates as low as 7%. Only 3 studies achieved ≥ 50% complete testing, with the highest rate (61%) achieved in a study that adopted EMR-reminders for testing. The two interventional studies showed over 40% increase of adequate testing. Interventions included early engagement of caregivers at time of birth with consultation, education, and close follow-up, EMR leverage to document HCV-exposure and send reminders for final testing at 18 months of age. Five studies retrospectively evaluated maternal and infant risk factors associated with perinatal HCV testing [Table2].

Conclusion
Overall, rates of perinatal HCV appropriate testing were suboptimal and varied widely. Prospective and EMR-based interventional studies showed higher rates of testing. Innovative testing schemes, public health and social support programs, similar to perinatal HIV model, are strongly needed to substantially improve perinatal HCV management. Further prospective and interventional studies are needed to formulate effective guidelines for perinatal HCV evaluation, and to identify and address barriers and enablers to optimal perinatal HCV care.

Disclosures
All Authors: No reported disclosures.
1248. Relationship Between ALT and New HBV Biomarkers in HBV/HIV Coinfected Persons Started on Antiviral Therapy
Authors: Rouster Susan D , Blackard Jason T , Horn Paul S , Stec Michael E , Sherman Kenneth E , Anderson Mark C , Peters Marion G , Cloherty Gavin 
Published: December 2022

Abstract

Background
While HBV DNA has served as a primary biomarker of HBV infection, newer biomarkers including pre-genomic HBV RNA (pgRNA) and quantitative HBV surface antigen (qHBsAg) may prognosticate treatment responses better. We analyzed the changes in these biomarkers over time following initiation of antiviral therapy in persons living with HIV (PLWH) to determine the relationship to ALT, a key marker of liver injury. FigureBiomarker changes

Methods
NIH AIDS Clinical Trials Group Study 5127 enrolled HBV/HIV PLWH into a Phase 2 treatment trial that randomized them to receive 48 weeks of either tenofovir (TDF) or adefovir (ADV). ALT and HBV DNA were evaluated as measures of treatment response. Stored samples were tested for HBV pgRNA and qHBsAg at baseline, 4, 12, 24, 36, and 48 weeks. HBV pgRNA was isolated using RNA-selective extraction chemistry followed by a multiplex RT-qPCR that targets the HBV X and core targets on the m2000 system (Abbott Molecular, Des Plaines, Illinois). A sensitive second-generation assay with a lower limit of quantification (LLOQ) of 10 copies/mL was utilized. Quantitative HBsAg was determined by Abbott ARCHITECT (List# 6C36) with a LLOQ of 0.05 IU/mL. Data were analyzed using SAS® version 9.4.

Results
Overall, 47 study participants had sufficient samples for biomarker testing. Participants were predominantly male (93.6%) and identified as white, non-Hispanic (55.3%) or black (34%). Groups were evenly randomized to receive either TDF (n=23) or ADV (n=24). Baseline ALT mean was 64.9 U/L, and HBV DNA was 9.1 (+1.6) copies/mL. Pre-treatment pgRNA serum concentration was 7.0 (+1.3) log U/mL, and qHBsAg was 195,574 (+272,190) IU/mL. Over the course of treatment, pgRNA was significantly correlated with the change in serum ALT levels (r=0.48; p=0.0035) but not HBV DNA (r=0.21; p=0.226). ALT was negatively correlated with qHBsAg (r=-0.52; p=0.02). pgRNA was also highly negatively correlated with qHBsAg (r=-0.49l; p=0.03) but not HBV DNA (r=0.13; p=0.59). (Figure).

Conclusion
HBV pgRNA is a better predictor of ALT change – a key measure of hepatocyte injury – than HBV DNA in PLWH who are initiated on nucleotide/nucleoside therapy. Quantitative HBsAg is inversely associated with ALT levels, supporting the hypothesis that HBsAg inhibits immune mediated injury to hepatocytes.

Disclosures
Michael E. Stec, MSc, Abbott Laboratories: Employee of Abbott|Abbott Laboratories: Stocks/Bonds mark C. Anderson, PhD, Abbott Laboratories: Employment|Abbott Laboratories: Stocks/Bonds Marion G. Peters, MD, Aligos: Advisor/Consultant|antios: Advisor/Consultant|Excision Biotherapeutics: DSMB Gavin Cloherty, PhD, Abbott: Employee|Abbott: Stocks/Bonds|Abbott Labs: Employee.