Contact Precautions For Patients Research Articles

Reducing Hospitalizations and Multidrug-Resistant Organisms via Regional Decolonization in Hospitals and Nursing Homes

Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections. To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths. This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California. Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP). Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs). Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%). Associated hospitalization costs per 1000 resident-days changed from $64 651 to $55 149 among participating NHs and from $55 151 to $59 327 among nonparticipating NHs (group × period interaction reduction, 26.8%; 95% CI, 26.7%-26.9%). Associated hospitalization deaths per 1000 resident-days changed from 0.29 to 0.25 among participating NHs and from 0.23 to 0.24 among nonparticipating NHs (group × period interaction reduction, 23.7%; 95% CI, 4.5%-43.0%). A regional collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in CP was associated with lower MDRO carriage, infections, hospitalizations, costs, and deaths.

Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions

BackgroundHealthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU).MethodsAn observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use.ResultsWe observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments “before” tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments “after” tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed.ConclusionsHH compliance was very low. Inappropriate glove use was associated with low compliance and the unit’s infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.

Discontinuation of contact precautions in patients with hospital-acquired MRSA and VRE infections during the COVID-19 pandemic: A multi-center experience.

Variations in the literature support the benefit of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) infections in the hospital setting. During personal protective equipment shortages throughout the COVID-19 pandemic, contact precautions were discontinued for MRSA and VRE-infected patients. Rates of hospital-acquired MRSA and VRE infections were compared before and after this intervention, along with hand hygiene proportions. Contact precaution discontinuation did not lead to an increase in hospital-acquired MRSA or VRE infections.

Directed carbapenemase testing is no longer just for Enterobacterales: cost, labor, and workflow assessment of expanding carbapenemase testing to carbapenem-resistant P. aeruginosa

ABSTRACT Molecular carbapenem-resistance testing, such as for the presence of carbapenemases genes, is commonly implemented for the detection of carbapenemase-producing Enterobacterales. Carbapenemase-producing P. aeruginosa is also associated with significant morbidity and mortality, although; prevalence may be underappreciated in the United States due to a lack of carbapenemase testing. The present study sought to compare hands-on time, cost and workflow implementation of carbapenemase gene testing in Enterobacterales and P. aeruginosa isolates versus sending out isolates to a public health laboratory (PHL) for testing to assess if in-house can provide actionable results. The time to carbapenemase gene results were compared. Differences in cost for infection prevention measures were extrapolated from the time of positive carbapenemase gene detection in-house versus PHL. The median time to perform carbapenemase gene testing was 7.5 min (range 5–14) versus 10 min (range 8–22) for preparation to send isolates to the PHL. In-house testing produced same day results compared with a median of 6 days (range 3–14) to receive results from PHL. Cost of in-house testing and send outs were similar ($46.92 versus $40.53, respectively). If contact precautions for patients are implemented until carbapenemase genes are ruled out, in-house testing can save an estimated $76,836.60 annually. Extension of in-house carbapenemase testing to include P. aeruginosa provides actionable results 3–14 days earlier than PHL Standard Pathway testing, facilitating guided therapeutic decisions and infection prevention measures. Supplemental phenotypic algorithms can be implemented to curb the cost of P. aeruginosa carbapenemases testing by identifying isolates most likely to harbour carbapenemases.

SG-APSIC1166: Strategies to reduce hospital-onset Clostridioides difficile infections in an acute-care hospital in Singapore

