Catheter Device Research Articles

Impact of a Daily Hospital-wide Huddle on Urinary Catheter Device Utilization nd Catheter Associated Urinary Tract Infection Rates

<h3>Background</h3> Excess device utilization may lead to device-related complications and infections. Increasing awareness of indwelling urinary catheters (IUC) can promote early removal and reduce device utilization rates (DUR). We implemented a hospital-wide Daily Interdisciplinary Safety Huddle (DISH) with infection control and device components. The purpose of this study is to evaluate the impact of DISH on IUC DUR and CAUTI rates. <h3>Methods</h3> Quasi-experimental study assessing DURs and infection rates before and after implementation of DISH. At DISH, infection prevention priorities and device utilization are discussed. Device use is reported by managers and the infection control practitioner (ICP) reviews indications and plans for removal. Use of external urinary catheter is encouraged and education is provided at the huddle and at the bedside. Data before and after implementation was compared. Paired T-test was used to assess for differences between both groups. <h3>Results</h3> DISH with infection prevention interventions was successfully implemented at a community hospital. The average DUR for IUC in ICU and non-ICU settings was reduced from 0.56 to 0.35 and 0.27 to 0.12 respectively. CAUTIs decreased by 87%. CAUTI rates decreased from 1.27/1000 IUC days (n=9) to 0.16 (n=1) after implementation. <h3>Conclusions</h3> A daily huddle with infection prevention and device components promoted IUC removal and reduced CAUTIs in ICU and non-ICU settings. The impact was more profound in non-ICU settings, where devices are less likely to meet indication. The reduction in CAUTIs had estimated cost savings of $110,793. stment or additional training and can bring major cost savings. DISH increased device removal, accountability and promotes a culture of safety. Our facility has remained CAUTI and CLABSI-free for more than 4 years. DISH was an important part of our journey to zero.

Prevalence of device use and transmission based precautions in nineteen large Australian acute care public hospitals: Secondary outcomes from a national healthcare associated infection point prevalence survey.

The use of invasive devices increases the risk of healthcare associated infections (HAI). The recent national HAI point prevalence survey secondary outcomes aimed to estimate the prevalence of patients with an indwelling urinary catheter device and vascular access devices; and also identify prevalence of those managed under transmission based precautions (TBP); and those colonised or infected with a multi drug resistant organism (MDRO). A point prevalence study was conducted in large acute care Australian public hospitals. All data were collected by two trained Research Assistants. Surveillance methodology was based on the European Centre for Disease Prevention and Control PPS Protocol. Data was also collected on prevalence of TBPs and MDROs. A total of 2767 acute adult inpatients were sampled across 19 hospitals. The prevalence of peripheral vascular, central vascular and urinary catheters devices was 55.2% (95%CI: 53.3%-57.1%), 14.8% (95%CI: 13.5%-16.1%) and 20.7% (95%CI: 19.2%-22.3%) respectively. Of the 2767 patients sampled 285 (10.3%, 95%CI: 9.2%-11.5%) were documented as either being infected or colonised with a MDRO, and 781 (11.8%) patients were being managed under the hospital TBP policy. This is the first national study to describe the prevalence of devices, TBPs and MDROs in Australian healthcare settings. In an era where device use should be constantly reviewed to minimise risk of HAI, and the increasing challenges of managing patients with MDROs, this data can serve as a benchmark for future studies.

Culture-proven Bloodstream Infections at a Specialist Pediatric Hospital.

Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality in children. This study was done to assess the local epidemiology and outcome of BSIs managed at a large specialist pediatric hospital with a focus on community-onset BSI. We retrospectively reviewed laboratory-confirmed BSI in children (0-18 years) at The Children's Hospital at Westmead over a 3-year period (2014-2016). Laboratory data and patient medical records were used to determine BSI rates, blood culture contamination rates, patient demographics, isolate profile, antimicrobial resistance and mortality rate in this cohort. In total, 47,368 blood cultures were collected; 1027 (2.2%) grew probable contaminants and 991 (2.1%) grew clinically significant isolates. Clinically significant bacteremia accounted for 4.8 per 1000 admissions, with 391 children managed for 465 culture-proven BSI episodes. One hundred thirty-one (28.2%) episodes were community-onset community-associated, and 334 (71.8%) were either community-onset healthcare-associated (HCA) (187; 40.2 %) or hospital-onset (147; 31.6%). Of the significant isolates, 243 (52.3%) were Gram-positive bacteria, 198 (42.6%) were Gram-negative bacteria, 6 (1.3%) were polymicrobial infections and 18 (3.9%) were yeast. Staphylococcus aureus (115; 24.7%) and Escherichia coli (54; 11.6%) were the most common organisms identified. Osteoarticular infection (44; 33.6%) and urosepsis (23; 17.6%) were the most frequent sites of infection associated with non-HCA BSI. Mortality at 30 days was reported in 15 (3.3%) children, all whom had preexisting comorbidities. The majority of BSI episodes managed in our hospital were either community-onset HCA or hospital-onset infections. This highlights the considerable importance of infection control and central venous catheter device care initiatives. Among community-associated BSI, S. aureus in association with osteoarticular infection was predominant.

