Staff Hand Hygiene Research Articles

Application of PDCA in improving hand hygiene compliance and nosocomial infection quality in orthopedics†

Abstract Objective To explore the effect of the Plan-Do-Check-Action (PDCA) cycle on hand hygiene and nosocomial infection quality of orthopedic medical staff. Methods The whole year of 2021 was selected to monitor the quality of hand hygiene and hospitalization. Follow-up monitoring and real-time recording during the period of morning shift and medical operation concentration time, and compare the compliance of hand hygiene before and after implementation, and evaluate the quality of nosocomial infection. Results The hand hygiene compliance of doctors and nurses in stage P was 82%. The compliance of medical staff in stage D was 93%. The compliance of stage C was 94% and that of stage A was 95%. The quality score of hospital self-examination nosocomial infection was also significantly increased. Conclusions The PDCA management cycle can effectively improve the compliance of hand hygiene and the nosocomial infection quality, which is worthy of circulatory application in orthopedic nosocomial infection quality control, especially improving the quality of hand hygiene.

1703. Pseudo-Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit: Implications for Surveillance

Abstract Background We conduct weekly surveillance screening for methicillin-resistant Staphylococcus aureus (MRSA) in our neonatal intensive care unit (NICU). In September 2021, we noted an increase in positive MRSA screening results and identified 2 patients with MRSA wound infection. We conducted an investigation to explore the possibility of in-unit transmission. Methods We launched a multi-pronged investigation that included additional patient screening. Surveillance isolates were assessed for the presence of MRSA using chromogenic agar. Additional antimicrobial sensitivity testing was performed on an automated bacterial identification system if chromogenic agar results were inconclusive, fig 1 & 2. We also conducted audits of staff hand hygiene, enhanced cleaning and disinfection of shared patient-care equipment, implemented standardized chlorhexidine gluconate (CHG) scrub use for NICU staff upon unit entry, and added new CHG bathing for certain patients. Positive control chromogenic agar plate Ambiguous chromogenic agar results Results Over the course of a 6-week long investigation, 18 neonates were found to be MRSA-positive on surveillance swabs using chromogenic agar. In the first 2 weeks of the investigation, PFGE showed that 9 MRSA isolates were genetically distinct. Over the next weeks, additional MRSA-positive surveillance swabs were collected and ultimately 15 isolates underwent whole genome sequencing at the Mass. State Public Health Laboratory. Only 2 pairs of isolates appeared related. Antimicrobial resistance genes were identified and revealed only 6 of the 15 isolates contained the mecA gene consistent with MRSA. As a result, all 18 positive surveillance swabs obtained during the investigation underwent full identification and sensitivity testing confirming only 6 samples contained MRSA and 12 contained methicillin-sensitive Staphylococcus aureus (MSSA). Testing discordance with breakthrough MSSA growth was reported to the chromogenic agar manufacturer. Conclusion Our investigation identified that an increase in MRSA-positive surveillance swabs was a pseudo-outbreak due to false-positive MSSA growth on MRSA selective media. At the conclusion of this investigation, the need for ongoing surveillance swabs was re-evaluated and ultimately discontinued. Clinical NICU specimens are now monitored in real-time by Infection Control. Disclosures James Kirby, MD, D(ABMM), Abbott Molecular: Educational Grant

Evaluation of the effectiveness of hospital infection prevention and control based on the SMART principle.

