Evaluate Infection Control Research Articles

P-349. Identification and Control of a Candida auris Outbreak in an Acute Spinal Cord Injury Unit at a Veterans Affairs Medical Center

Abstract Background Candida auris is an emerging pathogen that spreads easily in healthcare settings and can cause severe infections. In Dec. 2022, C. auris was identified at the Richmond VA Medical Center (VAMC) in an acute care spinal cord injury unit (SCIU). The SCIU is a regional SCI center in a 300-bed VAMC that provides medical and rehabilitation services to patients from multiple states.Figure 1.Point prevalence testing results and timeline of interventions during the outbreak investigation. Methods C. auris was identified in 1 urine culture from a SCIU patient, triggering an outbreak investigation. The Infection Prevention (IP) team performed point prevalence (PP) testing via superficial swabs of axilla and groin sent for polymerase chain reaction (PCR) testing. Initial screening included 31 unique patients in 2 units, A (n=16) and B (n=15). Admission testing was also initiated. Patients were isolated until tests resulted. Surveillance PP testing was performed biweekly and ceased after consecutive rounds of negative results. The IP team evaluated infection control practices in the SCIU that could contribute to transmission. Results The initial screening of 31 patients yielded 5 positives (16%; Figure 1). Overall, 92 PCR tests were completed on 51 unique patients for a positivity rate of 9.8% (n=5). Positive results occurred only during the initial testing. Positive patients were admitted for a median of 36 days (range: 16-412). No C. auris was isolated in culture and no invasive infections developed. Records and interviews revealed complex movement between healthcare facilities for the colonized patients. Multiple lapses in infection control practice were found. Admission testing with repeat testing at 90 days was implemented longitudinally, along with enhanced cleaning measures and reinforcement of transmission-based precautions (Figure 1). No new positive results were found over the subsequent 9 months. Conclusion PP testing for C. auris in an SCIU identified 5 colonized patients. As no isolates were recovered beyond the index case, IP could not determine whether this outbreak was due to intra-unit transmission versus multiple introductions. Improvements in infection control practices, along with implementation of surveillance testing, contributed to control of the outbreak. The SCIU remains vulnerable to C. auris due to the complex, multidisciplinary care needs of the patient population. Disclosures All Authors: No reported disclosures

A Global Perspective on Infection Control Measures for Healthcare Workers: A Systematic Review

Infection control measures are essential to safeguarding healthcare workers (HCWs) and preventing healthcare-associated infections (HAIs) worldwide. This systematic review examines the global implementation of infection control strategies, their effectiveness, and the disparities between high-income countries and low- and middle-income countries (LMICs). A comprehensive search was conducted across multiple databases, focusing on studies published since 2016 that evaluated infection control practices, including hand hygiene, personal protective equipment (PPE), vaccination, environmental cleaning, and waste management. Findings reveal significant variation in compliance and outcomes, with LMICs facing challenges such as resource shortages, inadequate training, and organizational deficiencies. Conversely, high-income countries demonstrate better adherence to infection control protocols, supported by advanced technologies and robust policies. Despite these differences, common barriers such as HCW burnout and vaccine hesitancy persist globally. The review underscores the need for equitable access to resources, international collaboration, and the integration of innovative technologies to enhance infection prevention measures. Addressing these disparities is critical to protecting HCWs, improving patient safety, and achieving global health equity.

Evaluation of the appropriateness of control measures related to nosocomial transmission of multidrug-resistant microorganisms within the SS Multipurpose Intensive Care Unit: observational study

Background: Healthcare-Associated Infections (HAIs), by definition, occur 48 hours or more after admission or within 30 days after discharge or surgical procedure; they represent a significant challenge for the healthcare system due to their prevalence in Italy and the involvement of multi-drug resistance. Intensive Care Units (ICU) exhibit the highest prevalence of such infections due to lapses in adherence to safety protocols. The primary cause of hospital-acquired infections is poor adherence to guidelines for the prevention and control of these infections. This study aims to evaluate infection control measures in a mixed ICU. Materials and Methods: a cross-sectional observational single-center study was conducted in the Mixed ICU at the University Hospital of Alessandria. The study used an assessment tool based on the DVA 91 rev 03 issued on 07/22/22. This tool provides guidance on isolation type (airborne, contact, droplet), patient accommodation, care measures, cleaning and disinfection protocols, patient transportation, and visitor management. Results: overall, 220 observations were included, primarily involving nurses (75.4%) and female personnel (65.9%), with a mean age of 35.8 years and a median length of service of 36 months in the Mixed ICU. Notably, all observations were made on patients in contact isolation. In 199 observations (92.6%), healthcare providers performed hand hygiene immediately after glove removal. Conclusions: the findings highlight a strong adherence to infection control protocols at Alessandria Hospital-University. These efforts promote a safety culture among healthcare providers, ensuring the effective implementation of preventive measures.

