Infection Prevention Department Research Articles

Clearing the Air, Breathe Easy: Intensive Care Unit Remodeling Unveils Insights into Aspergillosis Prevention

Background: Invasive aspergillosis (IA) poses a substantial threat to morbidity and mortality, particularly among immunocompromised individuals. In 2023, a New York City Intensive Care Unit (ICU) experienced an aspergillus outbreak following a structural water leak, resulting in two patients diagnosed with Invasive Aspergillus niger in their bronchial cultures. Immediate interventions, including patient relocation and ICU reconstruction were implemented to mitigate further impacts. This study aims to assess the impact of timely relocation of patients and renovation of the ICU, on the incidence of invasive aspergillosis. Method: A quasi-experimental study design of ICU patients over a nine month period included surveillance by the Infection Prevention department from March 1 to December 1, 2023. Surveillance included review of microbiology reports, environmental cultures, and patient chart reviews. The Pre-intervention spanned March 1 to May 1, and the post-intervention from May 4 to December 1. Indoor mold assessments of pre- and post-intervention involved testing wall surfaces for moisture, air sample collection for fungal spores, and surface swabs for direct fungal analysis. The intervention included relocating all seventeen patients from the impacted ICU and comprehensive reconstruction. Reconstruction involved the removal and replacement of all sheetrock within the unit extending four feet from the floor with moisture-resistant sheetrock. Additionally, moisture resistant single sheet welded vinyl flooring and cove-bases were installed. All heating, ventilation, and air-conditioning (HVAC) systems were inspected and cleaned. Construction activities strictly adhered to Infection Control Risk Assessment (ICRA) guidelines, with emphasis on maintaining negative pressure, to ensure a safe environment. Result: Environmental swab samples from 50% of ICU rooms indicated growth of Aspergillus/Penicillium, Chaetomium, and Stachybotrys/Memnoniella type spores during the pre-intervention phase. Environmental microbiology results strongly suggest the indoor environment as the fungal spore source, with the presence of fruiting structures indicating surface mold growth. Indoor air samples, when compared to outdoor samples collected during pre-intervention, showed rare (2-6 raw count) growth of Aspergillus in 55% of the sampled rooms and subequently no growth post-intervention. Prospective surveillance revealed no further aspergillus growth in the ICU population and environment. Conclusion: Our findings highlight a potential correlation between environmental modifications and reduced IA incidence. Swift mitigation and structural interventions are crucial in averting potentially fatal outcomes, marking a significant advancement of prevention strategies for inner-city hospital settings. Although promising, study limitations include the inability to speciate environmental aspergillus for comparison to patient bronchial cultures and the absence of baseline bronchial cultures for affected patients on admission.

The Impact of COVID-19 on Healthcare-Associated Infections: A Survey of Acute Care Hospitals

Background: The COVID-19 pandemic has placed an enormous strain on the healthcare system, including infection prevention and control. The response to the COVID-19 pandemic required extraordinary resources, which were often diverted from routine infection prevention and control activities and may have contributed to increased rates of HAI in the acute care setting. However, the impact of the COVID-19 pandemic on infection prevention and control departments, including staffing and resources, and on routine infection prevention and control activities is not well-described. The objective of this study was to describe the impact of the COVID-19 pandemic on IPC departments and department response to the pandemic. Methods: Between August and December of 2023, we conducted an electronic survey of all acute care facilities participating in the National Healthcare Safety Network. Survey data were analyzed using descriptive statistics. Results: Over 594 infection control departments participated in the survey, representing 1,400 NHSN facilities (20% response rate based on number of eligible NHSN facilities). Half of the respondents reported that their hospital experienced increases in the following HAI rates during the first two years of the pandemic: central-line associated bloodstream infections (54%), catheter-associated urinary tract infections (46%) and ventilator associated pneumonia (45%). When asked to identify the top three contributors to increased HAI rates in their facility, respondents cited the following factors: staffing shortages (70%), patient acuity (69%), use of travel nurses (48%), increased device utilization (37%), and reduced bedside acuity (31%). Respondents reported that their department utilized the following actions to decrease these HAI rates: increased rounding and monitoring of IPC procedures (81%), reeducation of frontline staff on IPC policies and procedures (77%), environmental care rounds (69%), monitoring of isolation compliance (66%), HAI Task Force/Committee (57%), nurse-driven catheter removal protocols (53%), and insertion prevention protocols (53%). When asked if the department experienced applied pressure or attempts to influence HAI reporting due to the increase in HAI rates in the facility experienced in the wake of the pandemic, 19% of respondents reported increased pressure from management/C-suite and 7% reported increased pressure from providers. Conclusion: The COVID-19 pandemic had a substantial impact on IPC departments in acute care hospitals and had a profound effect on IPC staffing, resources and routine IPC activities. Future work needs to identify best practices and lessons learned from the pandemic to inform future pandemic preparedness.

