Healthcare-associated Infections Surveillance System Research Articles

The impact of preoperative biliary drainage on postoperative healthcare-associated infections and clinical outcomes following pancreaticoduodenectomy: a ten-year retrospective analysis

BackgroundPancreaticoduodenectomy (PD) is a complex procedure and easily accompanied by healthcare-associated infections (HAIs). This study aimed to assess the impact of PBD on postoperative infections and clinical outcomes in PD patients.MethodsThe retrospective cohort study were conducted in a tertiary hospital from January 2013 to December 2022. Clinical and epidemiological data were collected from HAIs surveillance system and analyzed.ResultsAmong 2842 patients who underwent PD, 247 (8.7%) were diagnosed with HAIs, with surgical site infection being the most frequent type (n = 177, 71.7%). A total of 369 pathogenic strains were detected, with Klebsiella pneumoniae having the highest proportion, followed by Enterococcu and Escherichia coli. Although no significant association were observed generally between PBD and postoperative HAIs, subgroup analysis revealed that PBD was associated with postoperative HAIs in patients undergoing robotic PD (aRR = 2.174; 95% CI:1.011–4.674; P = 0.047). Prolonging the interval between PBD and PD could reduce postoperative HAIs in patients with cholangiocarcinoma (≥4 week: aRR = 0.292, 95% CI 0.100–0.853; P = 0.024) and robotic PD (≤2 week: aRR = 3.058, 95% CI 1.178–7.940; P = 0.022). PBD was also found to increase transfer of patients to ICU (aRR = 1.351; 95% CI 1.119–1.632; P = 0.002), extended length of stay (P < 0.001) and postoperative length of stay (P = 0.004).ConclusionPBD does not exhibit a significant association with postoperative HAIs or other outcomes. However, the implementation of robotic PD, along with a suitable extension of the interval between PBD and PD, appear to confer advantages concerning patients’ physiological recuperation. These observations suggest potential strategies that may contribute to enhanced patient outcomes.

Data quality review of the Brazilian nosocomial infections surveillance system

BackgroundSurveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. MethodsData Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. ResultsThroughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. ConclusionsWhile adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

Evaluation of an Infection surveillance program in residential aged care facilities in Victoria, Australia.

Infection surveillance is a key element of infection prevention and control activities in the aged care sector. In 2017, a standardised infection surveillance program was established for public residential aged care services in Victoria, Australia. This program will soon be expanded to a national level for all Australian residential aged care facilities. It has not been evaluated since its inception. The current study aimed to evaluate the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Aged Care Infection Indicator Program (ACIIP), to understand its performance and functionality. A mixed methods evaluation was performed using the Updated Guidelines for Evaluating Public Health Surveillance Systems developed by the United States Centers for Disease Control and Prevention as a framework. VICNISS staff who coordinate and manage the ACIIP were invited to participate in interviews. Residential aged care staff who use the program were invited to participate in a survey. Document analysis was also performed. Four VICNISS staff participated in the interviews and 38 aged care staff participated in the survey. The ACIIP is stable and able to be adapted quickly to changing definitions for infections. Users found the system relatively easy to use but have difficulties after the long intervals between data entry year on year. VICNISS staff provide expert guidance which benefits users. Users appreciated the benefit of participating and many use the data for improving local practice. The ACIIP is a usessful state-wide infection surveillance program for aged care. Further development of data validation, IT system capacity and models for education and user support will be required to support future scalability.

A Validation Study of Surveillance Data: Focus on the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module

A Validation Study of Surveillance Data: Focus on the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module

Comprehensive Evaluation of Healthcare Associated Infection Surveillance System

Background &amp; objectives: The electronic surveillance system has been applied in healthcare associated infection surveillance. We conducted an evaluation of the real-time healthcare associated infection surveillance system (RT-HAISS) to understand the early warning effect. Methods: We evaluated our RT-HAISS on a dataset of 29074 patients at the Wuxi traditional Chinese medicine (TCM) hospital in 2020, encompassing sensitivity, specificity, positive predictive value, negative predictive value, Youden index and false alarm rate.Results: 466 HAIs were confirmed in this hospital in 2020, The RT-HAISS warned the monitors a total of 1715 cases, with 2040 early warning entries and 1736 false alarm entries. The sensitivity and the specificity were 65.24% and 95.74%, respectively. The Youden index was 0.62. In addition, the positive predictive value was 14.90%, and the negative predictive value was 83.86%, with 85.10% of false alarm rate.Conclusion: The RT-HAISS is an important technical mean for healthcare associated infection surveillance, it’s necessary to further explore the improvement of real-time surveillance system.

