Background: Amid the COVID-19 pandemic, healthcare systems were stretched thin, with staffing shortages posing substantial challenges. Limiting spread of COVID-19 among healthcare professionals (HCP) is paramount to preventing exacerbation of such shortages, but strategies are highly dependent on HCP self-screening for symptoms and isolating when present. We examined HCP perceptions of barriers and factors that facilitate staying home when experiencing respiratory symptoms. Methods: At an academic tertiary-care referral center, in inpatient and ambulatory settings, we conducted an anonymous electronic survey between March 11, 2022, and April 12, 2022. Using logistic regression analysis, we analyzed predictors of employees reporting to work with respiratory symptoms using STATA and SAS software. Results: In total, 1,185 individuals including 829 clinical staff and 356 nonclinical staff responded to the survey. When excluding participants who reported working “remotely” (N = 381) and those who reported being unsure of whether they had worked with symptoms (N = 14), the prevalence of working with respiratory symptoms was 63%. There was no significant difference between clinical and nonclinical staff (OR, 1.1; 95% CI, 0.8–1.5; P = .60). Increasing number of years of service was protective against working with symptoms, achieving statistically significance in multivariable analysis after 16 years. Compared to those having worked <1 year, the odds ratios of working with symptoms were 0.32 (95% CI, 0.16–0.65; P = .002), 0.33 (95% CI, 0.15–0.74; P = .007), and 0.32 (95% CI, 0.13–0.79; P = .007) for those working 16–20 years, 21–25 years, and ≥26 years, respectively. More than half of HCP who worked with symptoms identified being understaffed (56.9%), having mild symptoms (55.3%), and sense of responsibility (55.1%) as reasons to work with respiratory symptoms. The following barriers, or reasons to work with symptoms, were more commonly identified as significant by those who worked with symptoms compared to those who did not: being understaffed (OR, 1.87; 95% CI, 1.35–2.58; P ≤ .001), having mild symptoms (OR, 1.96; 95% CI, 1.42–2.71; P < .001), and lack of support from management (OR, 1.84; 95% CI, 1.07–3.18; P = .03). Conclusions: Working with respiratory symptoms is prevalent in clinical and nonclinical HCP. Those with fewer years of work experience appear to be more susceptible to misconceptions and pressures to work despite respiratory symptoms. Messaging should stress support from leadership and the significance of even mild respiratory symptoms and should emphasize responsibility to patients and colleagues to stay home with respiratory symptoms. Strategies to ensure adequate staffing and sick leave may also be high yield.

Disclosures: None

Objectives: Sterilization failure is one of the main causes of surgical-site infections. We assessed the effectiveness of the sterilization process of surgical instruments to determine the reasons for sterilization failure. Methods: In total, 100 sterilization cycles were observed from February 4, 2022, to September 5, 2022, in hospitals in Dhaka City. We used sterilization quality assurance monitoring tools (ie, biological indicators) for rapid steam and ethylene oxide sterilization methods. Tests were performed using an automatic reading machine, chemical indicator strips, and indicator tape for both steam and ethylene oxide methods. For laboratory testing and data collection, APSIC guidelines were followed. All samples were incubated for 48 hours to cross check the accuracy of the auto-reader result. Results: All ethylene oxide sterilization cycles were 100% successful, as shown by the rapid biological indicator (auto-reader), chemical indicator strips, and indicator tape. However, 22% sterilization failure occurred with steam sterilization, which was confirmed by the auto-reader, chemical indicator strips, and indicator tape. All biological samples showed no growth after 48 hours of incubation, except the sample from steam sterilization, which did show growth after 48 hours of incubation. Conclusions: We detected 22% steam sterilization failure, and serious harm to patients could occur if these surgical instruments were used for surgery. Process recall would not have been not possible if rapid biological indicator tests had not been performed and other chemical monitoring tools had not been used. The regular use of monitoring tools according to guidelines can be a reliable solution to reduce surgical site infections caused by inappropriate sterilization of surgical instruments.

