Patient Rooms Research Articles

Deterministic Modeling of MIMO Communication Within Typical Hospital Patient Rooms

Deterministic Modeling of MIMO Communication Within Typical Hospital Patient Rooms

More than just cleaning: A qualitative descriptive study of hospital cleaning staff as caregivers

Background: Cleaning staff in hospitals can spend an average of 10–20 min per day per patient room. Published literature shows a pattern of interactions between housekeepers and patients, and that they believe themselves to be a part of the patient care team, but to date, no study has framed them as a caregiving population.
 Who is it for? Clinicians, healthcare staff, administrators & faculty
 Involvement & Engagement: Study design was co-created by the principal investigator and co-authors. Two members of the Environmental Services department at UC Davis Health were consulted in developing study aims and an online survey. (Survey data not included in article)
 Objective: To describe the experiences and perceptions of hospital housekeeping staff in relation to patient care.
 Setting: A 625-bed tertiary, academic medical center in the United States.
 Design & Methods: Eight housekeeping staff participated in this qualitative descriptive study. Design, implementation and monitoring was a product of collaboration between co-authors. Participants ranged from 40 to 62 years old, from diverse cultural and ethnic backgrounds, and worked at the study hospital from 4 months to 20 years. Interviews were conducted between September 2020-October 2020. Participants were recruited through flyers, email, and snowball sampling. Data were collected through semi-structured, in-depth interviews lasting 30 – 60 min. Data were analysed through thematic analysis using a 6-step framework that included data familiarization, generation of initial codes, search for themes, review of data, definition and naming of themes, and generation of a written report. Trustworthiness of the data was established through strategies such as reflective journaling, researcher triangulation and member-checking.
 Results: Three themes emerged: 1) “Here to take care of you” 2) Difficulties & Coping: and 3) Perceptions of their role. These three themes provide insight into participants' perceptions of patient interactions and the kind of connections they formed with patients as they went about their duties.
 
 Implications: The potential for cleaning staff providing care to patients opens multiple possibilities for future research. There is little understanding of this phenomenon from the patient perspective, and of the ways in which cleaning staff can support inter-professional care and collaboration. The retention of experienced staff is vital and so wages which reflect the value of their work must not be overlooked. Their contribution can also be recognized by giving them equal access to the same health benefits and paid sick leave, vacation leave as other staff. 
 Study findings suggest that there exists among housekeeping staff a respect for the humanity of patients, a duty to protect people from disease, and a longstanding practice of engaging in therapeutic connections with patients. These results reveal an opportunity to expand our understanding of who we call a caregiver, and to improve how we recognize and support each member of the healthcare team.
 https://www.sciencedirect.com/science/article/pii/S2666142X22000364

TASR in suicide risk evaluation in patients in crisis

Introduction and objective: To determine the value of the Tool for Assessment of Suicide Risk (TASR) for assessing suicide risk in the psychiatry admission room in patients in suicide crisis. Materials and methods: A case-control study was planned. The case group consisted of patients hospitalised after suicide attempt in suicide crisis (with diagnosed or suspected adjustment disorder). The control group comprised those with no previous suicide attempts. The TASR was performed in the admission room after psychiatric examination. Sociological data were also taken and included in the analysis. Results: In total, 82 patients hospitalised in psychiatric wards/acute poisons ward (aged 18–79 years) were recruited, of these 79 were included in the analysis (54 women, 25 men). No significant demographic nor socioeconomic differences were found between the case and control groups. Intergroup differences, at least at trend level, were observed for age over 65, harmful substance use, a history of physical or sexual abuse, anhedonia, anxiety and impulsive behaviour. No significant differences were noted in suicidal ideation, intention and plan. The proposed optimal total TASR score cut-off points between low, medium and high risk are 14 and 22 points. Conclusions: The TASR can be used in suicidal risk assessment in patients in crisis, but a holistic assessment is more important than one focused on individual risk factors, even suicidal thoughts or tendencies. However, the tool demonstrates low discriminatory power.