Academic-practice partnership: Exploring a model for collaborative nursing education in infection prevention and control

The academic-practice partnership has become increasingly important in nursing education. An academic-practice partnership between a health systems infection prevention and control (IPC) department and its academic affiliate may provide an opportunity to help advance undergraduate nursing student’s IPC knowledge and skills and provide IPC staff the opportunity to develop their clinical teaching skills as they teach and mentor students. We convened an exploratory workshop between our private university-based college of nursing and its affiliated health care system IPC department to brainstorm and identify areas for mutual collaboration and gauge interest in formalizing a partnership.

2437. The Impact of Healthcare Associated Infections on Costs and Lengths of Stay 2019-2023

Abstract Background As 85% of hospitals in the U.S. face unsustainable operating margins, extraordinary labor costs (LC) from nursing shortages, and have under resourced infection prevention departments, updated assessments of the costs of healthcare associated infections (HAI) are needed. However, most published cost analyses are either more than a decade old, or did not adjust for timing of infection. We sought to determine excess lengths of stay (LOS) and LC associated with HAI during the COVID-19 era, while adjusting for timing of infection. Timing of Infection Onset In Patients with an HAI Legend: dark orange = days before infection; light orange = days after infection; yellow bar = geometric mean national average length of stay of uninfected patients with the same diagnosis code; green circle = mean length of stay of local uninfected controls Methods All inpatients in an academic tertiary care center and 4 community hospitals in Western NY from 01-01-19 to 12-31-22 were included. Using nationally standardized definitions of catheter-associated urinary tract (CAUTI), central line associated bloodstream (CLABSI), and surgical site infections (SSI), 728 HAIs were identified and compared to patients during the same encounter with the same diagnosis codes (DRG) without an HAI (n= 90,046). Only days after infection onset were used to calculate excess LOS and cost. Results The mean yearly standardized infection ratios (SIRs), as defined by the National Healthcare Safety Network, were 0.89, 0.98, and 1.14 for CLABSI, CAUTI and SSI, respectively. Patients with an HAI had significantly higher LC and longer post-infection LOS (all p-values < 0.005) compared to a national benchmark and their DRG-matched HAI-negative counterparts. Per admission, the average excess labor cost and excess LOS were $43,975, 13.4 days for CLABSI; $31,253, 8.9 days for CAUTI; and $5,985, 1.4 days for SSI (Table). The 4-year total was $23.4 M, and 4810 excess days. 100% of CLABSI and CAUTI occurred after the 13th day, and the pre and post-infection LOS were similar. SSI occurred early in admission, and the post-infection LOS was longer than the pre-infection LOS (Figure). Re-admission occurred for 83% of SSI. For CLABSI and CAUTI excess LOS and costs increased 178% over the study period. Conclusion These findings suggest that for CLABSI and CAUTI, minimizing pre-infection LOS can provide a greater economic and safety impact than focusing entirely on preventing the infection. However, for SSI, focusing on preventing the infection may provide the greatest benefit. Other hospitals can adjust these data based on their individual SIRs. Disclosures All Authors: No reported disclosures

Needlestick and Sharps Injuries Among Healthcare Workers at a Tertiary Care Hospital: A Retrospective Single-Center Study.

