Known concentrations of Staphylococcus aureus and Candida auris were applied on gloves and gowns then sampled with E-swabs and BBL liquid Amies swabs. The mean numbers of colony-forming units per milliliter (CFU/mL) obtained from culture of the 2 swab types were not different, suggesting that either can be used for recovery of these two pathogens from personal protective equipment.

Timely euthanasia on swine farms can help to reduce the incidence of poor welfare outcomes for compromised pigs (Sus scrofa) when recovery is prolonged or impossible. Timely euthanasia relies upon caretakers’ abilities to identify compromised pigs and administer euthanasia in various environments. To determine appropriate timelines and most common reasons for on-farm euthanasia, an online survey was conducted with members of the United States National Pork Board. Additionally, two focus groups were conducted to investigate barriers and possible solutions associated with timely euthanasia. Clinical signs related to poor locomotion (57.6%), prolapses (47.2%), and hernias (43.5%) were identified by the greatest percentage of respondents who believed immediate euthanasia was warranted, while a greater percentage of respondents believed euthanasia was not warranted for clinical signs related to the integumentary (90.3%), reproductive (75.8%), and respiratory (67.5%) systems. The most common reason for euthanasia was poor body condition in pre-weaned piglets and non-ambulatory or severely weak for both breeding and non-breeding pigs. In the focus groups, two themes were identified when evaluating barriers to euthanasia on-farm, and participants agreed that making timely decisions relies upon several dimensions of risk analysis. An unsupportive farm culture was identified as a critical barrier to timely euthanasia decision-making, suggesting that caretaker characteristics may play a role in the success of any timely euthanasia programme. This present study has highlighted areas for future research and demonstrated the need to extend educational efforts both to swine industry leaders and producers to improve overall animal welfare by ensuring timely euthanasia in swine.

Women with opioid use disorder (“OUD”) are more likely than other women to experience sexual assault, unintentional pregnancy, transactional sex and coercion regarding reproductive health care choices than women without OUD. Laws described as family friendly may be punitive rather than helpful to women and rarely apply to men. Laws regarding reproductive health and OUD are unevenly enforced and therefore biased against poor, minority women. As part of a larger study oriented toward strengthening systems of care related to the intersection of HIV and OUD, we conducted an analysis of state laws related to pregnant and postpartum women with OUD. Data on disparities in child removals and pregnant women’s use of evidence-based treatment for OUD by income and race were captured for the five states with the most restrictive laws in both categories. Laws that were purportedly designed to improve reproductive health outcomes for women with OUD and/or their children often have the opposite of the expressed intended outcome. There is a relationship between restrictive reproductive choice and coercive OUD treatment policy for women. Restrictive state regulations for pregnant women with OUD persist despite negative outcomes for maternal and child health. Altering coercive and/or criminalizing regulation and redefining ‘family friendly’ may improve outcomes for individuals and families.

A chloroacetamide herbicide by application timing factorial experiment was conducted in 2017 and 2018 in Mississippi to investigate chloroacetamide use in a dicamba-based Palmer amaranth management program in cotton production. Herbicides used were S-metolachlor or acetochlor, and application timings were preemergence, preemergence followed by (fb) early postemergence, preemergence fb late postemergence, early postemergence alone, late postemergence alone, and early postemergence fb late postemergence. Dicamba was included in all preemergence applications, and dicamba plus glyphosate was included with all postemergence applications. Differences in cotton and weed response due to chloroacetamide type were minimal, and cotton injury at 14 d after late postemergence application was less than 10% for all application timings. Late-season weed control was reduced up to 30% and 53% if chloroacetamide application occurred preemergence or late postemergence only, respectively. Late-season weed densities were minimized if multiple applications were used instead of a single application. Cotton height was reduced by up to 23% if a single application was made late postemergence relative to other application timings. Chloroacetamide application at any timing except preemergence alone minimized late-season weed biomass. Yield was maximized by any treatment involving multiple applications or early postemergence alone, whereas applications preemergence or late postemergence alone resulted in up to 56% and 27% yield losses, respectively. While no yield loss was reported by delaying the first of sequential applications until early postemergence, forgoing a preemergence application is not advisable given the multiple factors that may delay timely postemergence applications such as inclement weather.