Hospital infection not only increases patient suffering and mortality, but also causes huge economic losses. It is urgent to take effective measures to improve the situation of hospital infection and focus on hand hygiene and disinfection. The SMART principle is to follow the principles of specificity, measurability, attainability, relevance, and timeliness when setting goals. This study aims to use the SMART principle in the prevention and control of hospital infection, to take a series of measures on the hospital infection such as hand hygiene, and to evaluate the implementation effect. This study is a retrospective study. From January to June 2020, the SMART principle was used to carry out intervention for infection prevention and control in the Xiangya International Medical Department, Central South University, and implement the infection prevention and control quality improvement plan. Using indicator data as targeting measurement standard, we established evaluation indicators for hospital infection prevention and control knowledge awareness and hand hygiene compliance rate as the process monitoring, surgical site infection rate and catheter-related urinary tract infection rate as the result monitoring. The evaluation indicators after intervention (July 2020 to June 2021) were compared with those before intervention (January 2019 to December 2019). Fifty-one medical staff working in the Xiangya International Medical Department were included. There were 12 doctors and 39 nurses, and 6 males and 45 females. The age ranged from 21 to 57 (30.2±7.1) years. After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff were significantly higher than those before the intervention (both P<0.05), but there were no significant differences in surgical site infection rate and catheter-related urinary tract infection rate before and after intervention (both P>0.05). After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff in the internal and surgical wards were higher than those before the intervention (all P<0.05). The awareness of hospital infection prevention and control knowledge of medical staff in surgical wards was low but improved significantly. The compliance rate of hand hygiene of medical staff in internal wards was high and improved significantly. After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of male and female medical staff were higher than those before the intervention (all P<0.05), both of which were significantly higher in males than in females. After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate for medical staff aged less than 30 years old and 30 to 40 years old were higher than those before the intervention (all P<0.05). Medical staff aged 30 to 40 years had a low awareness of hospital infection prevention and control knowledge, but both indicators improved most significantly. After the intervention, the awareness of hospital infection prevention and control knowledge of doctors and nurses was increased (both P<0.05). The awareness of doctors improved more significantly, and the hand hygiene compliance rate of nurses improved (P<0.05). After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff with primary and intermediate professional titles were higher than those before the intervention (all P<0.05), and the improvement was more significant for medical staff with intermediate professional titles. Based on the SMART principle management method, the implementation of quality improvement plans combined with various domestic and international evaluation standards for infection prevention and control can effectively improve the awareness of infection control knowledge and hand hygiene compliance rate of medical staff, strengthen the prevention and control of hospital infection, and further ensure the safety of patients.

A Novel Deep Learning-, Camera-, and Sensor-Based System for Enforcing Hand Hygiene Compliance in Healthcare Facilities

Hospital-acquired infections (HAIs) are a major cause of death worldwide, and poor hand hygiene compliance is a primary reason for their spread. This article proposes an artificial intelligence-, microcontroller-, and sensor-based system that monitors and improves staff hand hygiene compliance at various critical points in a hospital. The system uses a convolutional neural network (CNN) to detect and track if staff have followed the World Health Organization (WHO) handrub/handwash guidelines at alcohol dispensers, hospital sinks, and patient beds. The system also uses radio frequency identification (RFID) tags, vibration motors, LEDs, and a central server to identify staff, alert them of their cleaning requirements, monitor their cleaning activity, and report compliance data. We obtain an accuracy of 90.6% in classifying all steps of the WHO-stipulated handwash/handrub guidelines and a testing accuracy of 89.8% on Ivanovs et al.’s dataset. The system ensures that hospital staff stay compliant with all WHO hand hygiene guidelines, saving countless lives.

SG-APSIC1055: Hand hygiene challenges among the ancillary team during the COVID-19 pandemic

