bluuebunny/crossref_metadata_2025_split huggingface dataset:
1184. Structural Characteristics of Alcohol Venues are Associated with Positive HIV Test Results in Rural KwaZulu-Natal, South Africa
Authors: Norton Sarah , Morojele Neo , Friedland Gerald , Moll Tony , Shenoi Sheela 
Published: December 2022

Abstract

Background
The HIV epidemic in South Africa is among the largest in the world with a prevalence of 20% among adults. The South African National Strategic Plan recognizes the need to address social and structural barriers to HIV prevention, as well as sociocultural and behavioral drivers, including alcohol abuse. Alcohol venues (AVs) are important social venues, yet few studies have explored structural factors contributing to HIV risk. We sought to evaluate the relationship between structural characteristics of AVs and HIV status of patrons.

Methods
The study was conducted in rural Msinga, South Africa where, as part of a community-based approach, education, counseling and HIV testing was offered at a convenience sample of AVs. Nested within this study, staff completed a structural characteristic checklist of the AVs where testing occurred. Categorical analyses evaluated the association between structural characteristics and positive HIV results.

Results
Of the 488 individuals tested at 46 AVs, 43 (8.8%) were seropositive. The majority of AVs were rural (71.7%), along a gravel road (43.5%), un-registered (56.5%), informal (73.9%), lacked a liquor license (58.7%), were well-maintained (78.3%), single rooms (84.1%) with lighting (97.8%), make-shift seating (62.2%), and adjacent to outdoor space (65.8%). Sound systems (41%) and bathrooms (37%) were less common. Preventative health signage for under-age drinking (26%), smoking cessation (8.7%) and HIV prevention (2.2%) were rare. Several AVs employed women to work behind the bar; security guards and DJs were less common. Higher HIV prevalence was significantly associated with AVs that were well-maintained (p=0.008), in town (p=0.006) compared to remote, had an indoor toilet (p=0.004), discrete gender bathrooms compared to a single bathroom (p=0.003), and a security guard present (p=0.047).

Conclusion
Higher HIV prevalence was associated with certain structural characteristics of AVs. Further research is needed to understand social dynamics within AVs and how these structural characteristics facilitate risk behaviors to inform community-based interventions that can address HIV risk.

Disclosures
Sheela Shenoi, MD MPH, Merck: My spouse worked for Merck 1997-2007 and retains stock in his retirement account. There is no conflict with the work presented in the abstract.
1194. Efficacy of shortened high-level disinfection (HLD) protocols for GI duodenoscopes with disposable tips used for endoscopic retrograde cholangiopancreatography (ERCP)
Authors: Warren Bobby G , Muralidharan Sriya , Brown HannahSofia , Barrett Aaron , Graves Amanda M , King Carly , Mohammed Fahad S , Triplin Carlos , Anderson Deverick J , Seidelman Jessica , Smith Becky A , Dufault Darin 
Published: December 2022

Abstract

Background
The most efficient combination of manual washes (MW) and high-level disinfection (HLD) cycles for the reprocessing of duodenoscopes used for ERCP is unknown. The FDA recently announced the national recommendation for transition to duodenoscopes with disposable components.

Methods
We studied contamination of Pentax Medical duodenoscopes with disposable tips used for ERCP. Duodenoscopes were cleaned and disinfected following removal of the disposable tip. First, one manual wash was performed with detergent and brushes that fit into the suction channel, air/water valves, cylinder, and elevator chamber. Afterward, the duodenoscope underwent HLD with an automated endoscope re-processor. Our study evaluated the success of an abbreviated cycle of one MW followed by one HLD (MW-HLD) cycle compared to a pair of MW-HLD cycles.
Each duodenoscope was sampled in 4 locations after the first MW-HLD cycle and the second: 1) The elevator tab, 2) elevator channel distal opening, 3) composite duodenoscope tip, and 4) the elevator channel (Figure 1). Samples 1-3 were collected with flocked swabs. Swabs were plated on routine medias for relevant enteric pathogens. The 4th was collected by flushing 25 mL of neutralizing buffer through the elevator channel, then scrubbing the channel with a brush, followed by another 25 mL flush. The 50 mL eluent was vacuum filtered through a 0.22-micron filter and plated on TSA. Antibiotic resistance was assessed via PCR. CFU and proportion of contaminated scopes were compared between MW-HLD cycles.