Healthcare workers are still at risk from needlesticks and sharps injuries, which can expose them to blood-borne diseases like hepatitis B, hepatitis C, and HIV. We aimed to investigate the proportion of needlesticks and sharps injuries among healthcare workers in a tertiary care hospital in Somalia and also evaluate associated risk factors. This retrospective study was conducted at the Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital. The data was retrieved from the hospital record of the infection prevention and control department over a six-year period between 2017 and 2022. There were a total of 233 needlestick and sharps injury incidents. The highest number of needlestick and sharps injury cases were reported among nurses (52.4%), followed by cleaners (22.3%), physicians (18.5%), and technicians (6.9%) during the six-year period. Operation theaters were the most frequent place (21.9%) where injuries happened, followed by inpatient care (17.6%) and emergency rooms (16.7%). The most commonly reported instrument that resulted in injuries was a hypodermic needle (81.1%). About 24.9% of the needles or sharps devices that caused needlestick and sharps injury cases were contaminated with hepatitis B. There was a significant difference between gender and place of injury for needlestick and sharps injuries (P=0.001). Healthcare professionals around the world continue to face major health risks from needle stick and sharps injuries. The present study found that 8.6%of healthcare workers sustained a needle stick and sharps injuries incident in the past year. According to our findings, healthcare institutions need to regularly teach healthcare professionals, especially nurses and cleaners about the significance of needle stick and sharps injuries.

Reevaluating the Significance of Infection Preventionists and Infection Prevention and Control Departments in the Post-COVID-19 Era.

Infection preventionists are specialized health care professionals tasked with developing and implementing infection control policies, educating staff and patients on prevention practices, and investigating outbreaks. Infection preventionists role in developing effective measures for infection prevention and control and ensuring public health and safety became even more vital given the emergence of the COVID-19 pandemic. It is important for health care systems and institutions to incorporate lessons learned, enhance infection prevention and control resources, and grow the infection preventionists workforce to prepare for future pandemic events.

Nurses' experiences of managing COVID-19 contact tracing clinics in a tertiary care hospital.

The COVID-19 pandemic spread rapidly globally, making the WHO to declare it a public health emergency of international concern. The ability of health institutions to screen and test for COVID-19 has been critical in detecting, preventing, and managing the spread of the disease. This report documents lessons from the ambulatory care nursing for COVID-19 contact tracing at a tertiary care hospital. In March 2020, a multidisciplinary team consisting of staff of the Primary Healthcare Services, Ambulatory Care Center, Infection Prevention and Control Department, and Nursing Services at the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia, worked collaboratively to establish 2 dedicated COVID-19 contact tracing clinics away from hospital premises, one clinic established for the public and another for hospital staff. Surveillance system was established to detect and contain as many cases as possible. This report highlights the process of establishing and maintaining the structure and managing workflow of the contact tracing clinics. We calculated the number of nasopharyngeal swabs and the daily average number of patient visits for both clinics between March 2020 and March 2021. Over the one-year period, the clinics served 79 146 visitors with an average of 52 visits for staff, 159 visits for adults, and 16 visits for children per day. The 2 clinics conducted 73 924 polymerase chain reaction tests. There was zero transmission of COVID-19 infection to staff working at both clinics. Despite the challenge of setting up contact tracing clinics, the decision to use separate geographic locations contributed to reducing the risk of infection exposure among staff of the clinics. Effective implementation of contact tracing interventions relies on interdepartmental cooperation and effective communication to contain the risk of viral spread.

Mpox: What Practicing Gastroenterologists Need to Know

Mpox: What Practicing Gastroenterologists Need to Know

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.

Infection Prevention Resources to Respond to the Initial Coronavirus Disease Pandemic at an Academic Medical Center

