Free-floating planets (FFPs) can result from dynamical scattering processes happening in the first few million years of a planetary system's life. Several models predict the possibility, for these isolated planetary-mass objects, to retain exomoons after their ejection. The tidal heating mechanism and the presence of an atmosphere with a relatively high optical thickness may support the formation and maintenance of oceans of liquid water on the surface of these satellites. In order to study the timescales over which liquid water can be maintained, we perform dynamical simulations of the ejection process and infer the resulting statistics of the population of surviving exomoons around FFPs. The subsequent tidal evolution of the moons’ orbital parameters is a pivotal step to determine when the orbits will circularize, with a consequential decay of the tidal heating. We find that close-in ($a \lesssim 25$ RJ) Earth-mass moons with carbon dioxide-dominated atmospheres could retain liquid water on their surfaces for long timescales, depending on the mass of the atmospheric envelope and the surface pressure assumed. Massive atmospheres are needed to trap the heat produced by tidal friction that makes these moons habitable. For Earth-like pressure conditions (p0 = 1 bar), satellites could sustain liquid water on their surfaces up to 52 Myr. For higher surface pressures (10 and 100 bar), moons could be habitable up to 276 Myr and 1.6 Gyr, respectively. Close-in satellites experience habitable conditions for long timescales, and during the ejection of the FFP remain bound with the escaping planet, being less affected by the close encounter.

Background: In May 2018, The Joint Commission, The Pew Charitable Trusts, and the CDC cosponsored a meeting of experts who identified 6 evidence-based leading practices that antimicrobial stewardship programs (ASPs) should be doing beyond having basic infrastructure for improving antibiotic prescribing. The Joint Commission Department of Research working with external experts in 2020 conducted a prevalence study to assess what proportion of Joint Commission-accredited hospitals had implemented the 6 leading practices identified (results presented at SHEA Spring 2021). In this qualitative study, we collected information about how hospitals implemented ASP leading practices to identify facilitators and barriers to implementation among diverse hospitals. Methods: We conducted in-depth telephone interviews with a subset of ASP leaders from hospitals that participated in the 2020 prevalence study. We used purposive sampling to select 30 hospitals from 288 hospitals based on leading practices implemented, hospital size, and system membership. An experienced qualitative researcher (M.K.) not previously affiliated with the Joint Commission interviewed all participants using a semistructured interview guide. The framework method of analysis was used to review and organize data. We used the constant comparative approach to ensure that factors were not missed. Each transcript was reviewed by at least 2 researchers who compared coded findings in group discussion sessions. Two researchers independently identified key factors and combined findings following discussion and review. We focused on super factors that are relevant to implementing multiple leading practices. Results: ASP leaders from 30 hospitals were interviewed. Participating hospitals were evenly distributed across hospital size (10 small, 10 medium, 10 large) and membership in a health system (16 system, 14 nonsystem). At least 14, (46.7%) interviewees had pharmacist in their title; 11 (36.7%) had pharmacist-antimicrobial stewardship; and 5 (16.6%) had other titles (eg, infection preventionist). Super factors included ASP team capacity, ID expertise, having a physician champion, relationships with clinicians and relevant departments, structure of electronic health records, adequate software, and information technology resources. Small and rural nonsystem hospitals often lacked resources related to ID expertise, dedicated staff, and software tools, whereas hospitals that belong to a system benefit from centralized ID expertise and technical infrastructure provided. Conclusions: Specific factors related to personnel, relationships and IT resources have an outsized impact on implementing multiple leading antimicrobial stewardship practices in hospitals. Hospital ASPs could benefit by targeting resources toward these areas.

