Transmission Of Multidrug-resistant Organisms Research Articles

Nurses' satisfaction with an educational web application to prevent transmission of multidrug-resistant organisms.

Multidrug-resistant organism infections are a serious health problem globally, and can result in patient mortality and morbidity. In this descriptive study, we produced the first web application for transmission prevention specific to the situation based on nursing experience, knowledge, and practice guidelines and to evaluate web application satisfaction among Thai nurses. The sample comprised 282 Thai registered nurses experienced in caring for patients with multidrug-resistant organisms in a tertiary hospital. A demographic form and knowledge test were completed anonymously online. Data were analyzed using descriptive statistics. The application emphasized crucial topics for which participants had low preliminary knowledge and included tutorial sessions, pictures, video clips, drills, and a post-test. The application was piloted with a random sample of 30 nurses, and an instrument tested their satisfaction with this. Results revealed that preliminary knowledge scores for preventing transmission were moderate, and participants were highly satisfied with the application. Findings suggest the application is suitable for Thai nurses and could be applied to nursing practice elsewhere. However, further testing is recommended before implementing it into nursing practice.

Air dispersal of multi-drug-resistant organisms including meticillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii and carbapenemase-producing Enterobacterales in general wards: surveillance culture of air grilles

The environmental surveillance of air grilles in clinical areas has not been systematically analyzed. Samples were collected from frequently-touched items (n=529), air supply (n=295) and exhaust (n=184) grilles in six medical and eleven surgical wards for the cultures of multidrug-resistant organisms (MDROs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenemase-producing Enterobacterales (CPE), and isolates were selected for whole-genome analysis (WGS). The contamination rates were correlated with the colonization pressures of the respective MDROs. From 3-October to 21-November 2023, 9.8% (99/1008) of the samples tested positive, with MRSA (24.2%,24/99), CRAB (59.6%,59/99), and CPE (2.0%,2/99), being the only detected MDROs. The contamination rate in air exhaust grilles (26.6%,49/184) was significantly higher than in air supply grilles (5.8%,17/295;p<0.001). The contamination rate of air exhaust grilles with any MDRO in acute medical wards (73.7%,14/19) was significantly higher than in surgical wards (12.5%,4/32;p<0.001). However, there was no difference in the contamination rate of air exhaust grilles between those located inside and outside the cohort cubicles for MDROs (27.1%,13/48 vs. 28.8%,30/104;p=0.823). Nevertheless, the weekly CRAB colonization pressure showed a significant correlation with the overall environmental contamination rate (r=0.878; 95%CI:0.136-0.986;p=0.004), as well as with the contamination rate in air supply grilles (r=0.960;95%CI:0.375-0.999;p<0.001) and air exhaust grilles (r=0.850;95%CI:0.401-0.980;p=0.008). WGS demonstrated clonal relatedness of isolates collected from patients and air exhaust grilles. Air grilles may serve as MDRO reservoirs. Cohort nursing in open cubicles may not completely prevent MDRO transmission through air dispersal, prompting the consideration of future hospital design.

Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum β-lactamase-producing Enterobacterales by a contaminated duodenoscope

Contamination of duodenoscopes is a significant concern due to the transmission of multidrug-resistant organisms (MDROs) among patients who undergo endoscopic retrograde cholangiopancreatography (ERCP), resulting in outbreaks worldwide. In July 2020, it was determined that three different patients, all had undergone ERCP with the same duodenoscope, were infected. Two patients were infected with blaCTX-M-15 encoding Citrobacter freundii, one experiencing a bloodstream infection and the other a urinary tract infection, while another patient had a bloodstream infection caused by blaSHV-12 encoding Klebsiella pneumoniae. Molecular characterization of isolates was available as every ESBL-producing isolate undergoes Next-Generation Sequencing (NGS) for comprehensive genomic analysis in our center. After withdrawing the suspected duodenoscope, we initiated comprehensive epidemiological research, encompassing case investigations, along with a thorough duodenoscope investigation. Screening of patients who had undergone ERCP with the implicated duodenoscope, as well as a selection of hospitalized patients who had ERCP with a different duodenoscope during the outbreak period, led to the discovery of three additional cases of colonization in addition to the three infections initially detected. No microorganisms were detected in eight routine culture samples retrieved from the suspected duodenoscope. Only after destructive dismantling of the duodenoscope, the forceps elevator was found to be positive for blaSHV-12 encoding K. pneumoniae which was identical to the isolates detected in three patients. This study highlights the importance of using NGS to monitor the transmission of MDROs and demonstrates that standard cultures may fail to detect contaminated medical equipment such as duodenoscopes.