CENTRAL VENOUS CATHETER BASED PORT FOR MULTI-DOSE CHEMOTHERAPY; TECHNIQUES AND COMPLICATIONS

Background: the utility of percutaneous Chemo port devices in the administration of multi-dose systemic chemotherapy in malignancy patients for long term therapy. It is a small port that is implanted under the skin in subcutaneous tissue to allow easy and repeated access to the bloodstream. To avoid thrombophlebitis and extravasation of drugs&#x0D; Objective: To study the utility of percutaneous Chemo port devices in the administration of multi-dose systemic chemotherapy in malignancy patients.&#x0D; Methods: this was a prospective study. The study was done in the department of cardiovascular and thoracic surgery SKIMS soura Srinagar Kashmir .from October 2018 to January 2020.We included 50 patients who were advised for Chemotherapy by the Medical Oncology department .The gender distribution being 38 females and 12 males. The mean age group was 43 and 54 years respectively for females and males. A single type of port was used, constructed of titanium and silicone. Puncture was done ultrasound guided. All patients had baseline investigation and dopplar for upper limbs and to rule out central venous stenosis.&#x0D; Results: We included total 50 patients, 43 (87%) patients completed their chemotherapy regime including .one (2%) patient who developed ipsilateral pneumothorax which was managed by intercostal tube placement. 2 (4%) patients developed severe wound infection that prompted the instantaneous removal of chemoport device followed by irrigation of the infected pocket and antibiotics. 1 patient developed catheter block which required flushes of heparinised saline. 2 patients required re-orientation of port device for port tilting.One (2%) patient had refractory arrhythmias that did not settle with drugs and hence warranted port removal. None patients had spontaneous extravasation of the port through the skin.&#x0D; Exclusion criteria: Pediatric patients age less than 18 years. Patients having Central venous stenosis. Patients having deep venous thrombosis of bilateral upper limbs.&#x0D; Conculsion: Central venous based catheter device is a very good means of delivering chemotherapeutic agents in patients of malignancy who have to receive a multi-dose drug therapy.&#x0D; Keywords: Chemotherapy, device implantation, utility, complications and management

Patient characteristics, procedure details including catheter devices, and complications of catheter ablation for ventricular tachycardia: a nationwide observational study.

BackgroundNationwide data are insufficient with respect to the characteristics of patients undergoing ventricular tachycardia (VT) ablation, complications of VT ablation, and procedure details including catheter devices used during VT ablation. The present study was performed to describe the patient characteristics, procedure details including catheter devices, and in‐hospital complications of catheter ablation for VT using a national inpatient database.MethodsWe used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent VT ablation from July 2010 to March 2017. We examined patients’ age, gender, baseline diseases, comorbid conditions, admission status, catheter devices and drugs used, and in‐hospital complications of VT ablation.ResultsWe identified 10 641 patients (median age, 61 years) who underwent VT ablation. The most frequently observed background heart disease among patients with structural heart disease was ischemic cardiomyopathy. An irrigated ablation catheter was used in 73% of patients, a force‐sensing ablation catheter was used in 22%, and intracardiac echocardiography was used in 25%. The frequency of using these procedures continuously increased over time. Overall, the prevalence of in‐hospital complications was 3.5% (cardiac tamponade, 0.8%; stroke, 0.6%; critical bleeding, 1.9%; mechanical circulatory support, 0.9%; and in‐hospital death, 0.8%).ConclusionsThe results of this study show the clinical features of VT ablation in a real‐world clinical setting. The use of irrigated catheters, force‐sensing catheters, and intracardiac echocardiography increased over time. The prevalence of in‐hospital complications was 3.5%.

Ventricular arrhythmias in heart failure with reduced ejection fraction.

To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies. Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. Catheter ablation is superior to medical therapy for arrhythmia control and should be considered early, particularly for premature ventricular complex mediated cardiomyopathy. Novel technologies to deliver energy to previously inaccessible sites include high-impedance catheter irrigants, multicatheter bipolar ablation, specialized catheters with extendable needles, transcoronary ethanol infusion, and stereotactic body radiation therapy. Assessment and management of ventricular arrhythmias in systolic heart failure requires a systematic, multimodality approach aimed at identifying the underlying cause and reversible causes, optimizing medical therapy, assessing need for an implantable cardioverter defibrillator, and considering catheter ablation. Further research will focus on prevention of disease progression, improved risk stratification, and ablation technologies that minimize procedure duration and enable delivery of durable lesions.