Background: Healthcare personnel (HCP) acquire MRSA on their gown and gloves during routine care activities for patients who are colonized or infected with MRSA at a rate of ∼15%. Certain care activities (eg, physical exam, care of endotracheal tube, wound care and bathing/hygiene) have been associated with a higher frequency of transmission from the patient to HCP gown and gloves than other activities (ie, administration of oral medicines, glucose monitoring, and manipulation of IV tubing/medication delivery). However, quantification of MRSA contamination and risk to subsequent patients is poorly defined. Objective: We sought to determine the mean MRSA colony-forming units (CFU) found on the gloves and gowns of HCP who acquire MRSA after various care activities involving patients with MRSA. Methods: We conducted a prospective cohort study at the University of Maryland Medical Center from December 2018 to October 2019. We identified patients colonized or infected with MRSA based on culture data from the prior 7 days. HCP performing prespecified care activities on eligible patients were observed. To isolate the risk of each care activity, HCP donned new gloves and gown prior to a specific care activity. Once that care activity was performed, HCP gloves and gown were swabbed prior to the any further care activities. HCP gloves were cultured with an E-swab by swabbing each digit up and down 3 times followed by 2 circles on the palm of their hands. HCP gowns were sampled by swabbing a 15 × 30-cm area along the beltline of the gown and along each inner forearm twice. E-swab liquid was then serially diluted and plated in triplicate on CHROMagar MRSA II (BD, Sparks, MD) to obtain CFU. We calculated the median CFUs and the interquartile range (IQR) for each specific care activity stratified by gown and gloves. Results: In total, 604 HCP–patient care interactions were observed. Table 1 displays the mean MRSA CFUs stratified by gown and gloves for each patient care activity of interest. Conclusions: The quantity of MRSA found on gowns and gloves varies depending on patient care activities. Recognition of differential transmission rates between various activities may allow different approaches to infection prevention, such as the use of personal protective equipment in high- versus low-risk activities and/or the use of more aggressive interventions for high-risk activities.

Funding: None

Disclosures: None

Background: As carbapenem-resistant Enterobacteriaceae (CRE) prevalence increases in the United States, the risk of cocolonization with multiple CRE may also be increasing, with unknown clinical and epidemiological significance. In this study, we aimed to describe the epidemiologic and microbiologic characteristics of inpatients cocolonized with multiple CRE. Methods: We conducted a secondary analysis of a large, multicenter prospective cohort study evaluating risk factors for CRE transmission to healthcare personnel gown and gloves. Patients were identified between January 2016 and June 2019 from 4 states. Patients enrolled in the study had a clinical or surveillance culture positive for CRE within 7 days of enrollment. We collected and cultured samples from the following sites from each CRE-colonized patient: stool, perianal area, and skin. A modified carbapenem inactivation method (mCIM) was used to detect the presence or absence of carbapenemase(s). EDTA-modified CIM (eCIM) was used to differentiate between serine and metal-dependent carbapenemases. Results: Of the 313 CRE-colonized patients enrolled in the study, 28 (8.9%) were cocolonized with at least 2 different CRE. Additionally, 3 patients were cocolonized with >2 different CRE (1.0%). Of the 28 patients, 19 (67.6%) were enrolled with positive clinical cultures. Table 1 summarizes the demographic and clinical characteristics of these patients. The most frequently used antibiotic prior to positive culture was vancomycin (n = 33, 18.3%). Among the 62 isolates from 59 samples from 28 patients cocolonized patients, the most common CRE species were Klebsiella pneumoniae (n = 18, 29.0%), Escherichia coli (n = 10, 16.1%), and Enterobacter cloacae (n = 9, 14.5%). Of the 62 isolates, 38 (61.3%) were mCIM positive and 8 (12.9%) were eCIM positive. Of the 38 mCIM-positive isolates, 33 (86.8%) were KPC positive, 4 (10.5%) were NDM positive, and 1 (2.6%) was negative for both KPC and NDM. Also, 2 E. coli, 1 K. pneumoniae, and 1 E. cloacae were NDM-producing CRE. Conclusion: Cocolonization with multiple CRE occurs frequently in the acute-care setting. Characterizing patients with CRE cocolonization may be important to informing infection control practices and interventions to limit the spread of these organisms, but further study is needed.