The Use and Reprocessing of Endodontic Files in Saudi Arabia: A Cross-Sectional Study.

Objectives This study aimed to assess the awareness, implementation, and compliance with the infection control policy recommended by the Saudi Ministry of Health (MOH) for the use and reprocessing of endodontic files and to examine the association between compliance and gender, experience, clinical ranks, and workplace sector. Methods This was a cross-sectional study conducted using a validated self-administered electronic questionnaire created and distributed to dentists who perform endodontic treatment in Saudi Arabia. Data were collected between June and July 2023. Descriptive statistics were reported as counts and percentages. Comparisons among the demographic groups were done using the Kruskal-Wallis and Mann-Whitney tests. Results A total of 402 dentists completed the survey. The results showed that 76.1% (n=306) of respondents claimed that they were aware of the infection control policy recommended by the Saudi MOH for the use and reprocessing of endodontic files in dental clinics. Only 13.2% (n=53) of dentists used single-use endodontic files, and 36.6% (n=147) did not use an endodontic box in their dental clinics. The most commonly reported method of tracing the number of uses of endodontic files was to write the ID of the patient or the number of uses on the sterilization pouch as reported by 37.6% of participants (n=151). The average compliance score percentage was 63.5 ± 16.7. Most of the respondents showed moderate to high levels of compliance (51.7% (n=208) and 42.0% (n=169) of dentists, respectively). Dentists with less than 5 years of experience showed significantly less compliance than dentists with more than 10 years of experience (p = 0.005). Gender, clinical rank, and workplace sector were not significantly associated with the extent of adhering to the evaluated infection control policy. Conclusions Our findings indicate a relatively high level of compliance with the Saudi MOH policy of using and reprocessing endodontic files. However, critical measures such as the single-use of endodontic files, sterilizing new endodontic files, and using the sterilized endodontic box for each patient need improvement. Hence, this study recommends enhancing awareness through continuous education and training.

Awareness and monitoring of infection control practices among healthcare workers in three primary health centers in India.

This study aimed to assess the awareness of and adherence to infection control practices among healthcare workers (HCWs) in three primary healthcare centers (PHCs) near Aurangabad City, Maharashtra, India. A prospective observational study over six months involved 64 HCWs from three PHCs (A, B, and C). Questionnaires and observation checklists based on guidelines from the WHO and the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) were used to evaluate infection control practices across nine modules. These modules encompass health facility information, employee health, cleaning practices, hand hygiene, waste management, isolation and standard precautions, childbirth/obstetrics, sterilization, and preparation/administration of parenteral medications. The study revealed varying levels of adherence to infection control practices among the three PHCs. PHC-A demonstrated strong practices with an overall score of 66%, while PHC-B and PHC-C exhibited weaker practices with 40% and 38%, respectively. Hand hygiene practices showed higher compliance at PHC-A (78%), contrasting with lower compliance observed at PHC-B (39%) and PHC-C (33%). The study also noted deficiencies in hand hygiene facilities and inconsistencies in injection administration and waste disposal practices. This study underscores the importance of ongoing training and targeted interventions to enhance infection control practices among HCWs in PHCs. The findings provide valuable insights for policymakers and administrators seeking to improve infection prevention measures in primary healthcare settings, contributing to better healthcare outcomes and enhanced patient safety.

Outbreak of Burkholderia multivorans among patients at two acute-care hospitals in California, August 2021–July 2022