BackgroundInfection prevention specialists (IPS) are relied on as subject matter experts, providing guidance and support within healthcare facilities. During the coronavirus disease (COVID-19) pandemic, infection prevention (IP) department resources were heavily taxed, creating an increased IP staffing need. The objective of this study is to quantify the additional IP resources needed to support pandemic response at a large, academic medical center.MethodsPre-pandemic, our IP department included 12 full-time IPS, providing support to a 1315-bed hospital, 138 outpatient clinics, and 2 ambulatory surgery centers. The increased level of organizational support needed for the COVID-19 pandemic response required more full-time employees (FTE) to assist in managing additional duties. Duties included: conducting employee cluster investigations and contact tracing; reviewing positive COVID-19 lab specimens reported each shift to ensure appropriate isolation and bed placement; developing and reviewing COVID-19 related protocols across multiple hospital areas; and instituting a clinical case review process with infectious disease (ID) physicians to respond to call questions about testing, isolation requirements, and discontinuation criteria in complex patients.ResultsThe first known COVID-19 positive patient was admitted on 3/17/2020. Department call volumes peaked between May 2020 and end of June 2020. Calls during that time frame totaled 2,825 with an average of 202 calls daily. In response our IP department added 6 additional FTE. These FTE consisted of 2 reassigned bedside nurses and 4 contract nurses, supporting the 24/7 on-call service from 3/31/2020- 4/6/2021. Physician support increased to 2 dedicated epidemiologists managing COVID-19 guidance and IPS escalation needs, and a 24/7 on-call clinical review team, involving 16 ID physicians was implemented.ConclusionsA pandemic response effort can have a major impact on infection prevention staffing resources. Repurposing and/or onboarding non-IP staff and training them to support concrete IP processes can be an effective strategy to reduce strain on department resources.

Implementation of Evidence-based Maintenance Bundles to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) Rates

Background In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. Methods A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Results Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. Conclusions A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education. In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education.

Determining Infection Prevention Staffing for Pediatric Ambulatory and Procedural Setting

Background Since 2002, the recommended staffing levels for infection prevention and control (IPC) departments has been one full-time equivalent (FTE) per 100 occupied inpatient beds (O'Boyle et al., 2002). However, analyses by Bartles et al. (2018) suggest that this ratio should be one FTE per 69 beds, after accounting for facility/system complexity. With ambulatory utilization rising across the healthcare sector, accounting for these locations in infection preventionist (IP) staffing models is becoming increasingly important. With our pediatric enterprise's expanding ambulatory footprint, we sought to understand the complexity of our outpatient operations and assess the IPC staffing needed to support these locations/services. Methods This needs assessment applied the tool developed by Bartles et al. for their 2018 staffing analysis. Ambulatory and procedural areas on the main campus and 11 satellite/affiliated locations were surveyed for clinic complexity indicators. We obtained total IP hours/week dedicated to ambulatory/procedural locations by summing the estimated number of hours/week IPs spent engaged in rounding, offsite tasks, and education. IP hours spent on education were estimated as 30% of the total IP hours/week dedicated to rounding and offsite tasks. Results From our review, the institution's ambulatory and procedural locations represent 238 unique locations/services. The most common indicators of clinic complexity included performing surgical procedures (20.6%) and aerosol-generating procedures (31.9%). Moreover, an estimated 178 IP hours/week were dedicated to these locations, of which 43.8% consisted of providing consultative services. These hours equate to 4.4 FTEs required for our ambulatory and procedural areas. Conclusions Without accounting for future state operations, this analysis showed that our department would benefit from 2.4 additional FTEs to support our ambulatory/procedural operations. Assessing the complexity and scope of pediatric ambulatory/procedural locations is a valuable tool for (1) assessing IP staffing needs and (2) for determining whether there is an appropriate distribution of IP time and resources in such locations. Since 2002, the recommended staffing levels for infection prevention and control (IPC) departments has been one full-time equivalent (FTE) per 100 occupied inpatient beds (O'Boyle et al., 2002). However, analyses by Bartles et al. (2018) suggest that this ratio should be one FTE per 69 beds, after accounting for facility/system complexity. With ambulatory utilization rising across the healthcare sector, accounting for these locations in infection preventionist (IP) staffing models is becoming increasingly important. With our pediatric enterprise's expanding ambulatory footprint, we sought to understand the complexity of our outpatient operations and assess the IPC staffing needed to support these locations/services. This needs assessment applied the tool developed by Bartles et al. for their 2018 staffing analysis. Ambulatory and procedural areas on the main campus and 11 satellite/affiliated locations were surveyed for clinic complexity indicators. We obtained total IP hours/week dedicated to ambulatory/procedural locations by summing the estimated number of hours/week IPs spent engaged in rounding, offsite tasks, and education. IP hours spent on education were estimated as 30% of the total IP hours/week dedicated to rounding and offsite tasks. From our review, the institution's ambulatory and procedural locations represent 238 unique locations/services. The most common indicators of clinic complexity included performing surgical procedures (20.6%) and aerosol-generating procedures (31.9%). Moreover, an estimated 178 IP hours/week were dedicated to these locations, of which 43.8% consisted of providing consultative services. These hours equate to 4.4 FTEs required for our ambulatory and procedural areas. Without accounting for future state operations, this analysis showed that our department would benefit from 2.4 additional FTEs to support our ambulatory/procedural operations. Assessing the complexity and scope of pediatric ambulatory/procedural locations is a valuable tool for (1) assessing IP staffing needs and (2) for determining whether there is an appropriate distribution of IP time and resources in such locations.