Results
46 duodenoscopes were sampled from September 2021 through March 2022 resulting in 92 sample events and 368 total samples. After one MW-HLD cycle, 19 of 46 (41%) duodenoscopes remained contaminated, including 5 (11%) with VRE (Table 1). After two MW-HLD cycles, 11 (24%) remained contaminated and 0 (0%) with VRE (p=0.08, 0.02, respectively). Results were similar at the sample location level (p=0.03, 0.01, respectively).
Proportion of duodenoscopes contaminated with any flora and Vancomycin-resistant Enterococcus spp.

Conclusion
Our data demonstrate that 1 MW-HLD cycle is insufficient at decontaminating duodenoscopes with disposable tips but do support the use of two MW-HLD cycles. VRE was identified after one MW- HLD cycle, but not after two MW-HLD cycles. Further studies are needed to determine the optimal combination of MWs and HLDs while minimizing HLD staff time.

Disclosures
All Authors: No reported disclosures.
1575. Screening Plus Outreach Versus Referrals to Identify Patients for Outpatient COVID Medications
Authors: Parzen-Johnson Simon L , Sun Shan , Patel Sameer 
Published: December 2022

Abstract

Background
Scarcity of therapeutics to treat Coronavirus Disease 2019 (COVID-19) during the surge in cases caused by the Omicron variant raised concerns that structural inequities would decrease access to these medications for racial minorities and patients with lower socioeconomic status. We hypothesized that screening plus outreach would increase identification of eligible patients in these vulnerable patient populations when compared to referrals alone.

Methods
A retrospective cohort study of COVID medication allocation was performed at a quaternary pediatric medical care facility between 1/1/22–2/15/22. The two cohorts were patients referred for COVID therapy and patients identified via screening followed by outreach. Screening plus outreach included daily review of laboratory reports for new positive cases of SARS-CoV-2, followed by chart review for high-risk conditions, and communication with providers or directly with eligible patients to offer therapy. Demographic characteristics, chronic medical conditions, socioeconomic parameters, and medication receipt were compared between the two groups.

Results
Overall, 51 and 94 patients were identified via referral and screening plus outreach, respectively. Thirty-two patients received medication of which eight (25%) were identified by screening plus outreach alone. Compared to referred patients, patients in the screen plus outreach group were more likely to have moderate, low, or very low childhood opportunity index (COI) scores (74.5% vs 52.9%%, p = 0.009); public health insurance (69.1% vs 37.5%, p &lt; 0.001); asthma/obesity (63.8% vs 21.6%, p &lt; 0.001), and race/ethnicity other than White, Non-Hispanic (79.8% vs 54.9%, p = 0.002). Patients in the referral group were more likely to receive medication (47.1% vs. 8.5%, p &lt; 0.001).

Conclusion
Compared to referral, screening plus outreach for COVID medications can increase identification of patients who are racial minorities, have asthma/obesity, and have lower socioeconomic status. Future studies should investigate communication strategies to improve uptake of these medications after outreach.

Disclosures
All Authors: No reported disclosures.
1207. Epidemiology and Timing of Infectious Complications from Battlefield-Related Burn Injuries
Authors: Geringer Matthew , Stewart Laveta , Shaikh Faraz , Carson Leigh , Lu Dan , Cancio Leopoldo C , Gurney Jennifer M , Tribble David R , Kiley John L 
Published: December 2022

Abstract

Background
Thermal injury alters the host response, making burn patients more susceptible to infections. In fact, infections represent the most frequent complication and cause of mortality in burn patients. We describe the epidemiology, clinical characteristics, timing, and outcomes of infections among wounded military personnel with burns.

Methods
Data were collected through the Trauma Infectious Disease Outcomes Study, an observational study of US service members injured in Iraq and Afghanistan (6/09-12/14). Patients who sustained ≥1 burn injury and were admitted to the Burn Center at Brooke Army Medical Center were included in the analysis. Infections were defined using standardized criteria. For patients with multiple infections, only the initial infection was assessed.