Objectives: We noted moisture in Thompson retractor sets after steam sterilization in our hospital. Moisture can cause severe problems leading to potentially contaminated instruments that carry infection risk to patients and cause procedure delays, wasted time and effort, greater workload, and higher costs. We sought to reduce the number of retractor sets with moisture to zero. Methods: The central sterile supply (CSS) team discussed the cause of the problem. We hypothesized that temperature difference between the sterilizer chamber and inside the container might create condensation and thus moisture in the final surgical set. We collected and analyzed data and proposed an experiment to improve the sterilization process. We performed a trial of sterilization process improvements pertaining to proper loading technique and the packaging process. We also evaluated the appropriate drying time for rigid containers. We then rearranged the process and adjusted the cooling time from 30 to 60 minutes after steaming. Results: Moisture in Thompson retractor packs occurred because of thicker, rigid containers. We removed the previous type of lining material to separately steam the rigid surgical instrument, and we extended the cooling time to 60 minutes. We updated standard operation procedures and continued to monitor and re-evaluate the process. Conclusions: We identified the primary cause of moisture in Thompson retractor sets after steam sterilization. We illustrated that avoiding sterilizer overload, avoiding contact with fabric wrapping materials, and proper cooling time kept the pack moisture free. Occurrences of moisture in surgical packs after sterilization should be reported and handled efficiently by CSS personnel to preserve quality and avoid waste.

Background: Neonates colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk of developing life-threatening MRSA infection. Due to lack of evidence, national guidelines do not currently recommend a specific methodology for detecting MRSA colonization. We hypothesize that surveillance for MRSA colonization via polymerase chain reaction (PCR) is superior to culture for the detection of colonization. Methods: In this retrospective study, we compared results of MRSA surveillance by 2 methodologies, culture and PCR, after implementation of an MRSA surveillance and decolonization protocol in the Texas Children’s Hospital Pavilion for Women, a 42-bed neonatal intensive care unit. MRSA colonization of 3 body sites via the 2 methodologies was assessed from June 2017 through December 2020. All neonates were screened for MRSA upon admission to the NICU and weekly thereafter until MRSA-positive or discharged. Swab specimens were initially tested by PCR (Xpert MRSA NxG, Cepheid) and when MRSA-positive reflexed to culture to recover the organism for further characterization. This study was approved through the Baylor College of Medicine Institutional Review Board. Results: During the study period, 2,351 neonates were assessed for MRSA colonization by PCR; 81 (3.4%) infants were PCR positive (Fig. 1). Of those 81, 57 (70.4%) had concordant MRSA PCR and culture results, and 24 (29.6%) were MRSA PCR positive but no isolate was recovered in culture. Also, 8 specimens were indeterminate by PCR. However, 1 infant who was negative by culture but was PCR positive developed an MRSA orbital infection. Compared to PCR, the overall sensitivity of MRSA culture was 70.4% (range, 57.7%–80.8%, depending on the year) (Table 1). Conclusions: PCR is more sensitive than culture for detecting MRSA colonization in neonates. Utilizing a PCR method enhances the ability to identify MRSA colonized infants more readily and allows for prompt initiation of infection control interventions including isolation precautions and decolonization strategies. Reflex to culture remains important for strain characterization during outbreak investigations and for additional susceptibility testing. Resource utilization and cost–benefit analyses should be done in future studies to influence changes in national guidelines for the control of Staphylococcus aureus colonization and infection in neonatal intensive care units.

Disclosures: None

Background: Multimodal approaches are often used to prevent transmission of antimicrobial-resistant pathogens among patients in healthcare settings; understanding the effect of individual interventions is challenging. We designed a model to compare the effectiveness of hand hygiene (HH) with or without decolonization in reducing patient colonization with carbapenem-resistant Enterobacterales (CRE). Methods: We developed an agent-based model to represent transmission of CRE in an acute-care hospital comprising 3 general wards and 2 ICUs, each with 20 single-occupancy rooms, located in a community of 85,000 people. The model accounted for the movement of healthcare personnel (HCP), including their visits to patients. CRE dynamics were modeled using a susceptible–infectious–susceptible framework with transmission occurring via HCP–patient contacts. The mean time to clearance of CRE colonization without intervention was 387 days (Zimmerman et al, 2013). Our baseline included a facility-level HH compliance of 30%, with an assumed efficacy of 50%. Contact precautions were employed for patients with CRE-positive cultures with assumed adherence and efficacy of 80% and 50%, respectively. Intervention scenarios included decolonization of culture-positive CRE patients, with a mean time to decolonization of 3 days. We considered 2 hypothetical intervention scenarios: (A) decolonization of patients with the baseline HH compliance and (B) decolonization with a slightly improved HH compliance of 35%. The hospital-level CRE incidence rate was used to compare the results from these intervention scenarios. Results: CRE incidence rates were lower in intervention scenarios than the baseline scenario (Fig. 1). The baseline mean incidence rate was 29.1 per 10,000 patient days. For decolonization with the baseline HH, the mean incidence rate decreased to 14.5 per 10,000 patient days, which is a 50.2% decrease relative to the baseline incidence (Table 1). The decolonization scenario with a slightly improved HH compliance of 35% produced a relative reduction of 71.9% relative to the baseline incidence. Conclusions: Our analysis shows that decolonization, combined with modest improvement in HH compliance, could lead to large decreases in pathogen transmission. In turn, this model implies that efforts to identify and improve decolonization strategies for better patient safety in health care may be needed and are worth exploring.

