Patient Rooms Research Articles

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

1337. Detection of SARS-CoV-2 using an electrostatic precipitator air sampler in hospital patient rooms of coronavirus disease-2019 and public areas

Abstract Background Monitoring of airborne viruses in the air is a crucial step in the design of appropriate prevention and control measures. We used a novel wet-type electrostatic precipitator air sampler using a viral dissolution buffer containing a radical scavenging agent to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the air of a hospital room of coronavirus disease-2019 (COVID-19) patients and public areas. Methods The concentration of SARS-CoV-2 RNA in the air of hospital rooms of a total of 10 consented patients hospitalized for COVID-19 was measured using an electrostatic precipitator air sampler between February and August 2022. The air sampler was also used to measure the concentration of SARS-CoV-2 RNA in the air of an office room during the working hour, a food court of a shopping mall during lunchtime on a holiday, and a station corridor during morning and evening commuting hours. The office room and food court were 340 m3 and 2000 m3, respectively, and contained about 30 and 300 people, respectively, who removed their masks when eating, drinking, and talking. The station corridor was 1500 m3 in size and contained 100 people all wearing masks and had been walking during sampling. SARS-CoV-2 RNA collected in Buffer AVL was extracted using QIAamp Viral RNA mini kit and quantified by the real-time quantitative PCR (RT-qPCR) targeting the N2 region. SARS-CoV-2 RNA concentration in the air of each space was calculated from the amount of collected viral RNA, the air volume required for the collection, and the particle collection efficiency of the sampler. Results SARS-CoV-2 RNA ranging from 1.0 x 102 to 2.4 x 104 copies/m3 was detected in the air of the rooms of all eligible patients (Table 1). The patient with the longest viral detection in the air of the room was a severely ill patient with 1.3 x 103 copies/m3 viral RNA until 18 days after illness onset. In the office room and food court, 7.8 x 102 copies/m3 and 1.9 x 102 copies/m3 viral RNA were detected, respectively (Table 2).Table 1.Clinical characteristics of the patients and SARS-CoV-2 viral RNA concentrations in the hospital room air. The Gray shaded columns indicate the hospitalization period. *Ct value: Cycle threshold values of nasopharyngeal SARS-CoV-2 PCR on admission. ND**: Not detected.Table 2.RT-qPCR detection results of SARS-CoV-2 in the indoor environment and suspended concentrations. Conclusion The electrostatic precipitator air sampler is useful for measuring SARS-CoV-2 RNA in the air of hospital rooms of COVID-19 patients and of public spaces. Airborne viral RNA monitoring may aid in appropriate airborne infection control. Disclosures Hiroaki Baba, MD, PhD, Amano Co., Ltd.: Grant/Research Support Kyohei Fukuda, n/a, AMANO Co., Ltd.: KF was supported by AMANO Co., Ltd. in the form of salaries. Mie Yoshida, n/a, AMANO Co., Ltd.: MY was supported by AMANO Co., Ltd. in the form of salaries. Kouichi Kitabayashi, n/a, AMANO Co., Ltd.: KK was supported by AMANO Co., Ltd. in the form of salaries. Shinjirou Katsushima, n/a, AMANO Co., Ltd.: SK was supported by AMANO Co., Ltd. in the form of salaries. Hajime Kanamori, MD, PhD, MPH, Amano Co., Ltd.: Grant/Research Support Koichi Tokuda, MD, PhD, MPH, AMANO Co., Ltd.: Grant/Research Support

Understanding the Challenges Nurses Encounter with Monitoring Technologies in a NICU

A neonatal intensive care unit (NICU) provides an optimal environment for the care of preterm babies. Bedside nurses are fundamental to this care provided to preterm babies in the NICU. Modern NICUs are technology-intensive space, instrumented with several monitoring technologies to help the nurses track the babies in their care. These technologies help the nurses in a way that is essential for the successful operation of the NICU. To understand how these monitoring technologies function in the NICU from the viewpoint of the nurses, we conducted semi-structured interviews with seven nurses who work at a NICU in the US. We then performed a thematic analysis on the interviews and we found that, despite the utility of the monitoring technologies, they also pose several challenges to the nurses in performing their duties. More specifically, we discovered that: (1) all elements of the monitoring technologies posed a challenge in some way; (2) in a few specific situations, the nurses were able to make up for some of these challenges; and (3) the nurses suggested improvements to all elements of the monitoring technologies. Based on these findings, we describe six areas of future research that argue for the design of monitoring technologies as a way to empower nurses. These include: improved vital signs monitoring that facilitate kangaroo care, using voice to manage alarms, video feeds controlled by nurses in the patient rooms, giving more control over the alarm sounds to the nurses, having a common interface and leveraging augmented reality to help the nurses control the monitoring technologies.

