Transmission-based Precautions Research Articles

Clinical Outcomes After Admission of Patients With COVID-19 to Skilled Nursing Facilities

During the COVID-19 pandemic, stabilized COVID-19-positive patients were discharged to skilled nursing facilities (SNFs) to alleviate hospital crowding. These discharges generated controversy due to fears of seeding outbreaks, but there is little empirical evidence to inform policy. To assess the association between the admission to SNFs of COVID-19-positive patients and subsequent COVID-19 cases and death rates among residents. This cohort study analyzed survey data from the National Healthcare Safety Network of the Centers for Disease Control and Prevention. The cohort included SNFs in the US from June 2020 to March 2021. Exposed facilities (ie, with initial admission of COVID-19-positive patients) were matched to control facilities (ie, without initial admission of COVID-19-positive patients) in the same county and with similar preadmission case counts. Data were analyzed from June 2023 to February 2024. The week of the first observable admission of COVID-19-positive patients (defined as those previously diagnosed with COVID-19 and continued to require transmission-based precautions) during the study period. Weekly counts of new cases of COVID-19, COVID-19-related deaths, and all-cause deaths per 100 residents in the week prior to the initial admission. A stacked difference-in-differences approach was used to compare outcomes for 10 weeks before and 15 weeks after the first admission. Additional analyses examined whether outcomes differed in facilities with staff or personal protective equipment (PPE) shortages. A matched group of 264 exposed facilities and 518 control facilities was identified. Over the 15-week follow-up period, exposed SNFs had a cumulative increase of 6.94 (95% CI, 2.91-10.98) additional COVID-19 cases per 100 residents compared with control SNFs, a 31.3% increase compared with the sample mean (SD) of 22.2 (26.4). Exposed facilities experienced 2.31 (95% CI, 1.39-3.24) additional cumulative COVID-19-related deaths per 100 residents compared with control facilities, representing a 72.4% increase compared with the sample mean (SD) of 3.19 (5.5). Exposed facilities experiencing potential staff shortage and PPE shortage had larger increases in COVID-19 cases per 100 residents (additional 10.97 [95% CI, 2.76-19.19] cases and additional 14.81 [95% CI, 2.38-27.25] cases, respectively) compared with those without such shortages. This cohort study suggests that admission of COVID-19-positive patients into SNFs early in the pandemic was associated with preventable COVID-19 cases and mortality among residents, particularly in facilities with potential staff and PPE shortages. The findings speak to the importance of equipping SNFs to adhere to infection-control best practices as they continue to face COVID-19 strains and other respiratory diseases.

Implementation of contact precautions for multidrug-resistant organisms in the post-COVID-19 pandemic era: An updated national Emerging Infections Network (EIN) survey.

To understand how healthcare facilities employ contact precautions for patients with multidrug-resistant organisms (MDROs) in the post-coronavirus disease 2019 (COVID-19) era and explore changes since 2014. Cross-sectional survey. Emerging Infections Network (EIN) physicians involved in infection prevention or hospital epidemiology. In September 2022, we sent via email an 8-question survey on contact precautions and adjunctive measures to reduce MDRO transmission in inpatient facilities. We also asked about changes since the COVID-19 pandemic. We used descriptive statistics to summarize data and compared results to a similar survey administered in 2014. Of 708 EIN members, 283 (40%) responded to the survey and 201 reported working in infection prevention. A majority of facilities (66% and 69%) routinely use contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) respectively, compared to 93% and 92% in 2014. Nearly all (>90%) use contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter baumannii. More variability was reported for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing gram-negative organisms. Compared to 2014, fewer hospitals perform active surveillance for MRSA and VRE. Overall, 90% of facilities used chlorhexidine gluconate bathing in all or select inpatients, and 53% used ultraviolet light or hydrogen peroxide vapor disinfection at discharge. Many respondents (44%) reported changes to contact precautions since COVID-19 that remain in place. Heterogeneity exists in the use of transmission-based precautions and adjunctive infection prevention measures aimed at reducing MDRO transmission. This variation reflects a need for updated and specific guidance, as well as further research on the use of contact precautions in healthcare facilities.