A273 A PILOT PROSPECITVE, MULTI-CENTRE, RANDOMIZED CONTROLLED TRIAL COMPARING FECAL MICROBIOTA TRANSPLANTATION (FMT) TO PLACEBO AT INDUCING REMISSION IN MILD TO MODERATE CROHN'S DISEASE

Abstract Background FMT has shown promise at inducing remission in ulcerative colitis. The effect of FMT on inducing remission in Crohn’s disease however remains unknown. Aims To evaluate the efficacy of FMT at inducing remission in mild-to-moderate Crohn’s disease Methods This double-blind, randomized, trial conducted at 3 Canadian academic centers (Edmonton, Hamilton and Calgary) randomized. Adult patients with mild-to-moderate Crohn’s disease with modified Harvey Bradshaw Index (mHBI) score of ampersand:003E5 and at least one objective measure of inflammation (CRP ≥ 8mg/L or fecal calprotectin (FCP) ≥ 250 ug/g) on stable dosing of concomitant therapy were assigned to FMT or placebo. First assigned treatment was by colonoscopy followed by 20 [DK1] capsules weekly for 7 weeks. Endoscopic severity (SES-CD) was assessed at baseline during colonoscopic delivery of assigned treatment and at week 8 by a blinded central reader using video recording. The primary endpoint was the proportion of patients in both clinical (mHBI ampersand:003C 5) and endoscopic remission (SES-CD ≤ 5) at week 8. Responders (reduction of HBI ≥ 3 or HBI ≤ 5 and reduction of CRP or FCP by ≥ 10%) in FMT group were eligible to continue with open-label FMT capsule every 2 weeks. Non-responders in the placebo group were permitted to restart the trial at week 0 with open-label FMT. Secondary outcomes included patient reported outcomes and safety outcomes. Results Between July 2017 to Jun 2021, 28 were randomized (16 to FMT and 12 to placebo). The study team voluntarily suspended the trial twice due to Health Canada safety warnings regarding potential transmission of multi-drug resistant organisms and SARS-CoV-2 through FMT. At week 8, 0% (0/16) of patients in the FMT group versus 8.3% (1/12) in the placebo group reached the primary endpoint of combined clinical and endoscopic remission. Of the 50% (8/16) in the FMT group who achieved a clinical response and continued on open-label FMT every 2 weeks, 12.5% (1/8) achieved the primary endpoint. Of the 7 non-responders in the placebo group who restarted the trial at week 0 and received open-label FMT, 28.6% (2/7) achieved primary endpoint at week 8 on open-label FMT. No death or hospitalization were observed. The study was terminated early at the recommendation of the Data Safety Monitoring Board. Conclusions FMT was not effective at inducing remission in Crohn’s disease using the FMT regimen in this study. However, this study was limited by a small sample size and recruitment barrier during the COVID pandemic. Future studies may consider other strategies to potentially enhance treatment response, including antibiotic pre-treatment, optimized donor-recipient pairing, and concomitant anti-inflammatory diet. Funding Agencies CIHR

Genetic epidemiology and plasmid-mediated transmission of mcr-1 by Escherichia coli ST155 from wastewater of long-term care facilities.

