Long-term Care Hospitals Research Articles

A Study of Comparison of Moral Distress and Burnout between Long-term Care Hospital Nurses and General Hospital Nurses

A Study of Comparison of Moral Distress and Burnout between Long-term Care Hospital Nurses and General Hospital Nurses

Factors Influencing Performance of Pain Assessment and Pain Intervention for Dementia Patients among Long-term Care Hospital Nurses

Factors Influencing Performance of Pain Assessment and Pain Intervention for Dementia Patients among Long-term Care Hospital Nurses

Root-Cause Approach to New Reality in a Mid- Long-Term Care Hospital in Madrid-Spain

Root-Cause Approach to New Reality in a Mid- Long-Term Care Hospital in Madrid-Spain

NQPC-10 END-OF-LIFE PHASE OF GLIOBLASTOMA

BACKGROUNDDespite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home-care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in our hospital.METHODSWe retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017.RESULTIn total, 107 patients died; 28 (26%) at home, 25 (23%) in hospice care, 9(9%) in nursing homes, 21(20%) in long-term care hospitals (LTCH), 13(12%) in our hospital, and 11(10%) in other neurosurgical hospitals. The median survival time and length of EOL phase for patients who died at home were 596 and 77 days; 469 and 103 days in hospice care; 528 days and 149 days in LTCH; 388 days and 52 days in our hospital; 802 and 91 days in other neurosurgical hospital; and 565 days and 55 days in nursing homes, respectively. The KPS of patients who transferred to LTCH or was started palliative care in other neurological hospital was 60. That of other patients was 50.The patients who died at home entered deep coma in the last 3.5 days (n=24) of life and could not take oral feeds for 7 days (n=26).CONCLUSIONAccording to cancer patient study, the home-based palliative time of longer prognosis group were 59 days. EOL phase of GBM may be longer than other cancer. We must consider the problems of the EOL phase and improve the quality of EOL care.

Paired Interviews to Evaluate Patient and Proxy Responses on Patient Experience of Care Surveys (PECS)

Paired interviews are used to evaluate whether a questionnaire functions properly for both the target respondent and an alternate respondent (proxy). We developed a new application of this tool to evaluate whether a Patient Experience of Care Survey (PECS) for long-term care hospitals (LTCHs) and inpatient rehabilitation facilities (IRFs) functioned acceptably for patients and their family members. Frequently, patients in LTCHs and IRFs cannot fully recall their care experience and are often unable to complete surveys because of cognitive or physical limitations. For this project, researchers conducted interviews with 20 paired respondents: a patient and a proxy. Results revealed that the patient and their proxy went through similar response strategies and answered questions similarly to each other a majority of the time. We concluded that the questionnaires function acceptably for patients and proxies.

Quantity over Quality? Perception of Designating Long-Term Care Hospitals as Providers of Hospice and Palliative Care

Quantity over Quality? Perception of Designating Long-Term Care Hospitals as Providers of Hospice and Palliative Care

A study on delegation level of nursing activities, nursing professionalism and turnover intention for long-term care hospital nurses