The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Background: Healthcare-associated infections (HAI) continue to be a major public health concern throughout the world because of the associated mortality and socioeconomic costs. The significant financial burden of healthcare-associated infections is especially relevant for developing countries. Meta-analysis can be a major tool that can aid in decision making in the realm of public health, owing to theirevidence level, especially in countries with limited resources, such as Morocco. In Morocco, recently, the Ministry of Health creates the national coordination unit and the technical committee for the surveillance of antimicrobial resistance but still does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired infections HAIs. The main objective of this systematic review and meta-analysis is to estimate the overall prevalence of infections acquired in hospitals in Morocco using data from prevalence studies. We also studied the variability in the evolution of these infections over time.Methods: A multisource search strategy was used to retrieve all published and unpublished data.The search terms were used in databases, conference abstracts, national research banks, the World Health Organization database, Google scholar and were also applied in a manual search. Two reviewers independently extracted and evaluated the data and the concordance between the two examiners was calculated by Kappa (κ) statistical coefficient. The meta-analysis was performed using the R and Stata software with a random effects model.Results: Fourteen studies with 6,532 patients were included. The pooled prevalence of HAI was 10% (CI 95%: 8 - 12, I2= 87%). Of the 14 studies, ten were conducted in tertiary hospitals with pooled prevalence of 10.84% (CI 95%: 8.9 - 13.714 I2=86%), compared with 6.34% (CI 95% 4.43 – 8.99, I2=63%) in non-tertiary hospitals. When subgrouping analysis by infection type, the most common HAI were nosocomialurinary tract infections with a proportion of 24.52% (CI 95 %:14.09 - 39.15, I2=87%). This proportion was followed closely by surgical wound infections at 24.42% (CI 95%: 20.15 – 29.26, I2=51%). Respiratory infections accounted for 16.82% (CI 95%: 12.51 - 22.24, I2=57%) of the HAI. The change in number of HAI over time has increased between 2004 and 2014 (beta =0.05, 95% CI -0.07 to 0.16 and p = 0.9). There were no publication biases, as evaluated by Funnel Plot and Begg and Egger tests (p&gt; 0.05).Conclusion: The pooled prevalence of HAI across 6,632 patients in Morocco was 10%. The most common HAI were nosocomial urinary tract infections (rate of 24.52%), followed by surgical wound infections (rate of 24.42%), and respiratory infections (rate of 16.82%).

2470. A Survey of the Collection of Denominator Data in the Korean National Healthcare-associated Infections Surveillance System (KONIS), Intensive Care Unit Module

Abstract Background National surveillance data should be validated to identify data quality issues. While denominator data can have a significant effect on the healthcare-associated infection (HAI) rate, they are relatively overlooked compared to numerator data. The Korean National Healthcare-associated Infections Surveillance System (KONIS) has been conducting data validation, and this study analyzed the current status of, and problems with, collecting denominator data for the first time. Methods The web-based cross-sectional survey was conducted on January 6, 2023 on 183 infection control nurses from 127 hospitals, among a total of 275 participating hospitals in the KONIS ICU module. The questionnaire was delivered using the QR code method and answered online by participants via SurveyMonkey®. The survey examined denominator data collection methods, such as patient days and device days of central lines and urinary catheters. The knowledge of the types of central lines and urinary catheters for KONIS reporting and the responses to case questions about specific situations related to the calculation of device days, were also evaluated. Results The respective proportions of manual vs. electronic methods for counting denominator data were 10.4% vs. 81.4% for patient days, 22.4% vs. 67.8% for central line days, and 23.5% vs. 69.4% for urinary catheter days. About 27.3%, 29.5%, and 31.1% of respondents reported periodically checking the accuracy of patient days, central line days, and urinary catheter days data, respectively. Infection control nurses were responsible for collecting the majority (66.1%) of the denominator data and entering them into the Web-based Report and Analysis Program (88.0%). The survey results indicated that the rate of accurately understanding and responding to the case questions on device days for central lines ranged from 24.6% to 78.7%, while for urinary catheters, it ranged from 27.3% to 92.3%. Conclusion To maintain the reliability of the national HAI surveillance data, it is important to collect accurate denominator data, in addition to numerator data. This study has identified several areas where improvements in denominator data collection methods are needed. Continuing education on the definition of denominator data and accurate data collection methods is crucial. Disclosures All Authors: No reported disclosures

Development of a knowledge-based healthcare-associated infections surveillance system in China