Assessing airborne transmission risks in COVID-19 hospitals by systematically monitoring SARS-CoV-2 in the air.

The continuous emergence of highly infectious SARS-CoV-2 variants with the capability of immune evasion demands more effective risk assessment and management approaches for infection prevention and control. Controlling nosocomial transmission is critical in response to the COVID-19 pandemic upon the resumption of day-to-day activities. Here, we systematically analyzed the presence of airborne SARS-CoV-2 in the isolation ward and within the contaminant, emergency, and clean zones of a designated COVID-19 hospital. A total of 359 air samples collected in the clean and emergency zones tested negative for SARS-CoV-2, demonstrating the interruption of airborne transmission in a designated COVID-19 hospital by combining the closed-loop management, unidirectional airflow, and negative pressure of isolation wards. In contrast, some air samples in the corridor outside the isolation wards tested positive for SARS-CoV-2. The leakage of virus-containing air from patient rooms to adjoining areas during rounds and meal delivery sheds light on the need for intensive and widespread virus monitoring in designated COVID-19 hospitals. In conclusion, by systematically monitoring viruses in the air, the study provides a starting point for the standardization of transmission risk management in designated hospitals for the future pandemic of a newly emerged respiratory infectious disease.IMPORTANCERisk management and control of airborne transmission in hospitals is crucial in response to a respiratory virus pandemic. However, the formulation of these infection control measures is often based on epidemiological investigations, which are an indirect way of analyzing the transmission route of viruses. This can lead to careless omissions in infection prevention and control or excessively restrictive measures that increase the burden on healthcare workers. The study provides a starting point for standardizing transmission risk management in designated hospitals by systemically monitoring viruses in the air of typical spaces in COVID-19 hospitals. The negative results of 359 air samples in the clean and emergency zones demonstrated the existing measures to interrupt airborne transmission in a designated COVID-19 hospital. Some positive cases in the corridor of the contaminant zone during rounds and meal delivery highlighted the importance of monitoring airborne viruses for interrupting nosocomial infection.

Abstract 307: In-Situ Simulation-Based Booster ACLS Training to Increase the Confidence and Performance of Internal Medicine Residents as Code Blue Leaders - A Quality Improvement Project

Background: In the United States, nearly 290,000 adult patients develop in-hospital cardiac arrest (IHCA) every year. Delivery of guideline-based resuscitation has improved patient outcomes. During 2022, our hospital had 68 inpatient i.e., approximately 1 code/resident. Residents have reported desire for more exposure. The 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommended: 1) booster training, 2) in-situ simulation-based resuscitation training, and 3) specific teamwork and leadership training for healthcare providers. We aimed to implement such training to achieve an improvement in resident confidence and performance as code blue leaders. Methods: Pre-intervention, residents completed a 5-item 0-100 continuous scale to assess confidence in major code leader skills (Fig 1-A). Interventions included: 1) Calling residents to patient rooms to run simulation-based codes, and 2) a didactic session that discussed common errors during codes. Time to key ACLS steps was recorded during the simulations. At the end of the project, residents completed the post-intervention survey of confidence and balancing measures. Results: 13 residents led simulation-based codes, 20 attended the didactic session, and 25 completed the survey. Resident confidence in the defined skills increased by an average of 30%. (P<0.05) (Fig 1-A). Residents who led codes after the didactic session had shorter times to key ACLS steps (Fig 1-B). Balancing measures included resident-reported satisfaction and perceived disruption to clinical workflow (100% and 0% of responses, respectively). Conclusions: In-situ simulation-based booster ACLS training was associated with an increase in the confidence and performance of IM residents as code blue leaders. Incorporation of such training in IM residency curriculum should be considered as a practical application to sustain the gains of this QI initiative.