Menstrual pattern of severe intrauterine adhesion following hysteroscopy adhesiolysis

Objective: The purpose of this study was to evaluate the menstrual and uterine shape in patients diagnosed with severe intrauterine adhesion (IUA) on hysteroscopy and to assess the outcome following hysteroscopic adhesiolysis.&#x0D; Materials and methods: It is a retrospective study of patients with severe intrauterine adhesion who attended with complain of infertility, abortion , and repeated dilatation and curettage to our institution from January 2017 and December 2017. Post hysteroscopic adhesiolysis the inserted of urinary balloon catheter and intrauterine device (IUD). The sodium hyaluronate gel was administered inside the uterus and oral cyclical hormonal treatment was initiated after the surgery to all patients to prevent reformationof adhesion, and promote endometrial regeneration respectively. The outcome of menstrual pattern and uterine shape were retrospectively analyzed. Data analyzed was performed with SPSS for Windows, version 20.0). Statistically significant level was set at p&lt;0.05.&#x0D; Results: In a total number of 64 patients with severe intrauterine adhesion and mean age of 30.1 years old were participated in this study. No identification of any complication around the hysteroscopy adhesiolysis. Out of 64 severe IUA patients, 59 (92.1%) patients had second, 42 (65.6%) had the third hysteroscopic adhesiolysis procedure required. After 3 months follow-up, restore of uterine shape and 95 % of patients in progress to normal menstruation, which was considered as significant (p&lt;0.05).&#x0D; Conclusion: The patients with severe intrauterine adhesion (IUAs) have found significant progress of normal pattern of menstruation with normal shape of the uterine cavity following hysteroscopic adhesiolysis. The repeat procedure and strategies are necessary for prevention of adhesions.&#x0D; Bangladesh Journal of Medical Science Vol.19(3) 2020 p.475-479

MRI Catheterization: Ready for Broad Adoption.

In recent years, interventional cardiac magnetic resonance imaging (iCMR) has evolved from attractive theory to clinical routine at several centers. Real-time cardiac magnetic resonance imaging (CMR fluoroscopy) adds value by combining soft-tissue visualization, concurrent hemodynamic measurement, and freedom from radiation. Clinical iCMR applications are expanding because of advances in catheter devices and imaging. In the near future, iCMR promises novel procedures otherwise unsafe under standalone X-Ray guidance.

Single-center experience of using high definition (Hi-Def) imaging during neurointervention treatment of intracranial aneurysms using flow diverters

BackgroundA new dual resolution imaging x-ray detector system (Canon Medical Systems Corporation, Tochigi, Japan) has a standard resolution 194 µm pixel conventional flat-panel detector (FPD) mode and a high-resolution 76...

Design of a low-cost tactile robotic sleeve for autonomous endoscopes and catheters

Recent developments in medical robotics have been significant, supporting the minimally invasive operation requirements, such as smaller devices and more feedback available to surgeons. Nevertheless, the tactile feedback from a catheter or endoscopic type robotic device has been restricted mostly on the tip of the device and was not aimed to support the autonomous movement of the medical device during operation. In this work, we design a robotic sheath/sleeve with a novel and more comprehensive approach, which can function for whole body or segment-based feedback control as well as diagnostic purposes. The robotic sleeve has several types of piezo-resistive pressure and extension sensors, which are embedded at several latitudes and depths of the silicone substrate. The sleeve takes the human skin as a biological model for its structure. It has a better tactile sensation of the inner tissues in the torturous narrow channels such as cardiovascular or endoluminal tracts in human body and thus can be used to diagnose abnormalities. In addition to this capability, using the stretch sensors distributed alongside its body, the robotic sheath/sleeve can perceive the ego-motion of the robotic backbone of the catheter and can act as a position feedback device. Because of the silicone substrate, the sleeve contributes toward safety of the medical device passively by providing a compliant interface. As an active safety measure, the robotic sheath can sense blood clots or sudden turns inside a channel and by modifying the local trajectory and can prevent embolisms or tissue rupture. In the future, advanced manufacturing techniques will increase the capabilities of the tactile robotic sleeve.

First Reported Case of Postneurosurgical Ventriculoperitonitis Due to Kocuria rhizophila Following a Ventriculoperitoneal Shunt Placement

Abstract Kocuria rhizophila, a Gram-positive coccus, is usually regarded as a contaminant. It has been described in catheter device–related infections in children, but never as being involved in central nervous system infections. We report here for the first time a case of ventriculoperitonitis due to K. rhizophila in adult, identified by MALDI-TOF mass spectrometry and 16S rRNA gene sequencing.

