Objectives: Many medical devices and equipment have been reserved in hospital wards and outpatient departments. Among these items, >80% are not often used but are being reserved for emergency situations. We aimed to reduce the number of unnecessarily reserved medical devices and to reduce the cost of unnecessary resterilization of devices and equipment. Methods: The central sterile supply department (CSSD), in coordination with other 13 wards within the Thammasat University Hospital, established a standard action plan for improving the efficiency of medical supply stocking and storage. Medical equipment and/or devices were returned to the CSSD, which acted as the center of management and distribution. The CSSD also tracked and solved problems that occurred and reevaluated practice guidelines. User satisfaction was evaluated and statistic data were collected and analyzed. Results: Wards no longer reserve medical equipment. Thus, no repeated sterilization was needed for unused medical equipment from the participated 13 wards, and sufficient medical equipment was available for various wards when needed. This project helped reduce the cost of purchasing medical equipment, especially for a newly opened ward. The storage of all medical equipment and devices complied with the practice guidelines because the CSSD storage room had a standard temperature and humidity control system. Conclusions: In this project, the CSSD cooperated with the 13 participating wards. As the result of centralizing the supplies, the CSSD has sufficient medical equipment and devices for all other wards, including a newly opened ward. The hospital benefitted from reduced costs of purchasing new medical equipment for a newly opened ward as well as the cost savings of eliminating unnecessary resterilization of unused devices and equipment.

Background: Ventilator-associated pneumonia (VAP) is a significant cause of mortality in intensive care units (ICUs), but minimal research exists regarding the appropriateness of ordering endotracheal aspirate cultures (EACs). We evaluated the diagnostic utility of rationales given for EAC collection in ICUs at an academic medical center to assess potentially inappropriate EAC ordering. Methods: The study population comprised all adult patients admitted to an ICU in 2019 who underwent EAC collection. A random 10% sample from this population, stratified by ICU type, was selected. Clinical and diagnostic characteristics within 24 hours of EAC collection were identified by chart review. Clinical documentation was reviewed to identify ICU provider rationales for ordering EAC. Results: In total, 749 patients underwent EAC collection. Among them, 75 patients comprised the random sample, of whom 7 (9.3%) were excluded due to extubation before culture collection. Figure 1 shows patient distribution by ICU type. From these 68 patients, 105 EACs were collected. Of these, 41 (39%) were positive for potential pathogens, and 59 (56.2%) had explicit rationales for EAC collection, including fever (44.1%), hypoxia (18.6%), leukocytosis (16.9%), secretions (11.9%), shock (10.2%), and radiologic findings (8.5%). Also, 43.8% of EACs had no explicit rationale for collection. Table 1 shows sensitivities, specificities, positive likelihood ratios (LRs), and negative LRs for these rationales and related characteristics. Conclusions: EACs were commonly ordered without clear clinical indications. Of the noted rationales for EAC collections, most performed poorly at predicting positive cultures, which challenged common rationales for ordering EAC. This study could serve as a foundation for diagnostic stewardship interventions for EAC, potentially decreasing unnecessary cultures.

Disclosures: None

Altering the appearance of a computerized physician order entry (CPOE) interface reduces misuse of an HIV diagnostic test by 87%, demonstrating that CPOE design is a key component of diagnostic stewardship. Collaboration between infectious disease providers, clinical laboratorians, and information technology (IT) professionals can result in improved quality and decreased costs.

Background: Disinfection and sterilization of medical devices, instruments, and medical supplies are a crucial part of hospital infection control. The significant problems include insufficient cleaning, incorrect registration in the request form, no basic cleaning at the point of use (POS), and incorrect labelling. These problems were analyzed according using the fishbone diagram process. Objectives: We sought to decrease insufficient cleanliness of items after washing, to increase data accuracy in transferring contaminated devices from wards (from end users), to increase the rate of decontamination at the point of use, and to decrease incorrect labelling on instrument packaging. Method: The Community of Practice in Sterilization (CoP Sterile) team revised the disinfection and sterilization system of the Naresuan University Hospital Central Sterile Supply Department (CSSD) using root-cause analysis of subprocess problems and implementing prioritized solutions. A regular monthly meeting was set up to ensure active response, and closed monitoring was performed to ensure the implementation of the revised protocol according to the plan–do–study–act (PDSA) process. Results: From 2019 to 2021, the percentages of annual insufficient cleanliness of items after washing decreased from 4.8% to 3.6% to 3.1% each year. The percentages of incorrect request forms decreased from 14.59% to 2.91% to 1.84% during these same years. The percentages of decontamination ignorance at the point of use decreased from 3.13% to 0.12% to 0.03% from 2019 to 2021. The percentages of incorrect labelling were 0.013%, 0.008%, and 0.013% each year. Conclusions: The CoP Sterile team used quality improvement tools and regular monitoring to achieve reductions in insufficient cleanliness and incorrect request forms and to increase knowledge of decontamination procedures.