Long-term care facilities (LTCFs) for older people play an important and unique role in multidrug-resistant organism transmission. Herein, we investigated the genetic characteristics of mobile colistin resistance gene (mcr-1)-carrying Escherichia coli strains isolated from wastewater of LTCFs in Shanghai. Antimicrobial susceptibility test was carried out by agar dilution methods. Whole-genome sequencing and plasmid sequencing were conducted, and resistance genes and sequence types of colistin in E. coli isolates were analyzed. Core genome multilocus sequence typing (cgMLST) analysis was performed by the Ridom SeqSphere+ software. Phylogenetic tree through the maximum likelihood method was constructed by MEGA X. Out of 306 isolates, only 1 E. coli named ECSJ33 was found, and the plasmid pECSJ33 from ECSJ33 harbored the mcr-1 gene that was located with 59,080 bp belonging to IncI2 type. The plasmid pECSJ33 was capable of conjugation with an efficiency of 2.9 × 10-2. Bioinformatic analysis indicated pECSJ33 shared backbone with the previously reported mcr-1-harboring pHNGDF93 isolated from fish source. Moreover, the cgMLST analysis revealed that ECSJ33 belongs to different lineages from those reported from previous E. coli strains but shared high similarity to NCTC11129 in cluster 11. The phylogenetic tree revealed MCR-1 of ECSJ33 in this study was mostly of animal food origin and that they were closely related. Our study firstly reports detection of genome sequence of a multidrug-resistant mcr-1-harboring E. coli ST155 from wastewater of LTCF source in China. The data may prove that the plasmid pECSJ33 belongs to food origin and help to understand the antimicrobial resistance mechanisms and genomic features of colistin resistance under One Health approach.IMPORTANCEOne Escherichia coli named ECSJ33 was found from wastewater of a long-term care facility (LTCF) and the plasmid pECSJ33 from ECSJ33 harbored the mobile colistin resistance gene (mcr-1) that was located with 59,080 bp belonging to IncI2 type, which was capable of conjugation with an efficiency of 2.9 × 10-2. This paper firstly reports an mcr-1-carrying E. coli strain ST155 isolated from LTCF in China. Comparative genomics analysis indicated pECSJ33 shared backbone with the previously reported mcr-1-harboring pHNGDF93 isolated from fish source. The phylogenetic tree revealed MCR-1 protein of ECSJ33 in this study was mostly of animal food origin and that they were closely related. Therefore, the pECSJ33 could be considered as food-origin transmission mcr-1-harboring plasmid.

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.

Evaluating the Effectiveness of Isolation Precautions in Controlling the Spread of Multidrug-Resistant Organisms in Hospitals: A meta-analysis

In this meta-analysis, we evaluated the effectiveness of isolation precautions in preventing the spread of Multidrug-Resistant Organisms (MDROs) in hospital settings, focusing on contact precautions, use of Personal Protective Equipment (PPE), and cohorting of patients. Through a comprehensive literature search, 48 studies were included, highlighting the significant role these measures play in mitigating MDRO transmission. Findings demonstrate that isolation precautions, particularly contact precautions and PPE usage, significantly reduce MRSA and VRE transmission rates. Cohorting patients also proves effective, especially during outbreaks. This study underscores the importance of implementing stringent, evidence-based isolation precautions across healthcare settings to enhance patient safety and healthcare quality. The results advocate for continuous education, adherence monitoring, and tailored infection control strategies to address the dynamic challenges of MDROs in healthcare environments.

286. The Effect of Fecal Microbiota Transplantation on Decolonization of Multidrug-resistant Organisms in the gut

Abstract Background Gut colonization of multidrug-resistant organisms (MDROs), such as carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant Enterococci (VRE), precedes clinical infections. It increases the risk of patient-to-patient transmission of MDROs as well as clinical infections such as bacteremia. Therefore, decolonization of MDROs in the gut by restoring colonization resistance through fecal microbiota transplantation (FMT) could be an effective infection control strategy for MDROs. Methods From March 2019 to November 2022, FMT for CPE and VRE decolonization in the gut was conducted at Hallym University Chuncheon Sacred Heart Hospital. Frozen or capsulized stool (MicroBiotix FMT Delivery Microbiota Preparation) from unrelated pre-screened healthy donor was used for each FMT. The rates of and the time to successful decolonization, defined as 3 consecutive negative results from rectal swab culture repeated with 3-day intervals after the initial FMT, were investigated in CPE and VRE rectal colonizers, respectively. Results FMT was performed in 60 CPE rectal carriers (KPC=55, KPC &amp; NDM=2, KPC &amp; IMP=1, NDM=1, NDM &amp; OXA=1) and in 15 VRE rectal carriers (E. faecium=14, E. faecalis=1). Among patients with follow-up data after initial FMT, decolonization success rates for CPE and VRE rectal carriers were 44.8% (26/58) and 66.7% (10/15) at 1 month, 77.1% (37/48) and 92.9% (13/14) at 3 months, 95.5% (42/44) and 100% (14/14) at 6 months, respectively. Median and mean times to decolonization after initial FMT were 30 and 43 days in CPE rectal colonizers and 14 and 29 days in VRE rectal colonizers, respectively. FMT results for decolonization of MDROs in the gut of Chuncheon Sacred Heart Hospital (ClinicalTrials.gov number, NCT04583098) Conclusion FMT as a microbiome restoration therapy is an effective method to control CPE and VRE colonization (ClinicalTrials.gov number, NCT04583098). Disclosures All Authors: No reported disclosures