Objectives: Control of Clostridioides difficile infections (CDIs) in healthcare facilities presents significant challenges to infectious disease physicians, infection prevention and control practitioners, and environmental services staff. CDI is a common cause of infectious diarrhea and is associated with significant morbidity, mortality, and healthcare cost. A high infection rate was documented in our institution in 2017, higher than the national infection rate. Strategies to reduce hospital-onset CDI were implemented after review of international guidelines and relevant literature. The impact on hospital-onset CDI was assessed. Methods: The following strategies were implemented beginning early in 2018: (1) contact precautions for patients with diarrhea; (2) early recognition and diagnosis of C. difficile infection; (3) prompt isolation of C. difficile patients; (4) emphasis on hand hygiene and contact precautions; (5) enhanced environmental cleaning with chlorine-based disinfectant and use of UV-C and ionized hydrogen peroxide for equipment disinfection; (6) enhanced cleaning and disinfection using sporicidal wipes for shared high-risk equipment; (7) audit and feedback regarding compliance with practices and environmental cleaning; and (8) collaboration with antibiotics stewardship program (ASP) to reduce inappropriate antibiotic use. Hospital-onset CDI cases were tracked by infection prevention and control nurses using definitions from the Singapore Ministry of Health. Results: In total, 135 hospital-onset C. difficile infection cases occurred in 2017, a rate of 4.2 per 10,000 patient days. This rate gradually decreased to 3.0 in 2018 and to 2.3 in 2020, with an average of 87 infections per year. This rate further decreased to 1.8 infections per 10,000 patient days in 2021, with 61 clinical infections. Conclusions: Using multimodal strategies, CGH achieved a gradual and steady reduction in hospital-onset CDI over several years. These strategies require close collaboration among various departments to achieve the desired outcome.

Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

Overview of the actions to combat bacterial resistance in large hospitals

Objective:to analyze, in the clinical practice of large hospitals, how the adoption of measures to prevent and control the spread of bacterial resistance has occurred, and to propose a score for the institutions’ adherence.Method:a cross-sectional study carried out in 30 large hospitals of Minas Gerais, from February 2018 to April 2019, after approval by the Ethics and Research Committee. Interviews were conducted with hospital managers, with Hospital Infection Control Services coordinators, and with the care coordinators of the Inpatient Units and Intensive Care Center. In addition, observations were made of the adoption of preventive measures by the multidisciplinary team in the care units.Results:in the 30 participating hospitals, 93.3% (N=28) had protocols for prophylactic antibiotics, and 86.7% (N=26) performed their audit, 86.7% (N=26) for therapeutic antibiotics and 83.3% (N=25) their audit; 93.3% (N=56) used gloves and cloaks for patients in contact precautions, and 78.3% (N=47) of the professionals were unaware of or answered incompletely on the five moments for hand hygiene. In the score to identify the adoption of measures to control bacterial resistance, 83.3% (N=25) of the hospitals were classified as partially compliant, 13.3% (N=04) as deficient, and 3.4% (N=01) as non-adoption.Conclusion:it was found that the recommended measures to contain bacterial resistance are not consolidated in the clinical practice of the hospitals.

Decreased Hospitalizations and Costs From Infection in Sixteen Nursing Homes in the SHIELD OC Regional Decolonization Initiative

Distinguished OralBackground: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P &lt; .001), a reduction of 7% per quarter in hospitalization days due to infection (P &lt; .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.Funding: NoneDisclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) and Viral Surrogate Markers Outside Patient Rooms

Background: Patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization often shed MRSA, resulting in contamination of surfaces in their room. It is not known whether MRSA-colonized patients also frequently contaminate surfaces during medical appointments and other activities outside their room. Methods: We conducted an observational cohort study of MRSA-colonized long-term care facility (LTCF) residents to determine the frequency and mechanisms of contamination of surfaces outside patient rooms. Nares, skin, and clothing of patients in contact precautions for MRSA were cultured for MRSA, and high-touch surfaces in the residents’ room were contaminated with the live virus bacteriophage MS2 and cauliflower mosaic virus DNA. The participants were observed during activities and medical appointments outside their rooms for 3 days, and sites that were contacted were sampled for recovery of MRSA, bacteriophage MS2, and cauliflower mosaic virus DNA. Results: As shown in Fig. 1, bacteriophage MS2 and cauliflower mosaic virus DNA was transferred to 1 or more surfaces outside the resident’s room by 5 of the 7 participants, and MRSA was recovered from surfaces touched by 6 (86%) participants. MRSA was recovered during 16 of 35 episodes (46%) where sampling was performed, and recovery was similar for medical appointments (eg, hemodialysis, physical therapy) and nonmedical activities (eg, using the dining room or activity center). Moreover, MRSA, MS2, and the viral DNA marker were recovered both from sites contacted only by participants’ hands and from sites contacted only by clothing. Bacteriophage MS2 and the viral DNA marker were also recovered from portable equipment and from the nursing station. Conclusions: MRSA-colonized LTCF residents frequently disseminated MRSA and viral surrogate markers to surfaces outside their rooms through contact with contaminated hands and clothing. Efforts to reduce contamination of hands and clothing might reduce the risk for pathogen transmission.Funding: NoneDisclosures: None