Objectives: Ancillary staff members perform operational support functions and play an active role in enhancing the patient care experience. Infection prevention practices among ancillary staff play a critical role in preventing transmission of microorganisms, which ensures the safety of patients. Low hand hygiene compliance was found among porters in a cross-institutional hand hygiene audit in 2021. A quality improvement team was formed to improve hand hygiene compliance, especially during the COVID-19 pandemic. Methods: A focus-group discussion and survey were conducted to understand hand hygiene knowledge and challenges among porters. Using the findings, the team initiated Glo–germ education tools, pocket alcohol hand-rub agents, pocket moisturizer, poster display, and a toolbox messaging system via conversion of group roll call to satellite-area roll call. Respective satellite teams were sent hand hygiene reminders, and prompt corrective action was taken following noncompliance events. Analytic comparisons of pre- and postsurvey data were performed using the χ2 test, and P &lt; .05 was regarded as statistically significant. Results: In total, 572 ancillary staff participated in the survey. Knowledge of hand hygiene practices improved significantly following the interventions, as shown in the comparison of pre- and postintervention results: knowledge of the hand hygiene steps (P &lt; .001), knowledge of the duration of hand rub (P &lt; .001), and knowledge of duration of handwashing (P &lt; .001). Also, 295 staff members (97.68%) stated that implementation measures increased their awareness of the importance of hand hygiene. Moreover, the hand hygiene compliance rate improved from 77.8% to 100%. There were no significant differences related to sex (P = .089), age group (P = .355), years of working (P = .359), education level (P = .268), or difficulty in reading English (P = .906). Conclusions: Evaluating staff hand hygiene knowledge and understanding the challenges faced among porters helped toward the development of appropriate interventions and assurance of success in project.

Thực trạng tuân thủ vệ sinh tay thường quy của nhân viên y tế và một số yếu tố liên quan tại Bệnh viện Đa khoa thị xã Buôn Hồ, tỉnh Đăk Lăk năm 2021

Objectives: The study described the current situation and analyze some factors affecting the compliance of routine hand hygiene of health workers at the General Hospital of Buon Ho Town, Dak Lak Province in 2021. Research method: This was an analytical cross - sectional study. The sample size included 112 health staff. Each health worker was observed 3 hand hygiene times (5 times of hand hygiene and following 6 steps of routine hand hygiene as regulated by the Ministry of Health). Knowledge of health staff on rountine hand hygiene was self-administered collected after the observation was completed. Descriptive (frequency) and analytical statistic methods were applied (chi square test, odd ratios with a significance level at &lt;0.05) Results: The compliance of routine hand hygiene among health staff was only 25.9%. Poor knowledge of health staff about routine hand hygiene negatively affected the compliance of hand hygiene of health staff (OR=4.5; 95%CI: 1.8-11.1). Conclusion and recommendations: The compliance of routine hand hygiene among health staff of the hospital was low. Poor knowledge on hand hygiene is negatively associated with compliance of hand hygiene of health staff. It is necessary to provide training courses to increase knowledge of health staff about routine hand hygiene regularly. Key words: routine hand hygiene, influencing factors, health staff, Buon Ho, Dak Lak.

Novel care bundle of established basic and practical approaches greatly reduces urinary tract infections in nursing facility residents without indwelling catheters

BackgroundResidents in nursing facilities (NFs) are at greater risk of developing urinary tract infections (UTIs) with higher hospitalizations and costs than people living in communities. These residents also have increased likelihood of uroseptic shock and death. The objective of the study was to prevent UTIs and to reduce UTI-associated costs among NF residents. MethodsQuality assurance performance improvement initiative conducted between April 1, 2018 and March 31, 2022 at a large skilled NF. Participants were 262 residents newly diagnosed with UTIs without indwelling catheters. The initiative consisted of (1) a 12-month baseline; (2) a 12-month intervention; and (3) a 24-month follow-up. A novel care bundle which included staff's hand hygiene monitoring, residents’ hydration status, effective incontinence and perineal care, and in-house UTI treatment was implemented during the intervention. The plan-do-study-act cycle was used to gauge its effectiveness. ResultsQuarterly UTI rates decreased from 4.2% at baseline to 0.9% at follow-up, a 79% reduction (P < .001). All 262 residents were treated in-house with no UTI-related hospitalizations. Antibiotic prescriptions fell from 373 at baseline down to 143 at follow-up, a 62% reduction. Facility costs decreased from $42,188 at baseline to $8,281 at follow-up (P < 0.001). ConclusionThis bundle was very effective in preventing UTIs and reducing UTI-associated costs. Its use in other NFs is encouraged to determine suitability elsewhere.

Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy.

