National Health Safety Network Research Articles

584. Microbiological Outcomes of Culture-Negative Blood Specimens Using 16s rRNA Broad-Range PCR Sequencing: a Retrospective Study in a Canadian Province from 2018 to 2022

Abstract Background Broad-range bacterial PCR sequencing (BRBPS) has emerged as a novel tool to detect fastidious organisms. While its utility has been characterized in different specimen types, its role in culture-negative blood specimens remains poorly understood. Methods We reviewed all clinical specimens sent for culture-negative blood BRBPS (blood, serum and blood culture bottles) to the Laboratoire de santé publique du Québec, the reference laboratory for a large Canadian province, from May 2018 to November 2022. Sanger sequencing of the amplified 16s rRNA gene was performed in all PCR-positive specimens. Data were extracted from the laboratory information system, and the analysis was restricted to the first specimen per patient. Microbiological outcomes were categorized as interpretable sequence, uninterpretable sequence, or negative PCR result. Interpretable sequences were identified and then classified based on the National Healthcare Safety Network database (NHSN; Table 1) and microbiological characteristics.Table 1.Definitions of National Health Safety Network (NHSN) Classification and Examples Results A total of 1199 blood specimens were analyzed using BRBPS from 852 unique patients. Of these, there was no PCR amplification in 152, amplification with uninterpretable sequences in 445 and an interpretable sequence in 255 specimens (Figure 1). Blood specimens received at room temperature, in blood culture bottles, or with positive gram stain were more likely to yield interpretable sequences (Table 2). We identified 174 patients with BRBPS results suggestive of organisms associated with mucosal barrier injury (n=89) or possible pathogens (n=85), summarized in Figure 2. In contrast, 75 patients had results suggestive of contamination from common commensal organisms (n=44) or taxa not in the NSHN database (n=31).Figure 1.Flowchart of the analysis from primary specimens to those specimens with successful amplification of 16s rRNA Classification of interpretable sequences using the National Healthcare Safety Network database classification of microorganisms.Table 2.Characteristics of BRBPS of the 16s rRNA on Culture-Negative Blood SpecimensFigure 2.Tree Map of Mucosal Barrier Injury Organisms and Possible Pathogens by Genera Mucosal barrier injury (A) and possible pathogens (B) are categorized based on the National Healthcare Safety Network database. Microorganisms are colour classified based on microbiological characteristics. Conclusion Our findings demonstrate the potential utility of BRBPS in blood specimens from culture-negative patients, particularly infectious syndromes caused by fastidious gram-negative bacteria associated with animal or arthropod exposures or anaerobic bacteria. However, the frequent recovery of commensal and environmental organisms argues for careful and judicious use. Additional technical optimization is likely required to improve diagnostic yield, particularly with mixed sequences. Disclosures Matthew Cheng, MD, Amplyx Pharmaceuticals: Grant/Research Support|AstraZeneca: Advisor/Consultant|AstraZeneca: Honoraria|Cidara Therapeutics: Grant/Research Support|GEn1E lifesciences: Advisor/Consultant|GEn1E lifesciences: Stocks/Bonds|Kanvas Biosciences, Inc.: Board Member|Kanvas Biosciences, Inc.: Pending patents|Kanvas Biosciences, Inc.: Ownership Interest|Merck: Honoraria|nomic bio: Advisor/Consultant|nomic bio: Stocks/Bonds|Pfizer: Honoraria|Scynexis Inc.: Grant/Research Support|Takeda: Advisor/Consultant|Takeda: Honoraria

Etiology of Bacterial Sepsis and Isolate Resistance Patterns in Hospitalized Neonates in Zambia.