Shedding of multidrug-resistant gram-negative bacilli by colonized patients during procedures and patient care activities

Medical procedures and patient care activities may facilitate environmental shedding of health care-associated pathogens. We conducted a cohort study of hospitalized patients in contact precautions for carriage of extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli (N = 38) or carbapenem-resistant gram-negative bacilli (CR-GNB) (N = 22) to determine the frequency of environmental shedding during procedures and care activities. Perirectal, wound, and skin were cultured for ESBL-producing and CR-GNB. High-touch surfaces and portable equipment were disinfected before and cultured after procedures; control cultures were collected in the absence of procedures. Of 60 patients enrolled, 34 (57%) had positive perirectal and/or skin or wound cultures. For these 34 patients, 15 (44%) shed their colonizing organism to surfaces during 1 or more procedures. Patients with shedding had significantly higher concentrations of the pathogens recovered from perirectal swabs than those with no shedding (mean, 3.5 vs 2.2 log10 colony-forming units per swab; P < .01). Environmental shedding occurred more frequently during procedures and care activities than in the absence of a procedure (21 of 117, 18% vs 1 of 61, 2%; P < .01), and 6 of 56 (10%) portable devices used for procedures became contaminated. Environmental shedding of antibiotic-resistant gram-negative bacilli occurs frequently during medical procedures and patient care activities. Decontamination of surfaces and equipment and approaches that reduce the burden of carriage could reduce the risk for dissemination.

Duration of carriage of multidrug resistant Enterobacterales in discharged hospital and general practice patients and factors associated with clearance

SummaryObjectivesDutch guidelines recommend contact precautions in patients with multidrug resistant microorganisms cultured during the previous 12 months. To evaluate this policy, duration of carriage of multidrug resistant Enterobacterales was assessed among discharged hospital patients and patients attending their general practitioner (GP). Additionally, we assessed factors associated with clearance.MethodsFrom January 2013 until May 2016, rectal or faecal samples accompanied by questionnaires on patient characteristics were obtained at time of study inclusion and 3, 6 and 12 months later, in 72 patients with multidrug resistant Enterobacterales. Clearance was defined as one or more negative cultures without a subsequent positive culture at 12 months after study inclusion. The percentage of clearance, intermittent carriage and persistence was determined and associated factors were assessed by logistic regression analysis.ResultsClearance was found in 31 patients (43.1% [95%CI: 32.3–54.6]) of which 23 patients had two or more subsequent negative cultures. Twelve patients were classified as intermittent carriers (16.7% [95%CI: 9.8–26.9]) and 29 patients (40.3% [95% CI: 29.7–51.8]) as persistent carriers. Of the intermittent carriers, the majority (n=9) had two negative cultures during the study period. There was no difference in clearance between discharged hospitalized patients and GP patients. The only factor associated with clearance at 12 months in both univariable and multivariable analyses was not traveling to a foreign country (OR=3.5 [95%CI: 1.0–12.4]).ConclusionActive screening for clearance of multidrug resistant Enterobacterales in patients within the health care setting is probably not beneficial due to high levels of intermittent and persistent carriage.