Background: Due to the need for recurrent and direct access to the bloodstream, patients who require hemodialysis are at higher risk of developing healthcare-associated infections. Failure to assess gaps in systems and processes impedes the implementation of quality and performance improvement initiatives. In Michigan, there is no consultative service offered to dialysis units to assist with infection prevention practices, and no statewide dialysis data are being utilized. The Michigan Department of Health and Human Services developed a consultative, nonregulatory service dedicated to providing a comprehensive assessment of dialysis-based infection prevention programs. Methods: A multidisciplinary team created an infection prevention dialysis evaluation program using the six-sigma define–measure–analyze–design–verify model. These elements included content within the dialysis-specific Infection Control Assessment and Response (ICAR) Tool from the CDC with supporting program assessment items. From August 2021 through August 2022, the team completed 17 inpatient dialysis assessments within our cohort’s 17 hospitals. Data were analyzed using descriptive statistical analysis, and the final analysis included 1,086 observations from the developed assessment tool. Observations were grouped into 7 infection prevention categories: appropriate use of single and multiuse devices and supplies, aseptic technique, bloodborne pathogen prevention, cleaning and disinfection, hand hygiene, personal protection equipment (PPE) use, and storage of devices and supplies. Detailed summary reports were provided to the participating facilities after each site visit that included identified gaps, recommendations for improvement, and evidence-based resources. Results: Deficiencies were grouped into 7 major infection prevention categories among the 17 assessments, including cleaning and disinfection (n = 17, 100%), hand hygiene (n = 9, 53%), PPE use (n = 9, 53%), appropriate use of single and multiuse devices and supplies (n = 6, 35%), bloodborne pathogen prevention measures (n = 6, 35%), aseptic technique (n = 5, 29%), and storage of devices and supplies (n = 4, 24%). Conclusions: Our program’s prototype has been successful at detecting gaps in dialysis-based IP programs. By conducting data analyses of assessment findings, we have been able to assist the organization in establishing priorities for quality and performance improvement. Based on the results, comprehensive and robust systems to assess infection prevention programs, including those in dialysis settings, are necessary to enhance infection prevention operations across the continuum of care.

Disclosures: None

Background: The dialysis patient population is at a higher risk for nosocomial infections as well as related negative consequences including hospitalization and death. The CMS and the state of Tennessee mandate reporting of 3 types of dialysis events: positive blood culture, intravenous antimicrobial starts, and pus, redness, or increased swelling at the access site. We explored hospitalization and death outcomes by vascular access types for dialysis events reported to the NHSN for licensed outpatient hemodialysis clinics in Tennessee from 2015 to 2019. Methods: We looked at the frequency of hospitalization and death among those who experienced a dialysis event for 3 types of vascular access: arteriovenous fistula, arteriovenous graft, and tunneled central venous catheter (CVC). Other vascular-access types were excluded due to low usage rates. Odds ratios and confidence intervals were used to quantify the relationship between access type and hospitalization, and access type and death. Pooled analysis was used due to the stable rates of death and hospitalization among access types from 2015 to 2019. Results: From 2015 to 2019, 16,742 dialysis events were reported for the 3 access types: 8,055 dialysis events (48.1%) occurred among those with tunneled CVCs, 7,107 (42.5%) occurred among those with fistulas, and 1,580 (9.4%) occurred among those with grafts. Of the 16,742 dialysis events, 3,420 patients (20.4%) were hospitalized either due or related to their dialysis event; 220 (1.3%) deaths occurred either due to or related to the patient’s dialysis event. The odds of being hospitalized was 1.47 (95% CI, 1.29–1.67) times greater in those with grafts compared to those with fistulas. Patients with tunneled CVCs were 1.30 (95% CI, 1.20–1.41) times greater to be hospitalized compared to those with fistulas. The odds of death was 1.09 (95% CI, 0.9–2.5) times greater in those patient with tunneled CVCs compared to those with fistulas, whereas the odds of death among patients with grafts was 0.73 (95% CI, 0.82–1.43) times the odds of death compared to patients with fistulas. Conclusions: Overall, our findings conclude hemodialysis patients with tunneled CVCs have an increased risk for the negative health outcomes of hospitalization and death when compared to the other access types, supporting previous studies. Additionally, grafts had a higher risk of hospitalization compared to fistulas, but patients with grafts had lower odds of death than those with fistulas. Further investigation is needed to study how the COVID-19 pandemic may have affected the trends of negative health outcomes related to dialysis events.

