bluuebunny/crossref_metadata_2025_split huggingface dataset:
1199. Implementation of a Nasal Antiseptic Decolonization Program Reduces the Occurrence of Healthcare-Associated Infections in the Adult Intensive Care Unit Setting
Authors: Kreiling Stephanie , Watson Rachel , Perez Gabriela , Carr Adrienne , Wolfe Rachel 
Published: December 2022

Abstract

Background
Universal decolonization programs effectively reduce methicillin-resistant Staphylococcus aureus (MRSA) infections, bloodstream infections, and healthcare costs. However, universal decolonization programs that utilize mupirocin may promote antimicrobial resistance. Non-antibiotic interventions, such as nasal antiseptic decolonization, can contribute to the prevention of healthcare-associated infections (HAIs). A large hospital system sought to evaluate the impact of a universal nasal antiseptic program on HAIs in the adult intensive care unit (ICU) setting.

Methods
A nasal antisepsis decolonization quality improvement project (QIP) was implemented to reduce ICU HAIs by applying a 62% nasal antiseptic swab with emollients bilaterally to the nares every 12 hours for all adult ICU patients. The program was piloted across nine ICUs at three large hospitals from November 2021 to January 2022 and captured data from 12,404 patient days and 4,058 treatment days. Central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and MRSA bacteremia rates were compared a) between treated and non-treated patients during the QIP period and b) to rates during a three-month period prior to the QIP.

Results
The results of the pilot program indicated that patients who received treatment with the 62% nasal swab developed fewer HAIs than patients who did not receive the treatment. Two HAIs occurred in the treatment group (two CAUTIs) compared to 14 HAIs in the non-treatment group (three CAUTIs, nine CLABSIs, and two MRSA bacteremia). Figures 1 and 2 below demonstrate HAI rates in the non-treatment and the treatment groups. Figure 1Figure 2

Conclusion
Based on pilot results, the system approved implementation of a universal nasal antisepsis program using the 62% alcohol based nasal swab with emollients for expansion to all adult critical care units. Considerations for the future implementation of the program include broadening patient inclusion and performing ongoing HAI surveillance of treated and untreated patient groups.

Disclosures
All Authors: No reported disclosures.
1203. Assessment of Infection Prevention and Control Programs in Acute Care Facilities in Central and South America
Authors: Quiros Rodolfo E , Rock Clare , Fabre Valeria 
Published: December 2022

Abstract

Background
Little is known about the development of Infection Prevention and Control (IPC) programs in Latin American hospitals despite alarming rates of multidrug resistant healthcare-associated infections (HAIs) in the region. The aim of this study was to identify gaps in implementation of hospital IPC programs in Latin America.

Methods
We conducted a cross-sectional survey using a self-assessment tool (Spanish version) adapted from the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) in March 2022. The survey was deployed to 40 hospitals in Panama, Guatemala, Ecuador, and Argentina through a regional research network. The instrument has 8 components (score 0-100), with 800 as maximum overall score. Facility IPC program implementation is categorized into four levels based on the final score: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Median scores, overall and by component, were calculated. Additionally, for each question, we estimated the proportion of hospitals that met criteria stratified by private and public hospitals.

Results
Thirty five hospitals (14 private and 21 public) completed the evaluation (88% response rate), 83% were academic, and 14% were &lt; 110 bed-hospitals. Overall, 57% of hospitals fell in the “Advanced” category (percentile [p]10: 518; p 50 614; p90 744). The median score for each component is shown in the Figure. IPC education and training, and workload, staffing and bed occupancy had the lowest median scores (Figure). In general, public hospitals had lower scores than private hospitals (Figure). Most hospitals performed surveillance for HAIs and hand hygiene, although fewer monitored compliance with adherence to prevention bundles or communicate these data to front-line workers. Additional gaps were identified, principally between private and public hospitals (Table). Figure: Median score for individual IPCAF component for all hospitals, private and public heathcare facilities.

Conclusion
While most participating hospitals were considered “advanced” based on the IPCAF score, several gaps were identified, which differed between public and private hospitals. Insufficient IPC education and training, workload, staffing and bed occupancy, multimodal strategies and lack of leadership support may be barriers to effective IPC programs in the region.