Thoughts and Attitudes of Surgical Nurses on Planned Discharge Education and Influencing Factors

The shortening of the discharge time due to technological developments requires the patients to be discharged with sufficient information about the recovery process they will spend at home. Consequently, discharge planning and patient education are becoming more and more important in surgical patient care day by day. The aim of the study is to determine the thoughts and attitudes of surgical nurses related to discharge of patients after surgery and influencing factors. This descriptive study included 192 surgical nurses. Data were obtained with a questionnaire designed by researchers. It was found that 83.3% of the nurses provided discharge education to the patients and 71.9% of them implemented this education in a planned manner. In addition, while most of the nurses planned discharge education at the time of discharge, only 38.3% planned it at the time of hospitalization. Planned discharge education is usually given in the patient's room (93.0%), verbally (98.3%), taking into account the patient's age and education level (79.1%). Wound care (80.0%), self-care activities (79.1%) and drug therapy (73.0%) were the top three training topics. The institution where the nurse works, the clinic and the number of patients cared for in each shift are the top three factors affecting the provision of planned discharge education.

ANALISIS PROSEDUR PENDAFTARAN PASIEN RAWAT JALAN BPJS IGD GUNA MENUNJANG EFEKTIVITAS PELAYANAN DI RUMAH SAKIT MUHAMMADIYAH BANDUNG


 This study aims to describe the procedures for registering outpatient care at the BPJS IGD to support the effectiveness of services at Muhammadiyah Bandung Hospital. The research method used is a qualitative method with a descriptive approach. Data collection techniques use observation, interviews and questionnaires. From the research results obtained, descriptive analysis of the questionnaire. service time for patient registration was 84%. Meanwhile, the service provider style factor is 81%, which means that these two indicators are effective. However, there are several obstacles that arise, including: 1) There are still patients who do not know about the use of BPJS; 2) There are many BPJS patients who do not know about the registration procedure for outpatient emergency care and patients are still not active in seeking information about registration procedures at the IGD at Muhammadiyah Bandung Hospital. Problem solving efforts that have been made by the hospital to increase the effectiveness of services at the Bandung Muhammadiyah Hospital are: 1) socializing related to BPJS rules in the emergency room for patients; 2) The hospital provides KIUP, so that if there are patients who do not bring KIB, their identity can be found using KIUP.
 Keywords : Registration Outpatient, Outpatient, Effectiveness of services

GENDER-BASED VIOLENCE IN HOMICIDE–SUICIDE EVENTS: A CALL FOR ADHERENCE TO THE CDC DEFINITION FOR “MERCY KILLING”

Abstract Intimate partner homicide suicide (IPHS) events are overwhelmingly male perpetrated (90%). Gender-based violence (GBV) prevention requires ‘best practices’ for media reporting. Consider the following: In a patient room of a busy hospital, an overwhelmed man (71) suicided after firing shots at his wife (70) who had survived a stroke. The gunfire caused trauma among witnesses. Media reports used the term ‘mercy killing,’ but critical ingredients were missing. The CDC’s NVDRS (2022) defines ‘mercy killing’ as “…Killed, at the victim’s request…to end…pain or distress…Do not assume…murder/suicide by a sick, elderly couple is mercy killing.” Evidence of a clear wish to die, is needed “due to a hopeless or terminal condition.” Our IPHS, news surveillance study was updated 1999-2022 and used content analysis to identify GBV rationalizations, based upon 2219 events and over 5000 fatalities across young (n=987), middle aged (n=699), and older 60+ (n=533) categories. Only the 60+ group had claims of ‘mercy killing,’ mostly without adherence to the CDC definition. Older men who are suicidal may also harm an unsuspecting partner. For women, end of life decision-making is lost in ‘safe spaces,’ like homes or care facilities, which is made worse by rationalized excuses. Women are rarely suicidal and use passive methods (i.e., drugs). When women care for an ailing partner, they don’t commit IPHS. Older men are more suicidal and utilize more lethal firearm methods (similar to the IPHS patterns). Media best practices involve valuing persons with disabilities, publicizing services and recognizing violence is a public health problem.

