Transmission Of Multidrug-resistant Organisms Research Articles

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.

1196. Environmental Contamination of Rooms of Patients Harboring Multidrug-Resistant Organisms

Abstract Background Healthcare environmental contamination by patients harboring multidrug-resistant organism (MDROs) is an important source of hospital MDRO transmission. We aimed to determine the MDRO contamination and bioburden of surfaces within hospital rooms of patients with positive MDRO clinical cultures. Methods Patients with positive clinical cultures of MDROs (carbapenem resistant Acinetobacter baumannii [CRAB], carbapenem resistant Pseudomonas aeruginosa [CRPA], extended spectrum cephalosporin and carbapenem resistant Enterobacterales [ESCRE, CRE] and vancomycin resistant Enterococcus [VRE]) were identified through daily screening of clinical microbiology results. Patient peri-rectal, inguinal, and wound sampling was performed. E-swab and environmental sampling of room surface composites was performed using environmental sponge wipes. Composite 1 included the TV remote, telephone, call button and bed rails. Composite 2 included the room door handle, IV pole and overbed table. Composite 3 included toileting surfaces. Each composite surface area was no more than 350mm3 each. Sponge wipes were expressed in phosphate-buffered saline containing 0.1% Tween 20 using a stomacher. The eluate was concentrated removed leaving ∼ 5mL, and remaining resuspended by vortex. Undiluted suspension was plated on selective MDRO medias and broth. Microbial burden was calculated by summing composites bioburdens. Samples that were only broth positive were given a value of 1 CFU. Table 1.Demographic and Clinical Characteristics of Multidrug-resistant Organisms Positive Patients (n=5)Abbreviation: CRAB: carbapenem-resistant Acinetobacter baumanii, CRPA: carbapenem-resistant Pseudomonas aeruginosa, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, ESLD: end-stage liver disease, IBD: inflammatory bowel diseases, HTN: hypertension, MDRO: multidrug resistant organism, TBI: traumatic brain injury, VRE: vancomycin resistant enterococcus1- Immunosuppressed defined as solid organ transplant, bone marrow transplant within 12 months, chemotherapy within 6 months, HIV and CD4 &amp;lt;200, any immunomodulatory agent within the past 30 days, at least 10 mg of corticosteroid for &amp;gt;14 daysTable 2.Multidrug-resistant Organism Environmental Contamination and Bioburden of Patients and Environmental CompositesAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, CRPA: carbapenem-resistant Pseudomonas aeruginosa, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, VRE: vancomycin resistant Enterococcus, ND: not done, NG: no growth, N/A; not applicable1Patient Swab P1: peri-rectal, P2: wound or tracheostomy, P3: inguinal2Environmental Swab C1: TV remote, telephone, call button and bed rails; Composite 2 room door handle, IV pole and overbed table; Composite 3: toileting surfaces Results Five patients were included with target MDROs (1 CRAB, 1 CRPA, 2 ESCRE, 1 VRE). Demographic, clinical, and microbiological characteristics are summarized in Table 1. The same MDRO was detected in the environment of 60% (3/5) patients. Additional MDROs other than the clinical culture were cultured from patient and composite sites swabs (Table 2). Antibiotic susceptibility data confirmed similarity between patient and environmental isolates and identified additional MDROs present (Table 3,4). Additional patient enrollment and WGS isolates from clinical culture, patient and environmental isolates is ongoing. Table 3.Antimicrobial Susceptibility Profile of Isolates from Patients with Concordant Clinical and Environmental MDROsAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, MIC: minimum inhibitory concentration, N/A; not applicableTable 4.Antimicrobial Susceptibility Profile of Concordant Clinical and Environmental MDROsAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, MIC: minimum inhibitory concentration, N/A; not applicable, VRE: vancomycin resistant enterococcus Conclusion Concordance of clinical isolates with environmental isolates suggest that decolonization interventions could reduce environmental bioburden Disclosures All Authors: No reported disclosures.

Microbiological and chemical evaluation of dairy products commercialized in the Lebanese market.