Background:Burkholderia multivorans are gram-negative bacteria typically found in water and soil. B. multivorans outbreaks among patients without cystic fibrosis have been associated with exposure to contaminated medical devices or nonsterile aqueous products. Acquisition can also occur from exposure to environmental reservoirs like sinks or other hospital water sources. We describe an outbreak of B. multivorans among hospitalized patients without cystic fibrosis at 2 hospitals within the same healthcare system in California (hospitals A and B) between August 2021 and July 2022. Methods: We defined confirmed case patients as patients without cystic fibrosis hospitalized at hospital A or hospital B between January 2020 to July 2022 with B. multivorans isolated from any body site matching the outbreak strain. We reviewed medical records to describe case patients and to identify common exposures. We evaluated infection control practices and interviewed staff to detect exposures to nonsterile water. Select samples from water, ice, drains, and sink splash zone surfaces were collected and cultured for B. multivorans in March 2022 and July 2022 from both hospitals. Common aqueous products used among case patients were tested for B. multivorans. Genetic relatedness between clinical and environmental samples was determined using random amplified polymorphic DNA (RAPD) and repetitive extragenic palindromic polymerase chain reaction (Rep-PCR). Results: We identified 23 confirmed case patients; 20 (87%) of these were identified at an intensive care unit (ICU) in hospital A. B. multivorans was isolated from respiratory sources in 18 cases (78%). We observed medication preparation items, gloves, and patient care items stored within sink splash zones in ICU medication preparation rooms and patient rooms. Nonsterile water and ice were used for bed baths, swallow evaluations, and ice packs. B. multivorans was cultured from ice and water dispensed from an 11-year-old ice machine in the ICU at hospital A in March 2022 but no other water sources. Additional testing in July 2022 yielded B. multivorans from ice and a drain pan from a new ice machine in the same ICU location at hospital A. All products were negative. Clinical and environmental isolates were the same strain by RAPD and Rep-PCR. Conclusions: The use of nonsterile water and ice from a contaminated ice machine contributed to this outbreak. Water-related fixtures can serve as reservoirs for Burkholderia, posing infection risk to hospitalized and immunocompromised patients. During outbreaks of water-related organisms, such as B. multivorans , nonsterile water and ice use should be investigated as potential sources of transmission and other options should be considered, especially for critically ill patients.Disclosures: None

High Sensitivity of Mobile Phone Microscopy Screening for Schistosoma haematobium in Azaguié, Côte d'Ivoire.

Schistosomiasis infections continue to impact African settings disproportionately, and there is an urgent need for novel tools to evaluate infection control and elimination strategies at the community level. Mobile phone microscopes are portable and semiautomated devices with multiple applications for screening neglected tropical diseases. In a community-based schistosomiasis screening program in Azaguié, Côte d'Ivoire, mobile phone microscopy demonstrated a sensitivity of 85.7% (95% CI: 69.7-95.2%) and specificity of 93.3% (95% CI: 87.7-96.9%) for Schistosoma haematobium identification compared with conventional light microscopy, and 95% sensitivity (95% CI: 74.1-99.8%) with egg concentrations of five or more per 10 mL of urine. Mobile phone microscopy is a promising tool for schistosomiasis control and elimination efforts.

Antibiotic-Impregnated Cement-Coated Intramedullary Nail in Primary Fixation of Compound Fractures of Tibial Shaft – A Comparative Study with External Fixator in Terms of Infection Control

Introduction: Compound tibial shaft fractures are conventionally managed by debridement and primary stabilization by external fixators, followed by definitive fixation after the wound healing; however, many problems such as infection, difficult soft tissue reconstruction, and psychosocial effects encountered. Hence, a technique of antibiotic-impregnated cement-coated intramedullary nailing has been advocated. Aims: The aim of the study is to compare functional and biological outcomes of antibiotic-impregnated cement-coated nail with external fixators. Settings and Design: This was a prospective interventional study. Subjects and Methods: A total of 20 patients with Compound Grade 3A and 3B (Gustilo and Anderson) tibial shaft fractures who met the inclusion and exclusion criteria from January 2020 to June 2021 were selected. Group 1 was operated with antibiotic-impregnated cement-coated nails. Group 2 was operated with external fixators. Clinical and laboratory parameters were used to evaluate infection control. Final follow-up was taken at 6 weeks. Results: The infection rate after nailing was 10% in Group 1 (1/10) and 50% in Group 2 (5/10). Intraoperative time taken for soft tissue reconstruction procedures after primary fixation such as flap cover and skin grafting was comparatively less in Group 1 (mean time – 32 min ± 6.23) compared to Group 2 (51 min ± 5.83). Duration between primary and definite fixation was comparably less in Group 1 (mean duration 5.7 weeks ± 0.45) compared to Group 2 (6.3 weeks ± 1.004). Conclusions: Primary antibiotic-impregnated cement-coated nail is better than external fixator in terms of infection control and providing stability in compound fractures of shaft of tibia.