BackgroundIn the modern era of antibiotics, healthcare-associated infections (HAIs) have emerged as a prominent and concerning health threat worldwide. Implementing an electronic surveillance system for healthcare-associated infections offers the potential to not only alleviate the manual workload of clinical physicians in surveillance and reporting but also enhance patient safety and the overall quality of medical care. Despite the widespread adoption of healthcare-associated infections surveillance systems in numerous hospitals across China, several challenges persist. These encompass incomplete coverage of all infection types in the surveillance, lack of clarity in the alerting results provided by the system, and discrepancies in sensitivity and specificity that fall short of practical expectations.MethodsWe design and develop a knowledge-based healthcare-associated infections surveillance system (KBHAIS) with the primary goal of supporting clinicians in their surveillance of HAIs. The system operates by automatically extracting infection factors from both structured and unstructured electronic health data. Each patient visit is represented as a tuple list, which is then processed by the rule engine within KBHAIS. As a result, the system generates comprehensive warning results, encompassing infection site, infection diagnoses, infection time, and infection probability. These knowledge rules utilized by the rule engine are derived from infection-related clinical guidelines and the collective expertise of domain experts.ResultsWe develop and evaluate our KBHAIS on a dataset of 106,769 samples collected from 84,839 patients at Gansu Provincial Hospital in China. The experimental results reveal that the system achieves a sensitivity rate surpassing 0.83, offering compelling evidence of its effectiveness and reliability.ConclusionsOur healthcare-associated infections surveillance system demonstrates its effectiveness in promptly alerting patients to healthcare-associated infections. Consequently, our system holds the potential to considerably diminish the occurrence of delayed and missed reporting of such infections, thereby bolstering patient safety and elevating the overall quality of healthcare delivery.

Disinfection and sterilization measures in medical organizations of the Ural and Siberian Federal Districts: Results of 2022 and a long-term quality rating

BACKGROUND: Disinfection and sterilization activities are integral parts of the epidemiological safety system in healthcare aimed at preventing healthcare-associated infections. The quality of disinfection and sterilization activities affects healthcare efficiency and the safety of both patients and healthcare professionals. Continuous monitoring of key disinfection and sterilization indicators is an important constituent of a healthcare-associated infection surveillance system implemented in healthcare institutions, organizations, and bodies of Rospotrebnadzor (Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing).&#x0D; AIM: To analyze data on the disinfection and sterilization activities implemented in healthcare institutions of the Ural and Siberian Federal Districts.&#x0D; MATERIALS AND METHODS: Based on the information obtained from State Federal Statistical Monitoring form No. 27 Information on disinfection activities for 20152022 presented by the Rospotrebnadzor offices of the respective Russian Federation constituents, long-term average annual and Russias nationwide average figures were compared. The rating of the quality of disinfection and sterilization measures in the healthcare institutions of the Ural and Siberian Federal Districts was analyzed using Statistica 10, and the most significant groups of indicators were selected for analysis.&#x0D; RESULTS: The resulting rating scores and their long-term annual kinetics suggest that the steadiest quality indicators of the disinfection and sterilization activities were observed in healthcare institutions in the Khakass Republic, Tyumen, and Omsk Oblasts.&#x0D; CONCLUSIONS: Continuous monitoring of key disinfection and sterilization indicators in healthcare institutions allows the development of task-oriented preventive activities and their adjustment to changes in the epidemiologic situation in the region.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy

ObjectiveThe Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study designPoint prevalence survey. MethodsA pilot PPS was conducted between May–June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. ResultsAmong 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%–3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%–4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. ConclusionsA national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

External and internal validation of healthcare-associated infection data collected by the Korean National healthcare-associated Infections Surveillance System (KONIS)

This study analyzed the validity of healthcare-associated infection (HAI) data of the Korean National healthcare-associated Infections Surveillance System. The validation process consisted of external (EV) and internal (IV) validation phases. Of the 193 hospitals that participated from July 2016 through June 2017, EV was performed for 10 hospitals that were selected based on the HAI rate percentile. The EV team reviewed 295 medical records for 60 HAIs and 235 non-HAI control patients. IV was performed for both the 10 EV hospitals and 11 other participating hospitals that did not report any HAIs. In the EV, the diagnosis of urinary tract infections had a sensitivity of 72.0% and a specificity of 99.3%. The respective sensitivities of bloodstream infection and pneumonia were 63.2% and 70.6%; the respective specificities were 98.8% and 99.6%. The agreement (ĸ) between the EV and IV for 10 hospitals was 0.754 for urinary tract infections and 0.674 for bloodstream infections (P<.001, respectively). Additionally, IV found additional cases among 11 zero-report hospitals. This study demonstrates the need for ongoing validation and continuous training to maintain the accuracy of nationwide surveillance data. IV should be considered a validation method to supplement EV.