Disclosures: None

Objectives: Public health emergencies caused by airborne infectious agents are a significant concern, re-emphasized by the current COVID-19 pandemic. It is therefore vital to employ a technology that destroys microbes of all phyla and genera. We describe a novel technology called “Zebox” that can extract, trap, and destroy microbes from the air. This technology destroys even microbes that are resistant to known antibiotics. Methods: Airborne microbial load was enumerated using standard microbiological methods in both hospital ICUs and controlled conditions. Significant microbial reductions due to the ZeBox intervention in the ICUs were confirmed by statistical analysis. Results: ZeBox eliminated a broad spectrum of airborne pathogens (ie, viruses, bacteria, and fungi) in laboratory tests and in hospital ICUs, which are characterized by high, stochastic microbial loads. In closed-chamber experiments, ZeBox achieved a >99.999% reduction of airborne microbes. In the hospital ICU, ZeBox achieved a consistent >90% reduction across several months. Some of the airborne pathogens that ZeBox eliminated in the hospital ICU were multidrug resistant. Conclusions: ZeBox is an effective preventive technology against the spread of airborne pathogens and potentially associated infections. ZeBox could be used to reduce healthcare-associated infections in clinics and hospitals, as well as in burns units and immunocompromised patients. Zebox has the potential to be a significant prophylactic device in the global war on antimicrobial resistance.

Optimizing antibiotic prescribing is a crucial element of the fight against antibiotic resistance. Antibiotic prescribing patterns in jails have not been studied. We established a baseline of antibiotic prescribing between Massachusetts jails. We detected heterogeneity in quantity and duration of antibiotic prescriptions, revealing an opportunity for improved practice.

Background: In the post–COVID-19 era, competency of healthcare workers is very important, and new technology is imperative. The central sterile supply department (CSSD) staff must also improve their response when a patient infection is reported. The sterilization process is more important than ever. Objectives: We sought to simplify surveillance to act faster, to reduce the time to obtain patient data, and to eliminate nonvalue stream mapping in the workflow process in order to prevent patient harm and strengthen our infection prevention and control efforts. Methods: The CSSD staff met with an IT developer to determine requirements for an electronic surveillance program. Before this intervention, we scanned hard copies of patient records and stored them in a folder on a computer on a daily basis. These data were difficult to search, monitor, and display, and this method wasted time in locating patient data. The IT developer designed a program to track patients and instruments. The program collected data regarding the patient’s surgery, instruments used, and monitoring information. With the help of the IT developer, the CSSD staff tested and tweaked the new platform until accuracy and usability were achieved. Staff were trained on the use of the new system before it was implemented. Results: This project yielded simplified surveillance that improved the infection prevention process, reduced potential patient harm, and strengthened the ability of the IPC team to analyze and act on data. Conclusions: A simple surveillance system for tracking patients and instruments used assists both CSSD and IPC teams. This system assures the performance of sterilization procedures. When adverse events occur, patients who used these devices are tracked, and an analysis is performed to identify and implement improvements.

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 examined the effect of an antimicrobial stewardship program (ASP), procalcitonin testing and rapid blood-culture identification on hospital mortality in a prospective quality improvement project in critically ill septic adults. Secondarily, we have reported antimicrobial guideline concordance, acceptance of ASP interventions, and antimicrobial and health-resource utilization.