Objective To explore the effect of nursing in operating room combined with intraoperative heat preservation intervention on preventing incision infection and improving hemodynamics in patients with anterior cruciate ligament (ACL) injury and reconstruction under knee arthroscopy. Methods About 200 patients with knee arthroscopic ACL reconstruction in our hospital from January 2019 to July 2021 were enrolled. The patients were randomly assigned into two groups: the control group and the study group. The former group received nursing care in the operating room operating room and the latter group received nursing care in operating room combined with intraoperative heat preservation intervention. Nursing satisfaction, incidence of incision infection, knee joint VAS score, knee joint range of motion, knee joint Lysholm score, and hemodynamic indexes were compared. Results First of all, we compared the nursing satisfaction, the study group was very satisfied in 78 cases, satisfactory in 20 cases, and general in 2 cases, and the satisfaction rate was 100.00%, while in the control group, 445 cases were very satisfied, 20 cases were satisfied, 15 cases were general, and 8 cases were dissatisfied. The satisfaction rate was 82.00%. The nursing satisfaction of the study group was higher compared to the control group (P < 0.05). Secondly, we compared the incidence of incision infection. The incidence of incision infection in the study group was lower compared to the control group (P < 0.05). With regard to the knee joint VAS score, the knee joint VAS score of the study group was lower compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). In terms of the range of motion of the knee joint, the range of motion of the knee joint in the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). Regarding the knee joint Lysholm score, the knee joint Lysholm score of the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). Finally, we compared the hemodynamic indexes. Before nursing, there exhibited no significant difference (P > 0.05). During and after nursing, the indexes of HR and MAP in the study group fluctuated little (P < 0.05). Conclusion During the perioperative period of patients with ACL injury and reconstruction under knee arthroscopy, standardized and necessary operating room combined with intraoperative thermal insulation intervention measures should be given, attention should be paid to the management of operating room, and intraoperative thermal insulation intervention should be strengthened. It includes preoperative visit, psychological nursing of patients, strict application of antibiotics before operation, monitoring of air quality in operating room, disinfection and sterilization of surgical instruments, shortening operation time, maintaining body temperature during operation, and paying attention to hand hygiene of medical staff. It plays a supervisory role in promoting the attention of medical staff to the prevention of wound infection, which is beneficial to the healing of surgical wounds of patients. It plays a positive role in enhancing hemodynamic indexes. Comprehensive nursing intervention on the risk factors of each link can effectively prevent postoperative wound infection and strengthen the prognosis and quality of life of patients.

The role of patient involvement in the promotion of hand hygiene amongst nurses in hospital settings: a qualitative study of nurses’ and patients’ experiences

Background: To date, there is a wealth of evidence that patients have been invited to take an active role in prompting hand hygiene of hospital staff, but there is insufficient evidence on what happens in practice and whether this is acceptable to both staff and patients. Objective: To understand the role of patient involvement in the promotion of hand hygiene amongst nurses in the hospital setting. Methods: This qualitative interpretive study comprised of focus group discussions conducted with nurses (n = 36) and interviews with patients (n = 21). Data from nurses were analysed using inductive thematic analysis. Data from patients were analysed by critical incident analysis. Results: Experiences from nurses and patients can be summarised into four themes: 1) both nurses and patients acknowledged the patients’ right to ask, 2) both groups reported concerns that asking about hand hygiene could have an adverse impact on the nurse–patient relationship, 3) patients reported negative reactions from nurses when promoting hand hygiene and 4) patients reported that the promotion of hand hygiene was not only offensive and upsetting for nurses but also embarrassing for patients. Conclusions: Findings from this study suggest that patients are expected to adopt a passive role in infection control and remain silent when observing non-compliance to hand hygiene within the hospital setting, to avoid being embarrassed, offensive and upsetting nurses.

Non-pharmaceutical interventions and COVID-19 cases in US summer camps: results from an American Camp Association survey

BackgroundMost camps remained closed during Summer 2020, due to concerns regarding child transmission of SARS-CoV-2 and limited information about the effectiveness of non-pharmaceutical interventions (NPIs) within child congregate settings.MethodsWe surveyed...

