Comprehensive Infection Prevention Research Articles

Analyzing the Prevalence and Patterns of Antibiotic-Resistant Pathogens Causing Surgical Site Infections

Surgical Site Infections (SSIs) remain a critical healthcare challenge, contributing to increased morbidity, mortality, and healthcare costs. SSIs represent the third most common nosocomial infection globally with an incidence of 19-20%, while their prevalence in Pakistan was significantly higher, ranging up to 33.6%. The emergence of Multidrug-Resistant (MDR) organisms has worsened this issue. Objective: To determine the prevalence of antibiotic-resistant pathogens responsible for SSIs and analyze their antibiotic susceptibility patterns over the past decade. Methods: A systematic review was conducted adhering to PRISMA guidelines. Studies published between 2006 and 2023 were included. Data on the prevalence of antibiotic-resistant organisms associated with SSIs were extracted and analyzed through several databases (PubMed, Google Scholar, Sci-hub and Science Direct) using Boolean logic “AND” and “OR”, and Medical Subject Headings (MeSH Terms) and keywords. A total of 70 articles were retrieved from which 16 articles were considered eligible after applying detailed inclusion/exclusion criteria and removing the duplicates and irrelevant articles. Results: The study identified Staphylococcus aureus, coagulase-negative staphylococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter spp. as predominant MDR pathogens. A significant increase in the prevalence of antibiotic-resistant strains was observed over the study period. Gram-negative bacteria exhibited a higher resistance rate (66.8%) compared to Gram-positive organisms (51.1%). Conclusions: The increasing prevalence of antibiotic-resistant pathogens underscores the urgent need for comprehensive infection prevention and control measures to address the burden of SSIs. Targeted interventions, antimicrobial stewardship, and continued surveillance were essential to combat this growing challenge.

Critical measures for the prevention and control of respiratory infectious diseases in the workplace: a South African facilities management perspective

PurposeThis study aims to comprehensively examine the respiratory infection prevention and control measures used in South African workplaces, particularly in the context of facilities management (FM), during the 2020–2022 pandemic.Design/methodology/approachThe present research involved pre-crafted semi-structured interviews conducted by University of the Witwatersrand students with FM heads in Johannesburg, South Africa. Recurrent themes were generated using NVIVO software and analysed using frequencies, word counts and word clouds.FindingsThis study identified 119 measures and placed these into two broad categories. Twelve critical measures were found. These measures were further validated by five FM experts, separate from FM heads, who cross-referenced them with WHO guidelines, enhancing the credibility of the findings. Subsequently, challenges with implementing these measures were explored.Practical implicationsThe findings have direct relevance to the work of FM professionals, as they suggest that applying timely and comprehensive infection prevention and control measures can help employees to safely continue to work or return to the workplace during any future epidemic outbreaks.Originality/valueThus far, limited studies have explored critical measures used to prevent and control COVID-19 in the workplaces of developing countries during the 2020–2022 pandemic.

Assessments and observations of infection prevention and control practices in US outpatient hemodialysis facilities, 2015-2018: important opportunities for improvement.

Infections cause substantial morbidity and mortality among patients receiving care in outpatient hemodialysis facilities. We describe comprehensive infection prevention assessments by US public health departments using standardized interview and observation tools. Results demonstrated how facility layouts can undermine infection prevention and that clinical practices often fall short of policies.

Horizontal approaches to infection prevention: daily chlorhexidine gluconate bathing.

Healthcare-associated infections (HAIs) pose a significant challenge in hospitals. Infection control strategies have been widely employed to mitigate their incidence. In hospitals, chlorhexidine gluconate (CHG) solutions are commonly used as antiseptic skin cleansers as part of comprehensive infection prevention bundles, with daily CHG bathing being highly effective in reducing HAIs and lowering skin micro-organism density. This evidence review addresses the challenges of risk stratification in implementing CHG bathing protocols in hospitals. It highlights the benefits of a horizontal approach, where CHG bathing is implemented across the entire facility rather than being limited to specific patient populations. Evidence from systematic reviews and studies suggests that CHG bathing consistently reduces HAI rates in both intensive care unit (ICU) and non-ICU settings, supporting the adoption of a hospital-wide approach. The findings emphasise the significance of incorporating CHG bathing as part of a comprehensive approach to infection prevention in hospitals and highlight the potential for cost savings.