Disclosures
All Authors: No reported disclosures.
1205. Does Perception of Cleanliness Matter? A Correlational Study Exploring Patient Perception of Cleanliness and HAC Score Performance
Authors: Stowe Caitlin 
Published: December 2022

Abstract

Background
One of the most common causes of healthcare associated infections (HAIs) is due to environmental contamination of surfaces in the patient care areas. Cleaning and disinfection of these surfaces has been shown to reduce the incidence of HAIs and contributes to the overall hospital cleanliness. Currently, hospital cleanliness is publicly reported through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is sent to all patients discharged from a healthcare facility. There is very limited research on if the perception of hospital cleanliness is related to the incidence of HAIs in a healthcare facility as defined by the facility's performance in the Healthcare Acquired Conditions (HAC) program.

Methods
A retrospective correlational study was performed to examine the relationship of patient perception of hospital cleanliness and the incidence of Clostridioides difficile (C. difficile) and Methicillin Resistant Staphylococcus aureus (MRSA) HAIs defined by the facility's HAC score. Multiple Center for Medicare and Medicaid Services (CMS) datasets were utilized for the study. There were approximately 2300 acute care facilities included that reported data on the patient perception of room cleanliness question, and either C. difficile or MRSA standardized infection ratio (SIR) for the time period of October 1, 2018 to September 30, 2019. Basic descriptive statistics and Spearman's correlational analyses were performed to analyze the relationships between the HAI HAC scores and the HCAHPS answer description to measure the potential association.

Results
The study found that as the percentage of patients who reported that their room was “always” clean increased, the hospital’s CDI or MRSA SIR decreased (r= -0.228,p= 0.00; r= -0.130,p= 0.00). The analysis also revealed that as the percentage of patients who reported their room was "never" clean increased, the facility's CDI or MRSA SIR increased (r= 0.180, p = 0.00; r=0.140, p= 0.00).

Conclusion
This study found that a hospital’s HCAHP performance on patient perception of cleanliness is related to their performance on certain HAIs as defined by performance on HAC scores. Further research is needed to determine if there are specific factors that influence patient perception of cleanliness.

Disclosures
Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, ActivePure Medical: Employment|PDI Healthcare: Employment.
1206. Epidemiological interaction of MRSA, ESBL E.coli and C. difficile between ICU/Step-down Unit of University-affiliated Community Hospital and LTACs in Japan: Utility of Molecular Epidemiology Analysis by PCR-based ORF Typing (POT method)
Authors: Saito Hiroki , Kasai Fumimasa , Takakura Tomomi , Ohno Tatsuya , Hosoyama Akiko , Fujitani Shigeki 
Published: December 2022

Abstract

Background
Epidemiological interaction of drug resistant organisms between ICU and surrounding health facilities including LTACs have been of interest in the era of antimicrobial resistance (AMR) and aging society. In addition, conventional molecular epidemiology methods such as pulsed-field gel electrophoresis, and multilocus sequence typing are time-consuming and difficult to perform in a standard microbiology laboratory.

Methods
Patients admitted to a university-affiliated community hospital in Japan was recruited if their cultures collected clinically during admission grew the following target pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococci (VRE), ESBL Gram negative rods (GNR), carbapenem-resistant Enterobacteriaceae (CRE), multi-drug resistant Pseudomonas (MDRP) and Clostridioides difficile (C. diff). Their clinical information including admission to ICU/step-down unit vs regular wards and disposition was analyzed with chi-square test for binary outcomes.
For the isolates of MRSA, ESBL E. coli, and C. diff, further molecular epidemiology analysis was made, using PCR-based open-reading frame (ORF) Typing (POT method), a more resource-friendly and time-efficient technology originally developed in Japan.

Results
Among total 9639 hospital admissions in 2018-2019, the above-mentioned target pathogens grew from 233 patients (2.4%). There were 96 MRSA isolates (41.2%, out of 233), followed by 93 ESBL GNR (39.9%), 21 C. diff (9.0%), 13 CRE (5.6%), 10 MDRP (4.3%), and no VRE, respectively. Patients admitted to ICU/step-down unit were more likely to grow the target pathogens (117/1605 vs 116/7801, RR 4.90, 95% CI 3.81-6.30, p&lt; 0.001), and to be discharged to LTACs than patients admitted to regular wards (70/113 vs 32/116, RR 2.17, 95% CI 1.56-3.02).
Molecular epidemiology analysis with POT method identified 5, 3 and 3 common strains across 20, 11, and 7 patients with MRSA, ESBL E.coli, C. diff, respectively.

Conclusion
The study suggests the pathogens of higher priority were more prevalent in ICU/step-down unit and that the discharge from ICU/step-down unit to LTACs could impact on further transmission in the surrounding region. POT method can be utilized for more efficient molecular epidemiology analysis in the era of AMR.

Disclosures
All Authors: No reported disclosures.
1215. Variation in Hand Hygiene Improvement After Implementation of an Electronic Hand Hygiene System During the COVID-19 Pandemic
Authors: Steinberg James P , Overton Elizabeth , Feistritzer Nancye , Love Kari L , Holdsworth Jill , Whitson` Margaret , Lewis Lorry , Lewis Lorry , Swann Julie , Jacob Jesse T 
Published: December 2022

Abstract

Background
Electronic hand hygiene (HH) monitoring systems have many potential advantages but there are limited data on wide-scale implementation of these systems. TableHand Hygiene Observations, Improvement in Adherence Rates and SIR Trends by Hospital

Methods
We deployed an electronic HH monitoring system in over 2,100 acute and critical care rooms across 9 hospitals in an academic health system. Badges with a Bluetooth beacon were issued to over 7,000 healthcare workers. Deployment began in early 2020 and was interrupted by the pandemic. The rollout of interventions to improve HH adherence was managed at the hospital level. Healthcare-associated infections (HAIs) were determined by the infection prevention team using standard CDC definitions. Hospital-level HH adherence rates were compared to a composite SIR including SIRs for CLABSI, CAUTI, hospital-onset MRSA bloodstream infections and hospital-onset Clostridiodes difficile infections.

Results
Between January 2020 and April 2022, there were over 36 million hand hygiene opportunities with an average of 19 observations per staffed room per day. Overall HH adherence improved from 46% to 60%, with significant variation by hospital (4 improving by &gt;25% and 3 by &lt; 5%). Hospitals whose implementation was most delayed showed the least improvement. Preliminary analysis found no relationship between hand hygiene improvement and the SIR composite aggregated by calendar year.

Conclusion
Despite the challenges of large-scale implementation of an electronic HH system during a pandemic, we demonstrated an overall improvement in HH adherence. The wide variation in improvement among hospitals was due to timing of implementation, variation in the dedicated hospital-specific project management resources and leadership engagement. In addition to technology, successful implementation of electronic HH systems requires dedicated resources and culture change. Pandemic-related staffing challenges, disruption of standard HAI prevention efforts and intensive device utilization confounded our ability to show a relationship between HH adherence and HAI rates.

Disclosures
All Authors: No reported disclosures.
1218. Genotypic Investigation of a Rotavirus Cluster at a Pediatric Hospital in 2022
Authors: Yoon Hee-won , Kitt Eimear , Smith Kenneth , Comar Courtney E , Harris Rebecca , Hopkins Amy , Jaimes Jose , Rustempasic Slavica Mijatovic , Gautam Rashi , Esona Mathew D , Handy Lori 
Published: December 2022

Abstract

Background
Rotavirus group A (RVA) was the most common cause of infectious gastroenteritis among young children before introduction of rotavirus vaccine in the United States in 2006. Following widespread vaccination, U.S. hospital acquired (HA) rotavirus cases are rare. We describe a cluster of rotavirus infections in a pediatric hospital with a genotype uncommon among U.S. children.

Methods
Patient cases of HA gastrointestinal (GI) illness were detected through hospital-wide microbiology surveillance, performed by Infection Prevention and Control (IPC) practitioners per state requirements. Cluster procedures were implemented on a unit when 3 cases were identified by symptoms and/or laboratory tests within 48 hours. Due to the current rarity of rotavirus clusters, the hospital partnered with Centers for Disease Control and Prevention (CDC) laboratories to sequence strains in addition to instituting local control measures. RVA strains were genotyped by using the genotype specific qRT-PCR assays for VP7 and VP4 genes. Next Generation Sequencing (NGS) was performed for RVA strain characterization on Illumina MiSeq. Genotypes for all 10 RVA were determined by NCBI’s BLASTN program.

Results
Epidemiologic surveillance identified a rotavirus cluster of 10 patients aged 10 months to 10 years old, of whom 50% had received rotavirus vaccine. Symptoms included emesis and diarrhea. Cases could not be attributed to vaccine related shedding. All patients had epidemiologic links by contiguous bed spaces or shared care teams. Sequencing was conclusive for 9 of the 10 stool samples to be a G9P[4] genotype, which is rarely detected amongst U.S. children. Local control measures of increased education and cleaning, isolation of positive patients in single rooms, use of soap and water instead of alcohol-based hand sanitizer on room exit, and furlough of symptomatic healthcare workers halted transmission.

Conclusion
Routine surveillance of HA GI illness identified a cluster; RVA strain genotyping and characterization identified unusual rotavirus genotype G9P[4] as the cause. Partnership between IPC practitioners and laboratorians with CDC demonstrated the need to enhance infection prevention measures to halt transmission and identified a rare rotavirus strain as the likely cause of the cluster.

Disclosures
Courtney E. Comar, PhD, Pfizer: Stocks/Bonds|Viatris: Stocks/Bonds.
1222. Summary of CDC consultations related to non-traditional medical therapies, 2016─2021
Authors: Beshearse Elizabeth , Perz Joe , Perkins Kiran M 
Published: December 2022

Abstract

Background
Non-traditional medical therapies, which include invasive or parenteral therapies for unapproved conditions, such as stem cell joint injections and certain cosmetic procedures may lack regulatory oversight and pose infectious risks to patients. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving outbreaks or infection control lapses that involved non-traditional medical therapies to identify areas for prevention efforts.

Methods
We reviewed internal CDC records from January 1, 2016, through December 31, 2021, to identify consultations that involved investigations of disease transmission and infection control lapses involving non-traditional medical therapies in U.S. settings. We included consultations involving therapies and procedures such as facials, fillers, microneedling, intravenous hydration, vitamin infusions, platelet-rich plasma (PRP), and stem cell injections. We determined number of consultations and patients infected or exposed to infection control lapses, infection types, types of procedures implicated, pathogen of concern, and whether at-risk patients were notified.

Results
We identified 25 consultations that met inclusion criteria; 22 involved 65 infected patients and 3 involved infection control lapses without identified infections. Infection types included joint (n=8, 32%), skin and soft tissue (5, 20%), and bloodstream (3, 12%). The most common pathogens implicated included nontuberculous mycobacteria (3, 12%), hepatitis C virus (3, 12%), and several Enterobacterales (6, 24%). Therapies most frequently involved included PRP or stem cell joint injections (9, 36%), vitamin infusions/injections (4, 16%), and aesthetic treatments (6, 24%). Settings most commonly involved chiropractic clinics (3, 12%), pain clinics (3, 12%), medical spas (2, 8%), orthopedic clinics (2, 8%), and aesthetics clinics (2, 8%).

Conclusion
Lapses in infection control practices involving non-traditional medical therapies have the potential to place patients at significant risk of infection. Targeting infection control education and oversight to settings where these procedures commonly take place may help reduce patient risk.

Disclosures
All Authors: No reported disclosures.
1227. Candida Sternal Wound Infections After Cardiac Operations: Uncommon but Deadly
Authors: Seo Jung M , Louie Brian J , Phe Kady , Ghanta Ravi K , Trautner Barbara , Fukuta Yuriko 
Published: December 2022

Abstract

Background
Sternal wound infections (SWI) are a devastating complication of cardiac surgery. The majority of SWI are bacterial infections; however, Candida species are a less common cause and have not been well described. The purposes of this study were (1) to describe clinical characteristics, management and outcomes of Candida SWI and (2) to compare the risk factors and outcomes for Candida to bacterial SWI.

Methods
Our study reviewed medical records of 41 patients with Candida SWI after cardiac surgeries between 2013 - 2020 at our medical center, then compared them to 76 patients with bacterial SWI during the same timeframe via univariate analysis. We defined superficial SWI as positive culture isolates involving the skin or subcutaneous tissues, deep SWI as involving deep soft tissues or bone, and mediastinitis as involving the mediastinum.