Role of the contaminated environment in transmission of multidrug-resistant organisms in nursing homes and infection prevention

With aging of the population in the United States, there are more people in long-term care facilities than in hospitals. Nursing home residents have a high prevalence of colonization with multidrug-resistant organisms (MDROs). A shared environment with vulnerable patients can facilitate intra- and inter-facility transmission of MDROs. The aim of this paper is to examine the role of the nursing home environment in MDRO transmission and provide infection prevention strategies. We searched the published literature and reviewed selected articles on contamination, transmission, and infection associated with the nursing home environment. Nursing home residents were frequently colonized with MDROs, leading to contamination of the surrounding environment with the same pathogen. Surface contamination with MDROs was common in nursing home patient rooms, and to a substantial but lesser frequency in common rooms. Shared rooms were a risk factor for MDRO transmission between patients. Since outbreaks and infections via the environmental contamination cause substantial burden of morbidity and mortality in the nursing home residents, it is essential for healthcare personnel to recognize the role of the nursing home environment in infection transmission and adhere to the current infection prevention guidelines for cleaning and disinfection of environmental surfaces.

Effectiveness of Preventive Nursing Program for Multidrug-Resistant Organism Transmission: A Quasi-experimental Study

Multidrug-resistant organism infections are a major public health problem. Promoting nurses’ practice in preventing multidrug-resistant infections can reduce hospital transmission. This quasi-experimental study investigated the effectiveness of a preventive nursing program for multidrug-resistant organism transmission. The study was carried out in the Department of Internal Medicine in a tertiary hospital in south Thailand. Participants in this study were registered nurses. Two wards were randomly selected as the experimental ward and two as the control ward, then participants from each ward were purposively selected. Finally, there were 60 participants, n = 31 from the experiment wards and n = 29 from the control wards. The experimental group received a 4-week program, whereas the control group followed the usual practice. Then, the practices in preventing multidrug-resistant organism transmission of the experimental and control groups were assessed 4 and 12 weeks after the program ended. The instruments for data collection included a demographic data form and a preventive practice observation form. Data were analyzed using descriptive statistics and a chi-square test. The results showed that, at 4 and 12 weeks after completion of the program, nurses in the experimental group had a significantly higher proportion of correct practices (hand hygiene, use of personal protective equipment, patient placement, patient transport, patient care equipment management, environmental management, and linen and infectious waste management of multidrug-resistant organism transmission) than before receiving the program and in the control group. The findings suggest that the program effectively improves nurses’ correct practices in preventing multidrug-resistant organism transmission. The program can be applied to promote and support preventive practices among nurses. However, long-term follow-ups with the incidence of multidrug-resistant organism transmission should be further studied. In addition, as this study was conducted with nurses working in the internal medicine wards of a tertiary hospital, it is necessary to evaluate the program's effectiveness with different samples prior to its widerimplementation.

Reducing the Risk of Targeted Multidrug-Resistant Organism Transmission

Reducing the Risk of Targeted Multidrug-Resistant Organism Transmission

Development of a Broth Microdilution Method To Characterize Chlorhexidine MICs among Bacteria Collected from 2005 to 2019 at Three U.S. Sites.

Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms has been adopted by many U.S. hospitals, but increasing chlorhexidine use has raised concerns about possible emergence of resistance. We sought to establish a broth microdilution method for determining chlorhexidine MICs and then used the method to evaluate chlorhexidine MICs for bacteria that can cause health care-associated infections. We adapted a broth microdilution method for determining chlorhexidine MICs, poured panels, established quality control ranges, and tested Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae complex isolates collected at three U.S. sites. Chlorhexidine MICs were determined for 535 isolates including 129 S. aureus, 156 E. coli, 142 K. pneumoniae, and 108 E. cloacae complex isolates. The respective MIC distributions for each species ranged from 1 to 8 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 1 to 64 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 4 to 64 mg/L (MIC50 = 16 mg/L and MIC90 = 32 mg/L), and 1 to >64 mg/L (MIC50 = 16 mg/L and MIC90 = 64 mg/L). We successfully adapted a broth microdilution procedure that several laboratories were able to use to determine the chlorhexidine MICs of bacterial isolates. This method could be used to investigate whether chlorhexidine MICs are increasing. IMPORTANCE Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms and reduce health care-associated infections has been adopted by many hospitals. There is concern about the possible unintended consequences of using this agent widely. One possible unintended consequence is decreased susceptibility to chlorhexidine, but there are not readily available methods to perform this evaluation. We developed a method for chlorhexidine MIC testing that can be used to evaluate for possible unintended consequences.