Methods for infection prevention in the built environment—a mini-review

The COVID-19 pandemic has shown that infection prevention actions need to be more efficient in public indoor environments. In addition to SARS-CoV-2, the cause of COVID-19, many pathogens, including other infectious viruses, antibiotic-resistant bacteria, and premise plumbing pathogens, are an invisible threat, especially in public indoor spaces. The indoor hygiene concept for comprehensive infection prevention in built environments highlights that the indoor environment should be considered as a whole when aiming to create buildings with increased infection prevention capacity. Within indoor environments, infections can indirectly spread through surfaces, air, and water systems. Many methods, such as antimicrobial technologies and engineering solutions, targeting these indoor elements are available, which aim to increase the hygiene level in indoor environments. The architectural design itself lays a foundation for more efficient infection prevention in public buildings. Touchless solutions and antimicrobial coatings can be applied to frequently touched surfaces to prevent indirect contact infection. Special ventilation solutions and air purification systems should be considered to prevent airborne infection transmissions. Proper design and use of water supply systems combined with water treatment devices, if necessary, are important in controlling premise plumbing pathogens. This article gives a concise review of the functional and available hygiene-increasing methods—concentrating on indoor surfaces, indoor air, and water systems—to help the professionals, such as designers, engineers, and maintenance personnel, involved in the different stages of a building’s lifecycle, to increase the infection prevention capacity of public buildings.

SG-APSIC1069: Implementing infection prevention bundle significantly reduced multidrug-resistant organisms infection and healthcare-associated infections in intensive care unit at a national hospital in Vietnam

Objectives: In Vietnam, the burden of healthcare-associated infections (HAIs), especially by multidrug-resistant organisms (MDROs), can be greater at national hospitals where a high number of severe patients from lower-tier hospitals are received for treatment. To reduce MDRO and HAI incidences at the tropical diseases intensive care unit (ICU) of Cho Ray Hospital, the final line of treatment for 20 southern provinces of Vietnam, a comprehensive infection prevention bundle was developed and implemented in 2019. In this retrospective study, we evaluated the effectiveness of this intervention in preventing MDRO infections and HAIs among patients at risk. Methods: The infection prevention bundle included elements to improve administration controls, environmental controls, and personal protective equipment usage. The bundle was implemented via training and active monitoring. Medical data, such as microbiology results, length of hospital stay, treatment cost of all patients admitted to the targeted ICU, and data on adherence to the bundle elements, were collected via routine monitoring from July to December 2019. These data were reviewed and analyzed. An independent 2-sample t test was used to calculate the significance of the differences in MDRO and HAI rates before and after the intervention. Results: The mean number of MDRO infections decreased significantly after implementation of the infection prevention bundle (7.0 vs 3.3; P = .011). HAI and ventilator-associated pneumonia (VAP) rates also decreased significantly (5.9 vs 3.7; P= .013 and 20.4 vs 13.7; P=0.047, respectively). The mean total treatment cost per patient was reduced by 1.8 million VND (US $76.76). Bundle-element adherence was high throughout the intervention period, ranging from 72.7% (putting MDRO sign on beds) to 100% (hand hygiene, cohort patients, environment cleaning). Conclusions: Implementation of an appropriate infection prevention bundle with a high adherence rate by healthcare workers helped to effectively reduce MDRO infection and HAI rates in the tropical diseases ICU.