Dynamics of Staphylococcus aureus in patients and the hospital environment in a tertiary care hospital in the Netherlands

BackgroundThe dynamics of Staphylococcus aureus in patients and the hospital environment are relatively unknown. We studied these dynamics in a tertiary care hospital in the Netherlands.MethodsNasal samples were taken from adult patients at admission and discharge. Isolates cultured from clinical samples taken before and during hospitalization from these patients were included. Environmental samples of patient rooms were taken over a three-year period. Finally, isolates from clinical samples from patients with an epidemiological link to S. aureus positive rooms were included. Staphylococcal protein A (spa) typing was performed.ResultsNasal samples were taken from 673 patients. One hundred eighteen (17.5%) were positive at admission and discharge, 15 (2.2%) patients acquired S. aureus during hospitalization. Nineteen patients had a positive clinical sample during hospitalization, 15.9% of the S. aureus were considered as from an exogenous source. One hundred and forty (2.8%) environmental samples were S. aureus positive. No persistent contamination of surfaces was observed. Isolates were highly diverse: spa typing was performed for 893 isolates, identifying 278 different spa types, 161 of these spa types were observed only once.ConclusionLimited transmission could be identified between patients and the hospital environment, and from patient-to-patient. Exogenous acquisition was assumed to occur in 15% of clinical samples. Environmental contamination was infrequent, temporarily, and coincided with the strain from the patient admitted to the room at that time. MRSA was rare and not found in the environment.

Reenvisioning Patient Education with Smart Hospital Patient Rooms

Smart hospital patient rooms incorporate various smart devices to allow digital control of the entertainment --- such as TV and soundbar --- and the environment --- including lights, blinds, and thermostat. This technology can benefit patients by providing a more accessible, engaging, and personalized approach to their care. Many patients arrive at a rehabilitation hospital because they suffered a life-changing event such as a spinal cord injury or stroke. It can be challenging for patients to learn to cope with the changed abilities that are the new norm in their lives. This study explores ways smart patient rooms can support rehabilitation education to prepare patients for life outside the hospital's care. We conducted 20 contextual inquiries and four interviews with rehabilitation educators as they performed education sessions with patients and informal caregivers. Using thematic analysis, our findings offer insights into how smart patient rooms could revolutionize patient education by fostering better engagement with educational content, reducing interruptions during sessions, providing more agile education content management, and customizing therapy elements for each patient's unique needs. Lastly, we discuss design opportunities for future smart patient room implementations for a better educational experience in any healthcare context.

EFFECTIVENESS ENHANCED RECOVERY AFTER CAESAREAN SURGERY (ERACS) ON CONSCIOUS RECOVERY TIME IN SECTIO CAESAREA PATIENTS IN THE RECOVERY ROOM OF RSAD TK. II UDAYANA

Background: Enhanced recovery after Caesarean surgery (ERACS) is a method of perioperative care in the form of a multimodal approach. ERACS is a good method of pain management by reducing opioid use by 30-50 percent and using intravenous fluid therapy and a good combination of anti-nausea drugs. The ERACS technique was carried out starting from pre-intra and post-surgery. In its implementation, ERACS has various benefits, namely reducing postoperative complications, accelerating conscious recovery, saving costs and reducing morbidity. Urgency of this research is to find out effective surgical methods to speed up early postpartum mobilization without pain.
 Objective: To determine the effectiveness of the ERACS technique for conscious recovery in sectio caesarea patients with spinal anesthesia in the recovery room.
 Method: This study used a quasi-experimental with a cross-sectional approach using 2 groups, namely the control group and the treatment group. This research was carried out in June-August 2022 at TK II Udayana Hospital with 60 respondents for the control group and 60 for the treatment group. The research instrument uses a standard bromage score observation sheet. The research process was carried out by giving informed consent to the 2 groups and then post-surgery an assessment of conscious recovery was carried out in both groups.
 Results: The results of the study in the treatment group showed that the ERACS method had a faster recovery time of 15-30 minutes. The control group, namely the conventional method, has a longer conscious recovery time of 30-60 minutes. The statistical test Mann-Whitney test is sig <0.05 that can be concluded that ERACS is effective in decreasing the time to recover consciousness in the recovery room in patients with elective sectio caesarea surgery at RSAD Tk.II Udayana.
 Conclusion: The ERACS method is effective in accelerating the time to recover from consciousness in the recovery room and accelerating recovery in patients with elective sectio caesarea surgery at RSAD Tk.II Udayana. Therefore, the application of ERACS can be an effective choice to accelerate postoperative recovery with caesarean section.

Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial

ObjectiveTo evaluate the effect of chair placement on length of time physicians sit during a bedside consultation and patients’ satisfaction.DesignSingle center, double blind, randomized controlled deception trial.SettingCounty hospital in Texas,...

Integrative Lighting Aimed at Patients with Psychiatric and Neurological Disorders.

The purpose of this paper is to investigate the impact of circadian lighting-induced melatonin suppression on patients with psychiatric and neurological disorders in hospital wards by using an ad-hoc metrology framework and the subsequent metrics formalized by the CIE in 2018. A measurement scheme was conducted in hospital ward rooms in the Department of Neurology, Zealand University Hospital, at Roskilde in Denmark, to evaluate the photometric and colorimetric characteristics of the lighting system, as well as its influence on the circadian rhythm of the occupants. The measurement scheme included point measurements and data logging, using a spectrophotometer mounted on a tripod with adjustable height to assess the newly installed circadian lighting system. The measured spectra were uploaded to the Luox platform to calculate illuminance, CCT, MEDI, etc., in accordance with the CIE S026 standard. Furthermore, the MLIT based on MEDI data logging results was calculated. In addition to CIE S026, we have investigated the usefulness of melatonin suppression models for the assessment of circadian performance regarding measured light. From the results, the lighting conditions in the patient room for both minimal and abundant daylight access were evaluated and compared; we found that access to daylight is essential for both illumination and circadian entrainment. It can be concluded that the measurement scheme, together with the use of the Luox platform and Canva template, is suitable for the accurate and satisfactory measurement of integrative lighting that aligns with CIE requirements and recommendations.

Intraoperative Fluid Management Correlates with Intraoperative Complications in Cesarean Section: A Prospective Clinical Trial

Background: This study focused on perioperative fluid administration in pregnant women undergoing a caesarean section (CS) by comparing liberal and non-liberal fluid administration in a multicentre setting across various Hospitals in the Bali province and its surrounding areas.
 Methods: Sampling was conducted using a total sampling method. All patients meeting the inclusion criteria were included in this study. A total of 310 samples of pregnant patients undergoing CS surgery in various operating rooms across hospitals in the Bali province and surrounding areas were obtained during the period of January to December 2022. The fluid administration strategy was divided into two types: liberal and non-liberal. Data analysis was performed using the Chi-square test with the correlation test of the contingency coefficient.
 Results: The results showed that liberal fluid administration significantly increased complications in the operating room for pregnant patients undergoing cesarean section (p<0.001; r=0.305; OR 6.22) but not in the recovery room or postoperative hospital ward.
 Conclusion: Liberal fluid administration could significantly increase complications in the operating room for pregnant patients undergoing cesarean section but not in the postoperative period.

Infection precaution adherence varies by potential exposure risks to SARS-CoV-2 and job role: Findings from a US medical center