Funding: None

Disclosures: None

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a serious threat to public health due to high associated morbidity and mortality. Healthcare personnel (HCP) gloves and gowns are frequently contaminated with antibiotic-resistant bacteria, including CRE. We aimed to identify patients more likely to transmit CRE to HCP gloves or gowns and HCP types and interactions more likely to lead to glove or gown contamination. Methods:Between January 2016 and August 2018, patients with a clinical or surveillance culture positive for CRE in the preceding 7 days were enrolled at 5 hospitals in California, Maryland, New York, and Pennsylvania. Ten HCP–patient interactions were observed for each patient and were recorded by research staff. Following patient care, but prior to doffing, the gloves and gown of each HCP were sampled for the presence of CRE. Results: We enrolled 313 CRE-colonized patients, and we observed 3,070 HCP interactions. CRE was transmitted to HCP gloves in 242 of 3,070 observations (7.9%) and to gowns in 132 of 3,070 observations (4.3%). Transmission to either gloves or gown occurred in 308 of 3,070 interactions observed (10%). The most frequently identified organism was Klebsiella pneumoniae (n = 171, 53.2%), followed by Enterobacter cloacae (n = 36, 11.2%), and Escherichia coli (n = 33, 10.3%). Patients in the intensive care unit (n = 177, 56.5%) were more likely to transmit CRE to HCP gloves or gown (OR, 1.65; 95% CI, 1.03–2.64) compared to those not in an ICU and adjusted for HCP type. The odds of CRE transmission increased with the number of different items touched near the patient (OR, 1.32; 95% CI, 1.21–1.44) and with the number of different items touched in the environment (OR, 1.13; 95% CI, 1.06–1.21). Respiratory therapists had the highest rates of transmission to gloves and gown (OR, 3.79; 95% CI, 1.61–8.94), followed by physical therapists and occupational therapists (OR, 2.82; 95% CI, 1.01–8.32) when compared to HCP in the “other” category. Manipulating the rectal tube (OR, 3.03; 95% CI, 1.53–6.04), providing wound care (OR, 2.81; 95% CI, 1.73–4.59), and touching the endotracheal tube (OR, 2.79; 95% CI, 1.86–4.19) were the interactions most strongly associated with CRE transmission compared to not touching these items and adjusted for HCP type. Conclusions: Transmission of CRE to HCP gloves and gowns occurs frequently. We identified interactions and HCP types that were particularly high risk for transmission. Infection control programs may wish to target infection prevention resources and education toward these high-risk professions and interactions.

Funding: This work was supported by the CDC Prevention Epicenter Program (U43CK000450-01) and the NIH National Institute of Allergy and Infectious Diseases (R01 AI121146-01).

Disclosures: None

Background: Estimates of contamination of healthcare personnel (HCP) gloves and gowns with methicillin-resistant Staphylococcus aureus (MRSA) following interactions with colonized or infected patients range from 17% to 20%. Most studies were conducted in the intensive care unit (ICU) setting where patients had a recent positive clinical culture. The aim of this study was to determine the rate of MRSA transmission to HCP gloves and gown in non-ICU acute-care hospital units and to identify associated risk factors. Methods: Patients on contact precautions with history of MRSA colonization or infection admitted to non-ICU settings were randomly selected from electronic health records. We observed patient care activities and cultured the gloves and gowns of 10 HCP interactions per patient prior to doffing. Cultures from patients’ anterior nares, chest, antecubital fossa and perianal area were collected to quantify bacterial bioburden. Bacterial counts were log transformed. Results: We observed 55 patients (Fig. 1), and 517 HCP–patient interactions. Of the HCP–patient interactions, 16 (3.1%) led to MRSA contamination of HCP gloves, 18 (3.5%) led to contamination of HCP gown, and 28 (5.4%) led to contamination of either gloves or gown. In addition, 5 (12.8%) patients had a positive clinical or surveillance culture for MRSA in the prior 7 days. Nurses, physicians and technicians were grouped in “direct patient care”, and rest of the HCPs were included in “no direct care group.” Of 404 interactions, 26 (6.4%) of providers in the “direct patient care” group showed transmission of MRSA to gloves or gown in comparison to 2 of 113 (1.8%) interactions involving providers in the “no direct patient care” group (P = .05) (Fig. 2). The median MRSA bioburden was 0 log 10CFU/mL in the nares (range, 0–3.6), perianal region (range, 0–3.5), the arm skin (range, 0-0.3), and the chest skin (range, 0–6.2). Detectable bioburden on patients was negatively correlated with the time since placed on contact precautions (rs= −0.06; P < .001). Of 97 observations with detectable bacterial bioburden at any site, 9 (9.3%) resulted in transmission of MRSA to HCP in comparison to 11 (3.6%) of 310 observations with no detectable bioburden at all sites (P = .03). Conclusions: Transmission of MRSA to gloves or gowns of HCP caring for patients on contact precautions for MRSA in non-ICU settings was lower than in the ICU setting. More evidence is needed to help guide the optimal use of contact precautions for the right patient, in the right setting, for the right type of encounter.

Funding: None

Disclosures: None

The transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non–intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.