The Sepsis Prevention in Neonates in Zambia study is a prospective cohort study that evaluated an infection prevention and control (IPC) bundle in the University Teaching Hospital neonatal intensive care unit (NICU) in Lusaka, Zambia. We present here the etiologies, antimicrobial resistance profiles, and associated mortality of bloodstream infections (BSI) in this cohort. Venous blood was collected from neonates with clinically suspected sepsis and cultured with an automated blood culture system. Organism identification and susceptibility testing were done using the Vitek II system. We used the CDC National Health Safety Network criteria to define pathogens and commensals. There were 1120 blood cultures performed for 1060 neonates with suspected sepsis. Overall, 38% (424/1120) of cultures were positive of which 72% (306/424) grew pathogens. Blood cultures obtained after, as compared to before, 2 days of hospitalization were more likely to yield a pathogen (77% vs. 65%; P < 0.001). Klebsiella pneumoniae was the most prevalent organism, accounting for 74% (225/306) of all pathogens . K. pneumoniae isolates were highly resistant: 98% (221/225) were extended-spectrum beta-lactamase (ESBL)-positive, while 81% were resistant to gentamicin (182/225) and fluoroquinolones (177/219). Only one isolate was carbapenem resistant. Observed mortality rate was 32% (122/380); 61% (75/122) of the deaths was related to Klebsiella BSI. Multidrug-resistant ESBL-producing Klebsiella species were the main organisms responsible for BSI and were associated with increased mortality. BSI risk increased with prolonged hospitalization, underscoring the importance of IPC measures in the NICU.

Changes in Central Line-Associated Bloodstream Infection (CLABSI) Rates Following Implementation of Levofloxacin Prophylaxis for Children and Adolescents With High-Risk Leukemia.

Background: Despite initiatives to reduce central line-associated bloodstream infection (CLABSI), children and adolescents with hematologic malignancies, as well as those with relapsed disease, remain at the greatest risk for infection. This single-institution project evaluated changes in CLABSI rates following implementation of antibacterial prophylaxis with levofloxacin for patients with high-risk hematologic malignancies. Methods: Positive blood culture events meeting National Health Safety Network surveillance criteria to be classified as CLABSIs from January 1, 2006, to December 31, 2019, were included. Data were organized into four time periods for comparison based on implementation of CLABSI-reduction interventions. Conditional Poisson regression models were used to evaluate the effect of time (intervention period) on CLABSI rates with post hoc Tukey pairwise comparisons between each of the four time periods. Results: From 2006 and 2019, 227 patients experienced 310 CLABSIs. Clinically important decreases in CLABSI rates from baseline (4.84 per 1,000 line days) occurred with implementation of Children's Hospital Association (CHA) bundles (3.29 per 1,000 line days); however, this difference was not significant (p = .16). CLABSI rates decreased from baseline with the addition of formalized supportive cares (2.66 per 1,000 line days; incidence rate ratio [IRR] = 0.60; p < .01), and with the use of antibacterial prophylaxis (1.66 per 1,000 line days; IRR = 0.35; p < .01). Post hoc comparisons indicated decreased CLABSI rates with the use of antibacterial prophylaxis compared with CHA bundles alone (IRR = 0.49; p = .011) and CHA bundles plus formalized supportive cares (IRR = 0.58; p = .046). Discussion: Results demonstrate sustained success using a practice-based evidence approach to guide CLABSI-reduction interventions. Follow-up research, applying machine learning algorithms, may identify additional risk factors and inform future interventions.

A Whole New World: Changes in the Nursing Home Infection Preventionist Role in Response to the COVID-19 Pandemic

BackgroundNursing home (NH) infection prevention and control (IPC) programs struggled before the COVID-19 pandemic. As the pandemic began, NHs were challenged with frequently changing directives including isolation, testing, visitation, and reporting. Within a larger research project, we compared changes in the infection preventionist (IP) role pre-COVID (before March 2020) and during the pandemic.Methods78 Michigan NHs participated in a 12-month program to reduce healthcare-associated infections from 2018-2021. A 36-question survey on IPC characteristics was sent before starting each of four cohorts. Surveys were completed by IPs, nursing directors, or NH administrators. We compared IPC characteristics pre- and intra-COVID using Fisher's exact test and Wilcoxon Rank Sum to assess significance in categorical and continuous descriptors, respectively.Results74 (94.8%) NHs completed the survey, 56 pre-COVID (before March 2020) and 18 during COVID (> one year after COVID was identified in Michigan). Full-time equivalent (FTE) for the IP role was similar between the two groups, but hours worked per week increased significantly from an average 20 to 38 hours per week (p< 0.001). Half of respondents in 2021 reported working 40 hours or more on IPC activities. Despite the additional workload, the IP did not have a significant decrease in their non-IP responsibilities (e.g., staff educator, employee health). Pre-COVID, 21.8% of NHs were enrolled in CDC's National Health Safety Network (NHSN). As mandatory COVID reporting into NHSN began mid-2021, its use contributed to an average of five additional hours per week. Inter-facility notification of resident infections was done by a variety of methods, with facility-to-facility telephone calls increasing during COVID.ConclusionsCOVID-19 has dramatically added to the IP workload in NH settings with no reduction in their other non-IP responsibilities. With reporting requirements unlikely to decrease soon, investment into staffing is needed to reduce staff burnout, maintain quality of care, and resident safety.