A Survey of the Collection of Denominator Data in the Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module

Je Eun Song, Gang-Bok Oh, Young Hwa Choi, Sung Ran Kim, Su Ha Han, So-Yeon Yoo, Hyeon Mi Yoo, Ji-youn Choi, Myoung Jin Shin, Yee Gyung Kwak. Korean J healthc assoc Infect Control Prev 2023;28:78-84. https://doi.org/10.14192/kjicp.2023.28.1.78

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2020 through June 2021

Eun Jin Kim, Yee Gyung Kwak, Sun Hee Kwak, Su Hui Ko, Oh Mee Kweon, Eu Suk Kim, Jin Hwa Kim, Tae Hyong Kim, Taek Soo Kim, Hee-Won Moon, Sun Hee Park, Jin Young Ahn, So-Yeon Yoo, Hyeon Mi Yoo, Sang-Oh Lee, Yu-Mi Lee, Nan-Hyoung Cho, Young Hwa Choi, Pyoeng Gyun Choe, Ki Ho Hong, Mi Suk Lee, Korean National Healthcare-associated Infections Surveillance System (KONIS) ICU module. Korean J healthc assoc Infect Control Prev 2023;28:64-77. https://doi.org/10.14192/kjicp.2023.28.1.64

Impact of COVID-19 pandemic on healthcare-associated infections at intensive care units in South Korea: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS)

The coronavirus disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. To evaluate the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in intensive care units (ICUs). A retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System was conducted. Comparisons between incidence rates and micro-organism distributions of bloodstream infection (BSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic were performed according to hospital size. The incidence rate of BSI significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period (1.38 vs 1.23 per 10,000 patient-days, relative change -11.5%; P < 0.001). The incidence rate of VAP (1.03 vs 0.81 per 1000 device-days, relative change -21.4%; P < 0.001) significantly decreased during the COVID-19 pandemic compared to the pre-COVID-19 period, whereas rates of CLABSI (2.30 vs 2.23 per 1000 device-days; P= 0.19) and CAUTI (1.26 vs 1.26 per 1000 device-days; P= 0.99) were similar between the two periods. The rates of BSI and CLABSI significantly increased during the COVID-19 pandemic compared to the pre-COVID-19 period in large-sized hospitals, whereas these rates significantly decreased in small-to-medium-sized hospitals. The rates of CAUTI and VAP significantly decreased in small-sized hospitals. There were no significant changing trends in the rates of multidrug-resistant pathogens isolated from patients with HAI between the two periods. The incidence rates of BSI and VAP in ICUs decreased during the COVID-19 pandemic compared to the pre-COVID-19 period. This decrease was mainly seen in small-to-medium-sized hospitals.

Hepatitis B immune status of staff in smaller acute healthcare facilities.

Objective To determine the proportion of staff employed in smaller Victorian public acute healthcare facilities with evidence of immunity to hepatitis B. Methods For optimal long-term immunity, a completed hepatitis B vaccination course and post vaccination hepatitis B surface antibody (anti-HBs) level ≥10 mIU/mL is desirable for all high-risk staff employed in healthcare facilities. For the financial years 2016/17-2019/20, a standardised surveillance module developed by the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre was completed by the smaller Victorian public acute healthcare facilities (individual hospitals with Results A total of 88 healthcare facilities reported hepatitis B immunity status of high-risk (Category A) staff (n = 29 920) at least once over 5 years; 55 healthcare facilities reported more than once. The aggregate proportion with evidence of optimal immunity was 66.3%. Healthcare facilities with 100-199 Category A staff employed reported the lowest evidence of optimal immunity (59.6%). Of all Category A staff with no evidence of optimal immunity, the majority had 'unknown' status (19.8%), with only 0.6% overall who declined vaccination. Conclusions Our study found evidence of optimal staff hepatitis B immunity in only two-thirds of Category A staff working in surveyed healthcare facilities.

Nosocomial bacterial infections in Victoria decreased during the COVID-19 pandemic.