Disclosures: None

Objectives: The central sterile supply department (CSSD) provides sterile perineal care sets (SPC sets) for use with patients. However, the SPC sets exceed the standard, and the sterilization process incurs high cost. Therefore, a CSSD nursing team set out to find ways to save costs by providing clean perineal care sets (CPC sets) instead of sterile sets. We examined the rate of catheter-associated urinary tract infection (CAUTI) after using CPC sets, measured the satisfaction of the nursing staff who use the CPC sets, evaluated the decrease in the cost to the hospital. Methods: The CSSD nursing team presented some evidence of the benefits of using the CPC sets to the infection control subcommittee and asked for their approval to use CPC sets instead of SPC sets. After approval by the subcommittee, the CSSD nursing staff began to use CPC sets for patients. The incidence of CAUTI was monitored, and a satisfaction survey of the nurses who used the CPC sets was performed. We compared the costs between the SPC set and the CPC set to determine the cost savings. Results: The CAUTI rate did not change after using CPC sets. The nurses who used the CPC sets indicated no difference in satisfaction between the SPC and CPC sets, and the cost of the CPC set was cheaper than the SPC set (27 Baht per set). Conclusions: In a quality improvement effort, using the CPC set was safe for patients. The users were satisfied with the CPC set and trusted the safety of the instruments. Moreover, using the less expensive CPC sets saved the hospital >700,000 Baht per year.

Objectives: Since 2018, the workload in the central sterilization services department (CSSD) has intensified as surgeries have increased. The extended operative time among complicated surgical cases has also led to shortages of resterilized surgical instruments. One factor influencing these shortages was inadequate CSSD staff during high workload periods. We developed a strategy to improve the availability of resterilized instruments. We sought to reduce wasted time and improve effectiveness of surgical instrument preparation by adopting a shift-work arrangement. We additionally sought to minimize unorganized instrumentation and surgical equipment loss. Methods: Team members investigated workload disproportion shift by shift. We devised a practical arrangement of staff for each work shift by dividing manpower in ratios based on workload. Results: The period from 10:00 a.m. to 7:00 p.m. was the period of most intense workload in the CSSD. However, 3 staff worked the morning shift and 2 staff worked the evening shift (4:00 p.m.– 2.00 a.m.). We reassigned 1 person to work from 8.00 a.m. to 4.00 p.m. and 2 persons for an extra shift from 10:30 a.m. to 6:30 p.m. After the manpower readjustment, surgical equipment damage and loss decreased from 57 to 26 losses per year from 2018 to 2021. In addition, work productivity increased from 85% to 115%. Worker satisfaction improved >70%. Conclusions: Internal inconsistency concerning instrumental preparation and improper instrument arrangement can affect surgery time. By addressing workload and shift distribution of labor, productivity notably improved, with higher satisfaction and a dramatic decrease in surgical equipment loss.