Management of a Candida Auris Patient Across Two Healthcare Systems

BackgroundContaining Candida auris (C. auris) has proven to be especially challenging during the COVID-19 pandemic given the enormous constraints on Infection Prevention (IP) departments. Knowledge of the organism, appropriate identification methods, and infection prevention strategies are key to reducing the risk of transmission. Many IP departments have been unable to develop or maintain comprehensive admission screening protocols and have limited best practices available for managing C. auris patients in the acute care setting. We describe the first case of C. auris in the acute care setting in the state of Minnesota and outline the infection prevention strategies used by the two systems that provided care to this patient.MethodsUpon receipt of a preliminary positive C. auris result at Hospital One, the patient was placed into contact precautions. All patients that were identified as exposed were screened. A comprehensive infection prevention strategy was implemented in collaboration with the state health department and Hospital Two. The plan included transmission-based precautions, hand hygiene compliance, environmental cleaning and disinfection, and staff and patient education.ResultsA total of 48 patients were screened for C. auris at Hospital One and no additional positive results were identified. The patient was transferred to Hospital Two for progressive care needs and required an extensive hospital stay post-surgery. No additional screening was recommended by the state health department. Practical prevention strategies for high level disinfection and sterilization, environmental cleaning, patient transport and ambulation, and procedural protocols were developed. No additional C. auris colonization nor clinical isolates have been identified to date.ConclusionsThis case highlighted the importance of inter-facility communication and the need for an established screening protocol for C. auris to identify cases in a timely manner. The robust infection prevention strategies implemented by the two systems resulted in no known transmission to other patients or staff.

Assessment of infection prevention and control readiness for Ebola virus and other diseases outbreaks in a humanitarian crisis setting: a cross-sectional study of health facilities in six high-risk States of South Sudan.

Introductionthe study was conducted to assess the readiness and capacity of the core components of infection prevention and control and water, sanitation and hygiene in health facilities to effectively contain potential outbreaks of Ebola virus and other diseases in South Sudan.Methodsit is a descriptive cross-sectional study which was conducted in health facilities in six high-risk States of the country from September 2020 to December 2021. Data was collected using a structured questionnaire and analyzed with Microsoft Excel software.Resultsone hundred and fifty-one (151) health facilities with a total bed capacity of 3089 were enrolled into the study. Overall, the least prepared infection prevention and control, water and sanitation core components in ascending order were the coordination committee structure (13.19%), guidelines and SOPs (21.85%), vector control (22.02%), staff management (30.63%), and training received (33.64%). The best prepared components in descending order were integrated disease surveillance and response capacity (69.83%), medical waste management system (57.12%) and infrastructure compliance (54.69%).Conclusionthe findings of this study which is comparable to those of other studies in similar settings validates the perception that Infection Prevention and Control/Water, Sanitation, and Hygiene (IPC/WASH) capacity and readiness is inadequate in South Sudan. To scale up these core components, we recommend development and implementation of a comprehensive and long-term infection prevention and control strategic plan as part of the country’s broader health sector recovery planning.

Hepatitis B virus infection among 5 493 migrant workers in Shenzhen city′s Luohu Demonstration Zone for comprehensive hepatitis B prevention and treatment

Objective To examine the prevalence of hepatitis B virus (HBV) infection among migrant workers in Luohu district of Shenzhen city for providing evidences to HBV infection prevention in the workers. Methods A questionnaire survey and serum hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) detections with enzyme-linked immunosobent assay (ELISA) were conducted among 5 493 migrant workers in Shenzheng city′s Luohu demonstration zone for comprehensive prevention and control of hepatitis B (HB) when the workers had their physical examinations between April 2019 and June 2020. Results For all the workers, the positive rate was 6.54% and 60.37% for serum HBsAg and anti-HBs; the positive rate of both HBsAg and anti-HBs differed significantly by age, education, occupation, registered residence, and history of HBV vaccination. The results of binary logistic regression analysis on significant influencing factors of serum HBsAg and anti-HBs identified with univariate analysis demonstrated that inoculation of HBV vaccine is a protective factor against HBsAg positive; while, with the education of junior high school and lower and aged 30 – 49 years are risk factors for HBsAg positive; the results also indicated that the workers having received HBV vaccination, aged less than 30 years, and with a registered residence in East China were more likely to be serum anti-HBs positive compared to other migrant workers. Conclusion The prevalence of HBV infection decreased in comparison to that ten years ago among migrant workers in Shenzhen city′s Luohu demonstration zone for comprehensive HBV infection prevention and treatment but the prevention of HBV infection still needs to be strengthened in the unvaccinated migrant workers younger than 20 years and in those from southwest, northeast and northwest region of China.