Bacterial superinfection and antibiotic prescribing in the setting of the current mpox outbreak are not well described in the literature. This retrospective observational study revealed low prevalence (11%) of outpatient antibiotic prescribing for bacterial superinfection of mpox lesions; at least 3 prescriptions (23%) were unnecessary.

Objectives: Single-use devices are supposed to be used only once, but under some conditions those devices need to be reused. Therefore, we conducted the “Reuse of Single-Use Devices Management” project in our hospital. We evaluated single-use devices that are reused for the following factors: (1) reuse of the single-use device with the same patient; (2) a manufacturer stop production order; (3) lack of devices in inventory; and (4) device value >5,000 Thai baht (US $150). Every unit in the hospital is able to handle and monitor the reuse of single-use devices systematically for patient safety. We performed a quality surveillance project to monitor and prevent patient infection and injury from worn-out reused single-use devices, and we collected data related to the cost of reusing single-use devices. Methods: In a working group that studied single-use devices, responsibilities and roles were assigned and the purposes and scope of work were established. We reviewed the reuse of single-use devices policy. We created a request form for the reuse of single-use devices and a quality record form for use in units that reused single-use devices. We analyzed outcomes, monitored data, and audited the completion of these forms on these units. We assured the completion of single-use device registration. We measured the rate of reuse of single-use devices. We monitored the incidence of surgical wound infections related to reuse of a single-use device. Results: Both of these forms were implemented at 100%, and the number of surgical wound infections was zero. Conclusions: The project focused on single-use device registration and the rate of devices ready to use. The uptake of new procedures was 100%, and the expected number of surgical wound infections in patients was zero.

Background: The recent worldwide outbreak of Mpox virus infections has raised concern about the potential for nosocomial acquisition during handling of contaminated bedding or clothing. We conducted simulations to test the hypothesis that decontamination of bedding prior to handling could reduce the risk for contamination of personnel. Methods: We conducted a crossover trial to test the effectiveness of spraying contaminated bedding with a hydrogen peroxide disinfectant in reducing contamination of personnel during handling of the contaminated bedding. Bedding was contaminated on top and bottom surfaces with aerosolized bacteriophage MS2. Personnel (N = 10) wearing a cover gown and gloves removed the bedding from a patient bed and placed it into a hamper both with and without prior hydrogen peroxide spray decontamination. After handling the bedding, samples were collected to assess viral contamination of gloves, cover gown, neck or chest, and hands or wrists. Results: Contamination of the gloves and cover gown of personnel occurred frequently during handling of bedding and 20% of participants had contamination of their hands or wrists and neck after the simulation (Fig.). Decontamination of the bedding reduced contamination of the gloves and eliminated contamination of the cover gown, hands or wrists, or neck. Conclusion: Decontamination of bedding prior to handling could be an effective strategy to reduce the risk for nosocomial acquisition of Mpox by healthcare personnel.

Disclosures: None

Background: Avoidable infections in healthcare (healthcare-associated infections or HAIs) occur globally. The causes of HAI are influenced by a complex combination of gaps in policies, infrastructure, organization, knowledge, healthcare worker behavior, and patient-related factors. Through knowledge, best practices, and infrastructure improvement, the infection prevention and control (IPC) team aims to prevent harm to patients and healthcare workers due to HAIs. The most common HAIs are surgical site infections (SSIs) caused by harmful device-reuse practices, inadequate sterilization, and/or inadequate decontamination procedures. Disinfection and sterilization of instruments and medical devices play very important roles in HAI and SSI prevention. World Health Organization (WHO) Collaborating Centre in Quality Improvement Program certification, the first pilot project in Thailand, included the Central Sterilizing Services Association of Thailand and 15 hospital central sterile supply departments (CSSDs). This quality improvement program for sterilization reprocessing aimed to prevent harm to patients and healthcare workers due to HAIs. Objectives: We sought to reduce damage to instruments caused by inadequate reprocessing sterilization to zero incidents. We sought to reduce inadequate packing to ≤3 events per month. We sought to reduce the need to resterilize instruments by >80%. Methods: A root-cause analysis meeting was held by CSSD staff, and an IT vendor was consulted about developing an electronic alert system. The following changes were implemented: Staff packed instruments using a list of pictures for each set. Sticker labels were applied showing the proper number of pieces in the set. Identification O-rings were added to instruments with inventory dates, serial numbers, and instructions for use. Stickers were added to indicate the method of sterilization, such as ethylene oxide gas only or hydrogen peroxide only. Results: Reports of damage due to the sterilization process decreased to zero. No events related to the packing process were reported, and resterilization of instruments decreased by 98.94%. Conclusions: In this project, we implemented a quality improvement process and tracking system, reduced defects, and increased healthcare worker competency to improve patient safety.

