Long-term Acute Care Hospitals Research Articles

Implementation of a free water protocol at a long term acute care hospital

This feasibility study aimed to trial a Free Water Protocol (FWP) for patients with thin liquid dysphagia in the Long-Term Acute Care Hospital (LTACH) setting. Patients with dysphagia are often prescribed thickened liquids to avoid or mitigate aspiration. While this clinical intervention can minimize the risk of aspiration pneumonia (PNA), it is generally not well received by patients. As such, the goal of this study was to determine if patients who knowingly aspirate thin liquids can safely tolerate thin liquid water, and if so, to what degree of benefit. The study assessed for adverse events, fluid intake, hydration status, quality of life, and overall swallow function outcomes. These measurements were taken over a 7 day trial period using inventories, lab work, clinical judgment, and observation. Ten participants were enrolled in this study with 9 having sufficient data for analysis (n = 9). No adverse events related to the FWP were observed, and patients saw improved total fluid intake (P = 0.0074), swallow-related quality of life (P = 0.0273), and overall swallow function (P = 0.0002). The results in this feasibility study allowed for the hospital wide implementation of the FWP and laid out the groundwork for future studies looking at longitudinal effects of a FWP.

Driving Outcomes and Improving Documentation with Long-Wave Infrared Thermography in a Long-term Acute Care Hospital.

Hospital-acquired pressure injuries (HAPIs) have been increasing nationally, and unfortunately, long-term acute care hospitals (LTACHs) continue to report the highest prevalence and incidence. 1,2 To help reduce HAPI rates and to increase healing rates of all pressure injuries (PIs), including those that are present on admission, a 23-bed LTACH implemented a HAPI prevention and treatment protocol using new technology as a tool for patient skin assessments. A 75-day evaluation using long-wave infrared thermography (LWIT) was conducted for all patients admitted to the facility in conjunction with new PI treatment and prevention bundles that were created by the skin care team. Every PI was imaged using LWIT, which provided a photographic image of the PI, as well as a thermal image of the subcutaneous tissue underneath. This enabled staff to implement treatment and prevention measures as soon as possible. After the 75-day evaluation, the LTACH decided to make LWIT a permanent tool in their HAPI treatment and prevention program. For 10 months, the LTACH sustained a zero HAPI rate using the new treatment and prevention program including LWIT. The LTACH demonstrated that LWIT technology was an invaluable tool in the prevention and treatment of PIs. The use of LWIT has become common practice in this facility. The LTACH facility maintained a zero HAPI rate for 10 months after implementation of LWIT.

Rapid Response Systems at a Long-Term Acute Care Hospital.

Rapid Response Systems (RRS) improve patient outcomes at large medical centers. Little is known about how RRS are used in other medical settings. The purpose of this exploratory study was to describe RRS events at a long-term acute care hospital (LTACH). We conducted a retrospective review of 71 RRS event records at an urban 50-bed Midwestern LTACH. Measures included demographic data, triggering mechanisms, contextual factors, mechanism factors, and clinical outcomes. Of patients who experienced a RRS event, median age was 71 (62, 80) years; 52.1% were female; most (n = 49, 69%) were "full code." Most (n = 41, 58%) events occurred during the daytime. The most common trigger was "mental status changes/unresponsiveness." Registered nurses were the most frequent activator (n = 19, 26.8%) and responders (n = 63, 60.6%). Median duration of RRS events was 14 (6, 25) minutes. Most patients stabilized and their condition improved (n = 54, 76.1%). RRS can be expanded and modified to the LTACH population.