BackgroundInfection precautions (IP) facilitate standardized and safe patient care. Research has demonstrated several barriers to IP adherence among health care personnel (HCP) but potential exposure risk to SARS-CoV-2 and job role has not been considered. MethodsResearchers used self-reported baseline surveys with 191 HCPs at a university medical center to examine factors that may have affected IP adherence (eg, personal protective equipment [PPE] and hand hygiene errors) over the 2 weeks prior to the survey. Chi-square tests were used to determine if differences existed first, among job role and IP adherence, and second, the potential risk of exposure to SARS-CoV-2 and IP adherence. A binary logistic regression estimated if PPE nonadherence was associated with COVID-19 stress, job role, and potential exposure risk to SARS-CoV-2. ResultsPPE nonadherence varied by job role. Those in the Other group (ie, nonphysician/non-nursing HCP) reported significantly fewer errors (9.6%) compared to Physicians (26.5%) and Registered Nurses (33.3%). Hand/glove hygiene errors between COVID-19 patient rooms varied by job role. Respondents who had higher risks of exposure to SARS-CoV-2 were 5.74 times more likely to experience errors. ConclusionsThe results provide implications for adopting systems-level approaches to support worker knowledge and engagement across job roles to improve IP adherence.

The effect of window design factors on the cooling load in hospitals wards

PurposeThis paper investigates the optimization of window design factors (WDFs) in hospital buildings, particularly in government hospitals within the arid climate of the Qassim region, with the aim of achieving a better cooling load reduction. Continuous monitoring of the hospital ward section is crucial due to patients' needs, requiring optimal indoor air quality and cooling load.Design/methodology/approachThe study identifies the optimal conditions for WDF design to mitigate cooling load, including window-to-wall ratio (WWR), window orientation (WO), room size and U-value (thermal properties), effectively reduce energy consumption in terms of sensible cooling load (MWh/m2) and comply with local codes. Data collection involved a smart weather station, while the Integrated Environmental Solution Virtual Environment (IESVE) software facilitated the simulation process.FindingsKey findings reveal that larger patient rooms were about 40% more energy-efficient than smaller rooms. The northern orientation showed lower energy consumption, and specific WWRs and glazing U-values significantly affected energy loads. In an analysis of U-value changes in energy performance based on the Saudi Building Code (SBC), the presented values did not meet the minimum energy consumption standards. For a valid 40% WWR with a thermal permeability of 2.89, 0.181 MWh/m2 was consumed, while for an invalid 100% WWR with the same permeability but facing the north, 0.156 MWh/m2 was consumed, which is considered an invalid practice. It is vital to follow prescribed standards to ensure energy efficiency and avoid unnecessary costs.Originality/valueFocus lies in emphasizing the significance of adhering to prescribed standards, such as SBC, to guarantee energy efficiency and prevent unwarranted expenses. Additionally, the authors highlight the crucial role of optimizing glazing properties and allocating the WWR appropriately to achieve energy-efficient building design, accounting for diverse orientations and climatic conditions.

Analysis of Radiation Exposure Level on Linen and Other Objects in Patient Rooms at Nuclear Medicine Installation

Analysis of radiation contamination levels has been carried out using an Atomtex surveymeter in the patient rooms after thyroid cancer ablation therapy, in the Nuclear Medicine Installation, Abdoel Wahab Sjahranie Hospital. This study aims to measure the level of radiation exposure based on the rate of radiation exposure and radiation contamination of objects in the patient rooms after ablation therapy, and to find out how long linen can be washed since the first measurement. Data collection was carried out once a week, on the same weekday, for five weeks for objects in the patient rooms by using the surveymeter at a fixed distances from the objects’ surfaces. Radiation contamination measurements for linen items were carried out for 3 d by aiming the surveymeter to container containing linen items from certain distances. Based on this study, the level of radiation exposure obtained is categorized as low because the value range is below 10 μSv/h. The radiation contamination for some objects are categorized as low-level exposure because the value is less than 3.7 Bq/cm2. Other objects tend to be in the moderate-level category because the value is more than 3.7 Bq/cm2 and less than 37 Bq/cm2. The values obtained refer to the standard issued by BATAN. It can be concluded that the patient rooms in the Nuclear Medicine Installation of Abdoel Wahab Sjahranie Hospital are safe.

The Musical Semiotics of Voice in Distance: Some Reflections on the Question of Teleanalysis.