Risk factors for transmission of carbapenem-resistant Acinetobacter baumannii in outbreak situations: results of a case-control study

BackgroundAn increase in patients with multidrug-resistant organisms and associated outbreaks during the COVID-19 pandemic have been reported in various settings, including low-endemic settings. Here, we report three distinct carbapenem-resistant Acinetobacter baumannii (CRAB) outbreaks in five intensive care units of a university hospital in Berlin, Germany during the COVID-19 pandemic.MethodsA case-control study was conducted with the objective of identifying risk factors for CRAB acquisition in outbreak situations. Data utilized for the case-control study came from the investigation of three separate CRAB outbreaks during the COVID-19 pandemic (August 2020– March 2021). Cases were defined as outbreak patients with hospital-acquired CRAB. Controls did not have any CRAB positive microbiological findings and were hospitalized at the same ward and for a similar duration as the respective case. Control patients were matched retrospectively in a 2:1 ratio. Parameters routinely collected in the context of outbreak management and data obtained retrospectively specifically for the case-control study were included in the analysis. To analyze risk factors for CRAB acquisition, univariable and multivariable analyses to calculate odds ratios (OR) and 95% confidence intervals (CI) were performed using a conditional logistic regression model.ResultsThe outbreaks contained 26 cases with hospital-acquired CRAB in five different intensive care units. Two exposures were identified to be independent risk factors for nosocomial CRAB acquisition by the multivariable regression analysis: Sharing a patient room with a CRAB patient before availability of the microbiological result was associated with a more than tenfold increase in the risk of nosocomial CRAB acquisition (OR: 10.7, CI: 2.3–50.9), while undergoing bronchoscopy increased the risk more than six times (OR: 6.9, CI: 1.3–38.1).ConclusionsThe risk factors identified, sharing a patient room with a CRAB patient and undergoing bronchoscopy, could point to an underperformance of basic infection control measure, particularly hand hygiene compliance and handling of medical devices. Both findings reinforce the need for continued promotion of infection control measures. Given that the outbreaks occurred in the first year of the COVID-19 pandemic, our study serves as a reminder that a heightened focus on airborne precautions should not lead to a neglect of other transmission-based precautions.

Assessing infection prevention and control programs in residential aged care in Australia: A multi-methods cross-sectional study.

To assess infection prevention and control programs in residential aged care facilities. A cross-sectional survey and structured interviews from 10 residential aged care facilities in Victoria, Australia, were used. Infection prevention and control nurse leads from each facility completed a purpose-built survey based on best practice infection prevention control program core components, including staff training, policies and procedures, governance, and surveillance. Follow-up interviews with residential aged care staff, residents and family visitors were carried out to elaborate and verify survey data. Surveys from all 10 facilities were received and 75 interviews carried out. All facilities had an infection prevention and control lead nurse who had undergone additional training, and 60% of facilities had an infection prevention and control lead position description. All facilities had a committee to oversee their infection prevention and control program, and all had policies and procedures for standard and transmission-based precautions. One facility did not have a policy on healthcare-associated infection surveillance, and two facilities did not have an antimicrobial stewardship policy. All facilities provided staff training in hand hygiene and personal protective equipment use, but not all routinely assessed competency in these. The residential aged care facilities' infection prevention and control programs were generally in a strong position, although there were some areas that require improvement. Further assessment of the quality of infection prevention and control program components, such as content of education and training, and policies and procedures, and ongoing evaluation of programs is recommended. Geriatr Gerontol Int 2024; 24: 358-363.