Cheese is considered an essential component of the Lebanese table, however, several foodborne illnesses have been reported due to cheese consumption. This study aimed to assess the microbiological quality and the occurrence of antibiotic and pesticide residues in two traditional Lebanese cheeses, Akkawi and Baladiyeh. In addition, drug resistance of isolated pathogens from the cheese samples was evaluated. Fifty Akkawi and Baladiyeh cheese samples were obtained in duplicate from 37 different commercial brands in supermarkets and shops from various regions of Lebanon. Samples of different weights were either individually vacuum packed or soaked in brine unpacked where it was placed in plastic bag after being purchased. Samples were homogenized to determine antibiotic and pesticide residues using liquid and gas chromatography coupled to mass spectrometry, and microbiological evaluation was performed according to the International Organization for Standardization reference analytical methods. The disk diffusion method was used to determine the susceptibility of these isolates to antibiotics. Microbiologically, 17% of Akkawi and 14% of Baladiyeh samples were found to be non-conforming. The bacterial isolates (n = 29) were tested for their susceptibility to 11 different antibiotics commonly prescribed in the Lebanese community or used for treating infections caused by Gram-negative bacteria and listeriosis. Each isolate was found to be resistant to at least three antibiotics. Liquid and gas chromatography coupled to mass spectroscopy analysis showed the absence of pesticide residues in all samples. However, sulfamethazine antibiotic residue was found in 14% of the samples. The results suggest that the cheese samples tested could cause foodborne illnesses due to the detection of pathogenic bacteria and are a public health concern due to the presence of antibiotic residues and the transmission of multidrug-resistant organisms.

Impact of conducting hand hygiene audit in COVID-19 care locations of India—A large scale national multicentric study – HHAC study

PurposeHand hygiene (HH), the core element in infection prevention in healthcare, especially for multidrug resistant organism's transmission. The role of HH audits and HH adherence rates in the COVID-19 pandemic, especially in resource limited settings, are yet to be established. MethodsA nationwide multicenter study was conducted in India, involving public, private, teaching and non-teaching COVID healthcare facilities (COVID-HCFs) using the IBhar mobile application based on WHO's hand hygiene audit tool. The HH adherence rates (HHAR) such as complete HHAR (HHCAR), total HHAR (HHTAR), profession specific HHAR, WHO's 5 HH moment specific HHAR and associated variables were measured over 6 month duration (June–December 2021). ResultsA total of 2,01,829 HH opportunities were available and the HHCAR and HHTAR were 27.3% and 59.7%. The HHTAR was significantly higher in the west zone (72.2%), private institutes (65.6%), non-teaching institutes (67.7%), nurses (61.6%), HH moments 2 (71.8%) and 3 (72.1%), and morning shift (61.4%). The HHTAR was better in non-COVID HCFs (65.4%) than COVID-HCFs (57.8%) as well as non-COVID ICUs (68.1%) than COVID ICUs (58.7%). The HHTAR was increased from month 1 to month 6 except a small decrease in the month of December. ConclusionsThe hand hygiene adherence is comparable with adherence rate during COVID-19 pandemic in western countries as well as the resource limited settings. The use of gloves during the pandemic and simplified HH techniques and their influence over the HH adherence to be studied further. The sustainable adherence rate over long duration needs to be ensured by continuing the HH audit using multimodal interventions.

Brazilian perspective: antimicrobial stewardship in solid organ transplant.

The incidence of multidrug resistant organisms (MDROs) infections among solid organ transplant (SOT) patients is very high in Brazil. This review will discuss antimicrobial use and resistance in SOT in Brazil, highlighting the main barriers and facilitators for implementation of an antimicrobial stewardship programme (ASP). The most common group of MDROs is carbapenem-resistant Gram-negative bacteria and vancomycin-resistant Enterococcus. Carbapenem-resistant Enterobacterales (CREs) are the most frequent MDROs and have been reported as donor-derived as well. Although ASPs are mandatory in the country, there is a lack of information regarding ASPs in SOT recipients. The main barriers for the implementation of ASPs in Brazilian hospitals are lack of electronic medical records, absence of national guidelines specific to SOT recipients, lack of recommendations on surveillance culture to evaluate colonization and transmission of donor-derived MDROs, limited availability of rapid diagnostic tests, and insufficient pharmacist and clinician time allocated to ASP activities in some SOT centers. The incidence of MDRO infections caused mainly by VREs and CREs is very high in the country. There is limited data regarding antimicrobial use among SOT recipients in Brazil. The absence of antimicrobial stewardship national guidelines specific to SOT recipients is one of the main barriers for the implementation of ASPs in Brazilian hospitals.

