Background: Clostridioides difficile infection (CDI) is a major contributor to morbidity and mortality in patients with hematologic malignancy. Due to both immunosuppression and frequent antibiotic exposures, up to one-third of inpatients receiving chemotherapy or stem-cell transplant develop CDI. Transmission of C. difficile in healthcare facilities occurs due to environmental surface contamination and hand carriage by healthcare workers from colonized and infected patients. We investigated the effectiveness of enhanced room cleaning in collaboration with environmental services (EVS) staff to prevent CDI transmission and infection.

Methods: From April 1, 2018, to September 30, 2018, a multimodal enhanced cleaning intervention was implemented on 2 oncology units at the Hospital of the University of Pennsylvania. This intervention included real-time feedback to EVS staff following ATP bioluminescence monitoring. Additionally, all rooms on the intervention units underwent UV disinfection after terminal cleaning. We performed a system-level cohort study, comparing rates of CDI on the 2 study units to historic and 2 concurrent control units. Historic and concurrent control units received UV disinfection only for rooms with prior occupants with MRSA or CDI. All units during the intervention period received education on the importance of environmental cleaning for infection prevention. Mixed-effects Poisson regression was used to adjust for system-level confounders. Results: A median of 1.34 CDI cases per 1,000 patient days (IQR, 1.20–3.62) occurred during the 12-month baseline period. There was a trend toward a reduced rate of CDI across all units during the intervention period (median, 1.19; IQR, 0.00–2.47; P = .13) compared with all units during the historical period. Using mixed-effects Poisson regression, accounting for the random effects of study units, the intervention was associated with an incidence rate ratio for C. difficile of 0.72 compared to control units (95% CI, 0.53–0.97; P = .03). Average room turnaround time (TAT) increased across all units during the study period, from 78 minutes (IQR 74–81) to 92 minutes (IQR, 85–96; P < .001). Within the intervention period, TAT was higher on intervention units (median, 94 minutes; IQR, 92–98) compared to concurrent control units (median, 85; IQR, 80–92; P = .005). Conclusions: Enhanced environmental cleaning, including UV disinfection of all patient rooms and ATP bioluminescent monitoring with real-time feedback, was associated with a reduction in the incidence of CDI.

Funding: None

Disclosures: None

To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.

OBJECTIVES/GOALS: An age-dependent restitution defect in our neonatal pig intestinal ischemia model is rescued by unknown factors within homogenized mucosa of weaned pigs. A postnatally maturing network of enteric glia regulates the epithelial barrier, so we aim to show rescue is due to replacement of glial factors. METHODS/STUDY POPULATION: Jejunal tissues from suckling or weaned pigs were assessed by RNAseq and processed for immunofluorescent histology and 3-D volume imaging. Jejunal ischemia was surgically induced in weaned pigs and injured mucosa was recovered ex vivo with or without the glial inhibitor fluoroacetate (FA) while monitoring transepithelial electrical resistance (TER). RESULTS/ANTICIPATED RESULTS: Ingenuity Pathways Analysis of RNAseq data revealed significant suppression of numerous pathways critical for epithelial wound healing in suckling pigs (Z-score <−2 for of nine key pathways). Volume imaging studies confirmed lower density (P≤0.05) and complexity of the subepithelial glial network in suckling pigs. Treatment with FA inhibited TER recovery (P<0.0001) and restitution (P<0.05) in weaned pigs, mimicking the suckling pig phenotype and supporting glia as an important regulator of restitution in our model. DISCUSSION/SIGNIFICANCE OF IMPACT: These findings provide important evidence that a developing glial network may be critical to the postnatal development of intestinal barrier repair mechanisms. Ongoing work will explore glial-epithelial interactions in vitro to further define postnatal development of barrier repair.

A basic tenet of ecotourism is to enhance conservation. However, few studies have assessed its effectiveness in meeting conservation goals and whether the type of tourism activity affects outcomes. This study examines whether working in ecotourism changes the perceptions of and attitudes and behaviours of local people towards the focal species and its habitat and, if so, if tourism type affects those outcomes. We interviewed 114 respondents at four whale shark Rhincodon typus tourism sites in the Philippines to compare changes in perceptions of and attitudes and behaviours towards whale sharks and the wider marine environment. We found that the smaller scale tourism sites had greater social conservation outcomes than the mass or failed tourism sites, including changes in conservation ethics and perceptions of and attitudes and behaviours towards whale sharks and the ocean. Furthermore, of the three active tourism sites, the smallest site, with the lowest economic returns and the highest negative impacts on whale sharks prior to tourism activities, had the largest proportion of respondents who reported a positive change in perceptions of and attitudes and behaviours towards whale sharks and the ocean. Our results suggest that tourism type, and the associated incentives, can have a significant effect on conservation outcomes and ultimately on the ecological status of an Endangered species and its habitat.

This study is the first part of the validation of a French version of the Dutch Eating Behaviour Questionnaire (DEBQ), among a population of obese and normal-weight patients. The questionnaire was administered to 166 subjects. Construct validity was assessed by orthogonal factor analysis with a varimax procedure and reliability was measured by Cronbach's alpha coefficient. Results showed the presence of three major factors (“emotional”, “restrained” and “external eating”) with loadings similar to those of the original questionnaire. A high internal consistency was found in the different scales. This study clearly demonstrates the factorial validity and the reliability of a French version of the DEQB.

This paper considers some of the theoretical and practical problems of conducting cost-utility analyses alongside clinical trials. In order to measure utilities of different health states in a clinical trial a number of critical assumptions have to be made. Some of these assumptions are questionable on a theoretical level, others empirically invalid. The practical problems of measuring utilities are discussed. The standard gamble is shown to be the most validated method of utility measurement, but still based on very strong assumptions. The standard gamble instrument is also costly and difficult to administer in clinical trials. Other instruments are found to be less valid than the standard gamble. It is concluded that although cost-utility analysis seems relevant in some instances, investigators should avoid this assessment of utility and instead measure cost-effectiveness, cost-benefit and quality of life.