Economic evaluation of peripherally inserted central catheter and other venous access devices: A scoping review.

With the widespread use of peripherally inserted central catheters, plenty of studies have compared peripherally inserted central catheters with other venous access devices to choose the most appropriate device in different clinical scenarios. Economic attributes are one of the important influencing factors in the selection of venous access devices. Several economic evaluation studies have been conducted in this area, but the evaluation methods, contents, outcomes, and quality of these economic studies have not been systematically evaluated. Therefore, we aimed to map the existing research on the economic evaluations of peripherally inserted central catheters and other venous access devices to provide economic evidence for decision-makers to choose a suitable venous access device. Second, we appraised the quality of economic evaluation studies in this area to highlight methodological weaknesses and provide an outline for the normative application of this methodology for future research. A literature search was undertaken through 11 databases from inception until 11 March 2019, to identify economic evaluation studies comparing peripherally inserted central catheters with other venous access devices. After screening articles and extracting data independently, we summarized methods, contents, and outcomes of the included studies and appraised their methodological quality using the Joanna Briggs Institute critical appraisal checklist for economic evaluations. A total of 16 studies were included. Among the six studies comparing peripherally inserted central catheters with peripheral intravenous catheters, four studies performed a cost-effectiveness analysis and noted that peripherally inserted central catheters were more cost-effective than peripheral intravenous catheters. Two studies performed a cost analysis to compare peripherally inserted central catheters with peripheral intravenous catheters during the insertion and maintenance/removal periods but reached different conclusions. Seven of the included studies performed a cost analysis to compare peripherally inserted central catheters with central venous catheters. They pointed out that the catheter insertion costs of peripherally inserted central catheters were lower than those for central venous catheters in developed countries, whereas the opposite conclusion was reached in developing countries. Conversely, conclusions regarding the costs for catheter maintenance and catheter insertion and maintenance/removal were inconsistent. Six of the included studies performed a cost analysis to compare peripherally inserted central catheters with vascular access ports. They pointed out that the insertion costs of peripherally inserted central catheters were lower than those for vascular access ports, and the maintenance costs were higher than those for vascular access ports. Conversely, conclusions regarding the costs for catheter insertion and maintenance/removal were inconsistent. In addition, the methodological quality of the included studies had plenty of deficiencies, including no discounting, no sensitivity analysis, no incremental analysis, a lack of validity of costs and effectiveness, and so on. This scoping review highlighted the desperate paucity of economic evaluation studies of peripherally inserted central catheters and other venous access devices in amount, evaluation contents, and economic evaluation methods. The conclusions of the cost-effectiveness analysis of peripherally inserted central catheters with other venous access devices were consistent. Conversely, the conclusions of the cost analysis of peripherally inserted central catheters with other venous access devices were inconsistent mainly in the comparison of peripherally inserted central catheters with peripheral intravenous catheters, central venous catheters, and vascular access ports during the insertion and maintenance/removal periods. This review also highlighted many methodological issues of economic evaluations in this area. Therefore, it is necessary to conduct more high-quality economic evaluation studies on peripherally inserted central catheters and other venous access devices by performing cost-effectiveness analysis, cost-utility analysis, or cost-benefit analysis from catheter insertion to removal to provide evidence for clinical practitioners, patients, and decision-makers to choose a suitable venous access device in different clinical scenarios.

Introduction: History and Development of Flow Diverter Technology and Evolution.

The introduction of flow diverter technology to the field of neurointervention has revolutionized the treatment of intracranial aneurysms. The therapy approach has shifted from intrasaccular aneurysm treatment to exclusion of the aneurysm from the blood circulation with remodeling of the parent artery. Previously, "difficult"-to-treat aneurysms including fusiform and blister aneurysms, but also aneurysms arising from a diseased vessel segment, can now be safely and permanently treated with flow diverters. A little over a decade ago, after extensive bench testing and refinement of the flow diverter concept, the device was eventually available for clinical use and today it has become a standard treatment for intracranial aneurysms. Currently, United States Food and Drug Administration (FDA)-approved flow diverters are the Pipeline Embolization Device (Medtronic) and the Surpass Streamline Flow Diverter (Stryker). The devices can either be delivered or deployed via a standard femoral artery approach or a radial artery approach. Other considerations for catheter setup and device deployment strategies depending on aneurysm location or vessel anatomy are described.

First PGT-A using human in vivo blastocysts recovered by uterine lavage: comparison with matched IVF embryo controls†.