Background: Blood cultures are often ordered when an infection is suspected; however, they have a low yield in most cases. The overuse of blood culture is associated with high contamination rates, resulting in excess diagnostics, unnecessary antibiotics, longer hospital stays, and higher hospital costs. We evaluated the safety of a multifaceted intervention, which encompassed education and blood-culture restriction, and its impact on blood-culture utilization and antibiotic use in adult intensive care unit (ICU) patients. Methods: The study was performed between October 2020 and October 2021 in the 12 general medicine and specialty ICUs of a quaternary academic care center. The intervention, implemented in April 2021, included providing education to ICU and infectious disease physicians based on an algorithm adapted from the Johns Hopkins DISTRIBUTE study in addition to restricting blood-culture ordering on these units to these providers. The month of April 2021 was excluded as a washout period. Study outcomes comprised blood-culture utilization, blood-culture positivity, days of therapy (DOT), and length of therapy (LOT), which were compared across the study periods using IRR or the Pearson χ2 test, as appropriate. In addition, 30-day mortality and 30-day ICU readmission were evaluated utilizing multiple COX regression models. Results: In total, 6,303 patients (2,087 MICU, 3,636 SICU, and 580 both) were included in the study, with a median age of 65 years (IQR, 21). Most participants were male (57.5%), with a median length of stay of 175 hours (IQR, 186). After the intervention, blood-culture utilization rates decreased from 15.4% to 12.4% (IRR 0.80, 95% CI, 0.76–0.85) (Fig. 1). There was no difference in blood-culture positivity between the preintervention period (11.05%) and the postintervention period (11.64%; P = .459). Days of therapy decreased from 1,180 to 1,130 per 1,000 patient days (IRR, 0.96; 95% CI, 0.95–0.98), and the length of therapy decreased from 602 to 579 per 1,000 patient days (IRR, 0.96; 95% CI, 0.94–0.99) (Fig. 2). There was no difference in 30-day mortality (P = .241) nor 30-day ICU readmission (P = .888) across the study periods after adjusting for potential confounders (Table 1). Conclusions: Our multifaceted intervention decreased blood-culture and antimicrobial utilization in the ICUs without significantly affecting the positivity rate, mortality, or readmission. This study suggests that educating providers on appropriate blood-culture use along with restriction could safely improve healthcare outcomes. Further studies are warranted to validate our results across various institutions and to evaluate the impact of blood-culture optimization in non-ICU patients.

Disclosures: None

Objectives: We evaluated the BHQ instrument management strategies at Bangkok Hospital as well as the general instrument and surgical instrument inventories to develop effective management of general and surgical instruments. Methods: A survey of instruments that had been used and were ready for use was conducted in all departments of Bangkok Hospital. Data were collected and analyzed using statistical methods to adapt the “refill and reduce” strategy. We determined usage rates from each department to determine inventory needs based on the principles that patients are safest with sufficient instruments available and that the central sterilization supply department (CSSD) can provide the best inventory management. Results: Our evaluation revealed that BHQ instrument management strategies can assist the hospital in reducing the cost of resterilizing instruments and thus can lower the workload and reduce tracking conflicts related to overdue instruments. Conclusions: This report confirmed earlier findings that Bangkok Hospital can have more instruments ready to use and can reduce costs without buying replacement instruments by using a strategy of “filling missing parts and cutting the excess.”

Background: Blood cultures are a fundamental tool in the diagnosis of infections, but they can lead to clinical confusion and waste resources when they yield false results. To optimize blood-culture orders at our institution, we developed an evidence-based clinical guideline (Fig. 1) to be used by frontline providers on nonneutropenic hospitalized adult inpatients. We retrospectively reviewed charts of patients with positive blood cultures to evaluate whether frontline providers and infectious diseases (ID) attending physicians were able to consistently interpret the guidelines to determine whether blood cultures were drawn appropriately. Methods: In total, 95 nonneutropenic adults with an initial positive blood culture collected while on an inpatient unit were identified through a query of the electronic medical record from January 2021 through June 2022. Patients with polymicrobial bacteremia and bacteremia due to Enterococcus, Streptococcus, and gram-positive rods were excluded. Moreover, 4 medical resident physicians reviewed all patients and 2 ID attending physicians reviewed one-quarter of cases; all were blinded to the culture results. Blood cultures were determined to be either appropriately or inappropriately performed based on our institution’s guideline. The free-marginal multirater κ statistics with 95% CIs were calculated to evaluate interrater agreement. Results: Baseline patient demographics are shown in Table 1. Immune compromise without neutropenia was noted in 21 of 95 patients. Most patients were at high risk for bacteremia (72%) per our institutional guideline, most of whom were septic (67.7%). Low risk for bacteremia was found in only 12.3% of reviews. Medical resident physicians, ID attending physicians, and all reviewers combined agreed on whether blood cultures were drawn appropriately or inappropriately (84.2%, 92%, and 86.4% agreement rates, respectively). The free-marginal κ statistic was highest for ID attending physicians (0.84; 95% CI, 0.62–0.78), followed by attending physicians and resident physicians combined (0.73; 95% CI, 0.56–0.90), and resident physicians alone (0.68; 95% CI, 0.58–0.78). In the 21 patients with immune compromise, the agreement rates on blood culture appropriateness remained high among all reviewers, resident physicians, and ID attending physicians were 86.6%, 90.5%, and 95%, respectively. Conclusions: In our retrospective study of nonneutropenic hospitalized adult inpatients, frontline providers and ID attending physicians interpreted blood-culture guidelines consistently, largely agreeing on which patients had cultures drawn appropriately. Agreement among ID attending physicians was excellent and remained substantial among medical resident physicians. Guidelines on the appropriate use of blood cultures are vital to limiting unnecessarily collected cultures, which can lead to extended length of stay and increase cost across hospital systems. Further analyses on the clinical impact of this guideline are ongoing.