본 연구는 요양병원 간호사의 간호행위 위임정도, 간호전문직관 및 이직의도를 파악하고 이들간의 관계를 확인함으로써 향후 간호행위 위임에 필요한 정책적 지침 및 절차에 관한 기초자료를 제공하고자 시도되었다. 본 연구는 서술적 조사연구로 구조화된 설문지를 이용하여 2개 광역도 소재 6개 요양병원의 간호사 146명을 대상으로 실시하였으며, 자료수집기간은 2016년 7월부터 8월까지 이었다. 수집된 자료는 SPSS 22.0을 이용하여 기술통계, t-test, ANOVA, Pearson 상관분석을 실시하였다. 연구결과, 요양병원 간호사의 간호행위는 위임에 대한 명확한 지침이나 법적 절차가 없는 상태에서 7개 행위를 제외한 대부분의 간호행위가 간호보조인력에게 위임되고 있었다. 요양병원 간호사의 간호행위 위임정도와 간호전문직관, 이직의도와의 유의한 관련성은 없었으나 간호전문직관과 이직의도는 유의한 음의 상관관계를 보였다. 따라서, 요양병원 간호사의 이직의도를 낮추기 위해서는 개인적인 측면으로 긍정적인 간호전문직관을 확고히 하는 방안이 모색되어야 하며, 정책적인 측면에서는 요양병원의 적절한 간호인력배치 기준을 마련하여 간호행위 위임지침을 개발해야 한다.This study was aimed to prepare the evidences for establishing policies on nursing manpower by identifying the relationship among delegation level of nursing activities, nursing professionalism and turnover intention in long-term care hospital nurses. The study was a descriptive survey research that used a structured questionnaire. 146 nurses agreed to take part in the research. They worked in six long-term care hospitals located in A and B province. Data were collected from July to August 2016 and analyzed through SPSS 20.0 program, using descriptive statistics, t-test, ANOVA and pearson’s correlation coefficients. As a results, first, as for the delegation of nursing activities by long-term care hospital nurses, the levels of delegation of direct nursing activities were 34.63±14.12, and the level of delegation of indirect nursing activities were 1.71±1.75. Second, the mean score of nursing professionalism and the turnover intention of long-term care hospital nurses were 3.62±0.77 and 2.71±0.97, respectively. Third, the delegation of direct nursing activities by long-term care hospital nurses significantly differed depending on the number of nurses in the ward and the number of caregivers in the ward. The delegation of indirect nursing activities significantly differed depending on the number of nurses in the ward, the presence of conflicts and stress related to delegation. Forth, there was no significant correlation of the delegation of nursing activities by long-term care hospital nurses with nursing professionalism and with turnover intention. Most of nursing activities, were delegated to nurse aids, since there were no clear guidelines or legal procedures on nursing activities in long-term care hospital nurses. Therefore it is required to find how to clearly establish positive nursing professionalism and to develop a proper nursing manpower arrangement and the guidelines for the delegation of nursing activities in a long-term care hospital in terms of policy.

The Effects of Nursing Work Environment and Role Conflict on Job Embeddedness among Nurses of Long-term Care Hospital

The Effects of Nursing Work Environment and Role Conflict on Job Embeddedness among Nurses of Long-term Care Hospital

Post-acute care referral in United States of America: a multiregional study of factors associated with referral destination in a cohort of patients with coronary artery bypass graft or valve replacement

BackgroundThe use of post-acute care (PAC) for cardiovascular conditions is highly variable across geographical regions. Although PAC benefits include lower readmission rates, better clinical outcomes, and lower mortality, referral patterns vary widely, raising concerns about substandard care and inflated costs. The objective of this study is to identify factors associated with PAC referral decisions at acute care discharge.MethodsThis study is a retrospective Electronic Health Records (EHR) based review of a cohort of patients with coronary artery bypass graft (CABG) and valve replacement (VR). EHR records were extracted from the Cerner Health-Facts Data warehouse and covered 49 hospitals in the United States of America (U.S.) from January 2010 to December 2015. Multinomial logistic regression was used to identify associations of 29 variables comprising patient characteristics, hospital profiles, and patient conditions at discharge.ResultsThe cohort had 14,224 patients with mean age 63.5 years, with 10,234 (71.9%) male and 11,946 (84%) Caucasian, with 5827 (40.96%) being discharged to home without additional care (Home), 5226 (36.74%) to home health care (HHC), 1721 (12.10%) to skilled nursing facilities (SNF), 1168 (8.22%) to inpatient rehabilitation facilities (IRF), 164 (1.15%) to long term care hospitals (LTCH), and 118 (0.83%) to other locations. Census division, hospital size, teaching hospital status, gender, age, marital status, length of stay, and Charlson comorbidity index were identified as highly significant variables (p- values < 0.001) that influence the PAC referral decision. Overall model accuracy was 62.6%, and multiclass Area Under the Curve (AUC) values were for Home: 0.72; HHC: 0.72; SNF: 0.58; IRF: 0.53; LTCH: 0.52, and others: 0.46.ConclusionsCensus location of the acute care hospital was highly associated with PAC referral practices, as was hospital capacity, with larger hospitals referring patients to PAC at a greater rate than smaller hospitals. Race and gender were also statistically significant, with Asians, Hispanics, and Native Americans being less likely to be referred to PAC compared to Caucasians, and female patients being more likely to be referred than males. Additional analysis indicated that PAC referral practices are also influenced by the mix of PAC services offered in each region.