Standardized Approach to Wound Class and Impact on Surgical Site Infection Rate

<h3>Background</h3> Surgical wound classification is an important factor for surgical site infection (SSI) surveillance and reporting. Intended to be a surgeon's decision, use of electronic medical records (EMRs) may instead enter a default value. During SSI review, Infection Preventionists (IPs) will change a wound class if the entered value does not match the operative note's description but may not adjust the EMR-generated denominator. We assessed SSI rates when adjusting both numerator and denominator based on IP review. <h3>Methods</h3> We performed a retrospective review of all National Health Safety Network (NHSN) SSIs at our institution between 1/1/2019–10/31/2021. A meaningful change was one made by an IP that would change a wound class from I or II to III or IV. We calculated rate using class I and II procedures only. We used percent meaningful of all changes to estimate IP-derived denominators. We compared rates generated by different numerators and denominators (EMR and IP) using Fisher's exact test. <h3>Results</h3> We identified 176 SSIs during the study period. Of the 82 changes made by IPs, 37 (45%) were meaningful. The proportion of meaningful changes ranged from 0-60% across all months. Out of 34 months, 21 (62%) showed a higher rate when using EMR class vs. IP class with the largest difference of 2.33 vs. 0.47 (p = 0.22). When comparing the alternative rate to IP class rate across all months, the rate was 1.14 vs. 0.91 (p=0.17). For both comparisons, September 2019 showed the largest monthly rate difference. <h3>Conclusions</h3> This study found that using EMR wound class for numerator and denominator increases the SSI rate, although not significantly different from IP class rate, even when adjusting the denominator for meaningful changes. Rates using IP class numerator and EMR class denominators are likely accurate.

Dodging the bundle—Persistent healthcare-associated rhinovirus infection throughout the pandemic

Healthcare-associated viral infections (HAVI) are a common cause of patient harm in the pediatric population. We implemented a HAVI prevention bundle in 2015, which included 6 core elements: caregiver screening, symptom-based isolation, personal protective equipment (PPE), hand hygiene, staff illness procedures, and monitoring of environmental cleanliness. Enhanced bundle elements were introduced at the start of the COVID-19 pandemic, which provided an opportunity to observe the effectiveness of the bundle with optimal adherence to prevention practices, and to measure the impact on respiratory HAVI epidemiology. Respiratory HAVIs were confirmed through review of medical records and application of the National Health Safety Network (NHSN) surveillance criteria for upper respiratory infections (URIs) with predetermined incubation periods for unit attribution. Descriptive statistics of the study population were examined, and comparative analyses were performed on demographic and process metrics. Data analysis was conducted using R statistical software. We observed an overall decrease in respiratory HAVI of 68%, with prepandemic rates of 0.19 infections per 1,000 patient significantly decreased to a rate of 0.06 per 1,000 patient days in the pandemic period (P < .01). Rhinovirus made up proportionally more of our respiratory HAVI in the pandemic period (64% vs 53%), with respiratory HAVI secondary only to rhinovirus identified during 8 of 16 months in the pandemic period. Compliance with our HAVI prevention bundle significantly improved during pandemic period. Enhancement of our HAVI bundle during the COVID-19 pandemic contributed toward significant reduction in nosocomial transmission of respiratory HAVI. Even with prevention practices optimized, respiratory HAVIs secondary to rhinovirus continued to be reported, likely due to the capacity of rhinovirus to evade bundle elements in hospital, and infection prevention efforts at large in the community, leaving vulnerable patients at continued risk.

Reducing surgical site infections after colectomy: bundle item compliance, process, and outlier identification.