Optimizing Noise Levels in the Inpatient Room at Bumi Panua Pohuwato Hospital

Bumi Panua Hospital is the only hospital in Marisa District, Pohuwato Regency. In each building, there is a lot of activity going on between patients, nurses, doctors, and visitors who arrive. In addition, the vehicle parking location which is right in front of the hospital inpatient room can cause noise which can reduce patient comfort. The noise level of the hospital must be in accordance with its function and meet health requirements, especially in inpatient rooms. The aim of this research is to carry out measurements to optimize noise levels in patient inpatient rooms at Bumi Panua Pohuwato Hospital. The method used in this research is a descriptive analysis method with a quantitative approach and acoustic simulation using the I-SIMPA application. From the results of Background Noise and Reverberation Time research on class III and II inpatient rooms at Bumi Panua District Hospital. Pohuwato. The condition of background noise in class III and II inpatient rooms is not good because the (dB) produced by background noise in the room is quite high, above 66 dB and exceeds the recommended standard regarding (dB) background noise in patient rooms. It should be below 40 - 45 dB. Based on the simulation results, the reverberation time in class III and class II inpatient rooms produces reverberation time that exceeds the recommended standard due to not using acoustic materials and the shape and volume of the room which causes sound reflection to occur for longer. Optimization is carried out to reduce the reverberation time so that the sound intensity in the room is not too long and can reduce background noise in the patient room.

Description and results of a new method for assessing real-life performance of a UV-C disinfection robot

Due to the disadvantages of manual disinfection of patient rooms, mobile disinfection robots using ultraviolet C (UV-C) radiation are increasingly being used. Assessing their in situ effectiveness remains challenging. This study describes a new method to prove adequate in situ disinfection (≥5-log reduction in bacterial load), and uses this method to assess the efficacy of a mobile disinfection robot using UV-C radiation. Agar plates serving as proxies for smooth surfaces in patient rooms were inoculated with bacterial suspension and placed on various surfaces in a patient room. After irradiation by an automated mobile UV-C robot, reduction in colony growth was determined by comparing the irradiated plates to a reference series of non-irradiated plates, enabling the evaluation of whether an adequate reduction in colony-forming units (CFU's) of ≥5-log was reached on these irradiated surfaces. The new technique described here proved a successful method for demonstrating an in situ ≥5-log reduction in CFU's for five different bacterial pathogens. Of the 32 plates placed on UV-accessible surfaces, 31 showed an adequate reduction in CFU's of ≥5-log. One plate could not be assessed. Inoculated agar plates placed in patient rooms before irradiation and subsequently compared to a reference series can be used to assess in situ efficacy of mobile disinfection robots using UV-C radiation. Our findings support the idea that UV-C robots, used adjunctively to conventional manual washing and disinfection, may achieve adequate bacterial load reduction on UV-accessible smooth surfaces in patient rooms for a selected subset of pathogens.

Original Research: What Health Care Staff Who Experienced Assisted Patient Falls Can Teach Us: Implications for Fall and Fall Injury Risk.

This quality improvement project had three aims: to identify common assisted falls scenarios, describe staff members' experiences with and risk perceptions of such falls, and explore factors that influenced their perceptions. The overarching goal was to gain useful insight for the development of assisted fall-related strategies and policies. In the fall of 2020, 16 staff members from 13 health care facilities were purposively recruited and interviewed. Transcript summaries of these interviews, along with secondary narrative data from employee and patient injury databases, were analyzed using thematic content analysis. According to staff members' accounts, assisted falls most commonly took place in patient rooms or bathrooms when patients were ambulating or transferring. The interviewees described assisting falls by grabbing or holding the patient or by using their own body to brace or steady the patient. Interview and secondary narrative data noted various injuries that occurred during assisted fall events. These injuries most often involved the lower back (among staff) and the legs (among patients). Most interviewees perceived that using proper body mechanics would prevent injury. Interviewees' experiences with assisted falls indicate areas of improvement for fall prevention. The perception that using proper body mechanics will protect staff from injury may be a misconception. Although the literature reports mixed findings concerning whether staff should assist patient falls, this project's results led us to conclude that there is no safe way to physically assist a falling patient without risk of staff injury.

