bluuebunny/crossref_metadata_2025_split huggingface dataset:
1912. Addressing Uncertainty: An Evidence-Based, Data-Driven, Decision Matrix for Healthcare Operations During The COVID-19 Pandemic
Authors: Ausborn Valerie , Ostrosky-Zeichner Luis , Ellsworth Misti G , McInnis-Cole Tawanna A , Verrill Kristine Aleman , Lutz Shannon , Thomas Georgia , McCarthy James 
Published: December 2022

Abstract

Background
Uncertainty and continuously changing guidance for COVID-19 response has taken a toll on the mental health of all individuals. Growing uncertainty within a healthcare system can create stress and confusion, ultimately affecting patient care. We designed an evidence-based, data-driven, decision matrix for healthcare operations that adapts COVID-19 mitigation measures in a predictable fashion according to the CDC community risk level and wastewater positivity data.

Methods
A multidisciplinary team reviewed mitigation measures, published and internal data on the value and yield of these measures, and different operational aspects of a major healthcare system that are affected by COVID-19. The team also reviewed publicly available community risk metrics to then a create a decision matrix that adjusts mitigation measures and operational aspects in a predictable fashion according to COVID-19 risk in the community.

Results
When COVID-19 rates were low during the pandemic the yield of temperature and symptom screening was 0.19% people screening out and the yield of pre-procedure testing was 0.17% patients testing positive. Taking that into account, as well as published literature and public health guidance, we built the COVID-19 decision matrix shown in the figure, with adaptations for in-patient, out-patient, long-term care sites. The decision matrix was then posted online with a qualification that the enterprise COVID-19 status would only change with sustained changes ( &gt; 2 weeks) in CDC Community risk level or wastewater positivity. The enterprise COVID-19 status is inserted in all enterprise communications for operational awareness. The response to the COVID-19 decision matrix has been overwhelmingly positive by staff and visitors, with no safety or operational problems in the first month of implementation.

Conclusion
An evidence-based, data-driven, decision matrix provides predictable mitigation measures and operational responses to changes in the COVID-19 community risk levels and alleviates workforce uncertainty.

Disclosures
All Authors: No reported disclosures.
1914. Characteristics of Hospital Onset SARS Cov-2 Infections Before and After the Emergence of The Highly Transmissible Variant B.1.1.529 In a Comprehensive Cancer Center
Authors: Dib Rita Wilson , Spallone Amy , Khawaja Fareed , Bartek Jalen , Cantu Sherry , Dvorak Tanya , Feldman Adina , McMurry Hilary , Nahavandi Leila , Nguyen Kim , Odom Crystal , Hankins Amy , Gravis Linda , Chemaly Roy F 
Published: December 2022

Abstract

Background
SARS-CoV-2 B.1.1.529 (Omicron) variant was first identified in November 2021 in South Africa and was notable for its increased transmissibility and rapid spread worldwide. In the United States, this variant led to a surge in COVID-19 cases by December 2021. As a result, we experienced a steep rise in cases among patients and employees at our institution starting December 22nd, 2021. Therefore, we compared the incidence and characteristics of hospital-onset COVID-19 (HO-COVID-19) in our cancer patients prior to and during the surge of the Omicron variant.

Methods
We identified HO-COVID-19, as per the CDC definition, from our infection control surveillance database, and additional contact tracing information was reviewed to determine the possible sources of HO-COVID-19. Whole-genome sequencing studies were conducted randomly on nasopharyngeal swabs of patients and employees who had COVID-19 during the study period.