STUDY QUESTIONAfter controlled ovarian stimulation (COS) and IUI, is it clinically feasible to recover in vivo conceived and matured human blastocysts by uterine lavage from fertile women for preimplantation genetic testing for aneuploidy (PGT-A) and compare their PGT-A and Gardner scale morphology scores with paired blastocysts from IVF control cycles?SUMMARY ANSWERIn a consecutive series of 134 COS cycles using gonadotrophin stimulation followed by IUI, uterine lavage recovered 136 embryos in 42% (56/134) of study cycles, with comparable in vivo and in vitro euploidy rates but better morphology in in vivo embryos.WHAT IS KNOWN ALREADY In vivo developed embryos studied in animal models possess different characteristics compared to in vitro developed embryos of similar species. Such comparative studies between in vivo and in vitro human embryos have not been reported owing to lack of a reliable method to recover human embryos.STUDY DESIGN, SIZE, DURATIONWe performed a single-site, prospective controlled trial in women (n = 81) to evaluate the safety, efficacy and feasibility of a novel uterine lavage catheter and fluid recovery device. All lavages were performed in a private facility with a specialized fertility unit, from August 2017 to June 2018. Subjects were followed for 30 days post-lavage to monitor for clinical outcomes and delayed complications. In 20 lavage subjects, a single IVF cycle (control group) with the same ovarian stimulation protocol was performed for a comparison of in vivo to in vitro blastocysts.PARTICIPANTS/MATERIALS, SETTINGS, METHODSWomen were stimulated with gonadotrophins for COS. The ovulation trigger was given when there were at least two dominant follicles ≥18 mm, followed by IUI of sperm. Uterine lavage occurred 4–6 days after the IUI. A subset of 20 women had a lavage cycle procedure followed by an IVF cycle (control IVF group). Recovered embryos were characterized morphologically, underwent trophectoderm (TE) biopsy, vitrified and stored in liquid nitrogen. Biopsies were analyzed using the next-generation sequencing technique. After lavage, GnRH antagonist injections were administered to induce menstruation.MAIN RESULTS AND THE ROLE OF CHANCEA total of 134 lavage cycles were performed in 81 women. Uterine lavage recovered 136 embryos in 56 (42%) cycles. At the time of cryopreservation, there were 40 (30%) multi-cell embryos and 96 (70%) blastocysts. Blastocysts were of good quality, with 74% (70/95) being Gardener grade 3BB or higher grade. Lavage blastocysts had significantly higher morphology scores than the control IVF embryos as determined by chi-square analysis (P < 0.05). This is the first study to recover in vivo derived human blastocysts following ovarian stimulation for embryo genetic characterization. Recovered blastocysts showed rates of chromosome euploidy similar to the rates found in the control IVF embryos. In 11 cycles (8.2%), detectable levels of hCG were present 13 days after IUI, which regressed spontaneously in two cases and declined after an endometrial curettage in two cases. Persistent hCG levels were resolved after methotrexate in three cases and four cases received both curettage and methotrexate.LIMITATIONS, REASON FOR CAUTIONThe first objective was to evaluate the feasibility of uterine lavage following ovarian stimulation to recover blastocysts for analysis, and that goal was achieved. However, the uterine lavage system was not completely optimized in our earlier experience to levels that were achieved late in the clinical study and will be expected in clinical service. The frequency of chromosome abnormalities of in vivo and IVF control embryos was similar, but this was a small-size study. However, compared to larger historical datasets of in vitro embryos, the in vivo genetic results are within the range of high-quality in vitro embryos.WIDER IMPLICATIONS OF THE FINDINGSUterine lavage offers a nonsurgical, minimally invasive strategy for recovery of embryos from fertile women who do not want or need IVF and who desire PGT, fertility preservation of embryos or reciprocal IVF for lesbian couples. From a research and potential clinical perspective, this technique provides a novel platform for the use of in vivo conceived human embryos as the ultimate benchmark standard for future and current ART methods.STUDY FUNDING/COMPETING INTEREST(S)Previvo Genetics, Inc., is the sole sponsor for the Punta Mita, Mexico, clinical study. S.M. performs consulting for CooperGenomics. J.E.B. and S.A.C. are co-inventors on issued patents and patents owned by Previvo and ownshares of Previvo. S.N. is a co-author on a non-provisional patent application owned by Previvo and holds stock options in Previvo. S.T.N. and M.J.A. report consulting fees from Previvo. S.T.N., S.M., M.V.S., M.J.A., C.N. and J.E.B. are members of the Previvo Scientific Advisory Board (SAB) and hold stock options in Previvo. J.E.B and S. M are members of the Previvo Board of Directors. A.N. and K.C. are employees of Previvo Genetics. L.V.M, T.M.M, J.L.R and S. S have no conflicts to disclose.TRIAL REGISTRATION NUMBERProtocol Registration and Results System (PRS) Trial Registration Number and Name: Punta Mita Study TD-2104: Clinical Trials NCT03426007.