The purpose of this study was to implement a checklist monitoring system and identify critical surgical checklist items associated with post-colectomy surgical site infections (SSI). The relationship between checklist compliance, infection rates, and identification of non-compliant surgeons was explored. National Health Safety Network (NHSN) data were imported annually to establish baseline incidence of post-colectomy SSI from 2016 to 2019. A colectomy checklist was used to monitor compliance for 1694 random colectomies (1274 elective; 420 emergency). Reports were generated monthly to profile system, hospital, surgeon-specific infection, and checklist compliance rates. Checklist compliance improved in elective and emergent colectomies to > 90% for all items except oral antibiotic and mechanical bowel prep in elective cases. Annualized total SSI and organ space infection rates in elective cases decreased by 33% and 45%, respectively. Elective and emergency SSI's were reduced for Superficial Incisional Primary (SIP), Deep Incisional Primary (DIP), and Intra-Abdominal Abscess (IAB) by 66%, 60.4%, and 78.3%, respectively. Checklist compliance between low (< 3%) and high (> 3%) infection rate surgeons demonstrated significantly lower utilization of oral antibiotic prep (p < 0.03) and mechanical bowel prep (p < 0.02) in high infection rate surgeons. Surgeons compliant with colectomy checklists decreased elective and emergency colectomy infection rates. Ceiling compliance rates > 95% for bundle items are suggested to achieve optimal reductions in SSIs and efforts should be focused on surgeons with NHSN infection rates > 3%. Oral antibiotic prep and mechanical bowel prep compliance rates in elective colectomy appeared to differentiate high infection rate surgeons from low infection rate surgeons.

Central-line-associated bloodstream infections and central-line-associated non-CLABSI complications among pediatric oncology patients.

To assess central venous catheter (CVC) harm in pediatric oncology patients, we explored risks for central-line-associated bloodstream infections (CLABSIs) and central-line-associated non-CLABSI complications (CLANCs). Retrospective cohort study. Midwestern US pediatric oncology program. The study cohort comprised 592 pediatric oncology patients seen between 2006 and 2016. CLABSIs were defined according to Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) definitions. CLANCs were classified using a novel definition requiring CVC removal. Patient-level and central-line-level risks were calculated using a negative binomial model to adjust for correlations between total events and line numbers. CVCs were inserted in 62% of patients, with 175,937 total catheter days. The inpatient CLABSI and CLANC rates were 5.8 and 8.5 times higher than outpatient rates. At the patient level, shared risks included acute myeloid leukemia (AML) and age <1 year at diagnosis. At the line level, shared risks included age <1 year at diagnosis, non-mediports, and >1 lumen. AML was a CLABSI-specific risk. CLANC-specific risks included non-brain-tumor diagnosis, younger age at diagnosis or central-line placement, and age <1 year at diagnosis or line placement. Multivariable risks were for CLABSI >1 lumen and for CLANC age <1 year at placement. Among patients with CVCs, CLABSI and CLANC rates were similar, higher among inpatients than outpatients. For both CLABSIs and CLANCs, infants and patients with AML were at higher risk. In both univariate and multivariate models, lines with >1 lumen were associated with CLABSIs and placement during infancy with CLANCs.

Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation.

To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). An ambidirectional observation in a 528-bed teaching hospital. All inpatients from July 1, 2012, to February 1, 2021. Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2-3 FTE), below recommended IP levels (4-6 FTE), and at recommended IP levels (7-8 FTE). The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7-8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line-associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

Impact of cascade reporting of antimicrobial susceptibility on fluoroquinolone and meropenem consumption at a Veterans’ Affairs medical center

To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption. A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumption before and after the implementation of cascade reporting. A 399-bed, tertiary-care, Veterans' Affairs medical center. Antimicrobial consumption data across 8 inpatient units were extracted from the Center for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) antimicrobial use (AU) module from April 2017 through March 2019, reported as antimicrobial days of therapy (DOT) per 1,000 days present (DP). Cascade reporting is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow-spectrum agents. A multidisciplinary team developed cascade reporting algorithms for gram-negative bacteria based on local antibiogram and infectious diseases practice guidelines, aimed at restricting the use of fluoroquinolones and carbapenems. The algorithms were implemented in March 2018. Following the implementation of cascade reporting, mean monthly meropenem (P =.005) and piperacillin/tazobactam (P = .002) consumption decreased and cefepime consumption increased (P < .001). Ciprofloxacin consumption decreased by 2.16 DOT per 1,000 DP per month (SE, 0.25; P < .001). Clostridioides difficile rates did not significantly change. Ciprofloxacin consumption significantly decreased after the implementation of cascade reporting. Mean meropenem consumption decreased after cascade reporting was implemented, but we observed no significant change in the slope of consumption. cascade reporting may be a useful strategy to optimize antimicrobial prescribing.