Assessing Healthcare Provider's Skills in the Management of COVID-19 Infection at Busia County Referral Hospital, Kenya

Context: The zoonotic coronavirus of 2019 (COVID-19) was caused by an enveloped Ribonucleic Acid (RNA) virus from the Coronaviridae family in the Sarbecovirus subgenus and Severe Acute Respiratory Syndrome – Coronavirus – 2 (SARS-Cov-2) organism. The index case was believed to have originated and transmitted from animals (bats) to humans in November 2019 at the Wuhan live market in China, and subsequently, transmissions were among the human race through direct and indirect contact with respiratory droplets from an infected person(s) to the vulnerable person(s), while talking, sneezing, or coughing. World Health Organization (WHO) declared it a pandemic on March 11, 2020, while in Kenya, it was on March 20, 2020, and by June 11, 2021, Busia County had 3,982 infected individuals, with a positivity rate of 3.9%, 157 being health care providers across all cadres were infected and two deaths reported. Busia County Referral Hospital contributed 30% of the total infected healthcare providers across the seven sub-counties due to non-adherence to standard and transmission-based precautions as guided by the World Health Organization.
 Aim: The study assesses the healthcare provider's skills in managing COVID-19 infection at Busia County Referral Hospital in Kenya.
 Methods: The study utilized a descriptive cross-sectional study design, using a semi-structured questionnaire to collect qualitative and quantitative data from 153 study subjects stratified per cadre. The data collection tool was adapted from the facility readiness assessment questionnaire for COVID-19 (Centre for Disease Control and Prevention) and the risk assessment and management of exposure questionnaire of healthcare workers in the context of COVID-19 (World Health Organization).
 Results: The study reveals that respondents who had worked for shorter duration (1 to 3 years) and were taken through shorter training sessions (1 to 2 days) had higher odds 2.3 and 2.1 (p = 0.03) and p=0.04), respectively to demonstrate good skills in the management of COVID-19, which was statistically significant. Furthermore, knowledge of five moments of hand hygiene had p=0.007, with a higher odds ratio on availability of essential commodities such as gloves 2.5 odds, surgical face masks 3.8 odds, thermos-gun 3.8 odds, designated focal person at triage 6.1 odds and screening checklist 3.2 odds with p-value ≤ 0.05 enhanced good skills required to curb the pandemic.
 Conclusion: Frequent shorter periods of training of the health care providers and the availability of essential commodities for managing COVID-19 enhanced good skills to curb the pandemic infection. Knowledge of the five moments of hand hygiene influences good skills to prevent the spread of COVID-19 infection. The study recommended regular drills on appropriate use of personal protective equipment and adherence to five moments of hand hygiene by healthcare providers as key skills in managing COVID-19 infection. It further recommends establishing and disseminating policy on an essential list of health products and technologies required to manage COVID-19. In addition, the study recommends a further in-depth study on the impact of the mitigation strategies put in place to manage the pandemic.

Enhancing competency in infection prevention and control: Identifying priorities for clinical nurse educational needs

BackgroundHealthcare-associated infections (HAIs) have become a significant concern globally, posing risks to patients and imposing social and economic burdens. Competency in infection prevention and control (IPC) practices is essential for nurses to effectively reduce the risk of transmission. However, there is a lack of research on educational needs for competency in IPC practices. ObjectivesThis study aimed to assess and prioritize educational needs for the development of educational content focused on the IPC practices of clinical nurses. DesignA descriptive cross-sectional design was utilized. SettingsThis study was conducted at six general hospitals located in five urban regions in South Korea, each with 100 to 300 beds. ParticipantsA total of 226 nurses were recruited as participants for this study. MethodsData were collected from June to July 2021. A total of 226 nurses participated in this study. After examining the perceived importance and current performance of attributes related to IPC, educational needs were identified by paired-sample t-test, importance-performance analysis, Borich's needs analysis, and the Locus for Focus model. ResultsItems related to IPC were found to have lower performance than importance, highlighting the need for education. Educational needs were the highest for items in the “IPC practices according to microorganisms” category, such as MRSA, VRE, antimicrobial-resistant organisms, Clostridium difficile, scabies, and AIDS. Items in the “isolation precautions” category, including standard precautions, transmission-based precautions, management of isolation rooms, and wearing PPE, also demonstrated high priority in terms of educational needs. The findings suggest the need for training programs for clinical nurses with a focus on specific areas for improving IPC competency. ConclusionsThe development and implementation of training modules tailored to the educational needs of clinical nurses may enhance their skills, knowledge, and attitudes, ultimately resulting in improved performance.

Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols

IntroductionAdherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. MethodsA self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question “If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …” was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. ResultsStudy participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). ‘Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to ‘Tasks’ (43.7%) and ‘Organisation’ (30.6%) followed by issues related to ‘Person’ (16.9%), ‘Tools and technology’ (6.9%) and ‘Environment’ (1.9%). ConclusionMulti-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. Implications for practiceFuture studies that focus on evaluation of ‘Tasks’ and ‘Organisation’ domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.

Infection prevention and control in CT Part 1: An Australian study of roles, responsibilities and practices

IntroductionThe computed tomography (CT) suite presents Infection Prevention and Control (IPC) risks for staff and patients. This is the first of a two-part series on IPC in the CT setting and reports on Australian baseline data related to intravenous contrast media administration and the use of power injectors in the CT suite, including knowledge sources related to the delivery of contrast media. The second part provides insights into CT staff's perceptions of high-risk scenarios for non-adherence to standard or transmission-based precautions. MethodsThe study employed an online survey design, directed at radiographers and radiology nurses working in Australia. The survey included questions relating to CT workplace staffing and equipment, contrast media use and occupational roles, and knowledge sources used for infection control and contrast injectors. ResultsOverall, 160 study participants completed the survey (radiographers: n = 138, 86.3%; nurses: n = 22, 13.7%). Differences were identified between public and private practice. Public hospitals completed more contrast-enhanced scans, and with dual injecting systems, operated and cleaned by radiographers and nurses. Private clinics generally used single-system, power injectors. Radiographers and nurses relied heavily on their colleagues and product guidelines for IPC information. IPC teams were uncommon in private clinics, very common in public departments and 50% of respondents had undertaken IPC training in the last 12 months. ConclusionInsights into use and duties of professionals delivering intravenous contrast media administration using power injectors in the CT suite will help to inform decision-making processes on IPC education strategies and map risk. Implication for practiceFuture research should focus on how radiology workers in CT perceive IPC risk and/or might vary from best practice, which has direct clinical implications for safety if contamination, or incorrect information is routinely applied.

1660. Harnessing Handshake Rounds for Infection Prevention: Interventions and Great Catches in the First Year

Abstract Background There are national calls to engage Infection Preventionists (IPs) as antimicrobial stewards (AS), but it is unknown how this is translated into action and measurable outcomes. The Association of Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) 2012 joint position paper states that IPs can benefit ASPs. The paper summarizes key actions for IPs as promoting compliance with standard and transmission-based precautions, care bundle, hand hygiene, and educating staff, patients, and visitors. However, an initial review of the literature did not find any publications outlining IP actions or outcomes as participants in AS. Methods In August 2022 an IP was added as available to the existing handshake stewardship rounding team. During rounds the IP observed units for safe infection control practices, asked staff if there were any questions about IC policies or practices, and shared information about circulating illness and COVID-19 policy updates. Results Between August 2022 and March 2023, there were 201 interventions. The largest categories included environmental, education, and expired product. 42 (21%) were categorized as a “great catch”, defined as likely to have system-wide impact. Secure chat data was also collected as a baseline to assess change over time. IP interventions during ASP Handshake Rounds EHR Secure Chats to on call Infection Preventionists Conclusion The impact of including an IP during handshake stewardship was great. Impact includes environmental interventions: cleaning and disinfection processes, laundry, waste, damaged structures, construction, and ventilation issues. Educational impact: teaching providers how to access policies, answering questions about isolation and PPE, and the importance of standard precautions and policy changes surrounding COVID-19. Identifying and disposing of expired products and guidance on isolation precautions and PPE. Examples of a great catch included upgrading isolation status, identifying multiple expired products, correcting incorrect PPE or IC in real time, and educating large groups of staff members on critical IC topics. Health care teams and leadership expressed appreciation of education and support provided by the IP during rounds. Integration of IP into Handshake Stewardship will improve IC practices and Joint Commission readiness. Disclosures All Authors: No reported disclosures

Analysing the implementation of infection prevention and control measures in health care facilities during the COVID-19 pandemic in the African Region