187. The 30-Day Readmission and 30-Day Mortality of Hemodialysis Patients with Antibiotic-Resistant Gram-Negative Bacteremia

BackgroundAlthough antibiotic-resistant (AR) Gram-negative infections are more prevalent in hemodialysis (HD) patients, there are limited data on the impact of antibiotic resistance on clinical outcomes. The primary objective of this study was evaluating 30-day readmission and 30-day all-cause mortality of HD patients with AR-Gram-negative bacteremia (GNB). The secondary objective was assessing the association of risk factors for AR-GNB and Infectious Diseases (ID) consult with the primary outcomes.MethodsThis was a single-center, retrospective, cohort study, which enrolled adult HD patients with AR-GNB between January 1, 2010 and December 31, 2018. The AR included extended-spectrum β-lactamase (ESBL), carbapenem resistance (CR; resistant to at least one carbapenem), and multidrug resistance (MDR; resistant to at least one agent in three antibiotic classes). The risk factors for AR-GNB included: antibiotic use and long-term care facility stay within 90 days, hospitalization >30 days, central line, urinary catheter, and invasive medical device use, and severe underlying illness. Statistical analysis involved chi-square and Fisher’s exact tests.ResultsA total of 90 patients were included. The most common pathogen and source were Klebsiella pneumoniae (42.2%) and urine (29.5%), respectively. The most common AR was ESBL (39.6%), followed by CR and MDR (both 29.7%). Overall, 30-day readmission and 30-day all-cause mortality were 22% and 38.5%, respectively. Long-term care facility stay within 90 days was more likely associated with 30-day readmission (odds ratio [OR] 3.46, 95% confidence interval [CI], 0.99–12.15; P = 0.048), although it was not observed with multivariate analysis (P = 0.223). Hospitalization >30 days (OR 0.25, 95% CI, 0.1–0.64; P = 0.003) and ID consult (OR 0.13, 95% CI, 0.05–0.36; P < 0.0001) were less likely associated with 30-day all-cause mortality according to multivariate analysis. Overall, MDR was more likely associated with 30-day all-cause mortality than ESBL (P = 0.02) and CR (P = 0.002).ConclusionTo our knowledge, this is the first study evaluating the impact of AR-GNB in HD patients on 30-day readmission and 30-day all-cause mortality. Hospitalization of >30 days and having ID consult were less likely associated with 30-day all-cause mortality.Disclosures All authors: No reported disclosures.

506. Urinary Catheters Are Associated with Progression from Bacteriuria to Invasive Infections in Patients with Carbapenem-Resistant Enterobacteriaceae, Metropolitan Atlanta, 2011–2017

BackgroundPatients with carbapenem-resistant Enterobacteriaceae (CRE) bacteriuria have better outcomes than patients with an invasive CRE infection, but patients with bacteriuria may subsequently develop an invasive infection (“progression”). We sought to evaluate risk factors, particularly urinary catheters, for progression from CRE bacteriuria to an invasive CRE infection within one year.MethodsWe used population-based active surveillance data from the Georgia Emerging Infections Program to identify patients in metropolitan Atlanta with CRE in urine, but not in a concomitant or previous sterile site between August 1, 2011 and July 31, 2017. CRE was defined as an isolate resistant to tested third-generation cephalosporins and a minimum inhibitory concentration of ≥4 µg/mL for meropenem, doripenem or imipenem. We then assessed if these patients developed an invasive CRE infection (positive sterile site culture) with the same organism between one day and one year later. Demographics, culture site, comorbidities, and risk factors were obtained by chart review. Univariable analyses and multivariable logistic regression with progression as the outcome were performed in SAS 9.4.ResultsWe identified 551 patients with CRE bacteriuria in 6 years, with an annual incidence of 1.1 cases/100,000 population. Many patients previously resided in long-term care facilities (48%), had a Charlson comorbidity index (CCI) >3 (38%), a central venous catheter (CVC, 34%) or a decubitus ulcer (27%, Table 1). Twenty-five patients (5%) progressed from CRE bacteriuria to an invasive CRE infection within one year (median 34 days). Predictors of progression in univariable analyses included the presence of a urinary catheter (OR 6.4 [95% CI: 1.9–21.6]), decubitus ulcer, CVC or other indwelling device, Klebsiella pneumoniae, black race, CCI >3, and ICU stay after urine culture was obtained (Table 2). In a multivariable analysis, urinary catheter (OR 4.6 [95% CI: 1.3–16.1]) predicted progression as well as K. pneumoniae, CCI >3 and CVC.ConclusionProgression from CRE bacteriuria to an invasive CRE infection is rare but clinically significant and is associated with urinary catheters. Future interventions should target urinary catheter removal, where possible, in patients with CRE bacteriuria. Disclosures All authors: No reported disclosures.