A number of infection control interventions were implemented during the COVID-19 pandemic in order to reduce the spread of this virus. The purpose of this study was to determine if these interventions were associated with reduced nosocomial bacterial infections in Victoria, Australia. Observational data were obtained from the Victorian Healthcare Associated Infection Surveillance System (VICNISS) based on admitted hospital patients in two 6-month timeframes representing pandemic and pre-pandemic hospital practices. Data were collected for surgical site infections, Staphylococcus aureus bacteraemia, Clostridioides difficile infection, and central line-associated bloodstream infections. There was a significant reduction in the rates of S. aureus bacteraemia (0.74 infections/10, 000 bed days pre-pandemic vs. 0.53/10,000 bed days in the pandemic period [rate ratio 0.72, 95% CI 0.57-0.90]; p = .003) and in C. difficile infections (2.2 infections/10,000 bed days pre-pandemic vs. 0.86/10 000 bed days in the pandemic era [rate ratio 0.76, 95% C.I. 0.67-0.86]; p <.001). There was no change in the overall rate of surgical site infections or central line-associated infections however. The increased emphasis on infection control and prevention strategies during the pandemic period was associated with reduced transmission of S. aureus and C. difficile infections within hospitals.

Pilot Study of Healthcare-associated Infections Surveillance System in Long-term Care Facilities

Sung-Ran Kim, Kyung-Sook Cha, Jae Yeun Kim, Bo Ram Oh, Hyeon Mi Yoo, Nan-Hyoung Cho, Jong-Rim Choi, Ji-Youn Choi, Si-Hyeon Han, Hyuk Ga, Mi Suk Lee. Korean J healthc assoc Infect Control Prev 2022;27:153-61. https://doi.org/10.14192/kjicp.2022.27.2.153

2041. Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)

Abstract Background Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit. Methods We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic. Results The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days; P &amp;lt; 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days; P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days; P &amp;lt; 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly. Conclusion The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals. Disclosures All Authors: No reported disclosures.

The Epidemiology of Healthcare-Associated Bloodstream Infection in an Adult Intensive Care Unit: A Retrospective Cohort Study in a Single Tertiary Care Hospital in Hanoi, Vietnam.

Background Healthcare-associated infections (HAIs), including bloodstream infections (BSIs) in the intensive care unit (ICU), are growing global public health problems. While high-income countries have reported the burden of HAIs precisely, low- and middle-income countries (LMICs), including Vietnam, often lack surveillance systems for HAIs. In Vietnam, few reports described HAI-associated BSIs. Therefore, in this study, we aim to clarify the characteristics of HAI-associated BSIin an adult ICU. Materials and methods We conducteda retrospective cohort study of HAI-associated BSIin the adult ICU of Bach Mai Hospital (BMH), Vietnam, between December 2013 and August 2015. For every case identified with bacteremia, we collected characteristics and laboratory findings of the case andfollowed the length of hospital stay and seven-day and 30-day survival. Predictors of 30-day mortality were analyzed using univariate and multivariate analyses. Results Among the 90 cases identified, the median age of the study cohort was 57 (range: 18-90) years, and 59 (65.6%) were male. Chronic heart disease was the most frequent comorbidity (n = 26, 28.9%). The pathogens isolated were mostly Candida spp. (n = 26, 26.3%) and Enterococcus spp. (n = 19, 19.2%). Among the 90 patients with confirmed HAI-associated BSI, 34 (37.8%) patients survived, while 31 (34.4%)patients died in 30 days. In multivariate analysis, chronic heart disease tended to increase with 30-day all-cause mortality (odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.0-11.9, p = 0.051). Conclusions Our retrospective cohort study is the largest investigation to describe HAI-associated BSI in an adult ICU in a tertiary care hospital in Vietnam. Improved laboratory detection and infection surveillance systems are needed to reduce HAI-associated BSI.

Establishing a Standardized Surveillance System for Health Care-Associated Infections in Vietnam.

Standardized surveillance for health care-associated infections (HAI) is critical to understand HAI burden and inform prevention strategies at a national level. Due to differing and generally limited resources in Vietnam's health care facilities, implementation of HAI surveillance has been variable and data quality has not been systematically assessed. In 2016, the Vietnam Administration for Medical Services (VAMS) under the Ministry of Health, with the support of partners, began to establish a context-appropriate, standardized HAI surveillance system for bloodstream infections (BSI) and urinary tract infections (UTI) among 6 pilot hospitals in Vietnam. We identified 5 key elements of our HAI surveillance implementation process that have been conducive to ensuring data quality and program sustainability and scalability. These include: (1) engaging stakeholders, (2) designating roles and responsibilities, (3) developing context-sensitive, standardized surveillance protocols, (4) creating a surveillance implementation strategy, and (5) linking HAI surveillance and prevention activities. With the active participation of infection prevention and control staff from the 6 pilot hospitals, standardized HAI surveillance for BSIs and UTIs was expanded to 12 additional hospitals in 2019. Together, VAMS and partners are helping Vietnam fulfill its commitment to safe health care for all patients.