Transmission of multidrug-resistant organisms by VA CLC residents: A multisite prospective study

Background: Veterans Health Administration (VHA) community living centers (CLCs) provide postacute and long-term care. CLC veterans visit myriad locations outside their rooms (eg, rehabilitation, dialysis). Pathogen transmission during out-of-room visits is unknown. Methods: We recruited newly admitted veterans at 3 CLCs. After obtaining informed consent, we cultured nares, groin, hands, and 7 surfaces in the patient rooms. We accompanied veterans to up to 5 out-of-room visits and cultured patients’ hands and surfaces they touched. We tested for multidrug-resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and quinolone, carbapenem, and/or ceftazidime-resistant gram-negative bacteria (R-GNB). We defined transmission as a positive culture following an initial negative culture during the same visit. Results: We enrolled 137 veterans (median follow-up, 29 days; mean, 5.9 visits); 97% were postacute patients. We conducted 539 patient-room sampling visits (mean, 3.9 per veteran; 5,490 swabs) and accompanied 97 veterans to 266 out-of-room sampling visits (mean, 2.7 per veteran; 2,360 swabs). Of 137 patients, 47 (35%) were colonized with an MDRO at enrollment and 74 (58%) of 128 patients were colonized on any follow-up patient-room visits. Of 133 patients, 55 (41%) acquired a new MDRO, most often VRE (31 of 97, 32%). In patient rooms, toilet seats [114 (21%) of 538], curtains [101 (19%) of 530] and bedrails [98 (18%) of 539] were most frequently contaminated. Among 266 out-of-room visits, 17% had surfaces contaminated with MDROs, most commonly involving dialysis [4 (31%) of 13], radiology [2 (25%) of 8], and rehabilitation therapy [29 (18%) of 159] (Fig. 1).Transmission of MDROs during out-of-room visits was common and occurred in 18% of visits with 8% (9 MRSA and 12 VRE) acquiring a new MDRO on their hands and 12% (9 MRSA and 23 VRE) of MDRO transmission occurring from hands to a surface that the patient touched (Fig. 1). In 18 (58%) of 31 cases, the organism transmitted to a surface was on patient hands at the start of the visit. Transmission was most common during visits to dialysis (3 to patients and 2 to surfaces), radiology (1 to a patient and 2 to surfaces), and rehabilitation therapy (13 to patients and 21 to surfaces) (Fig. 2). Conclusions: New MDRO acquisition during VHA CLC stay was common, and nearly one-fifth of out-of-room visits resulted in MDRO transmission. Our analyses suggest that veterans’ hands may shed MDROs (MRSA and VRE) to surfaces. Interventions to reduce MDRO transmission during visits for rehabilitation, dialysis, and other therapies are needed.Disclosures: None

Whole-genome sequencing of carbapenem-resistant Enterobacterales isolates and evaluation of hospital-acquired infections

Background: Multidrug-resistant organisms (MDROs) are increasingly implicated in nosocomial outbreaks worldwide. We evaluated whole-genome sequencing (WGS) as an adjunctive epidemiological tool to identify infection clusters and MDRO transmission in the healthcare setting. Methods: Clinical isolates of carbapenem-resistant Enterobacterales (CRE) from July 1, 2021, to June 30, 2022, underwent Illumina WGS. Assembled genomes were taxonomically classified with GTDB-Tk software and were typed using multilocus sequence typing (MLST). Average nucleotide identity (ANI) was calculated between genomes. Numbers of differences among core single-nucleotide polymorphisms (SNPs) were calculated for pairs within taxonomic groups, and the data were evaluated in the context of patient dates and locations of care obtained from the electronic medical record. Results: In total, 39 CRE isolates underwent WGS (Fig. 1). Klebsiella pneumoniae represented the largest number of isolates (n = 18). Using MLST, 2 distinct groups of K. pneumoniae were identified (ST307 and ST258) with 5 and 4 isolates, respectively (Fig. 2). Within ST307, SNP differences ranged between 8 and 115. 3 isolates (CRE8, CRE10, and CRE12) were collected within 4 weeks of each other and had ≤26 pairwise SNP differences. Notably, CRE8 and CRE10 were located on the same unit at the same time and used the same MRI scanner on the same day. CRE35 had &gt;95 SNP differences and was admitted 8 months prior to others in ST307 but had surgery in the same OR as CRE8. Within ST258, pairwise comparison of samples revealed 139–588 SNP differences. CRE21, CRE31, and CRE33 had SNP differences of ≤150. These patients were in the same hospital room (CRE33 and CRE21) and unit (CRE31 and CRE33), but they did not overlap temporally. CRE37 had &gt;580 SNP differences, with no overlap in hospitalization dates or locations with other patients. Conclusions: Two closely related K. pneumoniae isolate populations were identified using WGS. Strong temporal and spatial commonalities were identified among isolates with few SNP differences. Isolate pairs with intermediate SNP differences shared spatial commonalities, suggesting possible indirect transmission between patients. No common exposures were identified for pairs with large numbers of SNP differences. WGS is an evolving tool to detect outbreak clonal populations of MDRO not identified through traditional epidemiologic techniques. WGS can provide insight into transmission patterns and the role of environmental contamination in propagating these nosocomial infections. More studies are needed to define the role and clinical significance of isolates with intermediate SNP differences in transmission of these pathogens between hosts and the healthcare environment.Disclosures: 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

Assessing Pathogen Transmission Opportunities: Variation in Nursing Home Staff-Resident Interactions.

The Centers for Disease Control and Prevention (CDC) recommends implementing Enhanced Barrier Precautions (EBP) for all nursing home (NH) residents known to be colonized with targeted multidrug-resistant organisms (MDROs), wounds, or medical devices. Differences in health care personnel (HCP) and resident interactions between units may affect risk of acquiring and transmitting MDROs, affecting EBP implementation. We studied HCP-resident interactions across a variety of NHs to characterize MDRO transmission opportunities. 2 cross-sectional visits. Four CDC Epicenter sites and CDC Emerging Infection Program sites in 7 states recruited NHs with a mix of unit care types (≥30 beds or ≥2 units). HCP were observed providing resident care. Room-based observations and HCP interviews assessed HCP-resident interactions, care type provided, and equipment use. Observations and interviews were conducted for 7-8hours in 3-6-month intervals per unit. Chart reviews collected deidentified resident demographics and MDRO risk factors (eg, indwelling devices, pressure injuries, and antibiotic use). We recruited 25 NHs (49 units) with no loss to follow-up, conducted 2540 room-based observations (total duration: 405hours), and 924 HCP interviews. HCP averaged 2.5 interactions per resident per hour (long-term care units) to 3.4 per resident per hour (ventilator care units). Nurses provided care to more residents (n= 12) than certified nursing assistants (CNAs) and respiratory therapists (RTs) (CNA: 9.8 and RT: 9) but nurses performed significantly fewer task types per interaction compared to CNAs (incidence rate ratio (IRR): 0.61, P < .05). Short-stay (IRR: 0.89) and ventilator-capable (IRR: 0.94) units had less varied care compared with long-term care units (P < .05), although HCP visited residents in these units at similar rates. Resident-HCP interaction rates are similar across NH unit types, differing primarily in types of care provided. Current and future interventions such as EBP, care bundling, or targeted infection prevention education should consider unit-specific HCP-resident interaction patterns.

Prevalence of Multidrug-Resistant Organisms in Healthy Adults in Shenzhen, China.

Public health problems caused by the high transmission of multidrug-resistant organisms (MDROs) have attracted widespread international attention. However, studies on healthy adults in this field are scarce. In this article, we report the microbiological screening results of 180 healthy adults recruited from 1,222 participants between 2019 and 2022 in Shenzhen, China. Findings show a high MDRO carriage rate of 26.7% in those individuals who did not use any antibiotics in the past 6 months and had not been hospitalized within the past year. MDROs were mainly extended-spectrum β-lactamase-producing Escherichia coli with high resistance to cephalosporin. With the assistance of metagenomic sequencing technology, we also performed long-term observations of several participants and found that drug-resistant gene fragments were prevalent even when MDROs were not detected by drug sensitivity testing. Based on our findings, we suggest that healthcare regulators limit the medical overuse of antibiotics and enact measures to limit its nonmedical use.

SG-APSIC1105: The effectiveness of the infection control interventions in decreasing multidrug-resistant organism transmission in the Department of Neonatology of Hung Vuong Hospital

Objectives: Infection control and prevention (IPC) is one of the most important factors in decreasing multidrug-resistant organism (MRDO) transmission. We evaluated the effectiveness of the IPC program in reducing the spread of MDROs at the Department of Neonatology of Hung Vuong Hospital. Methods: This research was conducted from April 2020 to September 2020 in the neonatology department in 3 phases: (1) We determined the compliance rate of hand hygiene and high-touch surfaces cleaning (via camera monitoring). (2) We conducted the following interventions: We developed specific cleaning protocols for the neonatology department. We provided training regarding MRDO transmission control and prevention for healthcare workers. We implemented a counseling program for active screening and isolation for hospitalized children; added isolation rooms for children with MRDO asymptomatic infections. And we improved feedback efficiency through an online group between the infection control and prevention team and the department of neonatology. (3) We re-evaluated compliance with hand hygiene practices and cleaning of high-touch surfaces, then we compared the rates of positive MRDO cultures before and after these interventions. Results: Before the interventions, 453 hand hygiene observations were recorded and 322 high-touch-surface cleaning observations were recorded. The hand hygiene compliance rate improved significantly from 33.2% to 85.5% (PR, 11.9; 95% CI, 7.4–19.3; P&lt; .01). The high-touch-surface cleaning rate increased from 82.4% to 93.5% (PR, 3.1, 95% CI, 1.5–6.4; P &lt; .01). The rate of high-touch surfaces being cleaned with proper technique increased from 38.5% to 87.9% (PR, 11.6; 95% CI, 6.3–21.3; P &lt; .01). In total, 103 swab samples were positive for MRDOs by culture before and after the intervention. The rate of positive MRDO cultures decreased from 80.8% to 64.7% (P = .017). Conclusions: Enhancing hand hygiene and high-touch-surface cleaning compliance helped reduce MRDO transmission in the Department Neonatology of Hung Vuong Hospital.

Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All.

The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients' being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.

Nosocomial transmission of multi-drug-resistant organisms in Ukrainian hospitals: results of a multi-centre study (2019–2021)

The increasing emergence and spread of multi-drug-resistant organisms (MDROs) in hospitals is a public health problem and continues to challenge infection control and hospital epidemiology practice worldwide. The aim of this study was to characterize the epidemiology of transmission of MDROs via healthcare workers (HCWs) and the environment in the hospital wards/patient rooms. A multi-centre prospective observational study was conducted in 17 hospitals in Ukraine. Species identification was performed with standard microbial methods. β-Lactamase genes were investigated by polymerase chain reaction. Pulsed-field gel electrophoresis (PFGE) was used to determine the genetic similarity between isolates. Among 51,656 isolates, 19.5% were MDROs. The proportions of MDROs among isolates from patients with healthcare-associated infections, environmental surfaces and HCWs (hands, gown/gloves) were 29.2%, 16.3% and 24.2%, respectively. In 51.9% of the tested isolates, identical MDROs were found in clinical isolates, environmental samples and HCWs' hands. Meticillin resistance was found in 32.4% of Staphylococcus aureus (MRSA) isolates, and vancomycin resistance was found in 28.9% of enterococci (VRE). Resistance to third-generation cephalosporins was detected in 48.4% of Enterobacterales, and carbapenem resistance in 19.1%. Overall, 37.4% of MDROs had broad-spectrum β-lactamase genes, including extended-spectrum β-lactamase (35.8%), OXA-type (29.7%), AmpC-type (25.1%), KPC-type (25.7%) and metallo-β-lactamases, including IMP-type (5.7%), VIM-type (31.7%) and NDM-1 (21.3%). In Ukrainian hospitals the prevalence of healthcare-associated infections caused by MDROs continues to increase, while infection control gaps in healthcare settings facilitate their transmission between patients.