Coronavirus disease 2019 (COVID-19) pandemic, central-line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts.

The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on US hospitalizations, affecting processes and patient population. To evaluate the impact of COVID-19 pandemic on central-line-associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs) in hospitals. We performed a retrospective study of CLABSIs and CAUTIs in 78 US 12 months before COVID-19 and 6 months during COVID-19 pandemic. During the 2 study periods, there were 795,022 central-line days and 817,267 urinary catheter days. Compared to the period before the COVID-19 pandemic, CLABSI rates increased by 51.0% during the pandemic period from 0.56 to 0.85 per 1,000 line days (P < .001) and by 62.9% from 1.00 to 1.64 per 10,000 patient days (P < .001). Hospitals with monthly COVID-19 patients representing >10% of admissions had a National Health Safety Network (NHSN) device standardized infection ratio for CLABSI that was 2.38 times higher than hospitals with <5% prevalence during the pandemic period (P = .004). Coagulase-negative Staphylococcus CLABSIs increased by 130% from 0.07 to 0.17 events per 1,000 line days (P < .001), and Candida spp by 56.9% from 0.14 to 0.21 per 1,000 line days (P = .01). In contrast, no significant changes were identified for CAUTI (0.86 vs 0.77 per 1,000 catheter days; P = .19). The COVID-19 pandemic was associated with substantial increases in CLABSIs but not CAUTIs. Our findings underscore the importance of hardwiring processes for optimal line care and regular feedback on performance to maintain a safe environment.

Nursing home oversight during the COVID-19 pandemic.

Background/objectivesRegulatory oversight has been a central strategy to assure nursing home quality of care for decades. In response to COVID‐19, traditional elements of oversight that relate to resident care have been curtailed in favor of implementing limited infection control surveys and targeted complaint investigations. We seek to describe the state of nursing home oversight during the pandemic to facilitate a discussion of whether and how these activities should be altered going forward.Design and settingIn a retrospective study, we describe national oversight activities in January–June 2020 and compare these activities to the same time period from 2019. We also examine state‐level oversight activities during the peak months of the pandemic.ParticipantsUnited States nursing homes.DataPublicly available Quality, Certification, and Oversight Reports (QCOR) data from the Centers for Medicare and Medicaid Services (CMS).MeasurementsNumber of standard, complaint, and onsite infection surveys, number of deficiencies from standard and complaint surveys, number of citations by deficiency tag, and number and amount of civil monetary penalties.ResultsThe number of standard and complaint surveys declined considerably in the second quarter of 2020 relative to the same time frame in 2019. Deficiency citations generally decreased to near zero by April 2020 with the exception of infection prevention and control deficiencies and citations for failure to report COVID‐19 data to the national health safety network. Related enforcement actions were down considerably in 2020, relative to 2019.ConclusionIn the months since COVID‐19 first impacted nursing homes, regulatory oversight efforts have fallen off considerably. While CMS implemented universal infection control surveys and targeted complaint investigations, other routine aspects of oversight dropped in light of justifiable limits on nursing home entry. Going forward, we must develop policies that allow regulators to balance the demands of the pandemic while fulfilling their responsibilities effectively.

Blood Culture Contamination: Still Hazy After All These Years

Despite the availability of a few methods for direct pathogen detection from whole blood, a blood culture is still the main method for diagnosing bloodstream infections. Detection of organisms in a patient’s blood culture has both diagnostic and prognostic value and is one of the most important functions of the diagnostic microbiology laboratory. Blood cultures support growth of most bacteria and fungi in specialized nutrient broth, pathogen and non-pathogen alike. Thus, growth of microbes in a blood culture can signal the presence of a true bloodstream infection or skin commensal contaminant introduced during the collection of blood. Monitoring blood culture contamination rates is a critical process for microbiology laboratories. Contamination of blood cultures can lead to negative patient outcomes. Blood culture contamination leads to unnecessary antimicrobial therapy, prolonged hospital stays, additional laboratory tests, and additional costs. The National Health Safety Network recently issued a master organism list that takes effect beginning January 2021. This review focuses on discussion of blood culture contamination, the history of benchmarking of the quality metrics related to blood culture contamination, and the need to reduce the impacts of blood culture contamination with standardized benchmarks and best practices to prevent contamination.