Contact Precaution: Acceptance of Health Professionals to Teaching Hospital

The adoption by health professionals to the practice of patient isolation is a decision that reduces patients’ risks of occupational exposure to potentially contaminated biological material and prevents nosocomial infections. Verify the compliance of health professionals to the practices of contact precautions in patients colonized by microorganisms in a teaching hospital. This was a prospective observational cohort study in a special-sized hospital located in southeastern Brazil. The observation of health professionals in delivery of health care to patients with contact precaution was performed regarding hand hygiene, use of overcoat, glove, and mask. We carried out 1502 observations involving the following professional categories: nursing technicians and/or nursing assistants (n = 1028; 68.4%), nurses (n = 200; 13.3%), physical therapists (n = 185; 12.3%), and physicians (n = 89; 5.9%), totaling 971.8 hours. Regarding the level of compliance of professionals to contact precaution practices with hand hygiene after the procedures, the use of overcoats, gloves, and masks, all were statistically significant (p Klebsiella pneumoniae was the most positive pathogen identified in laboratory tests. This study provided the mapping of the compliance of health professionals to the practices of contact precautions in order to support a safer management of patient care reducing the risks of Healthcare-Associated Infections (HAI). This study also showed that health professionals are using practice management to deal with their behavior to protect their health.

893. The SHIELD Orange County Project: A Decolonization Strategy in 35 Hospitals and Nursing Homes Reduces Multi-Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region

BackgroundPatient movement between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) contributes to MDRO spread. SHIELD OC is a regional decolonization collaborative among adult facilities with high patient sharing designed to reduce countywide MDRO prevalence. We report pre- and post-intervention MDRO colonization prevalence.MethodsDecolonization included chlorhexidine bath (CHG) (4% liquid or 2% cloth) and twice-daily nasal swab 10% povidone–iodine (PI). LTAC and NH used CHG for all baths and PI 5 days on admission and Monday–Friday every other week. Patients in contact precautions (CP) at hospitals had daily CHG and 5-days PI on admission. Point-prevalence screening for MRSA, VRE, ESBL, and CRE using nares, axilla/groin, and peri-rectal swabs was conducted pre-intervention (September 2016–March 2017) and post-intervention (August 2018–April 2019); 50 random LTAC and 50 CP hospitalized patients were sampled; for NH up to 50 were sampled at baseline and all residents post-intervention. Raw impact of the intervention was assessed by the average change in colonization prevalence, with each facility carrying equal weight. Generalized linear mixed models (GLM) stratified by facility type were used to assess the impact on MDRO colonization when clustering by facility.ResultsAcross 35 facilities (16 hospitals, 16 NHs, 3 LTACs), the overall MDRO prevalence was reduced 22% in NHs (OR 0.58, P < 0.001), 34% LTACs (OR = 0.27, P < 0.001), and 11% CP patients (OR = 0.67, P < 0.001, Table 1). For MRSA, raw reductions were 31% NHs (OR = 0.58, P < 0.001), 39% LTACs (OR = 0.51, P = 0.01), and 3% CP patients (OR = 0.88, P = NS). For VRE, raw reductions were 40% NHs (OR = 0.62, P = 0.001), 55% LTACs (OR = 0.26, P < 0.001), and 15% CP patients (OR = 0.67, P = 0.004). For ESBLs, raw reductions were 24% NHs (OR = 0.65, P < 0.001), 34% LTACs (OR = 0.53, P = 0.01), and 26% CP patients (OR = 0.64, P < 0.001). For CRE, raw reductions were 24% NHs (OR = 0.70, P = NS), and 23% LTACs (OR = 0.75, P = NS). CRE increased by 26% in CP averaged across hospitals, although patient -level CRE declined 2.4% to 1.8% (OR = 0.74, P = NS).ConclusionMDRO carriage was common in highly inter-connected NHs, LTACs and hospitals. A regional collaborative of universal decolonization in long-term care and targeted decolonization of CP patients in hospitals led to sizeable reductions in MDRO carriage. Disclosures All Authors: No reported Disclosures.