BackgroundThe declaration of SARS-CoV-2 as a public health emergency of international concern in January 2020 prompted the need to strengthen infection prevention and control (IPC) capacities within health care facilities (HCF). IPC guidelines, with standard and transmission-based precautions to be put in place to prevent the spread of SARS-CoV-2 at these HCFs were developed. Based on these IPC guidelines, a rapid assessment scorecard tool, with 14 components, to enhance assessment and improvement of IPC measures at HCFs was developed. This study assessed the level of implementation of the IPC measures in HCFs across the African Region during the COVID-19 pandemic.MethodAn observational study was conducted from April 2020 to November 2022 in 17 countries in the African Region to monitor the progress made in implementing IPC standard and transmission-based precautions in primary-, secondary- and tertiary-level HCFs. A total of 5168 primary, secondary and tertiary HCFs were assessed. The HCFs were assessed and scored each component of the tool. Statistical analyses were done using R (version 4.2.0).ResultsA total of 11 564 assessments were conducted in 5153 HCFs, giving an average of 2.2 assessments per HCF. The baseline median score for the facility assessments was 60.2%. Tertiary HCFs and those dedicated to COVID-19 patients had the highest IPC scores. Tertiary-level HCFs had a median score of 70%, secondary-level HCFs 62.3% and primary-level HCFs 56.8%. HCFs dedicated to COVID-19 patients had the highest scores, with a median of 68.2%, followed by the mixed facilities that attended to both COVID-19 and non-COVID-19 patients, with 64.84%. On the components, there was a strong correlation between high IPC assessment scores and the presence of IPC focal points in HCFs, the availability of IPC guidelines in HCFs and HCFs that had all their health workers trained in basic IPC.ConclusionIn conclusion, a functional IPC programme with a dedicated focal person is a prerequisite for implementing improved IPC measures at the HCF level. In the absence of an epidemic, the general IPC standards in HCFs are low, as evidenced by the low scores in the non-COVID-19 treatment centres.

Management and control of an outbreak of NDM-producing Klebsiella pneumoniae in a teaching hospital

Abstract Background Outbreaks caused by New Delhi metallo-β-lactamase (NDM)-producing Enterobacteriaceae are a major public health threat. We report an outbreak caused by NDM-producing Klebsiella pneumoniae (KP) in an Italian teaching hospital and describe the composite management approach that led to a successful containment. Methods On August 12 2022, a 39-year old Ukrainian patient with known colonization (rectal swab) by NDM-producing KP was admitted to the Hematology Unit of the University Hospital of Verona, Italy. Six days after, a second patient tested positive for carbapenem-resistant (CR) KP from rectal swab and 2 additional cases (rectal and pharyngeal swab respectively) were identified in the following 2 weeks. The 4 cases were identical strains. Results A multidisciplinary team coordinated the response actions. Isolation measures were ordered for positive patients, including use of dedicated instruments. Screening at admission and every 7 days was placed for all the ward patients. On-site inspections and microbiological screening of ward surfaces and devices were carried out. Infection prevention and control (IPC) measures were strengthened among personnel. Environmental cleaning was implemented by deep treatment of critical points (e.g. toilets) and reinforcement of routine cleaning. The Risk Manager developed an original checklist based on literature to review the implementation of IPC practices for CR Enterobacteriaceae. No new cases were identified from screening in the following weeks and the Unit returned to standard IPC measures. Given that environmental samples were negative and the cases had overlapping personnel, the hypothesis of contact transmission through caregivers was the most plausible. Reinforcement of training on hand hygiene and transmission-based precautions was planned. Conclusions It was possible to contain the hospital outbreak through rapid and diversified reaction capacity. Continuous IPC education is an essential control measure. Key messages • The spread of NDM-producing Enterobacteriaceae in the hospital setting must be countered with enhanced prevention and, in case of outbreak, rapid control. • Effective containment involves a mix of established measures (screening, hygiene, environmental controls) and innovative approaches (e.g. literature-based checklists).