Evaluation of the influence of "Internet+" hand hygiene management model on medical staff's hand hygiene compliance.

Evaluation of the influence of "Internet+" hand hygiene management model on medical staff's hand hygiene compliance.

THE RESEARCH OF THE STATUS OF HAND HYGIENE COMPLIANCE AMONG STAFF IN ACTIVE ANTIPOOXICICURATOR DEPARTMENT IN LAM DONG II HOSPITAL IN 2019

The research was carried out at Lam Dong II Hospital with a scale of 450 beds with the task of solving emergencies, providing medical examination and treatment for staff and people in 3 districts:Bao Loc, Da Huoai, and Di Linh. At the Intensive Care Unit - Anti-poison Department, Lam Dong II Hospital, patients have to undergo invasive procedures such as endotracheal intubation, mechanicalventilation, and the risk of hospital-acquired pneumonia is very high. To prevent people from risk, hand hygiene VST in patient care is a very important factor. The research analysis solves actual public health problems at Lam Dong II hospital with two main objectives: (1) Describe the current situation of routine hand hygiene of staff at the Intensive Care Unit - Anti-poison Department, Lam Dong II Hospital; (2) Proposing solutions to increase the hand hygiene rate among staff at the Intensive Care Unit - Anti-poison Department, Lam Dong II Hospital. Statistics show that the VST compliance rate of nurses at the Intensive Care Unit - Anti-poison Department is higher than that of doctors, nurses, the percentage of medical staff performing VSTwith quick hand sanitizer (71.8%) higher than the practice of washing hands with soap and water (28.2%), the survey results of 20 health workers showed that the knowledge about VST of the medicalstaff at the department meets the requirements of knowledge from 60% and above

Modern approaches to ensure hand hygiene of medical staff in a measure complex for prevention of nosocomial infections in health facilities

Hand hygiene of medical staff plays a significant role in the prevention of nosocomial infections in healthcare facilities. Therefore, there is a need to identify approaches to facilitate proper adherence to hand hygiene. The study aims to substantiate the need for hand hygiene of medical staff, to explore modern methods for evaluating the effectiveness of hand hygiene supplies and problems associated with the use of these supplies along with their solutions. The authors have carried out the general and targeted analysis and expert evaluation of research results regarding measures for the prevention of nosocomial infections in health facilities. Analytical study of a large number of sources (over 50) on modern approaches to ensure hand hygiene of medical staff has been conducted with Content analysis and Open Source Intelligence methods. As a result of the study, authors have identified the need for further development of strategies to facilitate hand hygiene in health facilities and for the improvement of existing educational and motivational programs dedicated to hand hygiene of medical staff. Factors that may affect the effectiveness of antiseptics usage have been highlighted. The authors emphasize adverse reactions associated with the use of hand hygiene supplies (contact dermatitis and contact allergy) and the need for the development of measures to reduce risks of these adverse reactions among medical staff.

Improving Hand Hygiene Compliance of Intensive Care Unit by Using Pender's Model.

Hand hygiene (HH) compliance is an effective behavior in controlling hospital-acquired infection because the hand is the main means of transmitting infections in patient-medical staff communication as well as the inanimate environment. This study aimed to explore the effect of applying Pender's Health Promotion Model on the HH compliance of intensive care unit staff. This quasi-experimental study with a single research group was conducted from January to July in 2019. The required data were collected from 90 staff of the intensive care units of Imam Reza Hospital in Mashhad, Iran through 1796 and 2343 opportunity of monitoring before and after the intervention. The data collection instruments were a standard HH observation form and a researcher-made HH questionnaire in the light of Pender's health promotion model. The data were statistically analyzed in SPSS using Paired-samples T-test and Chi-squared test. The mean age of the 90 included participants was 35.92 (± 6.5) years and the mean length of their work experience was 10 (±1.5). The hand hygiene index rose from 23% before the intervention to 41.4% after the intervention (p=0.001). Moreover, statistically significant differences were found in moments after touching surroundings (p=0.001), before and after touching a patient (p=0.001), and also in perceived barriers (p=0.015), interpersonal influences (p=0.008) and situational influences (p<0.001). Pender's model showed to have improved the staff's HH compliance as a professional behavior.