2038. Epidemiology of Carbapenem-Resistant Organisms in Alameda County, California (July 2019 - June 2021)

Abstract Background Carbapenem-resistant Enterobacterales (CREs) and some Carbapenem-resistant organisms (CROs) are considered urgent threats by the CDC. Since 2017, the Alameda County Public Health Department has mandated the reporting of CRE and encouraged voluntary reporting of non-CRE CROs. Surveillance data from these cases were analyzed to describe the epidemiology of infections and to target local public health interventions. Methods Healthcare facilities in Alameda County reported cases of CROs to the public health department directly to staff or through Electronic Laboratory Reporting and submitted isolates to the public health laboratory for ascertainment of carbapenemase genes by whole genome sequencing on the Illumina MiSeq platform; deaths were recorded via the California Electronic Death Registration System. Surveillance data were analyzed for cases July 2019 – June 2021 identified by the clinical laboratory as resistant to one or more carbapenems. Results From July 2019 – June 2021, 444 cases of CROs were reported to Alameda County from 409 patients. The county case rate for CROs over the two-year period was 29 cases per 100,000 population. Of the reported cases, 218 (49%) were CRE species: Escherichia coli, Klebsiella spp., and Enterobacter spp. Of the remaining cases, 157 (35%) were carbapenem-resistant Pseudomonas aeruginosa, 46 (10%) were carbapenem-resistant Acinetobacter baumannii (CRAB), and 23 (5%) were other carbapenem-resistant species. Cases by carbapenemase status are described in Table 1. Of the cases, 192 (43%) were among residents of long-term care facilities or long-term acute care hospitals; 340 (77%) cases were identified in patients over >50 years, and 168 (38%) cases have a death on record through January 2022. Among isolates with a carbapenemase gene (n = 129), KPC (32%) was the most commonly identified (Table 2). Conclusion The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing and infection prevention measures to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents and 104 (24%) cases were identified as carbapenemase-producing, with a higher percentage among CRAB isolates, informing future targeted public health interventions. Disclosures All Authors: No reported disclosures.

Organizational Capacity Among Hospitals in Medicare and Commercial Bundled Payments

Hospitals must strategically build organizational capacities to succeed in bundled payment arrangements. Given differences between Medicare and commercial arrangements, capacities may vary between hospitals in Medicare vs both Medicare and commercial bundled payment programs. This study compared organizational capacities between these 2 hospital groups. National survey of American Hospital Association (AHA) member hospitals with experience in bundled payment programs. We analyzed data from October 31, 2017, to April 30, 2018, collected from AHA member hospitals with bundled payment experience in only Medicare (Medicare-only hospitals) or in both Medicare and commercial insurers (multipayer hospitals). Survey questions examined capacity in 4 areas: (1) physician performance feedback, (2) care management, (3) postacute care provider utilization, and (4) health information technology. Our sample included 114 hospitals reporting experience in Medicare or commercial bundled payment programs. Both Medicare-only and multipayer hospitals reported high organizational capacities in performance measurement of physician-level quality and cost feedback and in incorporation of health information technology. More multipayer hospitals reported high capacity for coordinating hospital to postacute care settings (88% vs 52%). Although nearly all hospitals in both groups reported formalized relationships with skilled nursing facilities (98%), fewer hospitals reported such relationships with long-term acute care hospitals (83%) and inpatient rehabilitation facilities (80%). Although they have similar capacity in a number of areas, Medicare-only and multipayer hospitals differed with respect to other aspects of organizational capacity.

Content Validity Testing of a Novel Cognitive Screen Used to Inform Occupational Therapy Treatment Planning