Funding: None

Disclosures: None

Background: Most hospitals have a basic infrastructure in place for antimicrobial stewardship programs (ASPs). Although this is a critical first step, we need to ensure that ASPs are working to implement effective evidence-based approaches nationally. In 2018, a group of leading antibiotic stewardship organizations met and identified specific, effective, and recommended ASP activities based on current scientific evidence and their experience (Baker et al, Joint Comm J Qual Pat Saf 2019;45:517–523). To determine the extent to which hospitals are currently implementing the recommended practices, we conducted an electronic questionnaire–based assessment. Methods: A 50-item questionnaire-based assessment was sent via QualtricsTM to the hospital’s designated ASP leader. The sample comprised 992 Joint Commission accredited hospitals. The practices of interest related to (1) development of facility-specific treatment guidelines, (2) measuring appropriate use and concordance of care with these guidelines, (3) engaging clinicians while the patient is on the unit, (4) diagnostic stewardship, (5) measurement of antimicrobial utilization data, and (6) measuring hospital-acquired Clostridioides difficile infection (CDI) rates. Sampling weights were used to adjust the results for nonresponse using R software. Results: In total, 288 hospitals completed the questionnaire. Small and nonteaching hospitals were significantly less likely to respond (p < 0.005, p=0.01 respectively), however there were no differences by healthcare system membership or urban/rural location. 49% of respondents had the specialist term ASP or infectious disease (ID) in their title. Most hospitals (93.1%) had developed facility-specific treatment guidelines for specific inpatient conditions, often community-acquired pneumonia (85%), sepsis (81%), UTI (75%), and SSTI (69%). However, only 37% had formally assessed compliance with 1 or more of these guidelines. Also, 83% reported having a process for prospective audit and feedback, of which 43% do this 4–5 days per week. Similarly, 49% reported that they review all antimicrobials ordered. Recommendations are commonly given by the ASP pharmacist (69%) via some combination of telephone (78%), face-to-face (69%), text message (54%), and/or EHR alert (36%). Overall, 66% of hospitals had procedures in place to prevent inappropriate diagnostic testing for C. difficile, and 39% of hospitals had similar policies for urine specimens. Furthermore, >80% were routinely measuring days of therapy and CDI rates. Conclusions: Most hospitals have facility-specific treatment guidelines and measure CDI and days of therapy. Practices for active engagement with frontline staff in prospective audit and feedback vary widely. Greater understanding of barriers to assessing adherence to hospitals’ treatment guidelines is critical to improving this practice.

Funding: The Pew Charitable Trusts

Disclosures: None

Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation exposures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.

Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies.

Infect Control Hosp Epidemiol 2016;1–6

This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.

Background: To assess the state of health center integration into community preparedness, we undertook a national study of linkages between health centers and the emergency preparedness and response planning initiatives in their communities. The key objectives of this project were to gain a better understanding of existing linkages in a nationally representative sample of health centers, and identify health center demographic and experience factors that were associated with strong linkages.

Methods: The objectives of the study were to gain a baseline understanding of existing health center linkages to community emergency preparedness and response systems and to identify factors that were associated with strong linkages. A 60-item questionnaire was mailed to the population of health centers supported by the Health Resources and Services Administration’s Bureau of Primary Health Care in February 2005. Results were aggregated and a chi square analysis identified factors associated with stronger linkages.

Results: Overall performance on study-defined indicators of strong linkages was low: 34% had completed a hazard vulnerability analysis in collaboration with the community emergency management agency, 30% had their role documented in the community plan, and 24% participated in community-wide exercises. Stronger linkages were associated with experience responding to a disaster and a perception of high risk for experiencing a disaster.

Conclusions: The potential for health centers to participate in an integrated response is not fully realized, and their absence from community-based planning leaves an already vulnerable population at greater risk. Community planners should be encouraged to include health centers in planning and response and centers should receive more targeted resources for community integration. (Disaster Med Public Health Preparedness. 2007;1:96–105)

A Web-based training course with embedded video clips for reducing central line-associated bloodstream infections (CLABSIs) was evaluated and shown to improve clinician knowledge and retention of knowledge over time. To our knowledge, this is the first study to evaluate Web-based CLABSI training as a stand-alone intervention.

Since its inception, the Society for Healthcare Epidemiology of America (SHEA) has promoted research into prevention of adverse events in hospitals. In 1995, SHEA made this mission concrete by initiating a collaborative research project with the Joint Commission on the Accreditation of Health Care Organization (now known as the Joint Commission). In the early 1990s, the Joint Commission was implementing its “Agenda for Change” and associated Indicator Monitoring System. At the time, there were numerous competing measurement systems that used different definitions, all aimed at measuring the quality of patient care, and many had indicators measuring the incidence of hospital-acquired infections. Some of these indicators used administrative data, such as International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes, to measure adverse events.

The Project to Monitor Indicators (PMI) will be a collaborative effort between the Society for Healthcare Epidemiology of America (SHEA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The goal of this collaboration is to create an intellectual infrastructure to support the effective use, development, understanding, and continuous improvement of clinical quality indicators through coordinated study by hospital epidemiologists.

The Joint Commission is in the midst of an extensive effort to develop a set of indicators that reflect the performance of various aspects of clinical practice. These indicators will form the foundation of a national comparative measurement system called the Indicator Measurement System (IMSystem). It is the Joint Commission's plan that hospitals will be required to participate in the IMSystem as part of the accreditation process in the near future.