Think Outside the Plastic Barriers: Expanding the Role of Infection Prevention with a Focus on Construction and Facility Collaboration

<h3>Background</h3> The expected growth in the health care construction market presents unique challenges for short staffed infection prevention departments. Detailed, proactive infection control risk assessments for both new construction and infrastructure remediation projects are often overlooked or rushed when the Infection Preventionist's (IP) time is allocated to other responsibilities. Establishing strong relationships with the Facilities Department, Environmental Services and outside Contractors takes considerable IP time and knowledge. An Infection Prevention department in a large academic pediatric hospital looked for a solution to ensure IP involvement and understanding of construction and facility issues that may put patients at risk. <h3>Methods</h3> A full time IP position focusing on construction and facilities work was proposed to address a surge in construction activities and ongoing facilities projects requiring IP involvement. The goal was to provide consistent, standardized approaches to project management and build relationships with project managers and key leaders in Facilities. The IP visited all construction and facilities projects weekly to ask questions and learn about facility work standards and processes, while establishing relationships with the staff. <h3>Results</h3> The IP helped fill the gap between IP's and key leaders in project management and the Facilities Department. Education modules were implemented for all contracted staff performing work in the facility. The IP established a tracking system for observations on all construction projects. Quarterly in-services are held to educate the Facilities staff regarding the impact of their work on patient safety. Regular meetings are held with key Facility leaders. Ongoing documentation of information pertaining to water intrusions and air handler work has been valuable during investigation of possible healthcare associated infections. <h3>Conclusions</h3> This specialized IP role has provided much needed guidance and support to the Facilities Department and Contractors on site. This collaboration has helped ensure an emphasis on patient safety and infection prevention.

Who You Gonna Call? A Novel Approach to Supporting Infection Prevention On-Call

BackgroundThe Infection Prevention and Control (IPC) department of a large, pediatric health system provides on-call support to employees twenty-four hours a day, seven days a week. Over the past two years, IPC has experienced an approximately 50% increase in on-call pages, leading to frequent interruptions in daily work of the infection preventionists (IP) and more response required during non-business hours. We aimed to develop a more efficient method for answering and triaging IPC questions.MethodsIPC partnered with an existing 24/7 call center already in place at the health system. Employees call this IPC Communication Center directly with their questions. Agents answering calls were trained on topics including but not limited to isolation precautions, coronavirus disease 2019 (COVID-19), multi-drug resistant organisms and communicable diseases. Agents were provided resources to assist with immediate response to inquiries and they only escalated to the IP on-call as needed. IPC provided ongoing education to agents. Data were tracked and reviewed weekly including number of inquiries, inquiries agents resolved versus escalated to IPC and overall topic themes.ResultsOver seven weeks, agents handled 339 employee inquiries. During the first week post implementation, 17% were immediately answered by agents without IP escalation. By the end of week seven, 47% of callers received an immediate response to their inquiry without the need to escalate to IPC. Overall, 31% of inquiries required no IP escalation. Main inquiry topic themes were isolation precautions (32%) and COVID-19 (35%).ConclusionsAn IPC Communication Center provides direct supportfor employees while decreasing the number of inquiries reaching IPC. Partnering with other departments to implement a novel approach to IPC on-call assistance can lead to more efficient processes that provide better support to employees and IP within your health system.