The Covid 19 pandemic as a factor of compliance with the rules of hand hygiene of hospital staff

Introduction. Hand cleansing and disinfection is the most effi- cient method for reducing the rates of hospital-acquired infections which are a serious medical and economic problem. Striving to ensure the maximum safety of the therapeutic process, we decided to promote hand hygiene by implementing the educational pro- gram titled “Clean Care is a Safer Care”. The occurrence of the COVID-19 pandemic affected the compliance with procedures related to the sanitary regime, including the frequency and accu- racy of hand decontamination by medical personnel. Objective. The objective of the study was to assess the useful- ness of the educational program titled “Clean Care is a Safer Care” as a tool for increasing compliance with hand hygiene principles. Methods. We monitored the compliance with the hygiene proce- dure before implementation of the program as well as during the hand hygiene campaign by means of direct observation as well as the disinfectant consumption rates. Results. In the initial self-assessment survey, the hospital had scored 270/500 points (54%). Preliminary audit revealed the hygiene compliance rate at the level of 49%. After broad-scaled educational efforts, the semi-annual audit revealed an increase in hand hygiene compliance rate up to 81% (hospital average) while the final audit carried out after one year of campaigning revealed a compliance rate of 77%. The final score for the hospi- tal increased to 435/500 points. Conclusions. COVID-19 pandemic dramatically increased accu- racy of proper hand hygiene procedures and consumption of dis- infectant agents. The educational program has succeeded to reach its goal; however, long-term educational efforts are required to maintain and improve the quality of provided services.

Poor quality alcohol hand-rub associated multidrug resistant Klebsiella pnemoniae outbreak in a neonatal unit

Background: Klebsiella pneumoniae represents an important pathogen in hospital acquired infections. Outbreak of sepsis with ESBL producing Klebsiella pneumoniae with fatal outcome was reported in a neonatal unit of a District General Hospital in Sri Lanka. This study is to describe an outbreak of fatal sepsis caused by Klebsiella pneumoniae in 5 neonates, in a neonatal unit during May and June 2015, addressing the range of infection control measures in an outbreak including hand hygiene, in-ward intravenous fluid preparation and administration, under suboptimal infection control conditions. Methods and materials: Collection and culturing of suspected fluid samples, including infusates, humidifier water, prepared intravenous fluids done in stages; culturing the samples collected initially and repeat collection and culturing the fluid samples, after strengthening infection control practices. Observation and correction of infection control procedures according to the infection control manual, strengthening hand hygiene practice, stopping reuse of multi-vials after 24 hours. Inspecting hands of the staff, who prepare infusates, for absence of micro-organisms, after using locally prepared alcohol hand-rub. As the outbreak continued infecting new admission with same organism in blood cultures, quality of the local hand-rub was tested. After replacing local hand-rub with quality assured commercial hand-rub and thorough cleaning of the unit, resampling done. Results: Out of 13 fluid samples of initial cultures, 3 infusates connected to 3 neonates grew Klebsiella pneumoniae, whose blood cultures became positive with the same, subsequently. Awareness programme on hand hygiene, improved staff hand hygiene compliance from 30% to 94%. Samples of infusates taken following corrected infection control practices and strict hand hygiene grew same organism in 3 samples out of 12. Hand prints of staff, following hand-rub usage, grew micro-organisms, including Klebsiella pneumoniae. For local hand-rub preparation, as the starting solution, 70% isopropyl alcohol was used and alcohol percentage of final product was not tested. Samples taken after quality assured hand-rub, did not grow organisms. Conclusion: Poor quality of hand-rub, re-using multi-vials after 24 hours and poor hand hygiene practices have resulted the outbreak. Therefore it is compulsory to look into all the contributing factors and timely correction of them is lifesaving in management of outbreak.