<h3>Research Objectives</h3> To quantify the content validity of a novel cognitive screen being developed to better inform inpatient occupational therapy treatment planning. <h3>Design</h3> Two iterative rounds of Delphi-style expert review panels were conducted. <h3>Setting</h3> Gaylord Specialty Healthcare, a long-term acute care hospital in Wallingford, Connecticut, USA. <h3>Participants</h3> The first Delphi panel consisted of 9 content and field experts, including: 4 Occupational Therapists; 2 Speech Language Pathologists; 2 Neuropsychologists; and 1 Physician Assistant specialized in physical medicine and rehabilitation. The second panel consisted of 6 content experts, including: 4 Occupational Therapists; 1 Speech Language Pathologist; and 1 Physician Assistant specialized in physical medicine and rehabilitation. <h3>Interventions</h3> During both Delphi-style expert review panels, the relevance, essentiality, and clarity of each item was discussed. At the end of each discussion, panelists were asked to complete a content validity survey, summarizing their evaluation of each item. <h3>Main Outcome Measures</h3> Based on panelists' responses to the content validity survey, item and scale level relevance, essentiality, and clarity were quantified by calculating the respective content validity index, content validity ratio, and content clarity index. To ensure agreement, scale and item level relevance was also assessed by calculating the universal agreement and kappa statistics. <h3>Results</h3> After being drafted by the authors, an initial 24 item instrument covering 9 cognitive domains was presented to the first expert panel. In addition to evaluating the content validity/item relevance, item essentiality, and item clarity of the measure, two additional items were removed. In its current iteration, the final measure consists of 22 items/questions. From the first to second panel: the mean content validity score increased from 0.87 to 1.0, universal agreement increased from 0.52 to 1.0, the mean essentiality score increased from 0.52 to 0.94, and the mean clarity score increased from 2.5 to 2.9. <h3>Conclusions</h3> Following two rounds of Delphi-style expert panel review, we have determined this new cognitive assessment displays overall excellent content validity and is ready to proceed with criterion and construct validity testing. <h3>Author(s) Disclosures</h3> Authors have no relevant conflicts to disclose at this time.

Occupational and Physical Therapy Rehabilitation Strategies for COVID-19 Related Guillain-Barré Syndrome: A Case Report

<h3>Research Objectives</h3> To describe the occupational and physical therapy strategies used to rehabilitate COVID-19 related Guillain-Barré Syndrome (GBS). <h3>Design</h3> Single patient retrospective case report. <h3>Setting</h3> Long-term acute care hospital located in Wallingford, Connecticut, USA. <h3>Participants</h3> A 61 year old male admitted for physical and occupational therapy rehabilitation following intravenous immunoglobulin treatment for COVID-19 related GBS. The patient gave his written approval for the creation of this case report. <h3>Interventions</h3> Individual occupational and physical therapy sessions, occupational and physical therapy co-treatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. <h3>Main Outcome Measures</h3> Manual muscle testing, range-of-motion, grip-strength, Activity Measure for Post-Acute Care, and St. Louis University Mental Status Exam. <h3>Results</h3> Despite the unforeseen complication of a distal right fibula fracture, the patient was successfully discharged directly home 56 days after LTACH admission. The patient discharged with clinically improved ambulation, strength, self-care, and cognition. <h3>Conclusions</h3> This unique case highlights the complex and significant rehabilitation needs a patient may require to regain independence after a diagnosis of COVID-19 associated GBS. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.

The Relationship Between Patient-Specific Factors and Discharge Destination After COVID-19 Hospitalization.

The aim of this study was to determine the discharge destinations and associated patient-specific factors among patients hospitalized with COVID-19. A retrospective cohort study was carried out at a single-site tertiary acute care hospital. Among 2872 patients, discharge destination included home without services ( n = 2044, 71.2%), home with services ( n = 379, 13.2%), skilled nursing facility (117, 4.1%), long-term acute care hospital ( n = 39, 1.3%), inpatient rehabilitation facility ( n = 97, 3.4%), acute care facility ( n = 23, 0.8%), hospice services ( n = 20, 0.7%), or deceased during hospitalization ( n = 153, 5.3%). Adjusting by covariates, patients had higher odds of discharge to a rehabilitation facility (skilled nursing facility, long-term acute care hospital, or inpatient rehabilitation facility) than home (with or without services) when they were older (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.80-3.11; P < 0.001), had a higher Charlson Comorbidity Index score (3-6: OR, 2.36; 95% CI, 1.34-4.15; P = 0.003; ≥7: OR, 2.76; 95% CI, 1.56-4.86; P < 0.001), were intubated or required critical care (OR, 2.15; 95% CI, 1.48-3.13; P < 0.001), or had a longer hospitalization (3-7 days: OR, 12.48; 95% CI, 3.77-41.32; P < 0.001; 7-14 days: OR, 28.14; 95% CI, 8.57-92.43; P < 0.001). Patients were less likely to be discharged to a rehabilitation facility if they received remdesivir (OR, 0.44; 95% CI, 0.31-0.64; P < 0.001). Patient-specific factors associated with COVID-19 hospitalization should be considered by physicians when prognosticating patient rehabilitation.

