Background: Infection prevention surveillance revealed that patients admitted from two specific long term care facilities comprised the majority of multi-drug resistant organisms (MDRO) and scabies cases at our institution. Current practices include performing active surveillance for Candida auris and methicillin-resistant Staphylococcus aureus (MRSA) for specific high-risk patients, as surveillance for all MDROs and scabies is impractical. We therefore sought to create an admission screening process to efficiently identify patients from high-risk facilities (HRFs) and place them in pre-emptive contact precautions upon admission. Methods: Patients admitted from HRFs were identified on admission as part of the initial nursing assessment. For any positive responses, nursing received a Best Practice Advisory to place the patient in contact precautions and patient placement received an alert that the patient would require a private room. Infection Preventionists reviewed a report of all patients who screened positive and added a “High Risk Facility” banner to the chart. This banner remained for the duration of hospitalization and for every subsequent readmission and outpatient visit. We reviewed the electronic medical records of all patients with a HRF banner placed from March 8, 2023 to September 15, 2023 and abstracted data regarding the presence of scabies or any of the following MDROs before and after placement of the banner: C. auris, carbapenem-resistant enterobacterales (CRE), MRSA, vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Acinetobacter, and MDR Pseudomonas. Results: Of the 93 patients who had a HRF banner added during the study period, 31 (33.33%) were already known to have MDRO colonization at the time of admission to our facility. Thirty-three of the remaining 62 patients (53.22%) without known MDRO colonization were subsequently found to have MDRO colonization/infection or scabies infestation that may have required contact precautions during their index admission or a subsequent admission. This included 14 patients with C. auris, 2 with CRE, 3 with MDR Pseudomonas, 12 with MRSA, 12 with carbapenem-resistant Acinetobacter, and 2 with VRE. Patients were admitted for a median of 9 days before their diagnosis, and 36 of the 93 patients (38.71%) were re-admitted to our hospital during the study period. Conclusion: We found that empiric contact precautions based solely on exposure to specific HRFs facilitated earlier isolation by a median of 9 days. This approach should be considered in acute care hospitals with a high proportion of admissions from HRFs, especially when active and passive surveillance for MDROs is limited.

Experts recommend standing orders for hospital-administered vaccines to improve adult immunization rates. We implemented an admission assessment tool to offer pneumococcal vaccine to eligible hospitalized patients. We retrospectively reviewed vaccines for guideline concordance and found that immunization rates increased but less than half of study patients received the correct vaccine.

We investigated whether and how infection prevention programs monitor for health disparities as part of healthcare-associated infection (HAI) surveillance through a survey of healthcare epidemiology leaders. Most facilities are not assessing for disparities in HAI rates. Professional society and national guidance should focus on addressing this gap.

Infection prevention program leaders report frequent use of criteria to distinguish recently recovered coronavirus disease 2019 (COVID-19) cases from actively infectious cases when incidentally positive asymptomatic patients were identified on routine severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing. Guidance on appropriate interpretation of high-sensitivity molecular tests can prevent harm from unnecessary precautions that delay admission and impede medical care.

In a survey of infection prevention programs, leaders reported frequent clinical and infection prevention practice modifications to avoid coronavirus disease 2019 (COVID-19) exposure that exceeded national guidance. Future pandemic responses should emphasize balanced approaches to precautions, prioritize educational campaigns to manage safety concerns, and generate an evidence-base that can guide appropriate infection prevention practices.

Background: Inequities are seen in many health-related outcomes, and systemic and structural factors result in inequitable care based on social determinants of health (SDOH). However, whether disparities exist specifically in healthcare-associated infections (HAIs) based on these factors has not been well described. Furthermore, there are no national standards on whether information related to equity and SDOH should be included in HAI surveillance and how such information could be used. Methods: We surveyed US members of the SHEA Research Network (SRN), a consortium of healthcare facilities with leaders interested in healthcare epidemiology and infection prevention, via an online REDCap survey from October to December 2021. Results: Of the 68 eligible US SRN facilities, 28 (41%) responded. Among them, 27 institutions provide direct patient care and were analyzed. Of these 27 facilities, 8 (30%) collected data regarding variables related to equity including language for care, race or ethnicity, insurance status, and other. Of these faclilities, 38% are collecting but not otherwise using this information; other facilities use this information for a variety of reporting and intervention purposes (Fig. 2). Only 3 facilities (11%) analyzed whether disparities exist in any HAI rates. The most common barrier to collecting SDOH information is that facilities have not considered doing this work (Fig. 3). Of the 15 facilities not yet undertaking such work, 10 (67%) were interested in doing so. Specific recommendations about how to operationalize such collection are needed (Table 1). Conclusions: Most institutions in this sample are not collecting data that would allow for assessment of disparities in the rates of HAIs; however, there is interest in doing so. A minority of early adopter facilities are assessing whether disparities exist and are designing interventions. National guidance can play a key role in standardizing the collection of this information and translating early findings to identify and subsequently improve disparities within HAIs.