Healthcare Worker Perceptions of Germs and Personal Hygiene Routines in a Ventilator-Capable Skilled Nursing Facility (vSNF)

Background: During a 2017–2019 intervention in Chicago-area vSNFs to control carbapenem-resistant Enterobacteriaceae, healthcare worker adherence to hand hygiene and personal protective equipment was stubbornly inadequate (hand hygiene adherence, ~16% and 56% on entry and exit), despite educational and monitoring efforts. Little is known about vSNF staff understanding of multidrug-resistant organism (MDRO) transmission. We conducted a qualitative analysis of staff members at a vSNF that included assessment of staff perceptions of personal MDRO acquisition risk and associated personal hygiene routines transitioning from work to home. Methods: Between September 2018 and November 2018, 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) who had already received 1 year of MDRO staff education and hand hygiene adherence monitoring. More than 11 hours of semistructured interviews were collected and transcribed. Data collection and analysis included identifying how staff members related to their own risk of MDRO acquisition/infection and what personal hygiene routines they followed. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Staff members at all levels were able to describe their perceptions related to the risk of acquiring an MDRO and personal hygiene in great detail. The risk of acquiring an MDRO was perceived as a constant threat by staff members, who described germs as bad and everywhere (Table 1). The perceived threat of MDRO acquisition was connected to individual personal hygiene routines (eg, changing shoes before leaving work), which were considered important by staff members (Table 2). Nursing staff and certified nursing assistants noted that personal hygiene was a critical factor keeping their residents, themselves, and their families free from MDROs. Conclusions: In the context of a quality improvement campaign, vSNF healthcare workers are aware of the transmissibility of microscopic MDROs and are highly motivated in preventing transmission of MDROs to themselves. Such perceptions may explain actions such as why workers may be differentially adherent with infection control interventions (eg, more likely to perform hand hygiene leaving a room rather than going into a room, or less likely to change gowns in between residents in multibed rooms if they believe they are already personally protected with a gown). Our findings suggest that interventions to improve staff adherence to infection control measures may need to address other factors related to adherence besides knowledge deficit (eg, understaffing) and may need to acknowledge self-protection as a driving motivator for staff adherence.Funding: NoneDisclosures: None

Investigation of a Prolonged Group A Streptococcus Outbreak Among Residents and Outpatients Receiving Wound Care at a Long-Term Care Facility (LTCF)

Background: In February 2019, the Colorado Department of Public Health and Environment (CDPHE) identified a cluster of 3 invasive group A Streptococcus (GAS) infections in residents receiving wound care in a long-term care facility (LTCF). An investigation revealed a larger outbreak that extended to nonresidents receiving outpatient wound care at the LTCF. Methods: A case was defined as a positive culture for GAS emm type 82 from an individual with exposure to the LTCF between January and June 2019. Cases were categorized as clinical (symptoms of GAS disease or GAS isolated from a wound or sterile site) or carriage (no symptoms). Carriers were identified via samples collected from throat and skin lesions. Screening occurred in 2 rounds and included residents of affected units followed by screening of all wound-care staff and residents facility-wide. Available isolates were sent for emm type testing and whole-genome sequencing (WGS) at the CDC. CDPHE staff performed infection control observations. Results: We identified 14 cases: 8 clinical and 6 carriage (from 5 residents and 1 staff member). Two patients with invasive GAS died. Of 8 patients with clinical GAS, 6 resided in the facility on or 1 day prior to symptom onset; 2 were not residents but received outpatient therapy at the LTCF. All 8 patients with clinical GAS (100%) and 3 carriers had received wound care. The staff member with emm 82 carriage had provided wound care and occupational therapy to the affected residents and the 2 outpatients. Two additional cases were detected with onset dates following staff member decolonization. Moreover, 13 of the 14 emm 82 isolates were found to be identical by WGS. Infection control observations identified lapses in staff wound care and hand hygiene practices in the residential and outpatient settings of the facility. Conclusions: This investigation details a large GAS outbreak in an LTCF associated with asymptomatic carriage in residents and staff that included patients who had only received care in the outpatient portion of the facility. The outbreak was halted following decolonization of a staff member and improvements in infection control, including in the outpatient setting. Outpatient services, particularly wound care, provided by LTCFs should be considered when investigating LTCF-related GAS cases and outbreaks.Funding: NoneDisclosures: None