Trauma Incidence During the New Jersey COVID-19 Stay-At-Home Order: A Multicenter Study

IntroductionGiven the early surge of COVID-19 in New Jersey (NJ), a statewide executive order (EO) to stay-at-home was instituted on March 22, 2020. We hypothesized that the EO would result in a decreased number of trauma admissions, length of stay, and resources utilized in trauma patients at NJ trauma centers. MethodsIn an institutional review board-approved, retrospective, multicenter study, trauma registries at three level one trauma centers in NJ were queried from March 22 to June 14 in 2020 and compared to the same timeframe the year prior. Epidemiological and clinical data were obtained including demographics, select preexisting conditions, mechanism of injury, injury severity score, resources utilized, and outcomes. Results1859 trauma patients were evaluated during the EO versus 2201 the year prior. During the EO, trauma patients were less likely to be transferred from another hospital (21% versus 29% P < 0.05), more likely to have a penetrating mechanism (16% versus 12% P < 0.05), were equally likely to require a procedure (P = 0.44) and had similar injury severity score (5 [interquartile range [IQR] 1-9] versus 5 [IQR 1-9], P = 0.73). There was no significant difference in ventilator days (0 [IQR 0-1] versus 0 [IQR 0-2] P = 0.08), intensive care unit days (2 [IQR 0-4] versus 2 [IQR 0-3] P = 0.99), or length of stay (2 [IQR 1-5] versus 2 [IQR 1-6] P = 0.73). Patients were more likely to be sent home than to rehabilitation or long-term acute care hospital during the EO (81% versus 78%, P = 0.02). ConclusionsThe 2020 COVID-19 EO was associated with a significantly different epidemiology with a higher rate of penetrating injury during the EO, and similar volume of injured patients evaluated.

Development and 5-year Evaluation of Diagnosis-Specific Protocols for Visual Neuro-Rehabilitation in a Multicenter Inpatient Rehabilitation Network

ObjectiveTo provide a retrospective evaluation of a new eye and vision rehabilitation care pathway in a U.S. multi-site inpatient rehabilitation network involving the occupational therapy (OT) staff and a consulting doctor of optometry (OD) specializing in vision rehabilitation. DesignRetrospective study. SettingTwo Inpatient Rehabilitation Facilities (IRFs) and 1 Long Term Acute Care Hospital (LTACH). ParticipantsThere were 2083 records reviewed (44% women, avg. age 59 years). The most common diagnoses were hemispatial neglect (19.2%), homonymous field defects (18.5%), and oculomotor cranial nerve palsies (16.7%) (N=2083). InterventionsClinical care was reviewed where diagnosis-specific protocols were developed and training was provided to OTs in order to reinforce OD-prescribed interventions during daily treatment sessions, including (1) third, fourth, and sixth ocular cranial nerve palsies (OCNPs) with prisms fitted for full time, postural adaptation training, and oculomotor re-education using pursuits, saccades, head-rotations, and binocular vision exercises including alternate cover and vergence; (2) homonymous hemianopia with training awareness of field loss, eccentric viewing, and fitting of Peli lens for optical field expansion; and (3) prism adaptation therapy (PAT) for left hemispatial neglect. Main Outcome MeasuresFrequency of diagnoses. HypothesisDiagnoses with developed protocols were most common. Secondarily, feasibility and efficacy by anonymous OT survey. Results2083 vision consults were performed over 5 years. The most common diagnoses were hemispatial neglect (n=399, 19.2%), homonymous field defects (n=386, 18.5%), and OCNPs (n=347, 16.7%). None of the OTs reported the protocols were infeasible and 63% (IQR 38%-69%) reported their patients benefited from the interventions. The survey suggested prism for OCNPs helped in 42%, and Peli lens and PAT both helped in 38%. ConclusionsData support the feasibility of this inpatient eye and vision rehabilitation care pathway which may be used as a foundation for creating or refining similar programs elsewhere. Uniform administration of IRF-based visual neuro-rehabilitation care could provide a substrate for future clinical trials to evaluate efficacy.