514. Shedding of Multidrug-Resistant Gram-Negative Bacilli by Colonized Patients during Procedures and Patient Care Activities

BackgroundContaminated environmental surfaces contribute to transmission of healthcare-associated pathogens such as multidrug-resistant gram-negative bacilli. We hypothesized that medical procedures and patient care activities facilitate environmental dissemination of multidrug-resistant gram-negative bacilli in hospitalized patients.MethodsWe conducted a cohort study of hospitalized patients in contact precautions for carriage of extended-spectrum β-lactamase (ESBL)-producing or carbapenem-resistant gram-negative bacilli (CR-GNB) to determine the frequency of environmental shedding during procedures and care activities. Perirectal, wound, and skin were cultured for the gram-negative bacilli of interest. Prior to each procedure or activity, surfaces in the room and portable equipment used for procedures were disinfected. After procedures, high-touch surfaces and portable equipment were cultured; negative control cultures were collected after 1 hour in the absence of a procedure.ResultsOf 60 participants, 38 (63%) were in contact precautions for ESBL-producing gram-negative bacilli and 22 (37%) for CR-GNB. Thirty-four (57%) participants had positive perirectal, wound, or skin cultures. Contamination of surfaces with the colonizing multidrug-resistant gram-negative bacilli occurred frequently during procedures and activities such as wound care, assistance with meals, and urinary catheter or colostomy care (11% to 29% of procedures/activities), whereas contamination was rare in the absence of a procedure (1%). Contamination was recovered from 6 of 56 (10%) portable devices used for procedures.ConclusionEnvironmental shedding of multidrug-resistant gram-negative bacilli occurs frequently during medical and non-medical procedures in hospitalized patients. Our results suggest that there is a need for effective strategies to disinfect surfaces and equipment after procedures.Disclosures All authors: No reported disclosures.

Optimizing Contact Precautions to Curb the Spread of Antibiotic-resistant Bacteria in Hospitals: A Multicenter Cohort Study to Identify Patient Characteristics and Healthcare Personnel Interactions Associated With Transmission of Methicillin-resistant Staphylococcus aureus.

BackgroundHealthcare personnel (HCP) acquire antibiotic-resistant bacteria on their gloves and gowns when caring for intensive care unit (ICU) patients. Yet, contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA) remains controversial despite existing guidelines. We sought to understand which patients are more likely to transfer MRSA to HCP and to identify which HCP interactions are more likely to lead to glove or gown contamination.MethodsThis was a prospective, multicenter cohort study of cultured HCP gloves and gowns for MRSA. Samples were obtained from patients’ anterior nares, perianal area, and skin of the chest and arm to assess bacterial burden.ResultsAmong 402 MRSA-colonized patients with 3982 interactions, we found that HCP gloves and gowns were contaminated with MRSA 14.3% and 5.9% of the time, respectively. Contamination of either gloves or gowns occurred in 16.2% of interactions. Contamination was highest among occupational/physical therapists (odds ratio [OR], 6.96; 95% confidence interval [CI], 3.51, 13.79), respiratory therapists (OR, 5.34; 95% CI, 3.04, 9.39), and when any HCP touched the patient (OR, 2.59; 95% CI, 1.04, 6.51). Touching the endotracheal tube (OR, 1.75; 95% CI, 1.38, 2.19), bedding (OR, 1.43; 95% CI, 1.20, 1.70), and bathing (OR, 1.32; 95% CI, 1.01, 1.75) increased the odds of contamination. We found an association between increasing bacterial burden on the patient and HCP glove or gown contamination.ConclusionsGloves and gowns are frequently contaminated with MRSA in the ICU. Hospitals may consider using fewer precautions for low-risk interactions and more for high-risk interactions and personnel.