Results
Twenty-six HO-COVID-19 infections were identified from the beginning of the pandemic (February 2020) through February 2022 (Table 1). Only 17 cases occurred over 22 months from the beginning of the pandemic through early December 2021 (Figure 1). These HO-COVID-19 occurred during the 3 COVID-19 surges that were epidemiologically attributed to the variants seen prior to Omicron. Among these 17 patients, 12 (70%) were symptomatic, 9 (53%) had a link to an infected employee, 7 (41%) died during their hospitalization (3 of the deaths were attributable to COVID-19), and 10 (59%) recovered and were discharged. Over 6 weeks (from December 22nd, 2021, through February 1st, 2022), 9 HO-COVID-19 were discovered during the Omicron variant surge (Figure 1). Six (67%) of these patients were symptomatic, 8 (89%) had a link to an infected employee, 2 (22%) died (1 death was attributed to COVID-19 ), and 7 (78%) recovered and were discharged. Table 1.Characteristics and demographics of patients with hospital-onset COVID-19.Abbreviation: PCR, polymerase chain reaction; HOCI, hospital-onset COVID-19 infections.Figure 1.Bar chart of nosocomial COVID-19 cases graphed against line graphs of COVID-19 infections diagnosed weekly among patient and employee at MD Anderson Cancer Center between March 2020 through February 2022

Conclusion
The Omicron variant surge led to marked increases in HO-COVID-19 despite the continuous adoption of enhanced infection control practices, testing on admission, and daily symptoms screening of patients and employees.

Disclosures
Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support.
1919. Implementation of Hydrogen Peroxide Vapor (HPV) Decontamination of N95 Respirators for Reuse During COVID-19 Pandemic
Authors: Havill Nancy L , Martinello Richard A , Kenney Patrick , Bragg Cherie , Epright Jacqueline , Cintron Margaret , Solla Italo , Israel Scott 
Published: December 2022

Abstract

Background
To ensure an adequate supply of N95 respirators in response to the global shortages caused by the COVID-19 pandemic, we evaluated and implemented hydrogen peroxide vapor (HPV) to reprocess disposable N95 respirators. Previous work performed by our team showed that HPV was effective in eradicating viable viruses from experimentally contaminated N95 respirators and that they retained their breathability and filtering efficiency for 3 cycles of HPV disinfection.

Methods
A multidisciplinary team worked by performing experiments and PDSA cycles to develop the ultimate process. Key processes and stakeholders were identified and engaged in operations decisions.

Results
The respirator reprocessing program was successfully implemented. One of the critical components for its success was the implementation of a Personal Protective Equipment (PPE) liaison program which was developed to create a process and local, unit-level champion for the collection of used N95s and to educate the staff on the program and provide guidance per the hospitals’ PPE policy. A courier system was implemented for the collection, transport and delivery of bulk containers of respirators between facilities. Facility Services designed and constructed a centralized respirator reprocessing center to include a receiving location, a negative pressure decontamination area to sort and stage the respirators on racks, two HPV reprocessing rooms and a clean room to receive the reprocessed N95s and to repackage and label for distribution. Standard operating procedures, staff training and competencies, and logs for documentation were created.
Within 18 weeks (March 13, 2020 through July 2020), nearly 32,000 N95 respirators were reprocessed and packaged for redistribution utilizing the 2 HPV disinfection rooms and 5 full time employees. As built, there was capacity to reprocess 5,000 respirators per day and evaluated by the U. S. Food and Drug Administration (FDA) led to the issue of an Emergency Use Authorization.

Conclusion
This scalable program enabled YNHHS to ensure an adequate supply of respirators for the safety of staff during the COVID-19 pandemic and global shortages of PPE. A multidisciplinary team and leadership commitment to provide resources for space and personnel were critical for program success.

Disclosures
All Authors: No reported disclosures.
1921. Leveraging Bluetooth Low-Energy Technology to Improve Contact Tracing in Healthcare Settings during the COVID-19 Pandemic
Authors: Guillamet M Cristina Vazquez , Rjob Ashraf , Zhang Jingwen , Hamauon Reshad , Dai Ruixuan , Wang Ruiqi , Candell Jeff , Kwon Jennie H , Bailey Thomas , Lu Chenyang , Fraser Victoria J 
Published: December 2022

Abstract

Background
COVID-19 rapidly evolved into a global pandemic. Contact tracing with isolation and quarantine contribute to epidemic control but they are time consuming, costly and may be incomplete. We set out to assess the usability and performance characteristics of Bluetooth Low-Energy (BLE) wireless technology for indoor localization applied to contact tracing in healthcare settings.