Days at home after transcatheter or surgical aortic valve replacement in high-risk patients

Days at home (DAH) quantifies time spent at home after a medical event but has not been fully evaluated for TAVR. We sought to compare 1- and 5-year DAH (DAH365, DAH1825) among high-risk patients participating in a randomized trial of transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis versus surgical aortic valve replacement (SAVR). We linked data from the U.S. CoreValve High Risk Trial to Medicare Fee-for-Service claims in 456 patients with 450 (234 TAVR/216 SAVR) and 427 (222 TAVR/205 SAVR) analyzed at 1 and 5 years. DAH was calculated as the number of days alive and spent outside of a hospital, skilled nursing facility, rehabilitation, long-term acute care hospital, emergency department, or observation stay. Mean DAH365 was higher in patients who underwent TAVR compared with SAVR (295.1 ± 106.9 vs 267.8 ± 122.3, difference in days 27.2 [95% CI 6.0, 48.5], P=.01). Compared with SAVR, TAVR patients had a shorter index length of stay (LOS) (7.4 ± 4.5 vs 12.5 ± 9.0, difference in days -5.1 [-6.5, -3.8], P < .001). The largest contributions to decreased DAH365 were mortality days and total facility days after discharge from the index hospitalization (mortality days-TAVR: 34.7 ± 93.1 vs SAVR: 48.0 ± 108.8, difference in days -13.3 [95% CI -32.1, 5.5], P=.17; total facility days-TAVR: 27.9 ± 47.4 vs SAVR: 36.7 ± 48.9, difference in days -8.8 [95% CI -17.8, 0.1], P=.05). Mean DAH1825 was numerically but not statistically significantly higher in TAVR (TAVR: 1154.2 ± 659.0 vs SAVR: 1067.6 ± 697.3, difference in days 86.6 [95% CI -42.3, 215.6], P=.19). Landmark analysis showed no difference in DAH from years 1 to 5 (TAVR: 1040.4 ± 477.5 vs SAVR: 1022.9 ± 489.3, P=.74). In the U.S. CoreValve High Risk Trial linked to Medicare, high-risk patients undergoing TAVR spend an average of 27 additional DAH compared with SAVR in the first year after the procedure due to a shorter index LOS and the additive effect of fewer but nonsignificantly different mortality and total facility days after discharge from the index hospitalization compared with SAVR. After the first year, both groups spend a similar number of DAH. These results describe the postprocedural course of high-risk patients from a patient-centered perspective, which may guide expectations regarding longitudinal health care needs and inform shared decision-making.

Top long-term acute care hospital system switches to the Medela Invia negative-pressure wound therapy system after evaluation yields positive results.

Top long-term acute care hospital system switches to the Medela Invia negative-pressure wound therapy system after evaluation yields positive results.

Top Long-term Acute Care Hospital System Switches to the Medela Invia Negative-Pressure Wound Therapy System after Evaluation Yields Positive Results.

Top Long-term Acute Care Hospital System Switches to the Medela Invia Negative-Pressure Wound Therapy System after Evaluation Yields Positive Results.