Don't Jump to Conclusions, a Central Line-associated Bloodstream Infection Pseudo-Outbreak Investigation

<h3>Background</h3> Central-line associated bloodstream infections (CLABSI) are serious infections that have significant morbidity and mortality. Our institution tracks CLABSIs in all settings. Between February 2021 to March 2021, surveillance by our Infection Prevention and Control Department identified five Portacath (PAC) CLABSIs with methicillin susceptible Staphylococcus aureus (MSSA) in pediatric oncology patients. This was a significant increase from our baseline of 3 MSSA PAC CLABSI in the 12 months prior, initiating an outbreak investigation. <h3>Methods</h3> A line list was created and identified two epidemiologic links: all PAC were placed in interventional radiology (IR), and primary points of access were ambulatory oncology clinics. There was no common product used. Four of the five infections had identical antimicrobial susceptibility profiles. Pulsed-field Gel Electrophoresis (PFGE) was performed to discriminate between isolates. Observations in IR for line placement were performed with attention to skin preparation. Ambulatory oncology observations were performed to review skin preparation for PAC access and hand hygiene practices. We confirmed with the PAC manufacturer there were no recalls of the PAC lot numbers. <h3>Results</h3> All 5 isolates were unrelated by PFGE and, therefore excluded a true outbreak. Observations in IR revealed variabilities in skin preparation and recommendations were made to standardize practices to align with those in our operating rooms. Although no variations in practice were noted in ambulatory oncology this was used as an opportunity to re-educate staff on the attention to detail for PAC access. <h3>Conclusions</h3> Outbreak identification by traditional epidemiologic methods are complemented with technology such as PFGE to identify conclusive links between patients and can demonstrate when an apparent outbreak is not due to a single pathogen. Obtaining PFGE data supported broad-based interventions including observations of practice at the time of line insertion and access, as well as reeducation to providers performing these roles, to reduce CLABSI in our institution.

Novel Approaches to Healthcare-Associated Infection Surveillance Validation Using Cohen's Kappa

<h3>Background</h3> The Infection Prevention and Control Department (IPC) at an acute care pediatric facility is required, by state law, to report all healthcare-associated infections (HAI) using the National Healthcare Safety Network (NHSN) surveillance definitions. Due to the definitions being subjective, interpretation could impact data integrity. A novel surveillance validation program was created in 2018 as an internal approach for validation and continuous surveillance education. The aim of this project is to assess the quality assurance program for consistently identifying HAIs between Infection Preventionists (IP) across IPC. <h3>Methods</h3> Validators, who are expert IPs, investigated randomly sampled infection events that were already investigated by an IP in the department. They performed chart review and documented in a data collection tool if the infections were reportable to NHSN with supporting rationale. Discrepancies were identified and cases were adjudicated. IPC utilized a statistical method, Cohen's Kappa, to determine inter-rater reliability between the validator response and original documentation monthly. Inter-rater reliability was examined per month and plotted to show trends in surveillance competency. <h3>Results</h3> One hundred and thirty-one infections were chosen for validation between July 2020 and April 2021. Cohen's kappa for two raters was calculated for each month. The median and interquartile range for the monthly kappa values were 1.00 [0.83 - 1.00] which is well above the values of 0.60 - 0.80 considered to have substantial agreement. The minimum and maximum kappa values were 0.76 and 1.00 respectively. <h3>Conclusions</h3> Overall, this study confirms that the use of Cohen's Kappa is a unique asset to the department's surveillance validation program and allows us to assess inter-rater reliability continually and easily. IPC programs could benefit from statistical analyses in evaluating data integrity and management.