Methods
Consented healthcare workers (HCW) from 2 designated COVID-19 wards (one intensive care unit (ICU) and one medical ward) were equipped with coin-sized BLE- emitting beacons. The signal was captured by small embedded computers (anchors) placed at designated locations, time-stamped and transmitted to an edge server via secure Wi-Fi where data were stored and real time contact algorithms were run (Fig.1).
We developed experiments mimicking clinical scenarios and tested indoor localization during observed clinical activity for 6 months. We constructed our algorithms based on room structure (e.g. open spaces vs computer rooms) and activity characteristics (e.g. rounding in a large group vs 2 healthcare workers sitting together). We used 1) radio fingerprint localization where an initial virtual radio map was developed, 2) semantic localization which carries additional information such as proximity to a computer to define indirect transmission via fomites, and 3) clustering contact tracing to identify individuals rounding together. Close contact was defined as per the CDC guidelines. Fig. 1System configuration

Results
Consent rate was 43.3% with 187 HCW enrolled in the study. Consent rate was higher in the ICU and among attendings. All participants were compliant with wearing the beacons for the duration of the study. The performance characteristics for contact tracing using fingerprinting methods were AUROC 0.93, AUPRC 0.96, sensitivity 0.9, specificity 0.77 with F1 score of 0.89 and overall accuracy of 0.85. The clustering contact tracing registered a sensitivity of 0.86, specificity 0.89, F1 score 0.91 and accuracy 0.87. Computation time necessary to generate a list of close contacts as per specified criteria was less than 30 minutes.

Conclusion
We have developed and tested a reliable and accurate, low-cost and easily deployable system based on BLE technology to improve contact tracing among healthcare workers.

Disclosures
M Cristina Vazquez Guillamet, MD, AUPH: Stocks/Bonds|BNGO: Stocks/Bonds|OCGN: Stocks/Bonds|SESN: Stocks/Bonds.
2348. Distinct cerebrospinal fluid immune proteins mark neurosyphilis
Authors: Catalano Allison A , Yoon Jennifer , Farhadian Shelli F , Fertuzinhos Sofia , Gisslen Magnus , Zetterberg Henrik , Marra Christina M , Walsh Hannah L 
Published: December 2022

Abstract

Background
Neurosyphilis (NS) is increasing in prevalence in the U.S. but remains challenging to diagnose, particularly in asymptomatic cases. Uncovering central nervous system (CNS) specific immune pathways may shed light on disease pathogenesis and potential biomarkers.

Methods
Paired cerebrospinal fluid and blood were collected from participants with syphilis without neurological symptoms from 2013–2019. Participants were categorized as NS if CSF VDRL was positive and matched by RPR and date of enrollment to participants without neurosyphilis (non-NS), defined by VDRL negative and CSF WBC &lt; 5/uL. Paired CSF and plasma were run on a 71-plex chemokine/cytokine array, high-sensitivity (SIMOA) ELISA for markers of neuronal and astrocyte injury, and ELISA for neopterin, a marker of intrathecal macrophage/microglial activation. Comparisons between NS and non-NS were made using T-tests and Wilcoxon rank-sum tests, with p-values adjusted (FDR) for multiple comparisons.

Results
24 participants were enrolled with characteristics as in Table 1. HIV status, age, race/ethnicity, and plasma RPR values did not significantly differ by group. Six cytokines were significantly (p&lt; 0.05, FDR &lt; 0.10) different in the CSF in NS compared to non-NS, including MIG/CXCL9, IP-10/CXCL10, macrophage-derive-chemokine (MDC), IL-8/CXCL8 and BCA-1/CXCL13, which was previously recognized as elevated in NS (Figure 1B). Neopterin, but no neuronal or astrocyte markers, was elevated in the CSF of NS versus non-NS (p &lt; 0.001) (Figure 1A). After adjusting for multiple comparisons, there were no significant differences between markers in plasma of NS vs non-NS. Differences between NS and non-NS groups were not affected by HIV status.

Conclusion
There is a distinct and compartmentalized CNS immune response occurring in individuals with NS, as indicated by elevated markers of CNS inflammation and of key chemoattractants, the CXC family of proteins. Elevation of neopterin, but not neuronal injury markers suggest asymptomatic disease elicits an immune response without incurring neuronal damage. These immune biomarkers can provide insight into neuroinflammatory processes during asymptomatic NS and should be explored as potential CSF biomarkers of NS.