Results
Among 144 burn patients, 99% were males and 62% had combat-related burns with a median total body surface area (TBSA) of 6% (IQR 3-14%) thermally injured. Infections were diagnosed in 26 (18%) patients with pneumonia being the predominant initial syndrome (N=16, 62%), followed by skin and soft-tissue infections (N=6, 23%), bloodstream infections (N=3, 12%), and intra-abdominal infections (N=1, 4%). Median number of days to each of these initial infecting syndromes were 4 (IQR 3-5), 7 (IQR 4-12), 7 (IQR 6-7), and 17 (IQR 17-17) days, respectively. Patients with infections were more severely injured with greater TBSA (median 31 vs 5) and Baux scores (median 59 vs 29), and were more likely to have combat trauma, inhalation injury, require mechanical ventilation, and have longer time to definitive grafting (Table 1). Microbiology of initial infections varied with 35% of patients having polymicrobial infections (Table 2). Gram-negative organisms were recovered from 20 (77%) patients, of whom 20% had a multidrug-resistant Gram-negative. Gram-positive organisms and fungi were identified in 42% and 8% of patients, respectively.

Conclusion
Improved understanding of risk factors and the timing of infections in this unique population is critical for effective management. Patients with infections were more severely injured, had higher rates of inhalational injury, and longer days to definitive grafting. Initial infections were more commonly pneumonia.

Disclosures
David R. Tribble, DrPH, AstraZeneca: The HJF, in support of the USU IDCRP, was funded to conduct or augment unrelated Phase III Mab and vaccine trials as part of US Govt. COVID19 response.
1210. A Lean Six Sigma Approach to Improving Accuracy of Manual Hand Hygiene Observations
Authors: Drees Marci , Bonis Kathleen , Coles Krystal , Emberger John , Littleton Lauri , Mirage Mark , Mount-Campbell Austin , Briody Carol 
Published: December 2022

Abstract

Background
Hand hygiene (HH) is widely regarded as the most important factor in preventing transmission of infections. Since 2012 our health system has utilized unit-based direct observation to measure HH compliance. Although direct observation is widely used and considered gold standard, the discrepancy between unit-based HH compliance (UB-HH) and Infection Prevention validation HH audits (IP-HH) was increasing over time. To understand the drift in HH compliance, we began a Lean Six Sigma (LSS) Green Belt project to improve UB-HH observation accuracy.

Methods
The IP LSS Green Belt team included nursing, respiratory care, and human factors, and analyzed factors leading to inaccurate UB-HH using LSS tools including the Voice of the Customer, process mapping, fishbone diagrams, and failure modes and effects analysis. We updated HH observer web-based education; implemented a new process to ensure observer training; and eliminated unit report card penalties for poor UB-HH. We implemented a new, more accessible observation tool, which provides a dashboard for real-time access to HH results by all staff. IPs began weekly validation HH audits.

Results
Baseline data revealed a 34% discrepancy between UB-HH and IP-HH compliance (95% vs 61%) over 4 different monthly validation events; only 27% of observers had completed web-based training. Goal conflicts were discovered: units were penalized for poor HH, yet the observations were unit level self-report. These results prompted design changes to the online tool and the process flow of UB-HH observation; units implemented the new program sequentially between 9/20 and 12/20. These changes resulted in 99% of observers being web-trained; however, between 10/21-3/22, UB-HH compliance averaged 98% (n=19,940), while IP-HH compliance averaged 53% (n=579) (difference, 45%).

Conclusion
Using multidisciplinary process improvement, we enhanced our manual HH observation processes; however, no improvement in HH accuracy was observed. Unit-based staff, who lack dedicated time for HH observation, are biased to document HH compliance over non-compliance, even with recent re-training in non-biased HH observation processes and elimination of penalties. To improve HH accuracy, we recommend either dedicated neutral HH observers or automated systems.

Disclosures
All Authors: No reported disclosures.
1214. The Effects of Modified Personal Protective Equipment (PPE) Protocols on Healthcare Personnel Providing Patient Care During the COVID-19 Pandemic: A Qualitative Assessment
Authors: Chasco Emily E , da Silva Jaqueline Pereira , Jones DeShauna , Dukes Kimberly , Ward Melissa , Herwaldt Loreen 
Published: December 2022

Abstract

Background
Healthcare personnel (HCP) faced personal protective equipment (PPE)-related challenges during the COVID-19 pandemic including supply shortages, additional PPE items, different designs, and modified protocols (PR)/guidelines. We used a human factors engineering- and ethnography-informed approach to qualitatively assess the effects of these challenges on HCP and their PPE use during the pandemic.

Methods
We observed PPE use (e.g., donning/doffing) by HCP caring for patients with COVID-19, those under investigation (PUI), and those with other conditions in 1 acute, 1 intermediate, and 1 intensive care unit at a large Midwestern academic hospital. We conducted mini-interviews with a subset of HCP to clarify observed behavior and identify PPE-related concerns. We captured observation, interview, and additional data (e.g., unit layouts, signage) in structured and unstructured notes. We transcribed and imported notes into MAXQDA and applied a deductive-inductive analytical approach.

Results
From April-July 2021, we observed 188 patient care episodes and conducted 47 mini-interviews. Observations included COVID-19 (n=102), PUI (n=4), and non-COVID-19 (n=82) rooms on varying isolation precautions. PRs related to masks and eye protection changed during the study period and particularly affected donning practices. Other barriers included time-intensive PRs, unclear PR communication, unfamiliar designs, lack of surfaces on which to set supplies while donning/doffing, and inconvenient PPE storage/cleaning locations. We observed recommendation/PR deviations related to PPE use (e.g., exposed wrists, unapproved/no eye protection), cleaning, and signage/storage (e.g., designated “clean” surfaces). HCP reported PPE extended use/reuse, provision of design options, and their own adaptations (e.g., “batching” tasks, modifying PPE) facilitated donning/doffing. New PPE requirements highlighted tensions between HCP comfort and safety; despite this, some wanted to include modified PRs in their routine infection prevention practices permanently.

Conclusion
PPE use barriers and facilitators related to modified COVID-19 PRs have implications for the ongoing pandemic and future respiratory pathogen outbreaks.

Disclosures
Loreen Herwaldt, MD, 3M: • 3M is providing products for one of Dr. Herwaldt’s research studies unrelated to the work reported here.|PDI Healthcare: PDI Healthcare has provided research funding to Dr. Herwaldt unrelated to the work reported in this abstract.
1220. Public Health Investigations of Water-Related Organisms in Neonatal Intensive Care Units—United States, 2014–2022
Authors: Keaton Amelia , Li Ruoran , Glowicz Janet , Stuckey Matthew J , Perz Joseph , Perkins Kiran M 
Published: December 2022

Abstract

Background
Preterm and critically ill infants cared for in neonatal intensive care units (NICUs) are vulnerable to a wide variety of infections. Water use in healthcare settings is a known risk factor for opportunistic pathogen transmission due to the ability of such pathogens to persist in premise plumbing, though facility water risk assessments may also not account for practices within NICUs. We describe Centers for Disease Control and Prevention (CDC) consultations involving NICU patients and water-related organisms to help inform infection prevention and control response.

Methods
We searched internal CDC records from January 1, 2014, through December 31, 2021, to identify consultations involving investigations of potential or confirmed transmission of water-related organisms in NICU settings. We used available information to determine number of consultations and patients affected, most common organisms implicated, and potential exposure pathways and transmission routes.

Results
Of 92 consultations involving NICUs in the United States during the study period, we identified 30 consultations (33%) of water-related organism infections or outbreaks; combined, water-related organisms were isolated from 178 patients during these investigations. Serratia marcescens was the organism reported in the greatest number of investigations (n=10, 33%), followed by Pseudomonas spp. and Burkholderia cepacia complex (each n=4, 13%). Definitive transmission routes were not determined for all consultations, though investigations frequently identified concerns with water use in infant activities of daily living, such as bathing or feeding (n=14, 47%). Examples of such exposures unique to the NICU setting included the use of tap water to remove disinfectant residue from humidified isolettes and storage of supplies rinsed in water in infant bath basins to dry.

Conclusion
Consultations involving water-related organisms are common in the NICU. While clear sources of transmission are not always found, investigations often identified water exposures that may pose infection risks. To protect critically ill infants, hospitals should account for the extensive and unique characteristics of water use in NICUs when developing water management programs.

Disclosures
All Authors: No reported disclosures.
1229. Evaluation of Colorectal and Hip/Knee Arthroplasty Surgical Site Infections at Ocean University Medical Center
Authors: Ismail Omar , Nissim Yosef , Kerr Nancy , Lake Thomas , Dwivedi Sukrut 
Published: December 2022

Abstract

Background
A surgical site infection (SSI) is defined as an infection that occurs up to 30 days after surgery without an implant (or within one year if an implant is placed). The infection also must appear to be related to surgery. In 2021, there were 19 SSIs reported at Ocean University Medical Center (OUMC). These SSIs were associated with colorectal and hip/knee arthroplasty cases. The primary objective of this study is to evaluate appropriate preoperative antibiotic administration based on the type of surgical procedure. Some secondary objectives include the number of preoperative antibiotics administered and the appropriate timing of preoperative antibiotic administration.

Methods
A retrospective observational evaluation was conducted on patients identified to have a SSIs from January 1, 2021, to December 31, 2021. Appropriate preoperative antibiotics were defined as the administration of guideline-recommended antibiotics for the given procedure. Appropriate timing of antibiotics was defined as antibiotics administered within guideline-recommended time frames prior to procedure start time. Descriptive statistics were used to analyze the results.

Results
Of the 19 infections, ten were associated with colorectal procedures, and nine were associated with hip/knee arthroplasty procedures. Patients received preoperative antibiotics in 89% of the surgeries (17 of 19). We found that 71% (12 of 17) of patients received appropriate antibiotics determined by the surgical procedure. Of the five inappropriate antibiotic selection instances, two lacked appropriate bacterial coverage, while the other three covered the suspected pathogens but were not guideline-recommended agents. The timing of preoperative antibiotics was found to be appropriate in 76% of all surgeries. When assessing the overall compliance with antibiotic selection and timing, 58% (11 of 19) of cases followed all guideline recommendations.

Conclusion
This study has identified areas of improvement regarding the antimicrobial selection and timing, documentation process of administration, and the use of order sets to combat inappropriate prescribing of surgical antimicrobial prophylaxis. Educational materials and in-services have been provided at OUMC.

Disclosures
All Authors: No reported disclosures.
1232. Mupirocin Susceptibility of Staphylococcus aureus (SA), 2022: Is It Time for Change in MRSA Decolonization?
Authors: Shah Sonia , Labrecque Sophie , Fergus Diedre , Parry Michael F 
Published: December 2022

Abstract

Background
Nasal decolonization with mupirocin has been a commonly used strategy for the prevention of surgical site infections (SSIs) due to SA. We recently noted an increase in SSIs due to SA despite the use of mupirocin, including a case of post-operative mupirocin-resistant MRSA infection despite intranasal mupirocin. We therefore evaluated the mupirocin susceptibility of SA at Stamford Hospital to determine the optimal regimen for decolonization.

Methods
SA isolates were recovered from clinical and screening samples received in the microbiology laboratory from 8/1/2020 to 2/28/2022. Mupirocin susceptibility was determined using e-tests and a standardized inoculum on Mueller-Hinton agar. Isolates were categorized as “susceptible” (MuS) with minimum inhibitory concentrations (MIC) ≤4 mcg/ml or resistant (MuR) with MIC values ≥8mcg/ml. Resistant strains were further divided into low-level resistance, with MIC values from 8 to 256 mcg/ml, and high-level resistance, with MIC values &gt;256/ml. SA isolates were identified and tested for susceptibility by usual Clinical Laboratory Standards Institute (CLSI) criteria.

Results
223 unique SA isolates from 218 patients were tested. Patients ranged in age from newborn to 94 years. Twenty-four SA isolates (10.8%) were resistant to mupirocin (20 MRSA and 4 MSSA). Of the 24 MuR strains, 19 (79.2%) isolates demonstrated high-level resistance. MRSA strains were more likely to be resistant (22.5% were MuR) than MSSA strains (3.0% were MuR) (p&lt; 0.001). MuR strains did not differ from MuS strains with respect to patient age, sex, race, site of isolation, infected versus colonized, community-acquired versus hospital-acquired or inpatient/out-patient location.

Conclusion
Preventing surgical site infections is challenging. Decolonization with mupirocin nasal ointment has been a common component of preoperative optimization. However, the emergence of resistance would render mupirocin suboptimal and other regimens might be preferred. In our study, less than 80% of MRSA strains were MuS. These findings are concerning and have led us to reevaluate our current decolonization strategy. In patients colonized with MRSA at high risk for infection (e.g. total joint replacement), intranasal povidone iodine may be preferable to mupirocin.

Disclosures
All Authors: No reported disclosures.