Challenges and prerequisites of risk management program in the operating rooms of Iranian hospitals: A qualitative study

BACKGROUND: The World Health Organization (WHO) considers a safe operating room as one of the necessities of hospitals that support patients. Achieving safety in surgical operations in all countries of the world is the basic goal of healthcare centers and organizations; hence, the present study investigated the challenges and prerequisites for the implementation of an active risk management program in the operating rooms of Iranian hospitals. MATERIALS AND METHODS: This qualitative-phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, targeted sampling, and the participation of 20 experts (health policy and management experts and academic officials and faculty members of universities) and executive staff (nurses and operating room technicians, doctors and surgical specialists, and officials of surgical departments) and were analyzed using the framework analysis method. RESULTS: In the resulting qualitative study, the challenges and prerequisites for active risk management in the operating room from the point of view of experts and executive staff were divided into three sub-themes. These three themes include managerial challenges and prerequisites, organizational resources (financial resources, human resources, equipment, and facilities), and cultural issues. CONCLUSION: Considering managerial prerequisites, organizational resources (financial, human, equipment, and facilities), cultural issues, and removing challenges, an active risk management program in the operating room can be implemented correctly. With the correct implementation of this program, injuries in the operating room for personnel and patients will be greatly reduced, and the satisfaction of beneficiaries and the productivity of the hospital will be greatly increased.

Association of patient clinical and gut microbiota features with vancomycin-resistant enterococci environmental contamination in nursing homes: a retrospective observational study

Preventing transmission is crucial for reducing infections with multidrug-resistant organisms (MDROs) in nursing homes. To identify resident characteristics associated with MDRO spread, we investigated associations between patient characteristics and contamination of their proximate room surfaces with vancomycin-resistant enterococci (VRE). In this retrospective observational study, we used demographic and clinical data (including data on comorbidities, physical independence, catheter use within the past 30 days, and antibiotic exposure within the past 30 days) and surveillance cultures of patient body sites and room surfaces at enrolment and during weekly follow-up visits within the first month, and monthly thereafter (up to 6 months), in six US nursing homes collected in a previous clinical trial (September, 2016, to August, 2018). We did 16S rRNA gene sequencing on perirectal surveillance swabs to investigate the association between the gut microbiota and the culture status of participants and their rooms. We included 245 participants (mean age 72·5 years [SD 13·6]; 111 [45%] were men, 134 [55%] were women, 132 [54%] were non-Hispanic white, and 112 [46%] were African American). We collected 2802 participant samples and 5592 environmental samples. At baseline, VRE colonisation was present in 49 (20%) participants, with environmental surfaces being contaminated in 36 (73%) of these patients. Hand contamination among VRE-colonised participants was more common in those with environmental contamination compared with those without (50 [51%] of 99 vs seven [13%] of 55; p<0·0001). We found a correlation between hand contamination and both groin and perirectal colonisation and contamination of various high-touch room surfaces (Cohen's κ 0·43). We found participant microbiota composition to be associated with antibiotic receipt within the past 30 days (high-risk antibiotics p=0·011 and low-risk antibiotics p=0·0004) and participant VRE colonisation status, but not environmental contamination among VRE-colonised participants (participant only vs uncolonised p=0·071, both participant and environment vs uncolonised p=0·025, and participant only vs participant and environment p=0·29). Multivariable analysis to identify independent factors associated with VRE-colonised participants contaminating their environment identified antibiotic exposure (adjusted odds ratio 2·75 [95% CI 1·22-6·16]) and male sex (2·75 [1·24-6·08]) as being associated with increased risk of environmental contamination, and physical dependence as being associated with a reduced risk of environmental contamination (0·91 [0·83-0·99]). Our data support antibiotic use and interaction with proximal surfaces by physically independent nursing home residents as under-appreciated drivers of environmental contamination among VRE-colonised residents. Integrating resident hand-hygiene education and antimicrobial stewardship will strengthen efforts to reduce MDROs in nursing homes. US Centers for Disease Control and Prevention, National Institute of Health, Canadian Institutes of Health Research, and University of Michigan.