1159. Multidisciplinary Leadership Rounds Are Associated with Decreased Urinary Catheter and Central Venous Catheter Device Utilization at a Tertiary Care, Academic Hospital

BackgroundOptimizing use of urinary catheters (UCs) and central venous catheters (CVCs) is crucial to prevent catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and other complications. Despite education and adoption of catheter removal protocols, indwelling devices not meeting approved indications were still noted.MethodsTwice a week, UC and CVC surveillance rounds were conducted by a team of directors from nursing, vascular access, infection prevention, and hospital epidemiology. Different hospital units were selected each week in random distribution. Rounds emphasized face-to-face discussion with nurses and device observations to identify any removal opportunities and appropriate maintenance. Device utilization was monitored using CDC National Healthcare Safety Network (NHSN) standardized utilization ratio (SUR) and CAUTIs and CLABSIs were monitored using NHSN definitions. Relative ratios of SURs during pre-intervention (pre-INT) and post-intervention (post-INT) time periods for UCs and CVCs were compared using an exact binomial test and mid-P 95% confidence interval (CI). CAUTI and CLABSI rates were compared using Fisher’s exact test using mid-P value.ResultsA baseline time period A of 12 months pre-INT (June 2017-May 2018) was used to compare with the 10-month post-INT time period B (June 2018-March 2019). The UC SURs for periods A and B were 0.813 and 0.696 (Figure 1). The relative ratio shows a post-INT UC SUR that was 85.6% of the pre-INT period (95% CI: 84.1%, 87.2%, P < 0.001). CAUTI rates for periods A and B were not statistically significantly different at 2.276 vs. 2.164/1000 catheter days (P = 0.803). The CVC SURs for periods A and B were 1.244 and 1.081 (Figure 2). The relative ratio shows a post-INT CVC SUR that was 86.9% of the pre-INT period (95% CI: 85.7%, 88.0%, P < 0.001). CLABSI rates for periods A and B were statistically significantly different at 1.27 vs. 0.804/1000 central line days (P = 0.0335).ConclusionLeadership rounds were associated with a significant decrease in utilization of UCs and CVCs. A significant decrease was noted in CLABSI rates but not in CAUTI rates. Multidisciplinary oversight improved adherence to existing policies and should be considered for optimizing device utilization. Disclosures All authors: No reported disclosures.

1153. National Trend of Urinary Catheter Device Utilization by Hospital Type, National Healthcare Safety Network (2015–2019)

BackgroundReducing unnecessary urinary catheter use and optimizing insertion techniques and catheter maintenance and care practices are the most important urinary tract infection (CAUTI) prevention strategies. To monitor device use (DU) as quality improvement activity, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) developed the risk adjusted, standardized urinary catheter device utilization ratio in 2015. This study aims to assess national trends of DU from the baseline year 2015 through 2019.MethodsFor our trend analysis, we analyzed DU data (catheter days per 100 inpatient-days) that acute care hospitals (ACHs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and critical access hospitals (CAHs) reported to NHSN from 2015Q1 through 2019Q1. The ward and intensive care unit patient care locations included in our analysis are those that ACHs, LTACHs, IRFs and CAHs are required to report to CMS to comply with CMS Inpatient Quality Reporting program requirements. We regressed DU by quarterly period using generalized estimating equation modeling with the negative-binomial distribution, after adjusting for factors associated with corresponding SUR models of 2015 baseline and accounting for autocorrelation of error terms within a location. For graphic display, we also computed quarterly DU using marginal predictive models.ResultsThe DU decreased over time (P ≤ 0.05, average percent change per quarter (%change): −0.54 [95% CI: −0.54, −0.53]) among ACHs (Table 1, Figure 1), and −0.54 [95% CI: −0.58, −0.49] among LTACHs (Table 1, Figure 2). Among IRFs, quarterly DU in 2015Q2–2016Q3 were similar relative to 2015Q1, but decreased from 2016Q4 onward (P ≤ 0.05, % change: −0.51 [95% CI: −0.61, −0.40]) (Table 1, Figure 3). Among CAHs, quarterly DU in 2015Q2–2016Q4 were similar relative to 2015Q1, but decreased from 2017Q1 onward (P ≤ 0.05, % change: −0.22 [95% CI: −0.39, −0.04]) (Table 1, Figure 4).ConclusionThere was a statistically significant decrease in National DU of urinary catheter during 2015–2019 across NHSN, although the magnitude of change per quarter was not large. Further research is needed to explore causal factors associated with such reduction. Disclosures All authors: No reported disclosures.