Within the context of the debate over teleanalysis, I wish to reintroduce the discussion of voice as the primary link between analyst and patient, a link present in analysis on the phone. Far from questioning the importance of the in-person analysis, I aim to emphasize the voice, the musical semiotics of emotions, as a critical, if not the most vital, aspect of psychoanalysis as a "talking cure" and an art of listening. Insofar as the speaking is instituted in the body, the body is present through voice, even in the virtual analytic room in teleanalysis. I argue that the need for the presence of the material bodies in the session is one aspect of the analytic rituals that, along with the room, the couch, and other power objects, set the stage for the continuous projection of the role identities of the analytic couple. In teleanalysis, the seductive nature of the analytic situation and the status differential are more salient in the analyst's office turf than in the patient's room.

Effectiveness of SplashGuard Caregiver prototype in reducing the risk of aerosol transmission in intensive care unit rooms of SARS-CoV-2 patients: a prospective and simulation study

The contagiousness of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is known to be linked to the emission of bioaerosols. Thus, aerosol-generating procedures (AGPs) could increase the risk of infection among healthcare workers (HCWs). To investigate the impact of an aerosol protection box, the SplashGuard Caregiver (SGGC) with suction system, by direct analysis of the presence of viral particles after an AGP, and by using the computational fluid dynamics (CFD) simulation method. This prospective observational study investigated HCWs caring for patients with SARS-CoV-2 admitted to an intensive care unit (ICU). Rooms were categorized as: SGCG present and SGCG absent. Virus detection was performed through direct analysis, and using a CFD model to simulate the movement dynamics of airborne particles produced by a patient's respiratory activities. Of the 67 analyses performed, three samples tested positive on quantitative polymerase chain reaction: one of 33 analyses in the SCCG group (3%) and two of 34 analyses in the non-SGCG group (5.9%). CFD simulations showed that: (1) reduction of the gaps of an SGCG could decrease the number of emitted particles remaining airborne within the room by up to 70%; and (2) positioning HCWs facing the opposite direction to the main air flow would reduce their exposure. This study documented the presence of SARS-CoV-2 among HCWs in a negative pressure ICU room of an infected patient with or without the use of an SGCG. The simulation will help to improve the design of the SGCG and the positioning of HCWs in the room.

Should a forgotten guidewire be removed after years? An undesirable complication of hemodialysis catheter wire left in the body

Today, one of the most common methods used in the emergency room or intensive care unit (ICU) in patients is the Seldinger technique to access the central venous system, shunting for hemodialysis, intra-aortic balloon pump, or arterial insertion. Accidental leaving of the guide wire is an uncommon but important complication that can occur as a result of an incorrect technique, and it is sometimes found accidentally or due to complications years after the procedure. The case is a 53-year-old patient who underwent aortic valve replacement with a mechanical valve and mitral valve repair with a ring 12 years ago and was treated with warfarin. Two years after the heart surgery, due to chronic renal failure, the patient underwent dialysis, and after the preparation of an arteriovenous fistula, he underwent stenting. After approximately ten years, the patient developed fever, chills, and shortness of breath. During the examination, endocarditis was diagnosed, and a part of the aortic valve was released. There was a severe paravalvular leak in the aortic valve, and an abscess was formed in the aorta root. We also noticed a forgotten guide wire in the superior vena cava, right atrium, inferior vena cava, and hepatic vein, and echogenic masses were located on the guidewire. The diagnosis was confirmed by echocardiography, chest x-ray, and phenocopy. After antibiotic therapy, the patients underwent heart surgery, aortic valve replacement, and aortic root repair, and the guidewire was removed (70 cm long). Unfortunately, despite all measures, the patient died a few days after the surgery. Due to complications, a forgotten guidewire should be removed immediately after diagnosis. The preferred intervention is the removal of the guidewire by endovascular interventions, but surgical treatment should also be considered in some cases.

Does Implementing Calendars Outlining Inpatient Chemotherapy Schedules in Patient Rooms Improve Patient's Experience?