The geography of social vulnerability and nursing home facility factors related to infectious disease transmission

Background: The impacts of health inequities on healthcare access, utilization, and outcomes have been highlighted by the COVID-19 pandemic, but these issues have been ongoing, yet understudied, in infectious disease epidemiology. Health inequities affect access to care, quality of care, and health outcomes in all healthcare settings. One healthcare setting that has yet to be fully studied in the context of health inequities is nursing homes. Nursing homes have a host of facility and population-specific issues that differ from other healthcare settings, making the impacts of health inequities likely unique and imperative to understand. The impacts of health inequities on nursing homes are unclear, and they likely have downstream effects on trends in morbidity, mortality, and transmission of multidrug-resistant organisms (MDROs) and other pathogens. Method: Here, we present a descriptive analysis, integrating multiple datasets relating to nursing home facility factors (data from the CMS Provider of Services and the CDC NHSN), nursing-home staffing trends (data from the CMS Payroll-Based Journal data), and social vulnerability (data from the CDC Social Vulnerability Index). We conducted a spatial analysis of nursing-home locations and the social vulnerability of the area. Results: Investigations of facilities and health inequities are best conducted in small spatial geographies. Analyses with less detailed spatial geographies miss high levels of heterogeneity in social vulnerability. Figure 1 provides an example, showing that analyzing nursing homes at a smaller spatial scale (ie, healthcare service area or HSA) shows heterogeneity in poverty levels that might be overlooked at a rough spatial scale, like Hospital Referral Regions (HRR). The poverty level associated with a nursing home will differ greatly depending on the geography of the analysis. Conclusions: These findings highlight that health inequities affect the quality and quantity of care of in nursing homes and that research conducted at larger geographical scales may overlook important mechanistic factors. This work will inform epidemiological models for disease transmission in nursing homes, accounting for the impacts of health inequities on transmission. Abating health inequities in all healthcare settings is a necessity to improve public health for the entire United States.Funding: NoneDisclosures: None

Indwelling medical devices and skin microorganisms on ICU patients bathed with chlorhexidine gluconate

Background: Bathing ICU patients with chlorhexidine gluconate (CHG) decreases bloodstream infections and multidrug-resistant organism transmission. The efficacy of CHG bathing on skin microorganism reduction may be influenced by patient-level clinical factors. We assessed the impact of clinical factors on the recovery of microorganisms from the skin of patients admitted to an ICU who were receiving routine CHG bathing. Methods: We analyzed data obtained from 6 single-day point-prevalence surveys of adult ICU patients between January and October 2018 at 1 medical ICU, in the context of a CHG bathing quality initiative. Demographics and covariates were collected at the bedside and by chart review. Skin swabs were collected from neck, axilla, and inguinal regions and were plated to selective and nonselective media. Standard microbiologic methods were used for species identification and susceptibilities. Multivariable models included patients who received a CHG bath and accounted for clustering of body sites within patients. Results: Across all time points, 144 patients participated, yielding 429 skin swab samples. Mean age was 57 years (SD, 17); 49% were male; 44% had a central venous catheter; and 15% had a tracheostomy Also, 140 patients (97%) had &gt;1 CHG bath prior to skin swab collection, with a median of 9 hours since their last CHG bath (IQR, 6–13 hours). Gram-positive bacteria were more commonly recovered than gram-negative or Candida spp across all skin sites (Table 1). Variation by body site was detected only for gram-positive bacteria, with recovery more common from the neck compared to axilla or groin sites. On multivariate logistic regression (Table 2), presence of central venous catheter was associated with lower odds of gram-positive bacteria recovery among those who received a CHG bath. Presence of tracheostomy was associated with a significantly higher odds of gram-negative bacteria detection on skin. No clinical factors were independently associated with recovery of Candida spp. Conclusions: Central venous catheter presence was associated with lower odds of gram-positive bacteria detection on skin, suggesting the possibility of higher quality CHG bathing among such patients. Tracheostomy presence was associated with greater odds of gram-negative bacteria detection, suggesting that it may be a potential reservoir for skin contamination or colonization. Indwelling medical devices may influence CHG bathing effectiveness in reducing microorganism burden on skin.Funding: NoneDisclosures: None

Multidrug-resistant organisms in paediatric palliative care patients - Prevalence, risk factors and the impact of a liberal hygiene concept.

Multidrug-resistant organisms (MDRO) deserve special attention in health-care facilities for children with life-limiting conditions because these children have an increased risk for colonisation. To avoid nosocomial transmissions to other inpatients, single-room isolation is usually recommended. In the context of paediatric palliative care (PPC), such isolation counters the aim of participation in social activities for the patients. This study aimed to determine the prevalence of MDRO, the predictive value of risk factors and the incidence of nosocomial infections and nosocomial colonisations on a PPC inpatient unit applying a special hygiene concept that enables participation in social activities through risk-adaption and barrier nursing. Two-year surveillance with MDRO screening of all intakes (N=386) of a PPC unit on the day of admission and discharge. To determine the predictive value of pre-defined risk factors, logistic regression analyses were calculated. Receiver operating characteristic analyses were performed to determine the predictive power of the number of risk factors on the presence of MDRO. The rate of MDRO colonisation at admission was 12.7%; previous positive MDRO screening was the only significant individual risk factor. Over the 2-year period, no MDRO-related nosocomial infections occurred; nosocomial colonisation incidence density was 0.6. Results demonstrate that patients with at least one risk factor have to be cared for by barrier nursing until MDRO screening results are negative. Following these guidelines prevents nosocomial MDRO transmission.