Enhanced measures, including PCR-based screening and syndromic surveillance for nosocomial outbreaks of the COVID-19 Omicron variant, using descriptive epidemiology and whole-genome sequencing in a Japanese tertiary care hospital

IntroductionIn this study, we aimed to analyze the effectiveness of enhanced preventive measures against nosocomial COVID-19 Omicron outbreaks based on those encountered. MethodsWe introduced PCR-based screening and syndromic surveillance, in addition to standard and transmission-based precautions, during a COVID-19 outbreak in three wards of Kagoshima University Hospital, a Japanese tertiary care hospital, in February 2022, amid the Omicron variant endemic. Furthermore, we analyzed the descriptive epidemiology and whole-genome sequencing (WGS) of positive SARS-CoV-2 PCR samples from this outbreak. ResultsPCR-based screening tests were conducted following the identification of three cases through syndromic surveillance. As a result, 30 individuals tested positive for SARS-CoV-2, including 13 inpatients, five attendant family members, and 12 healthcare workers across the three wards. Notably, no new infections were observed within eight days following the implementation of preventive measures. Among the SARS-CoV-2 genomes analyzed (n = 16; 53.3%), all strains were identified as belonged to BA.1.1 variant. Detailed analysis of descriptive and molecular epidemiology, incorporating single-nucleotide polymorphism analysis of WGS and clarification of transmission links, considering two potential entry routes to the hospital. ConclusionsIntroduction of additional preventive measures, including PCR-based screening and syndromic surveillance, in addition to WGS and descriptive epidemiology, is useful for the early intervention of nosocomial outbreaks and for revealing the transmission route of the COVID-19 Omicron variant.

Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare.

The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.

Evaluation of an antigen-test-based strategy to reduce duration of transmission-based precautions for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in hospitalized patients.

An academic hospital implemented a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antigen-test-based strategy to facilitate discontinuation of precautions for patients admitted with a positive SARS-CoV-2 test. Of 171 patients that underwent antigen testing, 68% had an initial negative test performed a median of 5 days after admission. Antigen testing reduced isolation time by 144 hours.

Public health infection prevention: An analysis of existing training during the COVID-19 pandemic

ObjectivesIn response to the COVID-19 pandemic, agencies and organizations required trainings to support the needs of the public health workforce. To better understand the training resources available, this study identified, organized, and classified infection prevention and control (IPC) training and educational opportunities. Study designEnvironmental scan. MethodsA total of 306 IPC training resources were compiled between January and April 2021. Key themes and topics were identified and compared to the Healthcare Infection Control Practices Advisory Committee's (HICPAC) core IPC practices. ResultsThree hundred and six training resources, including webinars, fact sheets, module-based learning activities, infographics, and professional practice guidance materials, were identified. Common themes included proper use of personal protective equipment (e.g., masks, gloves), community reopening guidance, and mass vaccination resources. A large proportion (74.9%) of trainings were under 60 min. Using the HICPAC framework, the most frequently addressed content included standard precautions (40%), leadership support (31.6%), and transmission-based precautions (25.8%). Few trainings addressed performance monitoring and feedback (17.1%). ConclusionsA wide range of organizations developed IPC-specific content during the pandemic. However, these resources did not address the breadth of knowledge required to implement IPC concepts effectively. The creation of universally applicable IPC core competencies and the development of high-quality IPC education and trainings for public health and the overall responder workforces should be prioritized. Accessible high-quality online and just-in-time trainings are critical for future pandemic and disaster preparedness.

A 'train the trainers' approach to infection prevention and control training in pandemic conditions.

The first wave of the SARS-CoV-2 global pandemic in early 2020 required a rapid roll-out of infection prevention and control (IPC) training for healthcare workers (HCW), including use of appropriate personal protective equipment (PPE). Education about respiratory droplet and aerosol transmission was of paramount importance to ensure safe working practices and improve confidence. A joint working group of Infectious Diseases and IPC staff developed a 'train the trainers' programme, to be rapidly deployed over a three-week period. This model utilised a snowballing approach, training selected staff with the intention that they would train their teams, facilitating swift cascading of information. Targeted invitations prompted staff from diverse departments of the hospital to attend. Pre- and post-session questionnaires evaluated staff confidence with regard to appropriate PPE use. The programme trained 130 HCW over a three week period, was well received and led to increased confidence with PPE use amongst staff. Real-time evaluation ensured content could be adapted to the specific needs of HCW involved. We highlight perceived gaps in training despite existing and enhanced training structures. Provision of face-to-face training in transmission-based precautions, including PPE use, is required to maintain confidence in safe and appropriate IPC amongst hospital staff. We highlight the importance of including non-clinical staff in PPE educational programmes, recognising that these roles are vital for patient care and are frequently patient-facing. We recommend adopting the train the trainers model to facilitate rapid dissemination of education, with interactive multidisciplinary training in future outbreaks to improve HCW confidence and effective IPC.

