Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients,1 leading to substantial morbidity, mortality, and excess healthcare expenditures,1 and persistent gaps remain between what is recommended and what is practiced.

The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes2 in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.3

The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.

Background: Historically, diagnosis of urinary tract infections (UTIs) has been divided into 3 categories based on symptoms and urine culture results: not UTI, asymptomatic bacteriuria (ASB), or UTI. However, some populations (eg, older adults, catheterized patients) may not present with signs or symptoms referrable to the urinary tract or have chronic lower urinary tract symptoms (LUTS), making the diagnosis of UTI challenging. We sought to understand the clinical presentation of patients who receive urine tests in a cohort of diverse hospitals. Methods: This retrospective descriptive cohort study included all adult noncatheterized inpatient and ED encounters with paired urinalysis and urine cultures (24 hours apart) from 5 community and academic hospitals in 3 states (NC, VA, GA) between January 1, 2017, and December 31, 2019. Trained abstractors collected clinical and demographic data using a 60-question REDCap survey. The study group met with multidisciplinary experts (ID, geriatrics, urology) to define the “continuum of UTI” (Table 1), which includes 2 new categories: (1) LUTS to capture patients with chronic lower urinary tract symptoms and (2) bacteriuria of unclear significance (BUS) to capture patients who do not clinically meet criteria for ASB or UTI (eg, older adults who present with delirium and bacteriuria). The newly defined categories were compared to current guideline-based categories. We further compared ASB, BUS, and UTI categories using a lower bacterial threshold of 1,000 colony-forming units. Results: In total, 220,531 encounters met study criteria. After using a random number generator and removing duplicates, 3,392 encounters were included. Based on current IDSA guidelines, the prevalence of ASB was 32.1% (n = 975), and prevalence of patients with “not UTI” was 1,614 (53%). Applying the expert panel’s new “continuum of UTI” definitions, the prevalence of “not UTI” patients decreased to 1,147 (37.7%), due to reassignment of 467 patients (15.3%)to LUTS. The prevalence of ASB decreased by 24% due to reassignment to BUS. Lowering the bacterial threshold had a slight impact on the number of definitive UTIs (14.9 vs 15.9%) (Table 1). Conclusions: Our rigorous review of laboratory and symptom data from a diverse population dataset revealed that diagnostic uncertainty exists when assessing patients with suspicion for UTI. We propose moving away from dichotomous approach of ASB versus UTI and using the “continuum of UTI” for stewardship conversations. This approach will allow us to develop nuanced deprescribing interventions for patients with LUTS or BUS (eg, watchful waiting, shorter course therapy) that account for the unique characteristics of these populations.

Disclosures: None

Background: Blood cultures are commonly ordered for patients with low risk of bacteremia. Liberal blood-culture ordering increases the risk of false-positive results, which can lead to increased length of stay, excess antibiotics, and unnecessary diagnostic procedures. We implemented a blood-culture indication algorithm with data feedback and assessed the impact on ordering volume and percent positivity. Methods: We performed a prospective cohort study from February 2022 to November 2022 using historical controls from February 2020 to January 2022. We introduced the blood-culture algorithm (Fig. 1) in 2 adult surgical intensive care units (ICUs). Clinicians reviewed charts of eligible patients with blood cultures weekly to determine whether the blood-culture algorithm was followed. They provided feedback to the unit medical directors weekly. We defined a blood-culture event as ≥1 blood culture within 24 hours. We excluded patients aged <18 years, absolute neutrophil count <500, and heart and lung transplant recipients at the time of blood-culture review. Results: In total, 7,315 blood-culture events in the preintervention group and 2,506 blood-culture events in the postintervention group met eligibility criteria. The average monthly blood-culture rate decreased from 190 blood cultures per 1,000 patient days to 142 blood cultures per 1,000 patient days (P < .01) after the algorithm was implemented. (Fig. 2) The average monthly blood-culture positivity increased from 11.7% to 14.2% (P = .13). Average monthly days of antibiotic therapy (DOT) was lower in the postintervention period than in the preintervention period (2,200 vs 1,940; P < .01). (Fig. 3) The ICU length of stay did not change before the intervention compared to after the intervention: 10 days (IQR, 5–18) versus 10 days (IQR, 5–17; P = .63). The in-hospital mortality rate was lower during the postintervention period, but the difference was not statistically significant: 9.24% versus 8.34% (P = .17). The all-cause 30-day mortality was significantly lower during the intervention period: 11.9% versus 9.7% (P < .01). The unplanned 30-day readmission percentage was significantly lower during the intervention period (10.6% vs 7.6%; P < .01). Over the 9-month intervention, we reviewed 916 blood-culture events in 452 unique patients. Overall, 74.6% of blood cultures followed the algorithm. The most common reasons overall for ordering blood cultures were severe sepsis or septic shock (37%), isolated fever and/or leukocytosis (19%), and documenting clearance of bacteremia (15%) (Table 1). The most common indications for inappropriate blood cultures were isolated fever and/or leukocytosis (53%). Conclusions: We introduced a blood-culture algorithm with data feedback in 2 surgical ICUs and observed decreases in blood-culture volume without a negative impact on ICU LOS or mortality rate.