Modeling Transmission of Human Metapneumovirus in a Long-Term Care Facility

Background: In September 2019, the Louisiana Department of Health (LDH) was notified of a possible outbreak of influenza in a nursing home. Upon investigation, the infectious agent was determined to be human metapneumovirus (HMPV). By the conclusion of the outbreak, 35 (31.3%) symptomatic cases were identified of which 15 were laboratory-confirmed HMPV. Public health coordination, infection control interventions, environmental cleaning audits, halting new admissions, and ceasing group activities are credited with stopping transmission. Considering the high attack rate, LDH epidemiologists examined scenarios wherein the aforementioned interventions were not utilized. The aim of this analysis is to describe transmission of HMPV in a 112-bed nursing home using mathematical models under conditions wherein interventions were not readily implemented. Methods: Two deterministic and 1 stochastic susceptible–preinfectious–infectious–recovered (SEIR) models are presented. Although recovered persons can be susceptible to HMPV following an infection experience, the potential for reinfection was not considered for this analysis. Fixed variables considered include a 5-day incubation period, basic reproduction number of 2, 14-day infectious period, and 112 susceptible patients. Three counterfactual modeling conditions are considered: delaying notification of an outbreak to public health epidemiologists (model 1), staff hand hygiene compliance of 50% (model 2), and continuing to accept new admissions (model 3). Average rate of recovery per day was and other metrics are used to demonstrate the number of susceptible individuals. Excel workbooks developed by Vynnycky and White (2010) were used for analysis. Results: In model 1, the average rate of onset of infectiousness per day = 0.20, and the average recovery rate per day = 0.07. With no notification to public health epidemiologists, all 112 patients would have been infected with HMPV after 94 days. The reproductive number was doubled to 4 in model 2 to posit poor healthcare worker hand hygiene of 50% compliance. Given this, the number of days until all patients are infected with HMPV decreases to 39 days. Finally, the stochastic scenario (model 3) demonstrates that the number of newly infected persons per day = 0.86, and the hazard rate for infectious individuals becoming immune = 0.07. Conclusions: Infection control interventions are extremely useful for containing viral respiratory diseases for which there is no vaccine or treatment. Mathematical models can communicate utility of public health interventions in the presence of outbreaks. These models demonstrate worst-case scenarios for infection spread.Funding: NoneDisclosures: None

Reduction of Visitor- and Staff-Associated Risk of Infection by Complex Intervention in the Department of Feto-Maternal Medicine

Clinical trial registration of this trial: is to demonstrate in a department of feto-maternal medicine: (a) that a complex intervention improves hand hygiene of visitors, siblings and staff; and (b) that automated voice prompts at disinfectant dispensers improve rate of hand disinfection. (a) Pre-/post-test follow-up design with control (1-12/2016), intervention (1-12/2017), follow-up-period (1/2018-12/2019); and (b) RCT in quasi crossover design. Primary endpoints: (a) disinfectant consumption (DC) per patient-day, and (b) DC at disinfectant dispenser per passer-by. A multimodal strategy within the intervention period showed a relevant positive effect on hand hygiene compliance (in IP: 26.2% more DC; p=0.088). Voice prompts increased DC by 28.6% (p=0.025). The odds ratio for high positive fingertip testing plates of visiting children (siblings) between control and intervention period was 0.35 (95% CI [0.1074-0.9708] p=0.039). Complex intervention and electronic voice prompts on disinfectant dispensers improve hand hygiene behaviour in perinatology. Installation of disinfectant dispensers in a child-friendly position and adequate information material appeal to children. The data represent an important contribution to improve hand hygiene of visitors, siblings and staff in hospitals in a pandemic situation.