PURPOSE OF NURSES IN INFECTION CONTROL AND PREVENTION IN MEDICAL MANAGEMENT. A NEW APPRAISAL

Infection Control activity works in tandem with all healthcare disciplines to provide quality patient care through education and practical application of the principles of microbiology, epidemiology, and infection prevention and control.Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and health workers from being harmed by avoidable infection as a result of antimicrobial resistance. No one should catch an infection while receiving health care, yet, these infections can spread through outbreaks and many regular care practices, affecting hundreds of millions of people across the world every year. Infection prevention and control is one of the first topics introduced in nursing programs, yet its main tenets are often lost or forgotten. Objectives: The main objective of these guidelines is to prevent the health care workers and the environment from the transmission of infections. The specific objectives of these guidelines are to provide directions and information in relation to facilities, equipment, and procedures necessary to implement standard and additional (transmission-based) precautions for control of infections Cleaning, disinfecting and reprocessing of reusable equipment, Waste management, Protection of health care workers from transmissible infections, Prevention of HAI in patients, Infection control practices in special situations.

Impact of SARS-CoV-2 Preventive Measures against Healthcare-Associated Infections from Antibiotic-Resistant ESKAPEE Pathogens: A Two-Center, Natural Quasi-Experimental Study in Greece.

The COVID-19 pandemic led to unprecedented stress on healthcare systems worldwide, forming settings of concern for increasing antimicrobial resistance. We investigated the impact of SARS-CoV-2 preventive measures against healthcare-associated infections (HAIs) from antibiotic-resistant bacteria in two tertiary-care hospitals. We compared infection rates between March 2019 and February 2020 (pre-intervention period) and March 2020 and February 2021 (COVID-19 intervention period) from drug-resistant ESKAPEE bacteria (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci; carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli). Over 24 months, 586 drug-resistant ESKAPEE HAIs occurred in 439 patients (0.3% of 179,629 inpatients) with a mean age of 63 years, with 43% being treated in intensive care units (ICUs), and having a 45% inpatient mortality rate. Interrupted time series analysis revealed increasing infection rates before the intervention that were sharply interrupted by abrupt drops for most pathogens and henceforth remained stable in the ICUs but progressively increased in ordinary wards. In the ICUs, the pooled infection rate was 44% lower over the intervention period compared to the pre-intervention period (incidence rate ratio (IRR) 0.56, 95%CI 0.41-0.75, p < 0.001). Pooled infection rates in the wards were slightly higher over the COVID-19 period (IRR 1.12, 95%CI 0.87-1.45, p = 0.368). The findings confirmed the ancillary beneficial impact of the enhanced bundle of transmission-based precautions adopted against SARS-CoV-2 in rapidly constraining antimicrobial-resistant HAIs in two Greek hospitals.