An eight-year multicenter study on short-term peripheral intravenous catheter-related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC).

Data on short-term peripheral intravenous catheter-related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied. International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used. In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635-2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975-1.6351; P = .040).The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%. Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.

Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017–2019

BackgroundNavarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. Methods416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30 days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. ResultsThe cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories 2 and 3. ConclusionsThe incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.

Profile of Nursing Homes Enrolled in the National Health Safety Network: Focus on Interfacility Communication

Background: A robust infection prevention infrastructure is critical for creating a safe resident environment in nursing homes. The CDC NHSN provides a standardized approach to infection surveillance and analysis, which can drive internal quality improvement efforts in nursing homes and could serve as an indicator of facilities’ infection prevention aptitude. The purpose of this study was to compare the characteristics of nursing homes enrolled to those not enrolled in the NHSN, including interfacility communication methods, as an essential part of reducing resident infection-related risks. Methods: Over a 2-year period, 50 nursing homes participated in a 12-month program designed to reduce healthcare-associated infections (HAIs) by enhancing relationships between nursing homes and hospitals. Overall, 11 demographic surveys were administered to nursing homes prior to the start of the phase 1 pilot year between January and March 2018, and another 39 were administered prior to beginning phase 2 in January–February 2019. The survey consisted of 36 questions on facility characteristics, including NHSN enrollment, infection prevention and control (IPC) program and infection preventionist characteristics, and communication methods related to interfacility transfer of care. We compared facility, IPC program characteristics, and communication methods between nursing homes stratified based on NHSN enrollment. These were compared using the Fisher exact test. Results: In total, 50 nursing homes, varying in size and services provided, completed the demographic survey (Table 1). Of these 50 nursing homes, 11 (22%) were enrolled in the NHSN. Nursing homes enrolled in the NHSN were more likely to use a telephone report prior to resident transfer in and out of the facility (P = .04) and to disseminate infection data to all facility nursing staff (P = .02). Overall, less than half of nursing homes included a telephone report as part of their routine hand-off communication, and most nursing homes relied only on written transfer forms or discharge documentation. Moreover, 65% of the nursing homes reported use of a standardized method to accept new residents with history of multidrug-resistant organism (MDRO), including a review of infection or MDRO type, antibiotic orders, and ambulation status. NHSN-enrolled nursing homes were also more likely to have an antibiotic stewardship program and to use the electronic health record (EHR) to facilitate infection surveillance, though these differences were not statistically significant. Conclusions: A higher percentage of nursing homes enrolled in the NHSN engaged in activities connected with resident safety including verbal report prior to interfacility transfer and antimicrobial stewardship programs. Dedicating resources for nursing homes to enhance their IPC program including NHSN enrollment should be encouraged.Funding: This study was supported by a grant from the AHRQ (grant no. RO1HS25451).Disclosures: None

Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection.

Background/aimProlonged maintenance of central venous catheters, including peripherally inserted central catheters (PICCs), is a major risk factor for central line-associated bloodstream infection (CLABSI). This study was conducted to evaluate the appropriate duration of PICC maintenance to prevent CLABSI.MethodsA single-center retrospective study was conducted at an 824-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. CLABSI was diagnosed according to the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). To identifying statistical correlations between catheter days and PABSI, the odds ratio for PABSI on the basis of the continuous value of catheter days was analyzed using restricted cubic spline splits with five knots. The optimal cut-off value for catheter days was identified by maximizing the area under the receiver operating characteristic (ROC) curve (AUC).ResultsA total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Among them, 36 were confirmed as having a PABSI (3.5%, 36/1014; 1.14 per 1000 catheter days). In the restricted cubic spline regression, catheter days showed a dose-dependent relationship with the risk of PABSI. The AUC of the ROC curve for developing a PABSI according to the duration of catheter maintenance was 0.715 (95% CI, 0.639–0.790); the calculated optimal cut-off value was 25 days.ConclusionThe incidence of PABSI was 1.14 per 1000 catheter days and the optimal cut-off value of catheter days to avoid a PABSI was 25 days.