A FOUR-BODING FUTURE: POLYVIRAL INFECTION WITH SARS-COV-2, PARAINFLUENZA VIRUS TYPE 3, INFLUENZA A, AND ADENOVIRUS

A FOUR-BODING FUTURE: POLYVIRAL INFECTION WITH SARS-COV-2, PARAINFLUENZA VIRUS TYPE 3, INFLUENZA A, AND ADENOVIRUS

Risk Factors for Colistin-Resistant Carbapenem-Resistant Klebsiella pneumoniae in the Postacute Care Setting.

We assessed risk factors for colistin resistance among carbapenem-resistant Klebsiella pneumoniae (CRKP) from 375 patients in long-term acute care hospitals. Recent colistin or polymyxin B exposure was associated with increased odds of colistin resistance (adjusted odds ratio = 1.11 per day of exposure, 95% confidence interval = 1.03–1.19, P = .007).

Characterization of resistance to newer antimicrobials among carbapenem-resistant Klebsiella pneumoniae in the post-acute-care setting.

We assessed susceptibility patterns to newer antimicrobial agents among clinical carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from patients in long-term acute-care hospitals (LTACHs) from 2014 to 2015. Meropenem-vaborbactam and imipenem-relebactam nonsusceptibility were observed among 9.9% and 9.1% of isolates, respectively. Nonsusceptibility to ceftazidime-avibactam (1.1%) and plazomicin (0.8%) were uncommon.

Duration of Replication-Competent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Shedding Among Patients With Severe or Critical Coronavirus Disease 2019 (COVID-19).

BackgroundPatterns of shedding replication-competent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in severe or critical COVID-19 are not well characterized. We investigated the duration of replication-competent SARS-CoV-2 shedding in upper and lower airway specimens from patients with severe or critical coronavirus disease 2019 (COVID-19).MethodsWe enrolled patients with active or recent severe or critical COVID-19 who were admitted to a tertiary care hospital intensive care unit (ICU) or long-term acute care hospital (LTACH) because of COVID-19. Respiratory specimens were collected at predefined intervals and tested for SARS-CoV-2 using viral culture and reverse transcription–quantitative polymerase chain reaction (RT-qPCR). Clinical and epidemiologic metadata were reviewed.ResultsWe collected 529 respiratory specimens from 78 patients. Replication-competent virus was detected in 4 of 11 (36.3%) immunocompromised patients up to 45 days after symptom onset and in 1 of 67 (1.5%) immunocompetent patients 10 days after symptom onset (P = .001). All culture-positive patients were in the ICU cohort and had persistent or recurrent symptoms of COVID-19. Median time from symptom onset to first specimen collection was 15 days (range, 6–45) for ICU patients and 58.5 days (range, 34–139) for LTACH patients. SARS-CoV-2 RNA was detected in 40 of 50 (80%) ICU patients and 7 of 28 (25%) LTACH patients.ConclusionsImmunocompromise and persistent or recurrent symptoms were associated with shedding of replication-competent SARS-CoV-2, supporting the need for improving respiratory symptoms in addition to time as criteria for discontinuation of transmission-based precautions. Our results suggest that the period of potential infectiousness among immunocompetent patients with severe or critical COVID-19 may be similar to that reported for patients with milder disease.

Threshold-free genomic cluster detection to track transmission pathways in health-care settings: a genomic epidemiology analysis

A crucial barrier to the routine application of whole-genome sequencing (WGS) for infection prevention is the insufficient criteria for determining whether a genomic linkage is consistent with transmission within the facility. We evaluated the use of single-nucleotide variant (SNV) thresholds, as well as a novel threshold-free approach, for inferring transmission linkages in a high-transmission setting. We did a retrospective genomic epidemiology analysis of samples previously collected in the context of an intervention study at a long-term acute care hospital in the USA. We performed WGS on 435 isolates of Klebsiella pneumoniae harbouring the blaKPC carbapenemase (KPC-Kp) collected from 256 patients through admission and surveillance culturing (once every 2 weeks) of almost every patient who was admitted to hospital over a 1-year period. Our analysis showed that the standard approach of using an SNV threshold to define transmission would lead to false-positive and false-negative inferences. False-positive inferences were driven by the frequent importation of closely related strains, which were presumably linked via transmission at connected health-care facilities. False-negative inferences stemmed from the diversity of colonising populations that were spread among patients, with multiple examples of hypermutator strain emergence within patients and, as a result, putative transmission links separated by large genetic distances. Motivated by limitations of an SNV threshold, we implemented a novel threshold-free transmission cluster inference approach, in which each of the acquired KPC-Kp isolates were linked back to the imported KPC-Kp isolate with which it shared the most variants. This approach yielded clusters that varied in levels of genetic diversity but where 105 (81%) of 129 unique strain acquisition events were associated with epidemiological links in the hospital. Of 100 patients who acquired KPC-Kp isolates that were included in a cluster, 47 could be linked to a single patient who was positive for KPC-Kp at admission, compared with 31 and 25 using 10 SNV and 20 SNV thresholds, respectively. Holistic examination of clusters highlighted extensive variation in the magnitude of onward transmission stemming from more than 100 importation events and revealed patterns in cluster propagation that could inform improvements to infection prevention strategies. Our results show how the integration of culture surveillance data into genomic analyses can overcome limitations of cluster detection based on SNV-thresholds and improve the ability to track pathways of pathogen transmission in health-care settings. US Center for Disease Control and Prevention and University of Michigan.

Transmission of Pan-resistant and Echinocandin-resistant Candida Auris Between Healthcare Facilities During the COVID-19 Pandemic

BackgroundCandida auris is a Texas notifiable condition requiring isolate submission to the state public health laboratory. C. auris spreads in healthcare through contact with contaminated surfaces and unclean hands. During the COVID-19 pandemic, pan-resistant and echinocandin-resistant C. auris were identified in Texas for the first time.MethodsIn January 2021, a long-term acute care hospital patient's isolate was identified as C. auris. Retrospective surveillance identified a 2020 case. Remote and onsite infection control assessments (ICARs) were conducted at healthcare facilities (HCFs) where the cases received care. Colonization screenings were conducted until the HCFs achieved two rounds of negative results. Cases and those pending screening results were placed on contact precautions. Epidemiologists provided education and resources to HCFs to mitigate identified infection prevention gaps. Antifungal susceptibility testing (AST) was performed at the Antibiotic Resistance (AR) Laboratory Network laboratory. Whole genome sequencing (WGS) was performed by the Centers for Disease Control and Prevention (CDC) Laboratory.ResultsThere were 47 C. auris cases with collection dates from November 20, 2020, to September 27, 2021, including 15 clinical and 32 colonized cases from 22 years to 89 years old with a mean age of 63. Sixty-six percent (n=31) were males. Common gaps from the 46 ICARs conducted at 42 HCFs included using ineffective disinfectants, not following manufacturer's instructions, reusing disposable personal protective equipment, and not conducting audits. There were 59 colonization screenings at 20 HCFs. AST revealed two pan-resistant, seven echinocandin-resistant, and thirty-one fluconazole resistant cases. CDC performed WGS on 16 isolates, revealing clusters within and between HCFs, including a cluster of resistant cases.ConclusionsWGS supported transmission of pan-resistant or echinocandin-resistant C. auris for the first time in the United States. The pandemic presented new infection control risks. Rapid surveillance detection, colonization screenings, infection control assessments, and education are instrumental to outbreak containment.

Context Matters: Caregiver Engagement in Serious Illness Communication in the Long-Term Acute Care Hospital Setting (GP757)

Context Matters: Caregiver Engagement in Serious Illness Communication in the Long-Term Acute Care Hospital Setting (GP757)