Disclosures
Magnus Gisslen, MD, PhD, Amgen: Honoraria|AstraZeneca: Advisor/Consultant|AstraZeneca: DSMB membership|Biogen: Honoraria|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Honoraria|GlaxoSmithKline/ViiV: Advisor/Consultant|GlaxoSmithKline/ViiV: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Novo Nordic: Honoraria|Novocure: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Sanofi: Honoraria.
1927. Use of a SARS-CoV-2 Strand-specific Assay to evaluate for Prolonged Viral Replication among Hospitalized Patients. Tertiary Care Center, California 2020–2022
Authors: Ferguson Jessica , Contreras Anez Gustavo A , Tompkins Lucy S , Shepard John , Rosenthal Ayelet , Subramanian Aruna , Pinsky Benjamin A , Salinas Jorge 
Published: December 2022

Abstract

Background
Determining if a patient with SARS-CoV-2 remains infectious is an infection control challenge in healthcare settings; specially, among critically ill or profoundly immunosuppressed patients. We use an assay that detects minus-strand RNA as a surrogate for actively replicating SARS-CoV-2. We report positive strand-specific assays in relationship to time since admission and describe patients with a detectable strand-specific assay &gt;20 days since admission.

Methods
We use a 2-step rRT-PCR specific to the minus strand of the SARS-CoV-2 envelope gene. The strand-specific assay is used to evaluate for infectivity in asymptomatic patients with a positive admission screening or pre-procedural test or if ongoing replication is suspected (critical illness or profound immunosuppression). We retrieved strand-specific test results for patients hospitalized at Stanford Healthcare during August 2020–March 2022. We describe clinical characteristics for patients with a detectable minus strand-specific test &gt;20 days since admission.

Results
A total of 774 strand-specific tests were collected from 624 hospitalized patients. A total of 523 patients had only one test (84%) and 101 (16%) had ≥2 tests. The test positivity rate varied by time since admission: 19% in tests performed 0–5 days, 28% in 6–10 days, 22% in 11–20 days, and 41% in those &gt;20 days since admission. Among 35 patients tested &gt;20 days since admission, 13 (37%) had ≥1 detectable minus strand-specific test. Most were male (n=8, 62%) and mean age was 59. Of 13 patients with a detectable assay, seven (54%) had prolonged viral replication with persistent symptoms and detectable minus strand assays for &gt;20 days from symptom onset. Of these seven patients, four had a transplant (3 lung, 1 liver), 1 ovarian cancer, 1 CAR-T cell therapy, and 1 ESRD without immunosuppression. The remaining eight patients with a detectable assay &gt;20 days since admission had illness onset while hospitalized.

Conclusion
Among hospitalized patients with SARS-CoV-2 infection, we found a varying positivity rate according to the timing of testing, possibly reflecting different indications for the test. The strand-specific assay may help assess for infectiousness in profoundly immunocompromised patients.

Disclosures
Aruna Subramanian, MD, Gilead Sciences: Grant/Research Support|Regeneron, Inc: Grant/Research Support.
1930. Answering the Call: Inpatient Vaccination for SARS-CoV2 Infection in an Academic Hospital
Authors: Albrecht Benjamin , Green Sarah B , Moran Peter , Corkish Morgan E , Tilton Carrie , Rizzo Ashley , Hurtik Micheal , Ukpabi Chidozie , Vastakis Litsa , Mohammed Othman , McGraw Kristen , Metzger Nicole , Mohorn Phillip L , Francois Christele , Brown Mary , Thompson Terry , Sexton Mary Elizabeth 
Published: December 2022

Abstract

Background
While the available SARS-CoV2 vaccines are up to 94% effective at preventing COVID-19-related death or invasive mechanical ventilation, only 76% of the United States population aged ≥18 years have received a primary series and 49% have received a booster. Vaccine administration has been complicated by changing schedule recommendations, packaging in multi-dose vials, and federal reporting requirements that may have limited the locations offering vaccines. We therefore implemented a pharmacy-based initiative to provide SARS-CoV2 vaccination to patients admitted to an academic health center, in order to encourage vaccination when patients had presented for other care.