QOLP-40. END-OF-LIFE CARE FOR GLIOBLASTOMA PATIENTS IN JAPAN

Abstract BACKGROUND Despite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Unlike in other countries, most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in Japan. METHODS We retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017. RESULT: In total, 107 patients died; 27 (25.7%) at home, 24 (22.8%) in hospice care, 8 (7.6%) in nursing homes, 46 (43.9%) in hospitals (long-term care hospitals [LTCH; 19.8%], our hospital [13.3%], and other neurosurgical hospitals [10.4%]). According to our previous research, in 2001–2005, 6% of GBM patients died at home, 3% in hospice case, and 91% in the hospital. The KPSof patients who started palliative home care or transferred to another hospital was 50–60. The median survival time and length of EOL phase for patients who died at home were 498 and 76.5 days; 395 and 103 days in hospice care; 533 days and 149 days in LTCH; 374 days and 52 days in our hospital; 338 and 75.5 days in other neurosurgical hospital; and 557 days and 37 days in nursing homes, respectively. CONCLUSION The number of GBM patients who died at home in Japan is increasing, and we must consider the problems of the EOL phase and improve the quality of EOL care.

Predicting Carbapenem-Resistant Enterobacteriaceae Carriage at the Time of Admission Using a Statewide Hospital Discharge Database.

BackgroundTimely identification of patients likely to harbor carbapenem-resistant Enterobacteriaceae (CRE) can help health care facilities provide effective infection control and treatment. We evaluated whether a model utilizing prior health care information from a state hospital discharge database could predict a patient’s probability of CRE colonization at the time of hospital admission.MethodsWe performed a case–control study using the Illinois hospital discharge database. From a 2014–2015 patient cohort, we defined cases as index adult patient hospital encounters with a positive CRE culture collected within the first 3 days of hospitalization, as reported to the Illinois XDRO registry; controls were all patient admissions from the same hospital and month. We split the data into training (~60%) and validation (~40%) sets and developed a logistic regression model to estimate coefficients for predictors of interest.ResultsWe identified 486 index cases and 340 005 controls. Independent risk factors for CRE at the time of admission were age, number of short-term acute care hospital (STACH) hospitalizations in the prior 365 days, mean STACH length of stay, number of long-term acute care hospital (LTACH) hospitalizations in the prior 365 days, mean LTACH length of stay, current admission to LTACH, and prior hospital admission with an infection diagnosis code. When applying the model to the validation data set, the area under the receiver operating characteristic curve was 0.84.ConclusionsA prediction model utilizing prior health care exposure information could discriminate patients who were likely to harbor CRE at the time of hospital admission.

PROLONGED MECHANICAL VENTILATION: CHARACTERISTICS OF PATIENTS TREATED AT HOME COMPARED TO HOSPITAL LONG-TERM CARE

Rising numbers of patients receiving Prolonged Mechanical Ventilation (PMV) pose a challenge, and advancing technology supports ventilators appropriate for either Home or Hospital Long Term Care (HLTC).Data guiding decisions concerning place of care are lacking. This study describes the characteristics of the majority (120/123) of all PMV patients aged ≥18 (and their caregivers) in Jerusalem, covered by the Clalit Health Service, treated either with Home Hospital or HLTC. Patients were more alert and communicative at Home vs. HLTC (40/46 vs. 22/74), younger (54 vs.73 years, p12 years (36% vs.21%, p=0.1), and without legal guardian (59% vs. 12%, p<0.01). Primary reason for PMV at home was degenerative neuromuscular disease (59% vs. 28%), compared to post resuscitation/sepsis/CVA in HLTC patients (17% vs. 62%), who suffered more comorbidity, functional decline post-PMV, and pressure sores (0% vs. 42%). Ventilation was more likely to be planned at home vs HLTC (33% vs. 8%), and yet 119/120 were without Advanced Directives prior to PMV. Caregivers at home tended to be spouses (48% vs. 31%) and offspring at HLTC (17% vs. 47%), with reduced Modified Caregiver Strain Index at home (10.5 vs. 12.9, p=0.12). Mortality during follow-up was lower at home (15.2% vs. 27%). Costs to the health fund for home versus HLTC were approximately 1:3. Our findings suggest that with appropriate targeting of eligible PMV patients, Home Hospital may be the preferred model of care for patients, caregivers and healthcare providers.