P2436Preliminary data from “LAA-Print French registry”: a large national multi-centric prospective registry evaluating a new preoperative approach based on 3Dprinted simulation in LAAC procedures

Abstract Left atrial appendage closure (LAAC) is an alternative to OAC in patients with contra indication to OAC and AF. But LAAC may be at risk, especially in frail patients. There are no imaging criteria to asses individual procedural risk. Furthermore, procedural factors (double curve catheter alignment) are hard to predict 3D-printing simulation has capability to integrate all anatomical and procedural parameters and has demonstrated improvements in LAAC device sizing in a pilot study Aim To demonstrate efficiency of 3D-printing simulation to predict LAAC procedural risk (failure, long procedure time, pericardial effusion or others serious adverse events (SAES) or inappropriate implantations) Methods Open study: Prospective and Consecutive. Recruiting 150 patients in 16 centres (of 300 patients expected). Start: Jan 18th, 2018. Study Completion: Nov 1st, 2019. ClinicalTrials ID: NCT03330210. 1. Cardiac CT prior to LAAC. 2. Industrial manufacture, laser sintering, of 3D-printed models including the whole LA cavity including interatrial thin septum and vena cava (using material TPU with adequat elasticity: shore 50). 3. LAAC Simulation based on 3Dprinted models using specific sheaths and prosthesis. Prior to LAAC procedure each operator asses a risk score for procedural failure (low/moderate/high) based on real 3D printed LAAC simulation taking into account: trans-septal puncture site/sheath alignment with LAA ostium/device deployment and stability. 4. LAAC procedure TEE guided. 5. CT or TEE control M3 or M6. Procedural outcomes according to risk Sc Low risk (N=63) Moderate risk (N=50) High risk (N=37) p&lt;0.05 vs High risk Failure 1 (1.6%) 1 (2%) 10 (27%) * Recaptures ≥2 4 (6%) 5 (10%) 12 (32%) * Prosthesis ≥2 2 (3%) 1 (2%) 9 (24%) * Inappropriate implantation 0 6 (12%) 7 (19%) * SAES 2 (3%) 6 (12%) 12 (32%) * Pericardial effusion (pericardiocentesis) 2 (3%) 1 (2%) 4 (11%) * Haemorrhage (≥2 points) 0 2 (4%) 5 (13%) * Coronary syndrome 0 0 4 (11%) * Time (intra left atrium) min 21±10 29±16 50±25 * *p&lt;0.05 vs High risk group according to prospective risk score. LAAC simulation on 3D printed model Conclusion 3D printing simulation accurately stratifies the risk of procedure according to LA anatomy. 3D printing may guide the procedure through verification of the transseptal puncture site and/or using a specific catheter shape and device. In case of high risk, a careful assessment of risk/benefice ratio is mandatory Acknowledgement/Funding AG2RFondation and Boston Scientific

Quantitative Results of a National Intervention to Prevent Hospital-Acquired Catheter-Associated Urinary Tract Infection: A Pre-Post Observational Study.

Many hospitals struggle to prevent catheter-associated urinary tract infection (CAUTI). To evaluate the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care-associated infection (HAI). Prospective, national, nonrandomized, clustered, externally facilitated, pre-post observational quality improvement initiative, for 3 cohorts active between November 2016 and May 2018. Acute care, long-term acute care, and critical access hospitals, including intensive care and non-intensive care wards. Target hospitals had a high burden of Clostridioides difficile infection plus central line-associated bloodstream infection, CAUTI, or hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infection, defined as cumulative attributable differences above the first tertile in the Targeted Assessment for Prevention (TAP) strategy. Some additional nonrecruited hospitals also joined. Multimodal intervention, including Practice Change Assessment tool to identify infection prevention and control (IPC) and HAI prevention gaps; Web-based, on-demand modules involving onboarding, foundational IPC practices, HAI-specific 2-tiered approach to prioritize and implement interventions, and TAP resources; monthly webinars; state partner-led in-person meetings; and feedback. State partners made site visits to at least 50% of their enrolled hospitals, to support self-assessments and coach. Rates of CAUTI and urinary catheter device utilization ratio. Of 387 participating hospitals from 23 states and the District of Columbia, 361 provided CAUTI data. Over the study period, the unadjusted CAUTI rate was low and relatively stable, decreasing slightly from 1.12 to 1.04 CAUTIs per 1000 catheter-days. Catheter utilization decreased from 21.46 to 19.83 catheter-days per 100 patient-days from the pre- to the postintervention period. The intervention period was brief, with no assessment of fidelity. Baseline CAUTI rates were low. Patient characteristics were not assessed. This multimodal intervention yielded no substantial improvements in CAUTI or urinary catheter utilization. Centers for Disease Control and Prevention.