Methods
A pharmacy committee developed a protocol for administering the three authorized SARS-CoV2 vaccines to interested inpatients while minimizing vaccine waste, monitoring for safety events, and providing next dose education. Associated training included multidisciplinary education on requirements related to vaccine Emergency Use Authorization (EUA) status. While developing the protocol, the vaccine committee utilized a temporary procedure to administer vaccines once weekly through review by antimicrobial stewardship pharmacists during August 2021. The protocol went live in September 2021 for inpatient and emergency department sites, with subsequent tracking of the number of doses ordered (stratified by vaccine type and dose number) and number administered.

Results
From August 3 2021 to March 25 2022, a total of 389 vaccine orders were placed with 302 doses (78%) administered, including 126 Moderna (48 first, 20 second, 15 third, 42 booster, and 1 undesignated), 165 Pfizer/BioNTech (80 first, 24 second, 41 third, 14 booster, and 6 undesignated), and 11 Janssen COVID-19 vaccine doses. Only 18 vaccine orders were placed on patients in the ED, with 14 (78%) of those doses administered. Of the 87 vaccine orders not administered, 6 were placed but not given, and 81 were placed and then discontinued.

Conclusion
With multidisciplinary collaboration, SARS-CoV2 vaccination can be performed in inpatient and ED settings. However, orders should be monitored for protocol compliance and order discontinuation, as these may increase potential for waste.

Disclosures
All Authors: No reported disclosures.
1936. COVID- 19 Vaccination in an Inner City HIV Clinic
Authors: Nagarakanti Sandhya , Bishburg Eliahu 
Published: December 2022

Abstract

Background
Patients (pts) living with HIV (PLWH) are more likely to be hospitalized and experience increased rates of death from COVID-19. Vaccination has been shown to reduce hospitalization and death. Vaccination rate for general population in the state of New Jersey is 74.9%. We sought to analyze vaccination rates and its effects in an HIV outpatient clinic.

Methods
Retrospective review in an outpatient HIV clinic, study period 12/01/2020 - 12/30/2021. Data was collected on demographics, CD4 count, HIV Viral loads (VL), type and number of vaccines received, incidence and outcome of COVID-19 infection. Student t-test used for comparison.

Results
We included 635 pts, median age 53years (range 33-84), males 316 (49.7%), transgender 3 (0.48%). African American 568(89%), Hispanic 52 (8.1%), Caucasian 12 (1.9%), Asian 3(0.5%). HIV risk factors were heterosexual 451(71%), male having sex with male 122(19.2%), intravenous drug use 8(1.25%). CD4 &gt; 200 cells/mm3 in 587 (92.4%), HIV VL &lt; 200 copies/mL in 562 (88.5%). Two doses COVID vaccine was received by 442 (69.6%) pts. BNT162b2 (Pfizer) in 192 (43.4%), mRNA-1273(Moderna) in 181(40.9%), Ad.26.COV2.S (J & J) in 43(9.7%), unknown in 25 (5.7%). Booster dose in 126 (28.5%). Incomplete immunization in 7(4.4%). Vaccination in men 217/316(68.7%) vs. women 224/316 (70.8%) (p=NS). COVID-19 infection was diagnosed in 67(10.6%); 49(73%) were unvaccinated vs. 18 (27%) vaccinated; 14 received 2 doses and 4 were boosted (p&lt; 0.05); 15 pts were hospitalized for COVID-19, 13/15 (86.7%) unvaccinated vs. 2/15 (13.3%) vaccinated (p&lt; 0.05). CD4 was &gt; 200 cells/mm3 in 46/49(94%) in unvaccinated vs. 16/18 (88.8%) vaccinated pts (p=NS); HIV VL &lt; 200copies/mL in 46/49 (94%) unvaccinated vs.17/18(94%) vaccinated and infected (p=NS). One unvaccinated pt. expired.

Conclusion
In our outpatient HIV clinic, PLWH had vaccine acceptance rates similar to the general population. More unvaccinated became infected and hospitalized than vaccinated pts. There was no difference in CD4 and HIV VL in COVID infected pts who were vaccinated vs. unvaccinated pts.

Disclosures
All Authors: No reported disclosures.