Funding: None

Disclosures: None

Background: In 2008, the hospital-acquired conditions (HACs) initiative labeled central-line–associated bloodstream infections (CLABSIs) as preventable “never events” that could no longer be reimbursed by Medicare. However, some patients have inherent unpreventable etiologies for bacteremia, such as obstructive biliary malignancies. We assessed the number of CLABSIs that were reasonably preventable. Methods: We examined all CLABSI cases at 2 academic medical centers over a 2-year period (2019–2021). We established 3 categories of CLABSIs: (1) preventable CLABSI (pCLABSI); (2) end-of-life CLABSI (EOL-CLABSI), which were CLABSIs that were caused by underlying disease processes in patients who were nearing the end of their lives due to a debilitating comorbidity; and (3) definition-based (dCLABSI), which met NHSN criteria for a CLABSI but, based on the pathogen and the clinical situation, likely occurred as a consequence of a patient’s comorbidities. Two experienced infectious diseases physicians (D.U. and A.S.M.) reviewed the charts of each patient with a CLABSI and, based on expert opinion, determined the category for each CLABSI. Results: Over the 2-year period, 147 CLABSIs were identified among the 2 hospitals, 66 (44.9%) of which occurred in an ICU. Most CLABSIs were pCLABSIs, making up 99 CLABSIs (67.3%). In comparison, 20 cases were categorized EOL-CLABSIs (13.6%), although 26 cases were dCLABSIs (17.7%), and 2 cases could not be classified. There was no difference in the distribution of CLABSI types in an ICU versus a non-ICU setting (χ2P = .265). However, we detected microbiologic differences between pCLABSIs, EOL-CLABSIs, and dCLABSIs (χ2P < .001), with gram-positive cocci making up the large majority of pCLABSIs (62.6%), followed by Candida spp (24.2%). Gram-negative bacilli (GNR) made up 11.1% of pCLABSIs. In comparison, GNRs were more prevalent in EOL-CLABSIs and dCLABSIs, making up 30.0% and 38.5% of each CLABSI type, respectively. Conclusions: Two-thirds of CLABSIs were deemed preventable. Central lines are important for managing critically ill patients, many of whom have inherent risk factors for bloodstream infections. EOL-CLABSIs highlight the potential for early care discussions to avoid CLABSIs at the end of a patient’s life and to avoid unnecessary blood cultures for patients on comfort care. Additionally, the pCLABSI distinction allows hospital epidemiology teams to focus on the CLABSI cases that can realistically be prevented with appropriate central-line care, techniques, and hand hygiene. Creating these categories allows hospital systems to use more targeted approaches for improving CLABSI rates.

Funding: None

Disclosures: None

An N95 respirator ultraviolet germicidal irradiation and reuse program was rapidly implemented at an academic health system in the United States during the coronavirus disease 2019 pandemic. This process continues to be a safe and effective way to slow the consumption rate of N95 respirators.

Background:Candida auris is an emerging multidrug-resistant pathogen associated with outbreaks in hospitals and skilled nursing facilities (SNFs). Patients with C. auris can have invasive disease or asymptomatic colonization. Because C. auris can be difficult to treat and eradicate in the environment, the CDC recommends using contact precautions and sporicidal agents during patient care. After C. auris was identified in a patient from an LA County SNF (SNF-X), our institution initiated surveillance screening on high-risk patients. Methods: Nurses identified patients residing at SNF-X on admission and contacted infection prevention. These patients were placed on contact or spore precautions. Bilateral axilla and inguinal folds were swabbed with an Eswab and sent for testing by a clinical laboratory-developed RT PCR assay, which can detect C. auris with high sensitivity and specificity with a rapid turnaround time (4–6 hours). This PCR assay was based on a commercial platform IntegratedCycler (Diasorin) and reagents from the same vendor. Environmental swabs from the index patient’s room were sent for PCR by HardyCHROM Candida agar (Hardy Diagnostics) before and after cleaning with OxyCideTM. PCR-positive samples were set up for culture. Results: In total, 27 patients from SNF-X were screened by PCR. Of these patients, 15 (55%) had a tracheostomy present on admission. Moreover, 26 swabs were negative; 1 was positive in the index patient (cycle threshold [Ct] value, 26). Clinical specimens from the index patient’s blood did not grow C. auris; the tracheostomy sample grew predominantly C. albicans which made identification of C. auris challenging by culture. However, investigational testing of this sample by PCR was positive (Ct value, 31). Environmental swabs collected from the patient room were obtained before and after cleaning (Table 1); all environmental cultures were negative at 5 days. Conclusions: Developing hospital-based, high-risk patient screening for C. auris is feasible and may be useful for controlling the spread of C. auris within the community. Further study is needed to determine the usefulness of PCR for environmental testing to assess the risk of nosocomial transmission of C. auris.

Funding: None

Disclosures: None