The status of infection prevention and control structures in Eastern China based on the IPCAF tool of the World Health Organization

BackgroundThe burden of healthcare-associated infections (HAIs) and the spread of antimicrobial resistance can be potentially preventable through comprehensive infection prevention and control (IPC) programs. However, information on the current state of IPC implementation is rare in China.MethodsA cross-sectional study was conducted in Zhejiang province, China, from April to June 2021. The Zhejiang nosocomial infection control and quality improvement center (NICQI) cooperated with 11 municipal NICQI centers to introduce the purpose of this study and invite all licensed secondary and tertiary hospitals in Zhejiang province through WeChat group. The questionnaire had three sections, including information about participating hospitals, demographic information about IPs, and the Chinese version of the Infection Prevention and Control Assessment Framework that covered eight core components (CC).ResultsOf the 382 hospitals invited, 222 (58.1% response rate) accepted and completed the online questionnaire. The overall median score of the participating hospitals was 682 (630–723), which corresponded to an advanced level of IPC. There was a significant difference in scores between hospitals types (P < 0.001). Profound differences were revealed regarding the scores of the individual components, with CC2 (IPC guidelines) and CC6 (Monitoring/audit of IPC practices and feedback) having the highest (100) and lowest (65) median scores, respectively. Only 23 (10.4%) hospitals reported assessing facility safety culture.ConclusionsIPC structures are at a relatively high level in acute care hospitals in Eastern China. The identified potential areas for improvement were similar to those identified in developed countries, particularly regarding multimodal strategies for implementation and safety culture construction. Meanwhile, the Chinese government should pay more attention to IPC resources and practices among secondary care hospitals.

Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the ‘SPRINT’ principles

IntroductionThe COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with...

Validation and Extrapolation of a Multimodal Infection Prevention and Control Intervention on Carbapenem-Resistant Klebsiella pneumoniae in an Epidemic Region: A Historical Control Quasi-Experimental Study.

Objective: To verify the effects of comprehensive infection prevention and control (IPC) interventions for the prevention of the cross-transmission of carbapenem-resistant Klebsiella pneumoniae (CRKP) within intensive care units (ICUs) in an epidemic region.Methods: A historical control, quasi-experimental design was performed. The study was conducted between January 2017 and December 2019, following the implementation of a multimodal IPC bundle. The baseline period was established from January 2013 to June 2013, when only basic IPC measures were applied.Results: A total of 748 patients were enrolled during the entire study. The incidence of ICU-acquired CRKP colonization/infection was 1.16 per 1,000 patient-days during the intervention period, compared with 10.19 per 1,000 patient-days during the baseline period (p = 0.002). The slope of the monthly incidence of CRKP at admission showed an increasing trend (p = 0.03). The incidence of ICU-acquired catheter-related bloodstream infections caused by CRKP decreased from 2.54 to 0.96 per 1,000 central-line-days (p = 0.08). Compliance with contact precautions and terminal room disinfection improved during the intervention period. All environmental surface culture samples acquired after terminal room disinfection were negative for CRKP.Conclusion: Our findings suggest that in epidemic settings, multimodal IPC intervention strategies and consistent monitoring of compliance, may limit the spread of CRKP in ICUs.

Letter: Comprehensive Neurosurgery Infection Prevention and Control Practice in the COVID-19 “Return to Operate” Era

The COVID-19 pandemic has forced neurosurgeons to adapt in the face of an unforeseen crisis, including reevaluating an important aspect of neurosurgical practice: surgical infection control and prevention. Before COVID-19, surgical site infections (SSI) remained a costly and burdensome issue within neurosurgery and the medical field at-large. Furthermore, as options for linking payment to quality of care and mandatory reporting of SSI expands, cranial and spine surgery can expect to face increased oversight and pressure in efforts to reduce SSI. The risk of COVID-19 transmission to both patients and healthcare workers has inspired rigorous attention to inspection control practices. Therefore, at our institution we have applied the momentum gained introducing new infection control practices and procedures to prevent of COVID-19 transmission to the adoption of a surgical infection control bundle. We describe our implementation spanning screening and selection of patients for surgery, intraoperative precautions, postoperative care, and systems for monitoring and feedback.

Sexually Transmitted and Blood-borne Infections Among Patients Presenting to a Low-barrier Substance Use Disorder Medication Clinic.

To study the infection-related needs of patients with substance use disorders initiating care at a low-barrier-to-access program (LBAP) by describing the proportion with human immunodeficiency virus (HIV), hepatitis B and C virus (HBV, HCV), syphilis, gonorrhea, and chlamydia and determining rates of treatment and/or linkage to care. We reviewed the records of patients who completed an intake visit at an LBAP in Boston, MA during the first 9 months after implementation of a standardized intake laboratory panel (January 30, 2017-September 30, 2017). Among 393 patients initiating care, 84.7% (n = 333) completed at least 1 screening test. Baseline rates of HIV (9/393, 2.3%), current or past HCV (151/393, 38.4%), and chronic HBV (2/393, 0.5%) were high. Sixty-one new, active infections were identified through screening, including 1 HIV, 3 syphilis, 4 gonorrhea, 3 chlamydia, 1 chronic, and 1 acute HBV, and 48 cases of viremic HCV. Many patients were nonimmune to HBV (102/270, 37.8%) and HAV (112/255, 43.9%). Among new diagnoses, treatment was documented in 88% of bacterial infections and linkage occurred in 0/1 HIV, 2/2 HBV (100.0%), and 16/48 HCV (33.3%) cases. Patients initiating SUD care at an LBAP have substantial, unmet infection-related needs. Results justify the inclusion of comprehensive infection prevention, screening, and linkage-to-treatment protocols in LBAPs.

A Situational Review of Comprehensive Infection Prevention and Control Guidelines Aimed at Preventing the Nosocomial Spread of COVID-19

The COVID-19 pandemic has affected the world drastically by disrupting normal routines in society and healthcare facilities are no exception. Irrespective of a nationrsquos socio-economic background healthcare facilities are facing issues with shortage of skilled health workforce personal protective equipment PPE lack of oxygen supplies and adherence to multiple changes in infection prevention and control practices. Coronavirus disease COVID-19 caused by the novel severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 is leading to greater challenges for infection prevention and control measures in healthcare settings. Since the transmission can occur through droplets fomites airborne routes and from individuals who are asymptomatic or from individuals in the incubation phase the likelihood of spread of infection among the health care workers where there is close contact with infected individuals makes it very challenging. With guidelines being continuously updated as knowledge rapidly evolves and measures being taken even as there is unprecedented demand on healthcare facilities the authors felt the need to review and draw inferences from the relevant guidelines provided by the World Health Organization WHO International Health Organisations and respective Health Ministries which might serve to refresh and bring about better awareness among the health care workers and patients on tackling the nosocomial spread of COVID-19 and also highlight how the response to COVID-19 can in general help improve infection control practices and prevent nosocomial infection spread in healthcare settings in subsequent waves.nbsp

Antenatal Care Visit Attendance Frequency and Birth Outcomes in Rural Uganda: A Prospective Cohort Study.

Antenatal care (ANC) is designed to improve pregnancy outcomes by providing screening and treatment for preventable and treatable diseases. However, data are lacking on whether ANC affects stillbirth risk. We hypothesized stillbirth risk in Uganda is lower in women attending the recommended ≥ 4 ANC visits compared to those attending ≤ 3. We performed a secondary analysis of subset of 1,785 women enrolled in a prospective cohort of postpartum infection who presented to a regional referral hospital for delivery. Our primary outcome was documented stillbirth; a secondary composite poor birth outcome included stillbirth, early neonatal death, low birth weight (< 2500g), and 5-min APGAR score < 7. We performed multivariable logistic regression analyses to identify independent correlates of stillbirth and poor birth outcome. Of 1,785 participants, 58 (3%) pregnancies resulted in stillbirth and 198 (11%) had a poor birth outcome. Of 1,236 women attending ≥ 4 ANC visits, 31 (2.5%) had a stillbirth, compared to 27/510 (5.2%) attending ≤ 3. In multivariable analyses controlling for age, parity, distance traveled, referral status to hospital, malaria prophylaxis, and syphilis infection; attending ≥ 4 ANC visits was associated with significantly reduced odds of stillbirth (aOR 0.5, 95% CI 0.3-0.9, P = 0.02) and poor birth outcome (aOR 0.66, 95% CI 0.4-0.96, P = 0.03). Malaria prophylaxis was also independently associated with reduced odds of stillbirth (aOR 0.05, 95% CI 0.2-1.0, P = 0.04). Attending ≥ 4 ANC visits was associated with reduced odds of stillbirth and poor birth outcomes in this Ugandan cohort, which may be related to more comprehensive infection screening, treatment, and prevention services.

Clinical Management of Corona Virus Disease 2019 (COVID-19) in Pregnancy and Outcome- Case Reports

Bangladesh is a South East Asian country; the first case of COVID-19 was detected in early March 2020. In a land where 2.11% of the total world population resides; a devastating surge of the Pandemic of COVID-19 was anticipated to overwhelm the health sectors [1]. Specific high risk groups were identified and possible efforts to minimize both morbidity and mortality have been ensured. Pilot health projects launched with mass campaigns on preventive measures from COVID-19 and to educate people about mode of transmission, home treatment and isolations in mild cases. Apart from general cases, the obstetric cases became a delicate challenge for health professionals. Here both mother and babies requires standard treatment protocol, care along with unprecedented psychological support system for the mothers in all three antepartam, intrapartam and postpartam periods. A well designed care protocol introduced for neonatal care. A national guideline on clinical management of corona virus disease 2019 (COVID-19) has been developed on 30th March 2020 by Disease Control Division in combination with Director General of Health Services, Ministry of Health and Family Welfare of Government of the People’s Republic of Bangladesh [2]. The guidelines have been updated time to time to incorporate latest evidence and recommendations of WHO. New COVID-19 units reconstructed both in Government and Private sectors with adequate logistics, ICU support and trained stuffs with proper mother and baby isolation centers. A comprehensive infection prevention and control (IPC) is strictly maintained in every aspects of case management from community to hospital ICU. Severe and critical cases are treated in designated COVID-19 hospitals or units. Laboratory for patient screening tests and triage became a huge challenge for health facilities required constant supervision. Proper early diagnosis and case detection became the success tool of the disease. Two obstetric cases COVID-19 (SARS CoV2 virus) treatment and outcome have been discussed in this topic to highlight the management issue and to adopting national protocol.

Comprehensive gastroenterology endoscopy unit workflow and infection prevention during the COVID-19 Pandemic: Experience with 159 cases in Wuhan, China.

During the outbreak of the novel coronavirus disease (COVID-19) in Wuhan, the gastroenterology department of our hospital performed gastrointestinal endoscopy procedures using strict infection control measures. Thorough screening of incoming patients, separation of diagnostic and treatment areas, regional management, hierarchical protection, disinfection protocols, and other measures were enforced to prevent virus transmission during endoscopic treatments. During the COVID-19 pandemic, between February and March 2020, 159 endoscopic examinations and treatments were performed, including emergency endoscopy for 17 patients. Among these, seven patients were either previously infected with or were suspected carriers of the virus. Using the aforementioned control measures, we did not encounter a single case of cross-infection or infection among the patients or staff. The presented protocols may provide valuable insight regarding how to protect gastroenterology endoscopy units during the novel coronavirus disease pandemic.

A Novel On-Site Volunteer Community Infection Prevention Team Prevented Outbreaks at a Hurricane Harvey Mega-Shelter

Background: In the setting of global warming, natural disasters are increasing in pace and scope. Although natural disasters themselves do not cause outbreaks, the breakdowns in sanitary infrastructure and the displacement of populations, often to crowded shelters, have caused outbreaks. On August 26, 2017, category 4 hurricane Harvey made landfall near Corpus Christi, Texas, causing catastrophic flooding and displacing &gt;30,000 residents from the Southern Gulf Coast region. Dallas accepted &gt;3,800 evacuees at the Kay Bailey Hutchison Convention Center mega-shelter for 23 days, where a medical clinic was erected in the convention center parking garage. The medical clinic uniquely included a dedicated infection prevention team composed of local volunteer infection preventionists, healthcare epidemiologists, infectious diseases providers, and health department personnel. Methods: Evacuees were housed at the Dallas mega-shelter from August 29 through September 20. The infection prevention team maintained a presence of 3–4 members during clinical operations in shifts. The team conducted an initial needs assessment upon opening of the shelter medical clinic, facilitated acquisition of adequate numbers of hand sanitizer stations, sinks with running water, portable hand-washing stations, portable toilets and showers, and cleaning products. The infection prevention team coordinated and oversaw environmental cleaning services (EVS) carried out by local hospital EVS staff. Protocols for cleaning, disinfection, communicable disease testing, isolation, and treatment were created. In addition, education and training materials for the implementation of these protocols were distributed to volunteer staff. The infection preventionists created and provided oversight of the designated isolation units for respiratory, gastrointestinal and dermatologic infections of outbreak potential. Infection prevention rounding tools were developed and executed daily in the clinic, at the on-site daycare center, dining area, and the general shelter dormitory. Vaccination for influenza was formalized under a protocol and administered at the clinic and via mobile vaccination teams in the chronic illness section of the dormitory. Results: In tota3,829 residents were housed at the mega-shelter for 23 days. Moreover, 1,560 patients were seen in 2,654 clinic visits at the shelter medical clinic. In total, 48 (19%) clinic visits were for respiratory symptoms, 228 (9%) were for dermatologic problems, and 215 (8%) were for gastrointestinal symptoms. Also, 32 patients were referred to the isolation unit within the clinic. Overall, 98 influenza vaccines were administered. There was 1 confirmed case of influenza and 1 confirmed case of norovirus. Conclusions: No known transmission of communicable diseases occurred in this long-term, natural disaster–related mega-shelter, likely attributed to having a comprehensive infection prevention team of on-site volunteers available throughout the shelter operation. This model should be considered in future large-scale shelter settings to prevent disease transmission.Disclosures: NoneFunding: None

Nosocomial Transmission of Coronavirus Disease 2019: A Retrospective Study of 66 Hospital-acquired Cases in a London Teaching Hospital.

COVID-19 can cause deadly healthcare-associated outbreaks. In a major London teaching hospital, 66/435 (15%) of COVID-19 inpatient cases between 2 March and 12 April 2020 were definitely or probably hospital-acquired, through varied transmission routes. The case fatality was 36%. Nosocomial infection rates fell following comprehensive infection prevention and control measures.