Screening infection prevention policies for equity impacts

Background: Infection prevention teams utilize policies to guide practice; however, some policies may inadvertently uphold institutional racism and discrimination. Our institution utilizes an equity impact assessment tool during new policy creation or existing policy updates to identify, reduce, eliminate, and prevent inequities in care. Methods: We reviewed all 119 current institution-wide policy documents related to or managed by the infection prevention division at Seattle Children’s Hospital using an institutional equity impact assessment tool. The tool asks 6 open-ended questions to help policy owners identify potential inequities and to evaluate how marginalized groups may be affected. Each policy was assessed for its potential to create or sustain inequities for patients, families, or staff. Policies determined to have potential inequities were examined for any language to suggest that equity considerations had been incorporated into the existing policy. Initial policy review was performed by 2 infection prevention physicians, and disagreements were resolved by consensus. We defined the presence of equity considerations as any explicit mention of disparate impact of the policy on marginalized groups or mitigation of such effect. Results: Of the 119 policies reviewed, 43 (36%) were identified as having substantial potential to impact marginalized groups and create or sustain inequities. Among them, 42 (98%) of these policies lacked existing equity considerations. The policies with potential equity implications covered the following categories: COVID-19 (including masking, workforce restriction, testing), visitor restrictions, tuberculosis, central-line–associated bloodstream infections (CLABSIs), multidrug-resistant organisms (MDROs), public health reporting, medical behavioral unit policies, off-site affiliate housing policies, special pathogens program (including Ebola, MERS, SARS), surgical-site infections, home care including dialysis, and occupational health-related policies. Examples of policies that did not highlight inequities included those pertaining to construction, water intrusion, and transmission-based precautions. One example of change driven by use of the equity impact assessment tool concerned communication with patients and families about tuberculosis isolation and resulted in creation of a standardized multidisciplinary care conference to better communicate tuberculosis isolation processes (including testing required, visitor restrictions, and anticipated duration of isolation) to families in their language of care. Conclusions: Hospital-wide infection prevention policies have the potential to create or sustain existing inequities. Systematic consideration of equity implications using an equity impact assessment framework could be the first step in mitigating these effects and can result in concrete actions to reduce systemic racism.Disclosure: None

Use of contact precautions for multidrug-resistant organisms and the impact of the COVID-19 pandemic: An Emerging Infections Network (EIN) survey

Background: The CDC recommends routine use of contact precautions for patients infected or colonized with multidrug-resistant organisms (MDROs). There is variability in implementation of and adherence to this recommendation, which we hypothesized may have been exacerbated by the COVID-19 pandemic. Methods: In September 2022, we emailed an 8-question survey to Emerging Infections Network (EIN) physician members with infection prevention and hospital epidemiology responsibilities. The survey asked about the respondent’s primary hospital’s recommendations on transmission-based precautions, adjunctive measures to reduce MDRO transmission, and changes that occurred during the COVID-19 pandemic. We sent 2 reminder emails over a 1-month period. We used descriptive statistics to summarize the data and to compare results to a similar EIN survey (n = 336) administered in 2014 (Russell D, et al. doi:10.1017/ice.2015.246). Results: Of 708 EIN members, 283 (40%) responded to the survey, and 201 were involved in infection prevention. Most respondents were adult infectious diseases physicians (n = 228, 80%) with at least 15 years of experience (n = 174, 63%). Respondents were well distributed among community, academic, and nonuniversity teaching facilities (Table 1). Most respondents reported that their facility routinely used CP for methicillin-resistant Staphylococcus aureus (MRSA, 66%) and vancomycin-resistant Enterococcus (VRE, 69%), compared to 93% and 92% respectively, in the 2014 survey. Nearly all (&gt;90%) reported using contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter spp, but there was variability in the use of contact precautions for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase–producing gram-negative organisms. In 2014, 81% reported that their hospital performed active surveillance testing for MRSA, and in 2022 this rate fell to 54% (Table 2). The duration of contact precautions varied by MDRO (Table 3). Compared to 2014, in 2022 facilities were less likely to use contact precautions indefinitely for MRSA (18% vs 6%) and VRE (31% vs 11%). Also, 180 facilities (90%) performed chlorhexidine bathing in at least some inpatients and 106 facilities (53%) used ultraviolet light or hydrogen peroxide vapor disinfection at discharge in some rooms. Furthermore, 89 facilities (44%) reported institutional changes to contact precautions policies after the start of the COVID-19 pandemic that remain in place. Conclusions: Use of contact precautions for patients with MDROs is heterogenous, and policies vary based on the organism. Although most hospitals still routinely use contact precautions for MRSA and VRE, this practice has declined substantially since 2014. Changes in contact-precaution policies may have been influenced by the COVID-19 pandemic, and more specifically, contemporary public health guidance is needed to define who requires contact precautions and for what duration.Disclosures: None