WELL-BEING AND ADVANCE DIRECTIVES AMONG PROLONGED MECHANICAL VENTILATION PATIENTS AT HOME VERSUS HOSPITAL

Despite increasing numbers of older patients requiring Prolonged Mechanical Ventilation (PMV), little is known concerning their mood, well-being, distressing symptoms and attitudes towards ventilation. Furthermore differences may exist according to place of care- whether Home Hospital or Hospital Long Term Care (HLTC). These issues were addressed using the revised Edmonton Symptom Assessment System (r-ESAS)(10 items, max severity score=100), and Short Geriatric Depression Scale, in a study of the majority of PMV patients (n=120/123) aged ≥18 (range 18-96 years) all Clalit Health Service insurees, in Jerusalem. Communicative patients were interviewed (40/46 at home, 22/74 in HLTC, average age 54 vs.73 years, p<0.01). The following symptoms (dichotomized to “not-a-problem”/“problematic”) were frequently reported as “not-a-problem” among patients (Home,HLTC): tiredness (59%,58%), poor appetite (95%,90%), pain (69%,84%), drowsiness (77%,90%), nausea (85%,84%), and shortness of breath (82%,90%). General well-being (categorized to good/mild/moderate/severe impairment) was reported more frequently as good or mildly impaired at Home vs. HLTC (54% vs.26%), as was lower frequency of depression (34.4% vs. 44.4%, p=0.049). The total r-ESAS score was similar irrespective of setting: Home-24.9/100 (inter quartile range {IQR} 13.5-32.5) vs. HLTC-23.7/100 (IQR 17.5-32),p=0.74. The majority (119/120) of patients were without advanced directives prior to initiation of PMV. When asked if they had to choose again, 82% and 91% of communicative patients at home vs. HLTC would opt again for ventilation, as would 75% of caregivers of uncommunicative patients. Our findings emphasize the resilience and low levels of distressing symptoms among PMV patients, and may contribute to the decision-making process concerning advanced directives.

HOSPICE VISIT INTENSITY BY PHYSICIANS AND NURSE PRACTITIONERS ON THE GENERAL INPATIENT LEVEL OF CARE

The Medicare Hospice Benefit’s General Inpatient (GIP) level of care provides short-term services for pain and symptom management in an inpatient facility that cannot be managed in the patient’s home. Relatively little is known about how beneficiaries utilize services during GIP care. Among a cohort of Medicare hospice beneficiaries utilizing GIP during Federal Fiscal Year 2014 (FY2014), we used 100% Medicare hospice and Part B claims to identify physician and nurse practitioner services concurrent with GIP dates. We estimated logistic regression models to determine the likelihood a beneficiary never receives physician or nurse practitioner services. We found that among the 1.5 million GIP days serviced in FY2014, more than half (52.4%) lacked any recorded physician or nurse practitioner services. Absence rates for these services were particularly high among hospice GIP days provided in inpatient facilities (69.1% missing services), long-term care hospitals (84.3% missing services), and skilled nursing facilities (85.3% missing services). Moreover, one in five hospice episodes having at least three sequential GIP days lacked any physician or nurse practitioner services. Relative to hospice inpatient units, rates of absence were higher among episodes beginning in long-term care hospitals [59.3% long-term care hospital vs. 11.5% hospice inpatient units; AOR 9.65 95% CI 7.47-12.46] and skilled nursing facilities [51.3% skilled nursing facility vs. 11.5% hospice inpatient units; AOR 5.98, 95% CI 5.63-6.36]. More in depth research and monitoring is needed to further understand dimensions of GIP care provision, to ensure that hospice beneficiaries are receiving adequate services regardless of their inpatient setting.