Results
Of the 41 Candida SWI patients, relevant comorbidities included previous cardiac surgery (46.3%), heart failure (65.9%), and diabetes (58.5%). Candida SWI was diagnosed at an average of 123.6 days after cardiac surgery, with the majority being deep SWI (70.7%). Candida albicans was most common (70.7%). Bacterial co-infections were found in 53.7% (Table 1). Longer bypass and operative times for the initial cardiac surgery were found to be positively correlated to disease severity. Clinical cure rate after completion of antimicrobial treatment was 100% in superficial SWI, 72.4% in deep SWI and 25.0% in mediastinitis. Overall mortality was 29.3%: 25%, 24.1% and 50.0%, respectively. When compared to bacterial SWI, factors significantly associated with Candida SWI included: previous cardiac surgery (46.3% vs. 7.9%, odds ratio (OR): 5.9; 95% confidence interval (CI): 2.2-15.9), heart failure (65.9% vs. 11.8%, OR: 5.6; 95% CI: 2.4-12.9), and &gt;48 hours of postoperative antibiotics (39.0% vs. 3.0%, OR: 9.9; 95% CI: 2.7-35.9). Mortality rates were higher with Candida than with bacterial infections (29.3% vs. 1.3%, OR: 22.2, 95% CI 2.8-177.2) (Table 2).

Conclusion
This study showed Candida SWI as a serious complication of extensive cardiac surgery with higher mortality rates. Prior history of cardiac surgery and heart failure, prolonged surgeries, and complicated postoperative course were significant risk factors for the development of Candida SWI.

Disclosures
Barbara Trautner, MD, PhD, Genetech: Advisor/Consultant.
1242. Hepatitis C Treatment as a Complement to Syringe Service Programs: Pilot Progress and Pathways Forward
Authors: Guzman Miriam , Smith Renata , Mayer Stockton , Messmer Sarah , Huyck Michael , Cotler Karen F , Chaisson Lelia H , Jimenez Antonio , Guerrero Stephanie , Fortson Neisha , Tai Rex 
Published: December 2022

Abstract

Background
Hepatitis C (HCV) poses a significant chronic infectious disease threat in the United States, and people who inject drugs (PWID) are at elevated HCV risk. We assessed implementation of a program that provided low-barrier services for high-risk PWID, coupling harm reduction with clinical care, including HCV treatment.

Methods
In 2018, the University of Illinois at Chicago established a program to deliver comprehensive care to PWID in an underserved Chicago neighborhood, including syringe services (SS) and HCV treatment. We performed chart reviews of SS clients who sought HCV care from 09/2018-01/2021. We assessed patient demographics; the proportions prescribed and initiated on HCV treatment; and the proportions with undetectable HCV RNA at treatment week 4, end of treatment, and 12-weeks post-treatment.

Results
Among 67 patients, 45 (67%) were male, median age was 45 years (IQR 35-57), 22 (33%) were Black, and 11 (16%) were Hispanic. 66 (99%) reported current or former drug use and 62 (93%) injection drug use, and 3 (4%) sex work. 36 (54%) were undomiciled or lived in unstable housing, 22 (33%) were unemployed, 19 (28%) had been incarcerated within the past year, and 30 (45%) had a history of psychiatric illness. Median pre-treatment HCV RNA was 701,626 IU/L (IQR 39,944-1,979,898). 40 (60%) were prescribed HCV treatment and 31 (46%) initiated treatment (Figure). Of these, 21/31 (68%) completed HCV RNA testing at treatment week 4, of whom 18/21 (86%) had an undetectable viral load; 16/31 (52%) completed end of treatment testing, of whom 16/16 (100%) had an undetectable viral load; and 15/31 (48%) completed 12-week post-treatment testing, of whom 13/15 (87%) had an undetectable viral load. Of the 2 patients who did not achieve sustained viral suppression following treatment, 1 missed four weeks of treatment due to incarceration and 1 reported full adherence to treatment.
Numbers and percentages of patients at each step in the treatment cascade

Conclusion
This comprehensive program offering SS and HCV care successfully reached PWID in an underserved area before and during the pandemic. Losses along the HCV treatment cascade were high: Only 60% were prescribed treatment and less than one-third of those prescribed treatment achieved sustained viral suppression. Among those who remained in care, over 80% achieved sustained viral suppression.

Disclosures
All Authors: No reported disclosures.