Disclosures: None

Objectives: Single-use medical supplies are usually expensive, resulting in excess costs for hospitals and patients. Reusing single-use medical devices by resterilization or reprocessing has thus been enacted. We compared the cost of resterilizing single-use medical supplies with the cost of new purchases to reduce the unnecessary resterilization of medical supplies. Methods: The central sterile supply department (CSSD) listed single-use medical supplies that were sent for resterilization. Policies and guidelines for reusing or resterilizing single-use medical supplies were established following the standards for disinfection and sterilization. The costs of the resterilizing process for single-use medical supplies were compared with the expenses of new purchases of those medical supplies. Results: In 2019, many medical supplies were resterilized, and the resterilization of single-use devices cost up to 2,352,270 Thai baht (US $68,340). Since this project was implemented in fiscal year 2020 (October 1, 2019–September 30, 2020), the resterilization of medical supplies has decreased, and the cost of resterilization has decreased to 1,356,280 Thai baht (US $40,557), leading to a saving of 995,990 Thai baht (US $29,783, or 42% of the resterilization cost in 2019). The CSSD proposed a resterilization policy in which resterilization for reuse must be done for medical supplies and/or devices that cost ≥1,000 Thai baht (US $30). Conclusions: Although this project did not reach the target outcome of 100% reduction, the outcome was consistent with the aims of the project. The cost of resterilization of single-use medical supplies can be reduced, and a resterilization system can be developed that assures safety and effectiveness to both service providers and patients.

Background: Asymptomatic bacteriuria (ASB) is a widespread problem in hospitalized patients in which only a small subset of patients benefit from treatment. Other patient populations with ASB are harmed by treatment. In 2014, our institution implemented a urinalysis (UA)-driven reflex culture protocol which evaluated patient symptoms, risk factors, and the UA to determine whether bacterial culture was performed (Fig. 1). The goal of this process was to ensure that urine cultures were only performed in those patients who had symptoms of UTI and an abnormal urinalysis while allowing for exceptions in populations where treatment of ASB may be appropriate (ie, pregnancy, aged <3 years, impending urologic surgery, kidney transplant) or where the urinalysis may not be useful in determining whether infection is present (ie, neutropenia). An “other” indication with free-text documentation required was included to allow for unique situations. We evaluated the free-text option to determine whether additional indications were needed and whether data entered were medically appropriate. Methods: This retrospective review at a Midwestern, tertiary-care, academic medical center included inpatient UA with UTI evaluation order sets between July 1, 2020, and June 30, 2022. Descriptive statistics analyzed order-set utilization. Results: In total, 35,469 “urinalysis to reflex culture” order sets were submitted, of which 9,493 resulted in culture. Of these, 839 (8.8%) were ordered with an indication of “other.” “Other” was the most cited indication for special population override contributing to 40% (n = 839 of 2,085) of these indications, followed by kidney or pancreas transplant (29%) and neutropenia (13%). The write-in options fell into 1 of 11 themes (Fig. 2). The 3 most common reasons a urine culture was obtained using the free-text option were nonurologic surgical intervention (n = 223 of 839), immunosuppression not otherwise defined (n = 195 of 839), and symptom presence (n = 146 of 839). Based on current literature, 97% of other indications were inappropriate (n = 816 of 839). If the UTI protocol had been strictly followed, 696 of 839 (83%) cultures ordered with an indication of “other” would not have been obtained, due either to lack of symptoms or, if symptomatic, lack of pyuria. Conclusions: Most cultures obtained by selecting the “other” special population option on the algorithm were obtained in situations in which a urine culture was unnecessary. Removing the “other” indication from the algorithm may improve appropriateness of urine culturing with a possible decrease in CA-UTI and treatment of ASB. Although most write in rationales were inappropriate, adding an additional category for deceased donor-organ evaluation would be reasonable.

Disclosures: None

Objectives: We examined the washing evaluation method of the flusher disinfector installed in the medical site by visual evaluation using an ISO test soil and adenosine triphosphate (ATP) measurement. Methods: The test soil shown in ISO15883-5 was applied to the bedpan using 2 methods (N = 10) and was then visually evaluated using a 4-step scale. The ATP value on the surface of the bedpan corresponding to each scale was measured, and the correlation with the visual scale was confirmed. In addition, a visual evaluation was performed using a different flusher disinfector and bedpan (N = 3). Results: In the visual evaluation, when the test soil was applied to the entire surface of the bedpan, it remained in the parts where the water flow was hard to hit. When the test soil was applied to the surface of the bedpan except the lid, no soil remained. The 4-step visual evaluation scale and the logarithm of ATP value showed a positive correlation. In visual evaluations with different flusher disinfector and bedpan combinations, the residual soil patterns tended to be different. Some bedpans showed washing failure related to improper design. Conclusions: Poor cleaning of flusher disinfectors may occur when the amount of water used is insufficient or when the bedpan is significantly contaminated. It is important to carry out flusher disinfector washing evaluation at medical sites to evaluate the function of flusher disinfectors. An appropriate program must be utilized for staff education and appropriate management. Because flusher disinfectors and bedpans differ, flusher disinfector cleaning evaluations should be carried out at all facilities.

Background: Reflexive urine culturing, a strategy wherein urine cultures are only performed on samples with pyuria, is increasingly being used to reduce unnecessary urine cultures, healthcare costs, and inappropriate antibiotics. To support implementation of a reflexive urine-culture order for pediatric patients aged <18 years, we assessed the proportion of urine cultures that would be avoided with reflexive urine culturing, and we calculated the sensitivity and negative predictive value (NPV) of the ≥10 white blood cells (WBC) per high-powered field (HPF) threshold for diagnosing urinary tract infections (UTI) in patients aged <18 years who presented to the pediatric emergency department (ED). Methods: A retrospective review of patients <18 years with a urine culture performed from January to May 2022 in an urban, tertiary-care, pediatric ED was performed. A positive urine culture was defined as ≥50,000 CFU/mL for catheterized specimens and ≥100,000 CFU/mL for clean-catch or unspecified specimens. Pyuria was defined as ≥10 WBC/HPF. ‘True UTI’ was defined as a positive urine culture with a consistent clinical presentation (eg, fever or dysuria). Sensitivity, specificity, and NPV were calculated using the pyuria threshold of ≥10WBC/HPF compared to the gold standard of a ‘true UTI.’ Results: During the study period, 658 patients aged <18 years had urine cultures sent, of which 46 (7%) were positive. In all, 407 urine cultures (61.9%) were obtained by clean catch, 233 (35.4%) were obtained by urethral catheterization, 2 (0.3%) were obtained by Foley catheter, and 16 (2.4%) were unspecified. Among the 46 positive cultures, 32 (69.6%) had ≥10 WBC/HPF, and 55 (9.0%) of 612 negative cultures had ≥10 WBC/HPF. Of the 14 patients with positive urine cultures without pyuria, 8 had a contaminated sample or asymptomatic bacteriuria, 3 had urologic abnormalities, and 3 were infants aged <3 months. Of the 14 patients, 3 (21.4%) had a consistent clinical presentation for UTI and were treated with antibiotics: 2 were infants aged <3 months and 1 had urologic abnormalities. Using the ≥10 WBC/HPF threshold compared to ‘true UTI,’ sensitivity was 91.4%, specificity was 91.5%, positive predictive value was 36%, and NPV was 99.5%. Sensitivity and NPV increased to 100% when infants aged <3 months and urologic patients with positive urine culture were excluded. We estimated a cost saving of ~$200,000 had reflexive testing been in place. Conclusions: A reflexive urine culture for specimens with ≥10 WBC/HPF would have reduced the number of urine cultures substantially because 571 (86.8%) of 658 urine cultures would not have been performed. To prevent missed diagnoses of UTI, infants aged <3 months and children with urologic abnormalities should be excluded from this diagnostic stewardship intervention.

Disclosures: None