Impact of self-directed exercise intervention in a minority rich, hematopoietic stem cell transplant (HSCT) inpatient population at high risk for sarcopenia and falls.

390 Background: Extended hospitalizations in the adult HSCT population increase patients’ risk for deconditioning and sarcopenia. Sarcopenia negatively impacts overall survival in adult HSCT patients (Armenian et al, 2019) and is strongly associated with falls among older adults (Yeung et al, 2019; Marques A &amp; Queirós C., 2018; Wheatley et al, 2021). Methods: In a safety net, minority rich, academic medical center in suburban NYC, stationary pedals were placed inside patient rooms in a 31-bedded inpatient HSCT unit starting Q4 2020. Intentional, inpatient room placement prevented additional risk of infectious exposures to COVID-19 in late 2020-2021, allowed for safe access to pedals from a seated position in chairs inside patient rooms, and provided insight into self-directed exercise participation. Attending MDs, PAs and RNs encourage HSCT patients to utilize stationary pedals up to 3 times daily, while usage remains self-directed. Direct observation of patient pedal usage and patient-verbalized interest in participation reflects positive acceptance and consistent usage since implementation. Results: 2019-2023 Midas Event Reporting data was reviewed by the author. Total numbers of Weak/Impaired Gait patient falls decreased in the post-implementation period: 19 falls at baseline versus 13 falls in 2021, 11 falls in 2022, and 3 falls in Q1 2023. Pre-intervention 2019 data indicates 63.3% of falls are among Weak/Impaired Gait patients. (2020 falls data is not included due to unit closures during the COVID-19 pandemic). Post-intervention 2021-2023 data reveals a mean of 51.2% of falls are in Weak/Impaired Gait patients, indicating a 12.1% decline in falls in the post-intervention period of 2.25 years. Conclusions: Sarcopenia and inpatient falls impact patient outcomes (i.e., injuries, extended hospitalizations, and survival) and are financially burdensome. Each inpatient fall, whether injurious or not, costs hospitals approximately 35,000 (Dykes et al, 2023). Reductions in numbers of inpatient falls at this institution are potentially associated with the following hospital cost savings: 210K in 2021, 280K in 2022 and a projected 245K in 2023. Reduction in sarcopenia during extended hospitalizations, when reviewed alongside the financial impact of inpatient falls, supports the ongoing implementation of self-directed exercises in this population. Next steps include self-directed use of resistance bands, chair-based and bed-based stretches, and utilizing self-tracking devices to record exercise duration. (Full references available upon request).

PC-07.2 - AN INTERNET OF THINGS (IOT) SYSTEM TO REPORT ON ABNORMAL EVENTS IN NUCLEAR MEDICINE THERAPY PATIENT ROOMS

PC-07.2 - AN INTERNET OF THINGS (IOT) SYSTEM TO REPORT ON ABNORMAL EVENTS IN NUCLEAR MEDICINE THERAPY PATIENT ROOMS

Risk of organism acquisition from prior room occupants: An updated systematic review.

Evidence from a previous systematic review indicates that patients admitted to a room where the previous occupant had a multidrug-resistant bacterial infection resulted in an increased risk of subsequent colonisation and infection with the same organism for the next room occupant. In this paper, we have sought to expand and update this review. A systematic review and meta-analysis was undertaken. A search using Medline/PubMed, Cochrane and CINHAL databases was conducted. Risk of bias was assessed by the ROB-2 tool for randomised control studies and ROBIN-I for non-randomised studies. From 5175 identified, 12 papers from 11 studies were included in the review for analysis. From 28,299 patients who were admitted into a room where the prior room occupant had any of the organisms of interest, 651 (2.3%) were shown to acquire the same species of organism. In contrast, 981,865 patients were admitted to a room where the prior occupant did not have an organism of interest, 3818 (0.39%) acquired an organism(s). The pooled acquisition odds ratio (OR) for all the organisms across all studies was 2.45 (95% CI: 1.53-3.93]. There was heterogeneity between the studies (I2 89%, P<0.001). The pooled OR for all the pathogens in this latest review has increased since the original review. Findings from our review provide some evidence to help inform a risk management approach when determining patient room allocation. The risk of pathogen acquisition appears to remain high, supporting the need for continued investment in this area.