Disclosure: None

Background: Frequently used physical therapy (PT) equipment is notably difficult to disinfect due to equipment material and shape, however, the efficacy of standard disinfection of PT equipment is poorly understood. Methods: We completed a prospective observational microbiological analysis of fomites used in adult or pediatric PT at Duke University Health System, Durham, North Carolina, from September to December 2022. Predetermined study fomites were obtained after being used during a clinical shift and standard disinfection had been completed by clinical service staff. Fomites were split into 2 halves, left and right, for sampling. Samples were taken with premoistened cellulose sponges processed using the stomacher technique and were incubated on appropriate selective and general medias. We defined antimicrobial-resistant, clinically important pathogens (AMR-CIP) as MRSA, VRE, and MDR-gram-negative isolates, and non–AMR-CIP as MSSA, VSE, and gram-negative species. Study fomites were grouped as follows: (1) pediatric pig toy, (2) walking aids (walkers or canes), (3) balls (medicine, dodge, etc), and (4) other (foam roller, sliding board, etc). Results: In total, 47 patients, 61 fomites, and 122 were analyzed. Of the study patients, 24 (51%) were female, 13 (27%) had active infections, and 15 (32%) were on contact precautions. Because fomites were split in half, patients in the left and right study arms were identical. Overall, the median total colony-forming-units (CFU) of study fomites was 1,348 (IQR, 398–2,365): 468 (IQR, 161–1,230) for the left side study arm and 540 (IQR, 102–1,221) for the right study arm (P = .45). At the sample level, 52 (43%), 15 (12%), and 37 (30%) of 122 samples harbored any CIPs, AMR CIPs, or non-AMR CIPs, respectively. At the fomite level, 27 (44%), 5 (8%), 15(25%), and 7 (11%) of 61 fomites harbored any CIPs, only AMR-CIPs, only non-AMR CIPs, or both AMR and non-AMR CIPs, respectively. Generally, therapy balls were the most contaminated study fomites (n = 2,237; IQR, 1,425–2,658), and walking aids were most frequently contaminated with any CIPs (n = 26, 72%), AMR CIPs (n = 8, 22%), and non-AMR CIPs (n = 15, 47%). Discussion: Following routine disinfection, frequently used PT equipment remained heavily contaminated and harbored AMR and non-AMR CIPs, supporting the notion that PT equipment is difficult to disinfect via standard disinfection. Additionally, left-, and right-side fomite divisions had similar pathogens, suggesting that this sampling model of intrapatient comparisons may be helpful for resolving case-mix issues in future studies. Future work should focus on PT-specific enhanced disinfection strategies to improve the disinfection of PT equipment.

Financial support: This study was funded by PURioLABS.

Disclosures: None

We calculated the attributable cost of several healthcare-associated infections in a community hospital network: central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile infections (CDI-HOs) (43 hospitals); surgical site infections (SSIs) (40 hospitals). From 2016 to 2022, the total cost of CLABSIs, CAUTIs, CDI-HOs, and SSIs was $420,012,025.

We assessed Oxivir Tb wipe disinfectant residue in a controlled laboratory setting to evaluate low environmental contamination of SARS-CoV-2. Frequency of viral RNA detection was not statistically different between intervention and control arms on day 3 (P=0.14). Environmental contamination viability is low; residual disinfectant did not significantly contribute to low contamination.

The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

This retrospective review of 4-year surveillance data revealed a higher central line-associated bloodstream infection (CLABSI) rate in non-Hispanic Black patients and higher catheter-associated urinary tract infection (CAUTI) rates in Asian and non-Hispanic Black patients compared with White patients despite similar catheter utilization between the groups.

Our surveys of nurses modeled after the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) revealed that opportunity and motivation factors heavily influence urine-culture practices (behavior), in addition to knowledge (capability). Understanding these barriers is a critical step towards implementing targeted interventions to improving urine-culture practices.

In total, 50 healthcare facilities completed a survey in 2021 to characterize changes in infection prevention and control and antibiotic stewardship practices. Notable findings include sustained surveillance for multidrug-resistant organisms but decreased use of human resource-intensive interventions compared to previous surveys in 2013 and 2018 conducted prior to the COVID-19 pandemic.

We compared the effectiveness of 4 sampling methods to recover Staphylococcus aureus, Klebsiella pneumoniae and Clostridioides difficile from contaminated environmental surfaces: cotton swabs, RODAC culture plates, sponge sticks with manual agitation, and sponge sticks with a stomacher. Organism type was the most important factor in bacterial recovery.

Policies that promote conversion of antibiotics from intravenous to oral route administration are considered “low hanging fruit” for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days of therapy divided by total days of therapy for targeted agents and a method for hospital comparisons. External comparisons may help identify opportunities for improving prospective implementation.