Can a Free Mobile Application Improve Hand Hygiene Observation Collection? Experiences at a Pediatric Hospital in South Texas

<h3>Background</h3> Proper hand hygiene is the most important, simplest, and least expensive means of reducing the prevalence of hospital-acquired infections. However, hand hygiene (HH) compliance is still a struggle at many U.S. healthcare facilities. New technology has emerged to allow better HH tracking and monitoring, which is important for improving compliance. <h3>Methods</h3> An interventional, pre-post study was conducted at a 191-bed, pediatric hospital in South Texas to evaluate the impact of a free mobile application for HH observation collection, compared to traditional pen and paper methods. From June-November 2021, the hospital's trained observers for HH data collection utilized the free mobile application for their observation shifts, instead of the pens and small paper booklets typically employed. Hospital staff outside of the Infection Prevention and Control Department were not informed of this change. The observation data was then compared to the preceding six-month period. <h3>Results</h3> Use of the mobile application resulted in 7,388 HH observations collected, compared with 3,082 observations in the six months preceding the intervention. This represents a 140% increase in HH observations collected, with no increase in observation time. Additionally, administrative staff time to process observation data decreased from approximately 6-hours per week to 0, as observations were pushed directly to the Infection Preventionist in almost real-time; rather than data aggregated monthly, the HH monitoring data dashboard was updated as observations were received, several times each week. Data robustness also improved, with more variables collected during each HH observation. <h3>Conclusions</h3> HH observation data collection using a mobile application increases the number of HH audits, decreases administrative burden, and provides more robust data than traditional pen and paper methods. An increase in the number of variables collected at each observation, such as a timestamp providing time of day and day of week, will allow for more targeted HH improvement efforts in the future.

The Role of Infection Prevention Department Structure in Maintaining Program Resiliency

BackgroundInfection Prevention (IP) department structures vary in how responsibilities are assigned. During the COVID-19 pandemic IP program workload significantly increased and healthcare-associated infections (HAI) performance declined. This study assessed whether department structures that reassign administrative tasks away from hospital-based IPs are able to recover quickly from the effects of increased program demand and hospital surge.MethodsThe IP department structure of a 13-hospital system was modified in March 2020 with the creation of a centralized surveillance (CS) team. The CS team was assigned responsibility for communicable disease reporting, healthcare associated infection (HAI) surveillance, and maintenance of HAI-specific line listings. Line listing data entry included electronic health record review for potential performance improvement (PI) opportunities. Hospital-based IPs remained responsible for site-based functions. PI efforts were initiated during 2020 targeting abdominal hysterectomy (HYST), Clostridoides difficile (CDI) and catheter-associated urinary tract infection (CAUTI) using data gathered by the CS team both during and between surges of COVID-19.ResultsThe standardized infection ratio (SIR) of HAIs where PI efforts were initiated were compared from 2019 to 2021 to assess department resilience during periods of increased program demand. The CAUTI SIR decreased from 1.02 in 2019 to 0.485 in 2021. (p = 0.001). The CDI SIR decreased from 0.683 in 2019 to 0.457 in 2021. (p = 0.003). The HYST SIR decreased from 1.483 in 2019 to 0.00 in 2021. (p = 0.005). There was no statistical difference in central line-associated bloodstream infection (CLABSI) or methicillin-resistant Staphylococcus aureus (MRSA) performance from 2019 to 2021.ConclusionsIP program structure can create resiliency during periods of increased IP program demand. Decoupling surveillance and administrative tasks from hospital-based IPs is one approach hospitals and healthcare systems can consider helping ensure critical performance improvement activities continue regardless of demands within hospitals.

Developing an Infection Prevention Training Program for Infectious Disease Fellows