Effects of data-driven feedback on nurses' and physicians' hand hygiene in hospitals – a non-resource-intensive intervention in real-life clinical practice

Hand hygiene (HH) by healthcare workers (HCWs) is one of the most important measures to prevent hospital-acquired infections. However, HCWs struggle to adhere to HH guidelines. We aimed to investigate the effect of a non-resource intensive intervention with group and individual feedback on HCWs HH in a real-life clinical practice during the COVID-19 pandemic. In 2021, an 11-month prospective, interventional study was conducted in two inpatient departments at a Danish university hospital. An automated hand hygiene monitoring system (Sani Nudge™) was used to collect data. HH opportunities and alcohol-based hand rub events were measured. Data were provided as HH compliance (HHC) rates. We compared HHC across 1) a baseline period, 2) an intervention period with weekly feedback in groups, followed by 3) an intervention period with weekly individual feedback on emails, and 4) a follow-up period. We analyzed data from physicians (N=65) and nurses (N=109). In total, 231,022 hygiene opportunities were analyzed. Overall, we observed no significant effect of feedback, regardless of whether it was provided to the group or individuals. We found a trend toward a higher HHC in staff restrooms than in medication rooms and patient rooms. The lowest HHC was found in patient rooms. The automated hand hygiene monitoring system enabled assessment of the interventions. We found no significant effect of group or individual feedback at the two departments. However, other factors may have influenced the results during the pandemic, such as time constraints, workplace culture, and the degree of leadership support.

일제강점기 도립의원의 변화와 한계(1925-1945)

This study attempts to identify changes in the local medical environment and their limitations, focusing on “disease treatment,” one of the functions of provincial hospitals in the Japanese colonial era. Until 1945, when Korea was liberated from Japan, the provincial hospitals during the Japanese colonial era treated diseases of Japanese and Koreans as a central local medical institution. Until the liberation period, the size of each of the 46 provincial hospitals established nationwide varied widely, but the number of doctors continued to increase and the medical department was further subdivided. Jahye Hospital, the predecessor of the provincial hospital, classified patients into general patients who could afford to pay for the treatment and charity patients, enacted regulations to treat economically poor Koreans free of charge, and in 1912 began to provide circuit treatment for patients in remote areas without medical services. However, after 1920, after switching to a provincial clinic, after 1930, and after the end of the 1930s, the proportion of Koreans treated in provincial hospitals, most of whom were charity patients, plunged to 3.75 percent by 1941, and the number of clinics conducting circuit treatment decreased and became nominal.&#x0D; Provincial hospitals also played a role as a base hospital for treating diseases that were difficult to treat in general hospitals, such as infectious diseases, morphine addiction, and tuberculosis. Quarantine buildings for infectious diseases were installed from the beginning, and patients were quarantined when infectious diseases broke out. However, most of the quarantine rooms in the provincial hospitals were for general patients, and only the provincial hospitals in Anseong and Pyongyang had beds for charity patients with infectious disease, but their total number was only 14, which was very insignificant. As a result of the Japanese colonial government’s policy on morphine addicts in Korea, morphine-addicted patients were forcibly admitted to designated provincial clinics after 1927, treated for several months, and discharged after full recovery. Through this process, the Japanese authorities in the late 1930s estimated that morphine addicts had disappeared. An active national policy for tuberculosis patients began in 1936. Some provincial hospitals established separate isolation rooms for tuberculosis patients, but the number of beds was very insufficient compared to the number of tuberculosis patients distributed across the country at that time, and there were no beds for charity patients with tuberculosis.&#x0D; The provincial hospitals during the Japanese colonial era carried out various activities to treat diseases as a local hub hospital where people could experience Western medicine, but Koreans suffered from communication problems and ethnic discrimination, and the actual benefits were largely different from those advocated by the Japanese authorities as there were fewer opportunities for charity treatment for Koreans who were economically deprived at that time.