Factors Affecting the Attitude in Caring for Elders of Nurses in Long-term Care Hospitals

본 연구는 요양병원 간호사의 노인에 대한 공감력, 노인간호 스트레스 및 노인돌봄태도 간의 관계를 확인하고 노인돌봄태도에 영향을 미치는 요인을 규명하기 위한 목적으로 수행되었다. 자료수집은 B광역시 및 G시 소재 요양병원의 간호사를 대상으로 하였고, 자료분석에 사용된 프로그램은 SPSS 18.0이며 서술통계, t-검정, 일원분산분석, Scheffe&#769; 검정, Pearson s 상관계수 및 단계적 다중회귀분석을 활용하였다. 대상자의 노인돌봄태도 정도는 결혼상태, 교육정도, 직위, 총 임상경력, 가까이 지내는 노인유무, 노인간호 선호도, 노인을 위한 자원봉사활동 경험에 따라 통계적으로 유의한 차이를 보였다. 노인돌봄태도는 노인에 대한 공감력과 양의 상관이 있었으며, 노인간호 스트레스와는 음의 상관이 있는 것으로 나타났다. 본 연구에서 요양병원 간호사의 노인돌봄태도에 영향을 미친 요인은 노인에 대한 공감력, 노인간호 선호도, 교육정도, 노인간호 스트레스 순이었고, 이러한 요인들은 요양병원 간호사의 노인돌봄태도를 총 50.8% 설명하는 것으로 확인되었다. 본 연구결과를 토대로 요양병원 간호사의 긍정적인 노인돌봄태도 함양을 위해 노인에 대한 공감력을 증진할 수 있는 중재개발 및 적용이 요구되며, 학부교육에서부터 긍정적인 경험을 토대로 노인간호 선호도를 증진시킬 수 있는 참여형 교육전략이 활용되어야 할 것이다. 또한, 노인간호에 대한 상위 교육의 기회를 확대하며, 근무 중 발생하는 노인간호 스트레스를 완화할 수 있는 조직적 방안 마련과 함께 스트레스대처 전략 향상을 위한 지속적 노력이 필요하다.This study was a descriptive research to identify the influencing factors on attitude in caring for elders in nurses working in long-term care hospitals. Data were collected from 194 nurses in long-term care hospitals in B city, and analyzed using descriptive statistics, t-test, Scheffe test, Pearson s correlation coefficients, and stepwise multiple regression. Attitude in caring for elders among nurses in long-term care hospitals showed statistical differences according to marital status, educational level, position, length of career, having an elderly person close to oneself, preference for geriatric nursing, and volunteer experience with elders. Attitude in caring for elders was correlated with empathy for elders and stress for elderly care. The factors affecting attitude in caring for elders were empathy for elders, preference for geriatric nursing, educational level and stress for elderly care explaining 50.8% of the total variance of attitude in caring for elders. Therefore, to nurture positive attitude in caring for elders among nurses in long-term care hospitals, it is necessary to develop and apply interventions to enhance empathy for the elderly. In addition, educational opportunities are to be encouraged and strategies to be developed to alleviate the stress of nursing care for elderly and to improve the stress coping skills in nurses.

Understanding provider-level properties that influence the transmission of healthcare associated infections using network analysis

The goal of this study is to determine which provider-level properties (e.g., provider types, patient contact factors) of healthcare workers (HCW) have the greatest impact on the transmission of healthcare associated infections (HAIs). This study focused on Carbapenem-resistant Enterobacteriaceae (CRE) acquisition for patients who stayed in a long-term acute care hospital (LTACH) in central Virginia during July and August 2014. We used both patient data (e.g., bed movement, screening results for CRE) and provider activity data documented through the electronic medical record. We created a network of patients for each HCW and performed Poisson regression analysis including the network measures. A total of 204 providers saw at least one of the nine positive patients who stayed in the LTACH over the study period. From the Poisson regression, provider types, total number of patients each provider saw, LTACH workdays, average number of patients per day during LTACH workdays, and the provider’s network were associated with the frequency of case contact. Our study demonstrated that in addition to patient data, provider activity logs that show provider-level properties can be used to assess the role of healthcare workers in transmitting HAIs and highlight risk mitigation opportunities.