Background Hospital Infection Prevention (IP) is an increasingly important subdiscipline within infectious diseases (ID). We developed and evaluated a 2-week IP training program to allow ID fellows the opportunity to learn about IP. We aimed to educate on the scope of IP work with a focus on the role of ID within IP. Methods A training program was developed covering the role of IP in preventing hospital acquired infections focusing on 3 key areas: device related infections, outbreak exposures, and the hospital physical environment. We utilized the National Healthcare Safety Network (NHSN) patient safety component manual combined with practical experience performing surveillance, rounding and case study reviews. The effectiveness and utility of the program was evaluated with a pre- and post-training survey categorized on a Likert response scale (not at all familiar=1, slightly familiar=2, somewhat familiar=3, extremely familiar=4). Results The mean scored survey responses showed that prior to the rotation fellows reported slight familiarity with the scope of work of IP but had very little familiarity with the IP team members. All fellows reported slight familiarity with NHSN defined device related infections, the role of IP in outbreak investigations and their role in construction projects. Fellows reported that prior to their IP rotation they would be only slightly likely to contact the IP department for assistance or notification of a potential infection risk. Following the rotation, fellows reported being extremely familiar to all topics covered during the rotation. All fellows reported the rotation to be extremely useful. Conclusions The program was successful in improving the understanding of the scope of IP work. Fellows understood their role in documentation when a primary source of infection is suspected during central line bloodstream infection surveillance and the importance of communication when a hospital acquired environmental infection is suspected. The rotation has also fostered relationships between the departments. Hospital Infection Prevention (IP) is an increasingly important subdiscipline within infectious diseases (ID). We developed and evaluated a 2-week IP training program to allow ID fellows the opportunity to learn about IP. We aimed to educate on the scope of IP work with a focus on the role of ID within IP. A training program was developed covering the role of IP in preventing hospital acquired infections focusing on 3 key areas: device related infections, outbreak exposures, and the hospital physical environment. We utilized the National Healthcare Safety Network (NHSN) patient safety component manual combined with practical experience performing surveillance, rounding and case study reviews. The effectiveness and utility of the program was evaluated with a pre- and post-training survey categorized on a Likert response scale (not at all familiar=1, slightly familiar=2, somewhat familiar=3, extremely familiar=4). The mean scored survey responses showed that prior to the rotation fellows reported slight familiarity with the scope of work of IP but had very little familiarity with the IP team members. All fellows reported slight familiarity with NHSN defined device related infections, the role of IP in outbreak investigations and their role in construction projects. Fellows reported that prior to their IP rotation they would be only slightly likely to contact the IP department for assistance or notification of a potential infection risk. Following the rotation, fellows reported being extremely familiar to all topics covered during the rotation. All fellows reported the rotation to be extremely useful. The program was successful in improving the understanding of the scope of IP work. Fellows understood their role in documentation when a primary source of infection is suspected during central line bloodstream infection surveillance and the importance of communication when a hospital acquired environmental infection is suspected. The rotation has also fostered relationships between the departments.

Challenges in IPC training for non–healthcare workers

Background: In the last 2 years of the COVID-19 pandemic, Singapore has been forced to explore alternative sites to quarantine persons or manage infected cases during surge periods in a national effort not to overwhelm the public healthcare facilities. External quarantine facilities were created at the EXPO and further extended to D’Resort and other hotels in May 2020. Infection prevention (IP) practices were implemented at these external facilities, where training non–healthcare staff to quickly learn and understand these required practices has been challenging. A team of staff from different clinical disciplines was formed to manage the COVID-19 patients at these facilities. The Infection Prevention and Epidemiology (IPE) department was invited to train all staff, including the clinical team, management agency, and security staff, regarding IP measures. We have described the system and approach used in the rapid training of all staff in IP measures where the goal is zero transmission while providing care to COVID-19 patients. Methods: Training materials were developed to facilitate rapid learning by all staff; medical jargon was avoided. Curriculum included precautions to be taken while performing terminal cleaning of patient rooms, serving meals, disinfecting phones and thermometers, as well as donning and doffing personal protective equipment (PPE). “Green” and “red” zones were created to assist staff in remembering appropriate PPE to be used. PPE training was provided using slides and video. Posters were created as a guide for staff at donning and doffing stations. Additionally, the IPE training team utilized an online data collection tool to capture staff completion on IP training and PPE competency for record keeping. We used a ‘soft’ approach because staff members were fearful of the unknown when caring for COVID-19 patients. Daily audits were conducted with immediate concurrent feedback to engage the relevant stakeholders. Infection prevention liaison officers (IPLOs) were appointed to assist in the daily audits. An electronic audit tool was used to facilitate audit and quick analysis. Conclusions: The experience gained in the last 2 years has been useful and may provide a template if new external sites are needed in the future because of the potential surge associated with the ο (omicron) variant.Funding: NoneDisclosures: None