Sterilization and infection control practices to prevent transmision of COVID-19 in dental office

Aim: The review was to evaluate infection control measures and control of SARS – COV 2 infection in dental office. Objectives: To evaluate the infection control measures before and after the visit of patient, the awareness of dentists regarding SARS - COV 2, the knowledge, attitude and practices of dentists regarding infection control measures and control of SARS – COV 2 in dental office and their ability in identifying the source of infection and measures to curb it. Material and Methods: This review sought to assess the infection control measures in dental practice during covid-19 pandemic with a literature search covering the electronic databases: Cochrane library, PubMed, PubMed Central, Science Direct and Google scholar. Results: SARS-COV 2 infection occurs mainly through direct contact with micro droplets or core droplets and aerosol. Moreover, infected subjects, both with and without clinical signs of COVID-19, can transmit the virus. Virus enters human body mainly through mouth, nose, and eyes when they are touched by infected hands. Thus, dental practice poses highest risk of transmission of SARS COV2 infection. Conclusion: Review focused on the methods, protocols, and recent reports regarding the SARS CoV2 infection.

Outbreak investigation of CRAB at an acute-care hospital ICU during the COVID-19 pandemic–Chicago, Illinois, March 2020–September 2021

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is primarily associated with hospital-acquired infections and is an urgent public health threat due to its ability to contaminate the environment and cause severe disease. In 2019, Illinois began pilot surveillance for CRAB requiring select laboratories to submit specimens for molecular characterization. On July 17, 2020, the Chicago Department of Public Health (CDPH) was notified of an increase in CRAB infections in a 20-bed ICU at an acute-care hospital in Chicago (hospital A) during the initial COVID-19 surge. We summarize the outbreak investigation findings and infection control recommendations. Methods: Clinical cultures were collected from patients in hospital A, and CRAB-positive isolates were sent to the Wisconsin State Laboratory of Hygiene for mechanism of resistance and antibiotic susceptibility testing. On-site assessments and remote follow-ups were conducted by CDPH infection preventionists to evaluate infection control practices including environmental cleaning, hand hygiene compliance, and use of personal protective equipment (PPE). The Illinois Department of Public Health and CDPH summarized the testing results, facilitated a containment response, and provided recommendations for infection control. Results: From March 18, 2020, to September 30, 2021, 56 patients with CRAB infections were identified from hospital A, and 33 (59%) of these cases were pan-nonsusceptible. Most specimen sources were sputum (n = 30, 54%), followed by blood (n = 13, 23%), urine (n = 6, 11%) and other (n = 7, 13%). Among isolates with mechanism testing (n = 54), 45 (83%) were positive for OXA-24/40 and 9 (17%) were positive for OXA-23. Of the CRAB-positive patients, 28 (50%) were previously positive for SARS-CoV-2. To date, 25 of these patients (45%) have been discharged and 31 (55%) have died. Two onsite visits and 7 remote-assistance sessions were conducted as part of the investigation. In response to increased COVID-19 hospitalizations, hospital A moved to crisis-capacity PPE use and encountered staffing shortages, which led to compromised infection control measures. Cleaning agents (Quat disinfectant cleaner) were also found to be ineffective against CRAB and required long contact times. Conclusions: In response to the CRAB outbreak at hospital A, CDPH recommended that the hospital stop crisis-capacity protocols for PPE, conduct admission screening and point-prevalence testing for CRAB, implement a hand hygiene campaign, and use an EPA-registered List K product for environmental cleaning. These recommendations were implemented in May 2021, and no CRAB cases have been reported since July 2021. To reduce CRAB transmission during the pandemic, facility leadership must commit resources to educate staff on effective infection control practices including conventional use of PPE, appropriate cleaning agents, and improved hand hygiene.Funding: NoneDisclosures: None

Response to the coronavirus disease 2019 pandemic of dental hygienists in South Korea-Part Ⅰ: Knowledge and practice of infection control.

To evaluate infection control knowledge and its practice of clinical dental hygienists in response to Coronavirus Disease 2019 (COVID-19) in South Korea. Nine questions (Q9-K) on the degree of knowledge acquisition of dental hygienists in response to COVID-19, and another 9 questions (Q9-P) on the practices for COVID-19 infection and spread prevention were prepared. From 500 clinical dental hygienists in South Korea, answers about their general characteristics, Q9-K, and Q9-P were collected. 1 point was given to each question based on the 'yes' answers from Q9-K and Q9-P, and Score-K and Score-P were calculated, respectively. To identify factors affecting Score-P, a multiple linear regression analysis was performed. In all analyses, p-values lower than 0.05 were considered statistically significant. Average scores of Score-K and Score-P were 7.36±1.35 and 6.26±2.07, respectively. The regression model of Score-P was significant (F=20.788, p<0.001). Concerning Score-P, Score-K (β=0.385), age (β=0.275), dental hospital (β=0.158), monthly income of $2,360~$2,730 (β=0.104) had a significantly positive correlation, and the total years of career (β=-0.293) are found to have a significantly negative correlation. Infection control knowledge and practice of clinical dental hygienists in South Korea was found to be vulnerable in the group of hygienists who are younger than 27years old, working in dental clinics, and whose monthly income is less than under $2,000. Also, the factor that influences infection control practice the most was the degree of knowledge. Therefore, continuous infection control education and supplement targeting these vulnerable groups are necessary.

Central-line-associated bloodstream infections, multi-drug-resistant bacteraemias and infection control interventions: a 6-year time-series analysis in a tertiary care hospital in Greece

Central-line-associated bloodstream infections (CLABSIs) are serious healthcare-associated infections with substantial morbidity and hospital costs. To investigate the association between the incidence of CLABSIs, the implementation of specific infection control measures, and the incidence of multi-drug-resistant (MDR) bacteraemias in a tertiary care hospital in Greece from 2013 to 2018. Analysis was applied for the following indices, calculated monthly: CLABSI rate; use of hand hygiene disinfectants; isolation rate of patients with MDR bacteria; and incidence of bacteraemias [total Gram-negative carbapenem-resistant Acinetobacter baumanii, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae; and/or Gram-positive meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci]. The total number of bacteraemias from carbapenem-resistant Gram-negative pathogens was significantly correlated with an increased CLABSI rate for all (total) hospital departments [incidence rate ratio (IRR) 1.17, 95% confidence interval (CI) 1.05-1.31, P=0.006] and the adult intensive care unit (ICU) (IRR 1.37, 95% CI 1.07-1.75, P=0.013). In the adult ICU, every increase in the incidence of each resistant Gram-negative pathogen was significantly correlated with a decreased CLABSI rate (carbapenem-resistant A.baumanii: IRR 0.59, 95% CI 0.39-0.90, P=0.015; carbapenem-resistant K.pneumoniae: IRR 0.48, 95% CI 0.25-0.94, P=0.031; carbapenem-resistant P.aeruginosa: IRR 0.54, 95% CI 0.33-0.89, P=0.015). The use of hand disinfectants was correlated with a decreased CLABSI rate 1-3 months before the application of this intervention for all (total) hospital departments (IRR 0.80, 95% CI 0.69-0.93, P=0.005), and for scrub disinfectants in the current month for the adult ICU (IRR 0.34, 95% CI 0.11-1.03, P=0.057). Isolation of patients with MDR pathogens was not associated with the incidence of CLABSIs. Hand hygiene was associated with a significant reduction in the incidence of CLABSIs at the study hospital. Time-series analysis is an important tool to evaluate infection control interventions.

Estimating Tuberculosis Transmission Risks in a Primary Care Clinic in South Africa: Modeling of Environmental and Clinical Data.

Congregate settings, such as healthcare clinics, may play an essential role in Mycobacterium tuberculosis (Mtb) transmission. Using patient and environmental data, we studied transmission at a primary care clinic in South Africa. We collected patient movements, cough frequency, and clinical data, and measured indoor carbon dioxide (CO2) levels, relative humidity, and Mtb genomes in the air. We used negative binomial regression model to investigate associations. We analyzed 978 unique patients who contributed 14795 data points. The median patient age was 33 (interquartile range [IQR], 26-41) years, and 757 (77.4%) were female. Overall, median CO2 levels were 564 (IQR 495-646) parts per million and were highest in the morning. Median number of coughs per day was 466 (IQR, 368-503), and overall median Mtb DNA copies/μL/day was 4.2 (IQR, 1.2-9.5). We found an increased presence of Mtb DNA in the air of 32% (95% credible interval, 7%-63%) per 100 additional young adults (aged 15-29 years) and 1% (0-2%) more Mtb DNA per 10% increase of relative humidity. Estimated cumulative transmission risks for patients attending the clinic monthly for at least 1 hour range between 9% and 29%. We identified young adults and relative humidity as potentially important factors for transmission risks in healthcare clinics. Our approach should be used to detect transmission and evaluate infection control interventions.

Management of complex wounds treatment with a hydrofiber dressing in a public hospital in Bogota (Colombia)

Objective. To evaluate the efficacy of the use of a last generation hydrofiber dressing with silver, for the treatment of complex wounds that are difficult to heal.Materials and research methods. A prospective observational case-follow-up study was carried out, which included patients with acute or chronic wounds that were difficult to heal, treated in the plastic surgery service of a public hospital in Bogota-Colombia, who underwent healing with hydrofiber dressings reinforced, with silver ions, benzethonium chloride and EDTA (Aquacel Agplus®, ConvaTec). The wound was monitored, evaluating infection control, exudate and biofilm, as well as the number of required dressings and the time required for the complete closure of the wound.Research results. A total of 55 patients were included, with a median age of 44 years. In all cases, a follow-up was carried out until the definitive closure of the wound. At the end of the study, it was observed that, in 35 (63.6 %) patients, the wounds evolved to complete closure by second intention in an average of 59.3 days, requiring 12.5 dressings. 20 (36.4 %) patients had adequate wound bed preparation for definitive surgical coverage with grafts, flaps or dermal substitutes, in an average of 31.4 days, requiring 6.5 dressings on average.33 (60.0 %) wounds were infected and adequate infection control was achieved on average with 5 dressings. A decrease in the direct and indirect signs of biofilm was achieved after 6 dressings.Conclusion. The results show that the dressing studied is effective to control exudate, infection and biofilm, as well as to prepare the bed for a definitive surgical coverage.

Gewalt und Gewaltprävention in der stationären Altenpflege während der COVID-19-Pandemie.

Violence and Violence Prevention in Nursing Homes during the COVID-19 Pandemic - A partial analysis of Interviews with Managers or Team Leaders Abstract. Background: During the first wave of the COVID-19 pandemic, strict infection control measures were in force in long-term residential care in Germany that burdened staff and isolated residents socially. Both are considered risk factors for violence in long-term residential care. Questions: How does violence develop in nursing homes under pandemic conditions from the point of view of managers and how do strategies for preventing violence change? Methods: Semi-structured telephone interviews were conducted with staff in 43 nursing homes: 25 with service managers, 15 with nurse managers, 28 with nursing team leaders and 10 with registered nurses with extended tasks. The interviews were recorded as audio, transcribed and analysed in five steps following the "Thematic Framework Analysis". Results: The infection control measures were partly perceived as deprivation of freedom. Residents, relatives and staff partly reacted most with verbal violence. Nevertheless, the issue of violence was not a major concern for management and preventive measures were not carried out. Conclusions: The results show that strategies to prevent violence might not be sufficiently established in the institutions involved and would have to be adapted to the conditions of the pandemic. Further research is needed to evaluate infection control measures in their potential to increase the incidence of violence.

Infection Control Knowledge, Attitudes, and Practices among Students of Public Dental Schools in Egypt.

In developing countries such as Egypt, the risk of blood-borne diseases such as human immunodeficiency virus, hepatitis B virus, and hepatitis C virus is high for healthcare workers. To evaluate infection control knowledge, attitudes and practices, as well as the associated risk of percutaneous infection among dental students, a cross-sectional study was conducted in four Egyptian public dental schools in 2016. A total of 1776 students received an anonymous questionnaire on infection control knowledge, attitudes, and practices and the occurrence of needle and sharps injuries; 1067 (60.1%) completed the questionnaire. Third- (pre-clinical), fourth- (junior-clinical), and fifth-year (senior-clinical) students comprised 44.2%, 15.6%, and 40.2%, respectively. Although the majority of the students reported good attitudes and practices for infection control, knowledge scores were generally low. Female students scored higher on self-protection and sterilization practices than did male students, and the fourth-year students showed significantly higher scores for infection control practice than did the fifth-year students. In multivariate analysis, higher scores for all infection control practices were associated with higher scores for attitudes towards infection control and fewer (1–3) needle injury experiences. Although an alarming proportion had experienced needle or sharps injuries during clinical training, around 30% of the students had not received a complete hepatitis B vaccination. Future infection control education should introduce refresher training before graduation that focuses on injury prevention and post-exposure protocols. Additionally, introducing safer products and clinical procedures is highly recommended to minimize the risk of injuries during clinical practice for dental students in Egypt.

A Longitudinal Seroprevalence Study Evaluating Infection Control and Prevention Strategies at a Large Tertiary Care Center with Low COVID-19 Incidence

Personal protective equipment and adherence to disinfection protocols are essential to prevent nosocomial severe acute respiratory syndrome coronavirus (SARS-CoV-2) transmission. Here, we evaluated infection control measures in a prospective longitudinal single-center study at the Vienna General Hospital, the biggest tertiary care center in Austria, with a structurally planned low SARS-CoV-2 exposure. SARS-CoV-2-specific antibodies were assessed by Abbott ARCHITECT chemiluminescent assay (CLIA) in 599 health care workers (HCWs) at the start of the SARS-CoV-2 epidemic in early April and two months later. Neutralization assay confirmed CLIA-positive samples. A structured questionnaire was completed at both visits assessing demographic parameters, family situation, travel history, occupational coronavirus disease 2019 (COVID-19) exposure, and personal protective equipment handling. At the first visit, 6 of 599 participants (1%) tested positive for SARS-CoV-2-specific antibodies. The seroprevalence increased to 1.5% (8/553) at the second visit and did not differ depending on the working environment. Unprotected SARS-CoV-2 exposure (p = 0.003), positively tested family members (p = 0.04), and travel history (p = 0.09) were more frequently reported by positively tested HCWs. Odds for COVID-19 related symptoms were highest for congestion or runny nose (p = 0.002) and altered taste or smell (p < 0.001). In conclusion, prevention strategies proved feasible in reducing the risk of transmission of SARS-CoV-2 from patients and among HCWs in a low incidence hospital, not exceeding the one described in the general population.

Regional Public Health Response to Emerging Carbapenamase-Producing Organisms in Central Florida, 2019

Background: Detection of unusual carbapenemase-producing organisms (CPOs) in a healthcare facility may signify broader regional spread. During investigation of a VIM-producing Pseudomonas aeruginosa (VIM-CRPA) outbreak in a long-term acute-care hospital in central Florida, enhanced surveillance identified VIM-CRPA from multiple facilities, denoting potential regional emergence. We evaluated infection control and performed screening for CPOs in skilled nursing facilities (SNFs) across the region to identify potential CPO reservoirs and improve practices. Methods: All SNFs in 2 central Florida counties were offered a facility-wide point-prevalence survey (PPS) for CPOs and a nonregulatory infection control consultation. PPSs were conducted using a PCR-based screening method; specimens with a carbapenemase gene detected were cultured to identify the organisms. Infection control assessments focused on direct observations of hand hygiene (HH), environmental cleaning, and the sink splash zone. Thoroughness of environmental cleaning was evaluated using fluorescent markers applied to 6 standardized high-touch surfaces in at least 2 rooms per facility. Results: Overall, 21 (48%) SNFs in the 2-county region participated; 18 conducted PPS. Bed size ranged from 40 to 391, 5 (24%) facilities were ventilator-capable SNFs (vSNFs), and 12 had short-stay inpatient rehabilitation units. Of 1,338 residents approached, 649 agreed to rectal screening, and 14 (2.2%) carried CPOs. CPO-colonized residents were from the ventilator-capable units of 3 vSNFs (KPC-CRE=7; KPC-CRPA=1) and from short-stay units of 2 additional facilities (VIM-CRPA, n = 5; KPC-CRE, n = 1). Among the 5 facilities where CPO colonization was identified, the prevalence ranged from 1.1% in a short-stay unit to 16.1% in a ventilator unit. All facilities had access to soap and water in resident bathrooms; 14 (67%) had alcohol-based hand rubs accessible. Overall, mean facility HH adherence was 52% (range, 37%–66%; mean observations per facility = 106) (Fig. 1). We observed the use of non–EPA-registered disinfectants and cross contamination from dirty to clean areas during environmental cleaning; the overall surface cleaning rate was 46% (n = 178 rooms); only 1 room had all 6 markers removed. Resident supplies were frequently stored in the sink splash zone. Conclusions: A regional assessment conducted in response to emergence of VIM-CRPA identified a relatively low CPO prevalence at participating SNFs; CPOs were primarily identified in vSNFs and among short-stay residents. Across facilities, we observed low adherence to core infection control practices that could facilitate spread of CPOs and other resistant organisms. In this region, targeting ventilator and short-stay units of SNFs for surveillance and infection control efforts may have the greatest prevention impact.Funding: NoneDisclosures: None

Healthcare Worker Experiences Implementing CRE Infection Control Measures at a vSNF—A Qualitative Analysis

Background: During 2017–2019 in the Chicago region, several ventilator-capable skilled nursing facilities (vSNFs) participated in a quality improvement project to control the spread of highly prevalent carbapenem-resistant Enterobacteriaceae (CRE). With guidance from regional project coordinators and public health departments that involved education, assistance with implementation, and adherence monitoring, the facilities implemented a CRE prevention bundle that included a hand hygiene campaign that promoted alcohol-based hand rub, contact precautions (personal protective equipment with glove/gown) for care of CRE-colonized residents, and 2% chlorhexidine gluconate (CHG) wipes for routine resident bathing. We conducted a qualitative study to better understand the ways that vSNF employees engage with the implementation of such infection control measures. Methods: A PhD-candidate medical anthropologist conducted semistructured interviews with management (N = 5), nursing staff (N = 6), and certified nursing assistants (N = 6) at a vSNF in the Chicago region (Illinois) between September 2018 and November 2018. More than 11 hours of semistructured interviews were collected and transcribed. Data collection and analysis focused on identifying healthcare worker experiences during an infection control intervention. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Healthcare workers described the facility using language associated with a family environment (Table 1). Furthermore, healthcare workers demonstrated motivation to implement infection control policies (Table 2). However, healthcare workers expressed cultural and structural challenges encountered during implementation, such as their belief that some infection control measures discouraged maintenance of a home-like environment, lack of time, and understaffing. Some healthcare workers perceived that alcohol-based hand rub was ineffective over time and left unpleasant textures on the skin. Additionally, some workers did not trust the available gown and gloves used to prevent transmission. Lastly, healthcare workers typically did not prefer 2% CHG wipes over soap and water, citing residual resident postbathing smell as one indicator of CHG ineffectiveness. Conclusions: In a vSNF we found both considerable support and challenges implementing a CRE prevention bundle from the healthcare worker perspective. Healthcare workers were dedicated to recreating a home-like environment for their residents, which sometimes felt at odds with infection control interventions. Residual misconceptions (eg, alcohol-based hand rub is not effective) and negative worker perceptions (eg, permeability of contact precaution gowns and/or residue from alcohol-based hand rub) suggest that ongoing education and participation by healthcare workers in evaluating infection control products for interventions is critical.Funding: NoneDisclosures: None

Risk of Vascular Access Infection Associated With Buttonhole Cannulation of Fistulas: Data From the National Healthcare Safety Network

Compared with conventional (rope-ladder cannulation [RLC]) methods, use of buttonhole cannulation (BHC) to access arteriovenous fistulas (AVFs) may be associated with increased risk for bloodstream infection and other vascular access-related infection. We used national surveillance data to evaluate the infection burden and risk among in-center hemodialysis patients with AVFs using BHC. Descriptive analysis of infections and related events and retrospective observational cohort study using National Healthcare Safety Network (NHSN) surveillance data. US patients receiving hemodialysis treated in outpatient dialysis centers. AVF cannulation methods, dialysis facility characteristics, and infection control practices. Access-related bloodstream infection; local access-site infection; intravenous (IV) antimicrobial start. Description of frequency and rate of infections; adjusted relative risk (aRR) for infection with BHC versus RLC estimated using Poisson regression. During 2013 to 2014, there were 2,466 access-related bloodstream infections, 3,169 local access-site infections, and 13,726 IV antimicrobial starts among patients accessed using BHC. Staphylococcus aureus was the most common pathogen, present in half (52%) of the BHC access-related bloodstream infections. Hospitalization was frequent among BHC access-related bloodstream infections (37%). In 2014, 9% (n=271,980) of all AVF patient-months reported to NHSN were associated with BHC. After adjusting for facility characteristics and practices, BHC was associated with significantly higher risk for access-related bloodstream infection (aRR, 2.6; 95% CI, 2.4-2.8) and local access-site infection (aRR, 1.5; 95% CI, 1.4-1.6) than RLC, but was not associated with increased risk for IV antimicrobial start. Data for facility practices were self-reported and not patient specific. BHC was associated with higher risk for vascular access-related infection than RLC among in-center hemodialysis patients. Decisions regarding the use of BHC in dialysis centers should take into account the higher risk for infection. Studies are needed to evaluate infection control measures that may reduce infections related to BHC.