Objectives: Few reports have been published about the transmission of mpox in healthcare settings. During the 2022 multinational outbreak, the California Department of Public Health (CDPH) conducted a systematic review of healthcare personnel (HCP) with mpox, including their community and occupational exposures, to understand the transmission risk in healthcare settings. We also sought to inform return-to-work protocols by describing the frequency of HCP working while symptomatic for mpox and identifying occurrences of secondary transmission from infected HCP to patients. Methods: We analyzed surveillance data for laboratory-confirmed mpox cases in California with symptom onset from May 17 to September 30, 2022, collected by investigators at local health departments and reported to the CDPH. The reported data were supplemented by review of free-text variables, interview notes, and other files uploaded to state and county disease surveillance data registries. We identified HCP as all persons working in healthcare settings with potential for direct or indirect exposure to patients or infectious materials, including clinical and nonclinical staff but excluding remote workers. Results: The CDPH received reports of 3,176 mpox cases during the study period: 109 were HCP. Of the 109 HCP identified from 19 counties, 78 (72%) were aged 30–49 years, 102 (94%) were male, and 43 (39%) were Hispanic or Latino. Also, 29 HCP (27%) had received at least 1 dose of the JYNNEOS vaccine. Occupations requiring frequent physical interactions with patients were reported for 66 individuals (61%). During interviews with local health department investigators, nearly all HCP (n = 98, 90%) reported potential or confirmed sources of community exposure; 1 had confirmed occupational exposure with symptom onset 9 days after a sharps injury acquired during collection of an mpox specimen for testing. Of the 60 HCP who provided information about the days they worked, 35 (58%) worked while symptomatic, for a mean of 3.14 days (median, 2; IQR, 3). Also, 2 HCP worked for 12 days after symptom onset. No secondary cases of mpox were associated with HCP reported to the CDPH. Conclusions: This analysis suggests that HCP are more likely to be exposed to mpox in community settings than healthcare settings. The findings support recommendations against sharps use for mpox specimen collection. Although transmission between symptomatic HCP and patients was not reported, HCP can decrease opportunities for mpox transmission by closely monitoring themselves for symptoms after potential exposures and staying home from work if symptoms develop.

Disclosures: None

During the 2022 mpox outbreak, tecovirimat was accessed through an expanded access investigational new drug (EA-IND) protocol. We leveraged a unique public/private hospital partnership in New York City to create a novel infrastructure to navigate the EA-IND’s regulatory requirements and rapidly provide tecovirimat to patients.

Objectives: The central sterile supply department (CSSD) is responsible for sterilization processes, and instruments are then stored in a clean room until use. Environmental controls, such as temperature, and relative humidity, are important in preventing the spread of infection during the sterilization process and during storage of medical devices. Data regarding temperature and relative humidity readings in the operating room, and whether instruments remain covered for the duration of the operation, are difficult to obtain. For easy access to relative temperature and humidity data covering all operational intervals, a rapid and convenient notification system was designed using a software application to send temperature and humidity information to the ThingSpeak website. We identified abnormal values for temperature and relative humidity and submitted revisions for all operating periods to facilitate monitoring of the refrigeration system. Methods: We implemented 3 programs: (1) DHT11 humidity and temperature sensor; (2) NodeMCU ESP8266; and (3) Program Arduino IDE. Results: The ESP8266 board connected using WIFI SUTH Mobile, and the DHT11 displayed temperature and humidity. The temperature and humidity data were sent to the website every 10 minutes. When an alarm occurred, it triggered immediate notification via the software application. Conclusions: We designed a temperature and humidity alert system using DHT11. Environmental control was possible using ESP8266, and alerts were triggered in the software application when an anomaly occurred. Data were uploaded to ThingSpeak every 10 minutes. The triple system actually sends alerts through the application and records data every 10 minutes. This system can measure environmental conditions in real time.