Incidencia de infección de localización quirúrgica en cirugía de colon según metodología RENAVE: estudio prospectivo 2017-2019

BackgroundNavarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. Methods416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. ResultsThe cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories2 and3. ConclusionsThe incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.

The Limited Utility of Ranking Hospitals Based on Their Colon Surgery Infection Rates.

BackgroundThe Centers for Medicare and Medicaid Services (CMS) use colon surgical site infection (SSI) rates to rank hospitals and apply financial penalties. The CMS’ risk-adjustment model omits potentially impactful variables that might disadvantage hospitals with complex surgical populations.MethodsWe analyzed adult patients who underwent colon surgery within facilities associated with HCA Healthcare from 2014 to 2016. SSIs were identified from National Health Safety Network (NHSN) reporting. We trained and validated 3 SSI prediction models, using (1) current CMS model variables, including hospital-specific random effects (HCA-adapted CMS model); (2) demographics and claims-based comorbidities (expanded-claims model); and (3) demographics, claims-based comorbidities, and NHSN variables (claims-plus–electronic health record [EHR] model). Discrimination, calibration, and resulting rankings were compared among all models and the current CMS model with published coefficient values.ResultsWe identified 39 468 colon surgeries in 149 hospitals, resulting in 1216 (3.1%) SSIs. Compared to the HCA-adapted CMS model, the expanded-claims model had similar performance (c-statistic, 0.65 vs 0.67, respectively), while the claims-plus-EHR model was more accurate (c-statistic, 0.70; 95% confidence interval, .67–.73; P = .004). The sampling variation, due to the low surgical volume and small number of infections, contributed 74% of the total variation in observed SSI rates between hospitals. When CMS model rankings were compared to those from the expanded-claims and claims-plus-EHR models, 18 (15%) and 26 (22%) hospitals changed quartiles, respectively, and 10 (8.3%) and 12 (10%) hospitals changed into or out of the lowest-performing quartile, respectively.ConclusionsAn expanded set of variables improved colon SSI risk predictions and quartile assignments, but low procedure volumes and SSI events remain a barrier to effectively comparing hospitals.

1248. 30-Day Colon Surgical Site Infections: Using NSQIP to Cross Check NHSN

BackgroundWhile infection prevention (IP) programs utilize National Health Safety Network (NHSN) definitions, surgical site infection (SSI) case-finding methods may vary between facilities based on resources and availability/type of healthcare-associated infection (HAI) electronic surveillance tracking software. Furthermore, surgeons may receive SSI data from other databases such as National Surgery Quality Improvement Project (NSQIP) which has slightly different definitions and case finding methodologies. Our goal was to compare colon SSIs across our health system found by IP using NHSN definitions to those obtained utilizing NSQIP case finding methodology and definitions.MethodsBetween January 2018 and September 2018 across 8 acute care facilities ranging in size from 100 to 898 beds, HAI electronic surveillance tracking triggered IP and infectious diseases (ID) trained physician review for NHSN SSI criteria if a patient was either readmitted or had a positive culture within 30 days of colon surgery. SSI results were compared with NSQIP SSI data which reviews all charts and conducts post-discharge surveillance during active surveillance periods. All discrepant cases were reviewed by an infection preventionist, an ID physician and surgery physician champion. Cases were classified as discrepant due to different case inclusion criteria, different case finding or clinical misclassification.Results69 cases were reviewed. Both databases called 11 cases (16%) an SSI initially. NSQIP identified 35 cases that were not detected by IP surveillance. Of the 35 NSQIP detected SSI, 17 (49%) were felt to meet NHSN SSI criteria after review (7 organ space, 10 superficial). Majority (76%) were discordant due to case finding issues (diagnosed as outpatient, same hospital course with no cultures to flag for review). Two infections were missed because of human error. Once the SSIs were entered into NHSN, only one facility had an increase in the SIR which impacted interpretation of SSI performance (from 0.949 up to 1.423). NHSN identified 23 cases that were not identified in the NSQIP database. There were 8 organ space infections and 8 superficial site infections.ConclusionWithout 100% surveillance, SSIs may be missed. Not all missed infections were superficial. Opportunities were found for both NHSN and NSQIP.Disclosures All authors: No reported disclosures.