1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital

BackgroundHand hygiene (HH) is the cornerstone of infection prevention and improved compliance has been associated with reduced healthcare-associated infections (HAIs). However, traditional methods for HH data collection have limitations and may not accurately reflect true compliance. We sought to evaluate whether an electronic hand hygiene monitoring system (HHMS) can improve data collection, compliance, and reduce HAIs.MethodsA HHMS was implemented as part of a pilot at a single facility in June 2018 for all healthcare workers (HCWs) who entered patient rooms. The system prompted HCWs to perform HH with an audible and visual reminder emitted from a badge if a HH event had not been registered within specific timeframes of entering or exiting a patient room. The system captured compliance with preferential handwashing (soap and water) for at least 15 seconds upon exit of Clostridioides difficile (C. difficile) designated rooms. All HH data were collected by the HHMS. Hand hygiene compliance and HAI data were compared for the pre-intervention (June 2017-May 2018) and intervention periods (July 2018-March 2019). No changes were made to environmental cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices.ResultsHH compliance by direct observation in the pre-intervention period was 91% (1,612 observations). HH compliance with the HHMS during the intervention period was 97% (2,778,402 observations). The mean monthly HH opportunities recorded during the pre-intervention period was 134, while the HHMS captured 308,711, a greater than 2,300-fold increase. The incidence of healthcare facility-onset C. difficile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41 GDH+/Toxin+ laboratory-identified [labID] events/42,726 patient-days). With the HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID events/31,169 patient-days). No policy changes in environmental cleaning of high-touch surfaces were made or observed during the pilot.ConclusionThe use of an HHMS facilitated more comprehensive HH data and improved compliance. The preliminary findings also support an association between more robust HH compliance data and a significant decrease in toxin-producing CDI.Disclosures All authors: No reported disclosures.

Effects of pressure ulcer prevention training among nurses in long-term care hospitals

BackgroundNurses caring for elderly patients with a high risk of pressure ulcer at long-term care hospitals require the necessary knowledge, behaviors, and attitudes regarding preventing pressure ulcers. ObjectivesTo identify the effects of pressure ulcer prevention training on nurses' knowledge, behaviors, and attitudes regarding pressure ulcer prevention. DesignA comparison group pretest-posttest design. SettingsLong-term care hospitals in a metropolitan area of the Republic of Korea. ParticipantsParticipants were conveniently assigned to team-based learning (n = 30) or lecture-based learning (n = 30) groups. MethodsWe examined pre-post differences in the scores for pressure ulcer prevention knowledge, behaviors, and attitudes in each group using the paired t-test. Additionally, pre-post difference scores were compared between the two groups using the independent samples t-test. ResultsBoth groups exhibited significant increases in scores for pressure ulcer prevention knowledge, behaviors, and attitudes after the intervention as compared before it. However, we found no significant differences in the pre-post difference scores for any of the variables between the two groups. ConclusionsPressure ulcer prevention training, regardless of whether it utilizes team-based or lecture-based learning, is useful for enhancing nurses' pressure ulcer prevention knowledge, behaviors, and attitudes. Further study is needed to verify the longitudinal effects of pressure ulcer prevention training on nurses' actual performance and the incidence of pressure ulcers among patients.

476. Risk Factors of Community-Onset Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Bacteremia in South Korea Using National Health Insurance Claims Data