Background: Patients who receive inpatient chemotherapy for malignancy are dealing with both a physically and mentally challenging admission. Their chemotherapy regimen is predetermined and usually only discussed during rounds. Often times, patients feel overwhelmed and may miss the outline of their schedule. Furthermore, patients families may not be able to attend morning rounds and may miss the proposed schedule. This can lead to a feeling of loss of control in both the patient and their family, and thus, frustration. First year medicine residents are also overwhelmed with a large patient load and having to keep track of multiple chemotherapy regimens. We are hoping that by providing a calendar that outlines patient's anticipated chemotherapy schedule, we may be able to give patients a small sense of control back and help residents provide the best care to their patients. Ultimately, we hope that this leads to a better inpatient experience. Methods: Patients admitted to the hematology/oncology floor at Henry Ford Health Hospital in Detroit, Michigan over three months were screened, and those receiving inpatient chemotherapy were selected. Within this group, any patient that was getting inpatient chemotherapy for longer than three days was asked if they would like to participate in the study. If the patient agreed, they were provided a calendar that outlined their chemotherapy schedule. Calendars were updated if any adjustments were made to the schedule. At the end of their inpatient stay, patients filled out a questionnaire asking if the calendar helped them understand their schedule better. The primary resident caring for the patient was also asked if the calendar helped them keep track of their patient's schedule. Results: Overall, patients responded positively to the calendars. We have preliminary data on ten patients and four providers from three months. On average, on a scale of 1-10 (with 1 indicating not helpful at all, and 10 indicating extremely helpful) patients rated the calendars helping them at a level of 7.5. Patients found that the calendars particularly helped their families who were not able to come visit in the hospital. Providers found the calendars extremely helpful, rating the calendars at a level of 10. We will continue to collect data and update our results. Conclusions: Implementing patient calendars in inpatient rooms helps patients keep track of their chemotherapy schedules and leads to a positive inpatient experience. We are hoping to implement this as a standard of care in all inpatient rooms on the hematology/oncology floor.

1422. Surveillance for fungi in hospital environments housing high-risk hosts using culture and culture-independent methods

Abstract Background Nosocomial outbreaks of fungal infections are increasingly reported. There are scant data on fungal burdens in hospital environments. Standardized surveillance methods are lacking. Methods We developed culture and culture-independent (real-time PCR, reference to standard curve) methods for measuring airborne fungal burdens using SAS Super 100 and SASS 3100 Dry Air samplers. We performed serial surveillance in 7 units with high-risk, immunosuppressed patients in 2 hospitals and outside. Results Methods were optimized for multiple variables, including volume, duration, flow of air sampling; culturing techniques (direct impact plates, cultures at different stages of filter processing); filter DNA recovery (extraction protocols, stage of filter processing); PCR (targets, primers, PCR parameters). To date, we have surveyed each unit ≥4 times. Pathogenic moulds were cultured in >50% of outdoor and indoor air, including azole-resistant Aspergillus species [Figures 1A-B]. Fungal burdens were significantly greater outside than inside hospitals, by both positive culture % and DNA burden [Figure 2]. There was no correlation between outside and inside genome equivalents (GEs; R2< 0.06), nor were there significant differences in GEs within a given unit (nurses stations, patient rooms; all p >0.1). GEs were greater in culture-positive than culture-negative samples (Aspergillus, 2.4 vs. 1.5 log10; pan-fungal, 2.8 vs. 1.5 log10GE; p< 0.0001; best results with sonicated filters). Direct impact cultures were less sensitive than filter cultures. Conclusion We developed standardized methods for sampling airborne fungi in hospitals that yield reproducible results. Fungal burdens were significantly lower in hospitals than those immediately outside, but fungal DNA and viable Aspergillus and other moulds were commonly recovered from units housing high-risk patients. Outside fungal burdens could not be used to estimate relative burdens within hospitals. Direct impact cultures, commonly used in surveillance, lacked sensitivity for detecting viable fungi and did not correlate with DNA burdens. We are optimizing direct metagenomic sequencing from airborne samples. We will assess correlations between environmental surveillance data and nosocomial fungal infections. Disclosures Alexander Sundermann, DrPH, CIC, FAPIC, OpGen: Honoraria Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant