bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood-culture ordering practices in patients with a central line at an academic medical center–Iowa, 2020
Authors: Kovoor Elias , Kobayashi Takaaki , Sheeler Lorinda , Trannel Alexandra , Etienne William , Abosi Oluchi , Holley Stephanie , Kukla Mary , Dains Angie , Jenn Kyle , Meacham Holly , Hanna Beth , Marra Alexandre , Parsons Meredith , Ford Bradley , Wellington Melanie , Diekema Daniel , Salinas Jorge 
Published: May 2022

Background: The IDSA has a clinical definition for catheter-related bloodstream infection (CRBSI) that requires ≥1 set of blood cultures from the catheter and ≥1 set from a peripheral vein. However, because blood cultures obtained from a central line may represent contamination rather than true infection, many institutions discourage blood cultures from central lines. We describe blood culture ordering practices in patients with a central line. Methods: The University of Iowa Hospitals & Clinics is an academic medical center with 860 hospital beds. We retrospectively collected data for blood cultures obtained from adult patients (aged ≥18 years) in the emergency department or an inpatient unit during 2020. We focused on the first blood cultures obtained during each admission because they are usually obtained before antibiotic initiation and are the most important opportunity to diagnose bacteremia. We classified blood-culture orders as follows: CRBSI workup, non-CRBSI sepsis workup, or incomplete workup. We defined CRBSI workup as ≥1 blood culture from a central line and ≥1 peripheral blood culture (IDSA guidelines). We defined non-CRBSI sepsis workup as ≥2 peripheral blood cultures without cultures from a central line because providers might have suspected secondary bacteremia rather than CRBSI. We defined incomplete workup as any order that did not meet the CRBSI or non-CRBSI sepsis workup. This occurred when only 1 peripheral culture was obtained or when ≥1 central-line culture was obtained without peripheral cultures. Results: We included 1,150 patient admissions with 4,071 blood cultures. In total, 349 patient admissions with blood culture orders (30.4%) met CRBSI workup. 62.8% were deemed non-CRBSI sepsis workup, and 6.9% were deemed an incomplete workup. Stratified by location, ICUs had the highest percentage of orders with incomplete workups (8.8%), followed by wards (7.2%) and the emergency department (5.1%). In total, 204 patient admissions had ≥1 positive blood culture (17.7%). The most frequently isolated organisms were Staphylococcus epidermidis (n = 33, 16.2%), Staphylococcus aureus (n = 16, 7.8%), and Escherichia coli (n = 15, 7.4%) Conclusions: Analysis of blood culture data allowed us to identify units at our institute that were underperforming in terms of ordering the necessary blood cultures to diagnose CRBSI. Being familiar with CRBSI guidelines as well as decreasing inappropriate ordering will help lead to early and proper diagnosis of CRBSI which can reduce its morbidity, mortality, and cost.Funding: NoneDisclosures: None
The evaluation of central-line–associated bloodstream infection (CLABSI) preventability at an academic institution
Authors: Hsueh Leon , Uslan Daniel , De St. Maurice Annabelle 
Published: May 2022

Background: In 2008, the hospital-acquired conditions (HACs) initiative labeled central-line–associated bloodstream infections (CLABSIs) as preventable “never events” that could no longer be reimbursed by Medicare. However, some patients have inherent unpreventable etiologies for bacteremia, such as obstructive biliary malignancies. We assessed the number of CLABSIs that were reasonably preventable. Methods: We examined all CLABSI cases at 2 academic medical centers over a 2-year period (2019–2021). We established 3 categories of CLABSIs: (1) preventable CLABSI (pCLABSI); (2) end-of-life CLABSI (EOL-CLABSI), which were CLABSIs that were caused by underlying disease processes in patients who were nearing the end of their lives due to a debilitating comorbidity; and (3) definition-based (dCLABSI), which met NHSN criteria for a CLABSI but, based on the pathogen and the clinical situation, likely occurred as a consequence of a patient’s comorbidities. Two experienced infectious diseases physicians (D.U. and A.S.M.) reviewed the charts of each patient with a CLABSI and, based on expert opinion, determined the category for each CLABSI. Results: Over the 2-year period, 147 CLABSIs were identified among the 2 hospitals, 66 (44.9%) of which occurred in an ICU. Most CLABSIs were pCLABSIs, making up 99 CLABSIs (67.3%). In comparison, 20 cases were categorized EOL-CLABSIs (13.6%), although 26 cases were dCLABSIs (17.7%), and 2 cases could not be classified. There was no difference in the distribution of CLABSI types in an ICU versus a non-ICU setting (χ2P = .265). However, we detected microbiologic differences between pCLABSIs, EOL-CLABSIs, and dCLABSIs (χ2P < .001), with gram-positive cocci making up the large majority of pCLABSIs (62.6%), followed by Candida spp (24.2%). Gram-negative bacilli (GNR) made up 11.1% of pCLABSIs. In comparison, GNRs were more prevalent in EOL-CLABSIs and dCLABSIs, making up 30.0% and 38.5% of each CLABSI type, respectively. Conclusions: Two-thirds of CLABSIs were deemed preventable. Central lines are important for managing critically ill patients, many of whom have inherent risk factors for bloodstream infections. EOL-CLABSIs highlight the potential for early care discussions to avoid CLABSIs at the end of a patient’s life and to avoid unnecessary blood cultures for patients on comfort care. Additionally, the pCLABSI distinction allows hospital epidemiology teams to focus on the CLABSI cases that can realistically be prevented with appropriate central-line care, techniques, and hand hygiene. Creating these categories allows hospital systems to use more targeted approaches for improving CLABSI rates.Funding: NoneDisclosures: None
CDC COVID-19 healthcare infection prevention and control assistance to health departments, January 2020–December 2021
Authors: Hart Ayana , Schrodt Caroline A. , Hunter Jennifer C. , Ham David , Soda Elizabeth , Perz Joseph , Perkins Kiran 
Published: May 2022

Background: Throughout the COVID-19 pandemic, CDC Division of Healthcare Quality Promotion (DHQP) has provided technical assistance in support of state, tribal, local, and territorial health departments for COVID-19 healthcare outbreak management and infection prevention and control (IPC). We characterized the volume and trends of technical assistance provided during the pandemic to inform the future needs of health departments for COVID-19 healthcare IPC and DHQP resources required to meet these needs. Methods: In January 2020, DHQP began receiving COVID-19 IPC TA requests directly from health departments for remote assistance or from CDC staff on field deployments providing onsite support. DHQP subject-matter experts provided responses via e-mail or, for more complex inquiries, outbreaks, or field deployments, via phone consultations. Records of e-mail communications and phone consultations were entered into an inquiry database for tracking. We calculated the number, mean, and range of technical-assistance responses by jurisdiction and by month from January 2020 through December 2021. We designated months as high-volume periods for technical assistance if inquiries surpassed the 75th percentile. Results: In total, 1,869 IPC technical-assistance responses were provided. Of all technical-assistance responses, 1,725 (92%) were to state or local health departments, 115 (6%) were tribal nations, and 28 (2%) were US territories. IPC technical assistance was provided to all 50 states and the District of Columbia, 16 tribal nations, and 5 US territories. The average total number of technical assistance responses per site during the 24-month period was 34 to state and local HDs (range, 2–111), 6 to tribal nations (when tribal nation was specified; range, 1–17), and 6 to US territories (range, 1–15). E-mail communications comprised 1,164 responses (62%); phone consultations made up the remaining 705 responses (38%). Of phone consultations, 350 (50%) were with CDC field deployers providing onsite support to health departments. The average number of technical-assistance responses provided each month across all jurisdictions was 78 (range, 0–334); months with high volumes included April–August 2020 and January 2021. Conclusions: These findings highlight the high-level collaboration between federal and state, tribal, local, and territorial health department partners in remote and onsite support of COVID-19 prevention and response efforts in healthcare settings. Variations in monthly volumes of health-department COVID-19 healthcare IPC technical assistance requests may reflect factors such as fluctuations in community infection rates and changes in CDC IPC guidance. The ability to provide effective technical assistance during pandemic response depends on the CDC maintaining sufficient healthcare IPC staffing and expertise.Funding: NoneDisclosures: None
Monoclonal antibody therapy for prevention of severe disease in nosocomial COVID-19
Authors: Zimilover Adam , Doan Thien-Ly , Jain Sumeet , Malhotra Prashant 
Published: May 2022

Background: In November 2020, the FDA issued an emergency use authorization (EUA) for monoclonal antibodies (mAbs) to be used in outpatients with COVID-19 infections who are at a high risk of progressing to severe disease. However, becuase the EUA had limited indications for inpatients, data on their use in hospitalized patients are limited. In this study, we have described the use of mAbs among hospitalized patients with nosocomial COVID-19. Methods: We retrospectively analyzed cases of nosocomial COVID-19 in 2 tertiary-care hospitals from November 1, 2020, to October 11, 2021, and we identified patients who received mAbs. The study period was prior to the ο (omicron) variant (B.1.1.529) being detected in the United States, and infections in the patients were likely primarily with the α alpha variant (B.1.1.7) and the δ (delta) variant (B.1.617.2) of SARS-CoV-2, which responded well to treatment with bamlanivimab and casirivimab–imdevimab. All patients had a negative SARS-CoV-2 PCR on admission. Data on clinical outcomes, including administration of medications for COVID-19, increases in oxygen requirements, ICU admission, mechanical ventilation, and death were collected by a review of the electronic medical record. The study was approved by the institutional review board with expedited approval. Descriptive statistics, such as means and standard deviations of continuous variables and proportions of categorical events or variables, were tabulated to describe patient characteristics and outcomes. Results: The 71 patients included in the study (age range, 39–89 years; median age, 70 years; 51% female) received either bamlanivimab (n = 31) or casirivimab–imdevimab (n = 40). The length of stay ranged from 6 to 242 days (median, 26 days). The comorbidities present included cardiovascular disease (56%), diabetes (45%), obesity (31%), autoimmune disease or immunosuppression (27%), kidney disease (23%), and pulmonary disease (20%). Most of the patients included in the study were incompletely vaccinated or unvaccinated (94%) and were negative for SARS-CoV-2 antibodies (81%). Prior to receiving the mAbs, 23% of patients required supplemental oxygen, including 3 patients who required mechanical ventilation. These patients required oxygen support due to non–COVID-19–related conditions. After mAb infusion, 72% of patients had no increase in their oxygen requirements, and 93% did not progress to mechanical ventilation. Overall, 7 deaths were attributed to COVID-19 among the studied patients (10%). Conclusions: Our study describes the use of mAbs in hospitalized patients with nosocomial COVID-19. Most of the patients who received mAbs had no progression to severe COVID-19, despite having significant comorbidities. The use of mAbs in nosocomial COVID-19 may be associated with beneficial outcomes.Funding: NoneDisclosures: None
Risk factors associated with SARS-CoV-2 transmission, outbreak duration, and mortality in Fraser Health acute-care settings
Authors: Duncombe Tamara , Garrod Matthew , Xuetao Wang , Ng Joyce , Lee Eunsun , Short Katy , Tan Kennard 
Published: May 2022

Background: Transmission of SARS-CoV-2 in acute-care settings affects patients, healthcare workers, and the already-burdened healthcare system. An analysis of risk factors associated with outbreak severity was conducted to inform prevention strategies. Methods: This study was a cross-sectional analysis of COVID-19 outbreaks at Fraser Health (FH) acute-care sites between March 2020 and March 2021. Outbreak severity measures included COVID-19 attack rate, outbreak duration, and 30-day case mortality. Covariates at patient, outbreak, unit level, and facility level were included (Table 1). Generalized linear models with generalized estimation equations were used for all outcome measures, with outbreak duration and 30-day case mortality using multivariate negative binomial distributions, and attack rate using Gaussian distribution. A P value of .05 indicated statistical significance. Analyseswere performed using SAS version 3.8 software, R version 4.1.0 software, and Stata version 16.0 software. Results: Between March 2020 and March 2021, 54 COVID-19 outbreaks were declared in FH acute-care sites involving 455 SARS-CoV-2–positive patients. The average outbreak duration was 23 days, the average attack rate was 28%, and the average 30-day all-cause mortality per outbreak was 2 deaths. The results of the full models are shown in Table 1. Discussion: We identified an inverse relationship between increased hand hygiene compliance during outbreaks and all 3 severity measures. Paradoxically, hand hygiene rates in the year prior to the pandemic were positively associated with duration and mortality. Increased unit age was also associated with increases in each of the severity measures. Comorbidity total factor was correlated with outbreak attack rate and duration, demonstrating the importance of individual patient characteristics in an outbreak. Conclusions: Our findings highlight the importance of hand hygiene practices during an outbreak. Additionally, it is important to understand the difficulties faced by older facilities, many of which face infrastructural challenges. This study reinforces the need to incorporate infection control standards into healthcare planning and construction.Funding: NoneDisclosures: None
Rapid identification and isolation of patients with COVID-19 reduces the odds of transmission to hospital roommates
Authors: Alban Jessica , Burke Patrick , Sitaras Joanne , Fraser Thomas 
Published: May 2022

Background: The Cleveland Clinic Main Campus is a multispecialty academic medical center with 1,200 adult patient beds, 58% of which are double occupancy. Our facility relies on double-occupancy rooms to provide needed care during the COVID-19 pandemic. Inherently, double occupancy poses a greater risk of exposure to SARS-CoV-2 despite mitigation efforts. We investigated the incidence of postexposure SARS-CoV-2 infection in double-occupancy rooms and evaluated risk factors for viral transmission. Methods: Early in the observation period patients were tested for SARS-CoV-2 based on clinical suspicion. By June 2020, all admitted patients were tested. Symptomatic patients were admitted with pending tests under transmission-based precautions. Asymptomatic patients were managed with standard precautions including patients admitted to double-occupancy rooms. A double-occupancy exposure event was defined as an uninfected patient sharing a room with a patient positive for SARS-CoV-2. All patient exposures were tracked and evaluated by the infection prevention (IP) team. The IP prospective review of source patients included determination of lowest cycle threshold (Ct) value of first COVID-19 test, and whether their infection was hospital or community onset. Review of exposed patients included sex, age, and exposure time (in hours) to the source patient. Postexposure infection was defined as a positive test for SARS-CoV-2 in the exposed population within 14 days of the defined exposure event. We fit a multivariable logistic regression model to estimate the effect of exposure time on the odds of postexposure infection in susceptible roommates. Results: From March 15 to December 15, 2020, 172 susceptible patients were exposed to a roommate with COVID-19. Also, 28 exposed patients met our definition for postexposure infection (attack rate, 16%). The frequency of postexposure infection was higher in patients for whom the source was hospital-onset versus community-onset disease (25% vs 10%; P = .01) and when the source patient’s Ct value was below the median value of 21.1 (26% vs 11% p Conclusions: We identified a postexposure infection attack rate of 16% for double-occupancy patients in the first 9 months of the pandemic. Time exposed to source patient was significantly associated with infection. Our experience demonstrates the potential benefit of asymptomatic admission testing with expedited turnaround time to mitigate viral transmission between patients in double-occupancy rooms.Funding: NoneDisclosures: None
COVID-19 postvaccination adverse events and vaccine hesitancy among hospital employees: Is there a link?
Authors: Weiland Anastasiia , Vallapureddy Rangit , Boaitey Sarah , Ravakhah Keyvan 
Published: May 2022

Background: Vaccination against COVID-19 has demonstrated high efficacy in preventing illness severe enough to result in hospitalization. Despite these data, universal vaccine adoption by different population groups, including hospital employees, has been a challenging public health task. Vaccine-associated adverse events, the novelty of the vaccines, and the absence of long-term follow-up data have been reported as major contributors to COVID-19 vaccines mistrust. We sought to quantify postvaccination adverse events, to assess their correlation with unvaccinated status, and to evaluate other factors contributing to COVID-19 vaccination hesitancy. Methods: In a 240-bed community hospital located in a metropolitan area in the United States, we conducted a voluntary and anonymous online survey among contracted employees between September and November 2021. The study protocol was approved by the institutional review board at our facility. Results: Of all 185 responders, 143 (77%) were female, 95 (51%) were aged <51 years, and 146 were White (79%). Most (n = 100, 54%) reported no past medical history. Most common comorbidities included heart disease (n = 45, 24%), diabetes (n = 20, 11%), and chronic lung disease (n = 17, 9%). Among those surveyed, 178 were vaccinated either fully (n = 172, 93%) or partially (n = 6, 3%), and 7 (4%) were unvaccinated. Moderna was the most common vaccine received (n = 152, 85%). Those who received a 2-dose series reported experiencing more adverse events after the second dose than after the first dose (710 vs 451) of either Moderna or Pfizer vaccine. Adverse events included pain at the injection site (n = 257, 22%), fatigue (n = 178, 15%), chills (n = 133, 11%), muscle pain (n = 120, 10%), and headache (n = 117, 10%). Also, 2 responders reported omitting the second dose due to the severity of symptoms after the first dose of both Moderna and Pfizer vaccines. Concern for safety (n = 5, 71%) was the leading reason for vaccine refusal among unvaccinated followed by concern for efficacy (n = 3, 43%), lack of trust in government promoting vaccination (n = 3, 43%), religious reasons (n = 2, 28%), and immunity due to prior COVID-19 (n = 2, 28%). In addition, 3 responders reported intent to be vaccinated in the future. Conclusions: Most of the responders reported at least 1 adverse event related to COVID-19 vaccination. No severe adverse events were reported; however, a high prevalence of self-limited postvaccination adverse events might be misinterpreted as a concern for vaccine safety, as seen among surveyed unvaccinated individuals in our cohort. Targeted education is needed to limit knowledge gaps and address existing cognitive biases in COVID-19 vaccination among hospital employees.Funding: NoneDisclosures: None
Postacute sequelae of SARS-CoV-2 (PASC) in nursing home residents: A case–control study
Authors: Clark Sophie , Bautista Liza Marie , Neeb Karen , Montoya Ana , Gibson Kristen , Mantey Julia , Min Lillian , Mody Lona 
Published: May 2022

Background: Postacute sequelae of SARS-CoV-2 (PASC) include fatigue, dyspnea, anxiety, and cognitive impairment. Few studies have explored the prevalence or presentation of PASC among nursing home (NH) residents. Method: A case–control study was conducted at 1 NH in Michigan in December 2021. Cases were defined as residents with SARS-CoV-2 infection between November 2, 2020, and October 8, 2021. Controls lived at the same NH during this interval and never tested positive for SARS CoV-2. Patient characteristics were compared between cases and controls using the Fisher exact test and Wilcoxon rank-sum test. Primary outcomes were functional decline, cognition, and adverse health outcomes. Outcomes were assessed by comparing measures on last observation to observations before COVID-19 diagnosis (cases) or to earliest observation (controls). Multivariable logistic regression assessed correlation between COVID-19 diagnosis and outcomes. Results: In total, 152 residents were identified for inclusion (147 included in final analyses, 76 cases, 71 controls); 5 were excluded due to insufficient data. We collected the following resident characteristics: 66% were aged ≥80 years; 73% were female; 95% were non-Hispanic white; 82% were long-stay residents; median of 3 comorbidities (IQR, 2–4). The mean number of follow-up observations was 2.60 (SD, 1.25). No significant differences in population characteristics were detected between cases and controls. Moreover, 106 patients (46 cases and 60 controls) had at least 1 follow-up visit and were thus included in the analyses to evaluate long-term outcomes. Among them, cases experienced significant declines in completing transfers (OR 5.65, p Conclusions: Nursing home residents with COVID-19 are more likely to enter hospice and have a higher mortality rate in the year following infection. Survivors experience significant functional decline in basic activities of daily living, specifically in the ability to transfer and dress. Larger studies are needed to further characterize our findings and to design interventions that can help overcome these long-term sequelae from COVID-19.Funding: NoneDisclosures: None