BackgroundAntibiotic resistance is a significant threat to public health not only in healthcare setting but also in community because antimicrobial-resistant infections can be transmitted in community. Although it is essential to know whether there are particular reasons that caused antibiotic-resistant infection in community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae bloodstream infection (ESBL-KP BSI) in South Korea. In the present study, we aimed to reveal risk factors for community-onset ESBL-KP BSI.MethodsFrom May 2016 to April 2017, patients with community-onset KP BSI (n = 408) from six sentinel hospitals in South Korea were included. The hospitals are located in different districts throughout South Korea, and had a total of 5,194 beds, ranged from 715 to 1,050 beds per hospital. Admission history and previous usage of antibiotics and medical devices before bacteremia were acquired from National Health Insurance claims data. Risk factors of ESBL-KP BSI were analyzed with a multivariable logistic regression model. PCR and sequencing for the identification of genes encoding ESBLs, and multilocus sequence typing were performed.ResultsOf 408 patient of community-onset KP BSI, 70 (17%) were ESBL-KP BSI patients. ESBL-KP isolates most frequently carried CTX-M-1-group ESBLs (74%, n = 52), followed by CTX-M-9-group ESBLs (16%, n = 11). Most prevalent sequence type (ST) among ESBL-KP isolates was ST48 (14%, n = 10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n = 70). Analyzing with multivariate analysis, recent admission to long-term care hospital within 3 months (OR, 5.7; 95% CI, 2.1–15.6; P = 0.001), previous usage of trimethoprim-sulfamethoxazole (OR, 11.5; 95% CI, 2.7–48.6; P = 0.001), expanded-spectrum cephalosporin (OR, 2.2; 95% CI, 1.2–3.9; P = 0.01), and previous use of urinary catheter (OR, 2.3; 95% CI, 1.1–4.5; P = 0.02) were identified as independent risk factors for community-onset ESBL-KP BSI.ConclusionRecent admission to long-term care hospital, use of urinary catheter, recent usage of antibiotics were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures in long-term care hospital are needed. Disclosures All authors: No reported disclosures.

1687. High-Rates of Candida auris Carriage and Co-Colonization with Multidrug-Resistant Organisms (MDROs)

Background Candida auris is an emerging multidrug-resistant pathogen that can persist in the environment and lead to healthcare-associated outbreaks. Residents of long-term acute care hospitals (LTACHs) are at particular risk for carriage of both MDROs and C. auris. However, there are few data on co-colonization rates of C. auris with other MDROs in LTACHs.MethodsWe conducted a point prevalence survey for MDROs, C. auris and C. difficile in a Chicago LTACH in March 2019. A combined axilla/groin E-swab (Copan) was collected and plated for C. auris isolation using CHROMagar Candida (Hardy). A rectal E-swab (Copan) was collected for C difficile PCR and MDRO detection including Carbapenem-resistant Enterobacteriaceae (CRE), Extended-spectrum B-lactamases (ESBLs) and Vancomycin-resistant Enterococci (VRE). Each swab was plated directly on VACC agar (Vancomycin, Amphotericin B, Ceftazidime, Clindamycin) and CHROMagar ESBL (Hardy). Bruker MALDI-TOF was used for bacterial and yeast identification and disc diffusion method for antimicrobial susceptibility testing. ESBL phenotypic confirmation was done using double-disc synergy method per CLSI guidelines. Carbapenemase production was confirmed using Xpert Carba-R assay (Cepheid). C. difficile PCR was performed using Xpert C. difficile/Epi assay (Cepheid).ResultsOf 38 patients 36 were eligible for the study (2 patients declined). Overall, 26/36 (72%) patients had an MDRO. Eight (22%) patients were positive for C. auris. Eight (22%) patients had ESBLs (2 P. mirabilis and 6 E. coli), six (17%) had CREs that were all blaKPC positive (4 K. pneumonia, 1 E. coli, and K. pneumoniae). Eight (22%) patients were positive for other gram-negative (GN)-MDROs including 1 A. baumanii, 3 P. aeruginosa, 2 E. cloacae, 1 E. asburiae and 1 P. aeruginosa, and A. baumanii. 20 patients (56%) had VRE colonization. Five (14%) were C. difficile PCR positive. 7/ 8 (87.5%) patients with C. auris were also colonized with another MDRO (2 VRE, 1 ESBL, 1 VRE, ESBL and KPC, 1 VRE and GN-MDRO, 1 VRE, ESBL and GN-MDRO, 1 VRE, KPC, and GN-MDRO).ConclusionWe found a high rate of MDRO co-colonization among patients with C. auris carriage. Continuous active surveillance may be appropriate in LTACHs to limit the spread of C. auris and other MDROs.Disclosures All authors: No reported disclosures.