Understanding nurses’ workflow: Batching care and potential opportunities for transmission of infectious organisms, a pilot study

Caring for patients in contact precautions can be challenging. In this pilot study, we sought to understand, using qualitative and visual methods, how nurses provide care for patients in contact precaution rooms and to identify potential breakdowns in practice that could increase risk of disease transmission. Qualitative data were collected while shadowing 4 nurses on 2 medical/surgical units at a university medical center between September and October 2016. Observers documented nurses' movements in handwritten fieldnotes. Fieldnote data were analyzed using a descriptive approach with visual depiction to map care delivery in precaution and non-precaution rooms. Nurses moved between non-precaution rooms, completing 1-4 tasks per room entry, over the course of several brief room entries and exits. In contrast, nurses rarely entered contact precaution rooms to complete only a few tasks, generally completing ≥10 tasks per room entry. Although hand hygiene on room entry/exit was consistently performed, a breakdown in practice occurred in precaution rooms as nurses tended to move between tasks and contact with the environment without performing hand hygiene. Differences in how nurses structure their work in contact precaution rooms may contribute to risk of infectious disease transmission. Understanding and addressing the challenges specific to how nurses work is a critical part of infection prevention in today's hospital environment.

Shedding of methicillin-resistant Staphylococcus aureus by colonized patients during procedures and patient care activities.

Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding. A Veterans Affairs hospital. This study included 75 patients in contact precautions for MRSA colonization or infection. Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P 0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04). Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.

1728. Effectiveness and Healthcare Personnel (HCP) Perceptions of a Multi-Site Personal Protective Equipment (PPE) Free Zone Intervention

BackgroundCDC provides guidelines for using contact precautions (CP) when caring for patients with antibiotic-resistant bacteria or Clostridium difficile. However, HCP frequently report discomfort, difficulty of use, and interrupted workflow with CP. Modifying CP guidelines to balance these issues requires testing to assess benefits and maintenance of safe practices. A promising approach using a “PPE Free Zone” strategy within rooms of patients in CP has not been well-studied.MethodsThe PPE Free Zone comprised a 3–6 foot area inside door thresholds of CP patient rooms denoted by red tape placed on the floor. Within the zone, HCP were not required to don PPE. HCP were considered compliant if they performed hand hygiene (HH) and donned appropriate PPE before crossing the zone. Observers at 6 acute care facilities (ACF) were trained on observing HCP HH and use of PPE with CP. Observations were made before and after implementation of a PPE Free Zone. Intervention ACF conducted observations on 8 intervention units and 6 nonintervention units. Models of overall compliance and entry HH compliance were constructed using a generalized linear-mixed effects model with a logistic link function. Pre-intervention observations from all 6 ACF and intervention phase observations from the 3 intervention ACF were used in models.ResultsWe observed 4,510 room entries. HH adherence declined over time in both intervention and control units but declined less among intervention units from pre to post intervention (β: 0.71, P = 0.007, Figure 1). Stratified by precautions type, the effect of the PPE Free Zone on HH was only significant for rooms in enteric precautions (P < 0.001). Compliance with PPE use was not significantly different pre- versus postintervention (P = 0.133). When surveyed, HCP had positive views of the PPE Free Zone: 65% (n = 172) agreed or strongly agreed the zone facilitates communication with patients, permits checking on patients more frequently, and saves time [n = 169] (Figure 2).ConclusionAlthough HCP viewed the zone positively and it had a significant effect on HH in enteric precautions rooms, the zone did not improve PPE compliance. Future interventions in the ACF setting should consider the complex sociotechnical system factors influencing behavior change. Disclosures All authors: No reported disclosures.

The CDC SHIELD Orange County Project – Baseline Multi Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region

The CDC SHIELD Orange County Project – Baseline Multi Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region

Contact Precautions—Isolation for Life?

BACKGROUND: Project begun to safely update Contact Precautions Practices for MRSA, VRE and Stenotrophomonas to reduce the impact on patients and families, improve the quality and quantity of patient interactions, and patient and medical staff satisfaction. Studies have shown that care for patients in contact precautions, also known as contact isolation, is often “bundled,” leading to a lack of care-provider interaction and the potential for hospital acquired conditions. Although CDC guidelines (2007) do not provide clear guidance on discontinuing transmission-based precautions for both infection and colonization of various multi drug resistant organisms, a literature review provided criteria to consider.