Containment of a carbapenem-resistant Acinetobacter baumannii complex outbreak in a COVID-19 intensive care unit

BackgroundA carbapenem-resistant Acinetobacter baumannii outbreak in the COVID intensive care unit of a community hospital was contained using multidrug resistant organism guidelines. The purpose of this study is to report on an outbreak investigation and containment strategy that was used, and to discuss prevention strategy.MethodsA multidisciplinary approach contained the spread of infection. Strategies implemented included consultation with experts, screening, and reversal of personal protective equipment conservation. Ensuring infection control best practices are maintained remain important efforts to reduce the spread of multidrug resistant organisms.ResultsFive patients with carbapenem-resistant Acinetobacter baumannii were identified from routine clinical cultures within one week and one patient was identified from active surveillance cultures.DiscussionPersonal protective equipment conservation, strategies to prevent health care personnel exposure, and patient surge staffing protocols may have increased the likelihood of multidrug resistant organism transmission. Environmental and behavioral infection control regulations with effective administrative guidance, active surveillance cultures, and antimicrobial stewardship are critical to prevent future outbreaks.ConclusionsAfter outbreak containment strategies were implemented, no additional patients were identified with carbapenem-resistant Acinetobacter baumannii. Conventional infection prevention and control strategies were re-instituted. A multidisciplinary approach with continued focus on hand hygiene, environmental cleaning, and correct use of personal protective equipment needs to be put in place to successfully contain and prevent the spread of carbapenem resistant infections.

Effect of a “feedback prompt” from a disinfection tracking system on portable medical equipment disinfection

Portable medical equipment (PME) may contribute to transmission of multidrug-resistant organisms without proper disinfection. We studied whether a Disinfection Tracking System (DTS) with feedback prompt, attached to PME, can increase the frequency of PME disinfection. DTS devices were placed on 10 workstations-on-wheels (WOWs) and 5 vitals machine (VM). After a 25 day "screen-off" period, the DTS device screens were turned on to display the number of hours since the last recorded disinfection event for a 42 day period. We used a Bayesian multilevel zero-inflated negative binomial model to compare the number of events in the display "screen-off" to the "screen-on" period. During the "screen-off" period, there were 1.26 and 0.49 mean disinfection events and during the "screen-on" period, there were 1.76 and 0.50 mean disinfection events for WOWs and VM, respectively, per day. The model estimated mean events per device per day in the the "screen-on" period for WOW's were 1.32 (1.10 - 1.57) times greater than those in the"screen-off" period and the "screen-on" period for VM devices was 1.37 (0.89 - 2.01) times greater than those in the "screen-off" period. The rate of disinfection events for WOWs increased following the implementation of the DTS feedback prompt.

Cost utility analysis of strategies for minimizing risk of duodenoscope-related infections

Transmission of multidrug-resistant organisms by duodenoscopes during ERCP is problematical. The U.S. Food and Drug Administration recently recommended transitioning away from reusable fixed-endcap duodenoscopes to those with innovative device designs that make reprocessing easier, more effective, or unnecessary. Partially disposable (PD) duodenoscopes with disposable endcaps and fully disposable (FD) duodenoscopes are now available. We assessed the relative cost of approaches to minimizing infection transmission, taking into account duodenoscope-transmitted infection cost. We developed a Monte Carlo analysis model in R (R Foundation for Statistical Computing, Vienna, Austria) with a multistate trial framework to assess the cost utility of various approaches: single high-level disinfection (HLD), double HLD, ethylene oxide (EtO) sterilization, culture and hold, PD duodenoscopes, and FD duodenoscopes. We simulated quality-adjusted life years (QALYs) lost by duodenoscope-transmitted infection and factored this into the average cost for each approach. At infection transmission rates<1%, PD duodenoscopes were most favorable from a cost utility standpoint in our base model. The FD duodenoscope minimizes the potential for infection transmission and is more favorable from a cost utility standpoint than use of reprocessable duodenoscopes after single or double HLD at all infection rates, EtO sterilization for infection rates >.32%, and culture and hold for infection rates >.56%. Accounting for alternate scenarios of variation in hospital volume, QALY value, post-ERCP lifespan, and environmental cost shifted cost utility profiles. Our model indicates that PD duodenoscopes represent the most favorable option from a cost utility standpoint for ERCP, with anticipated very low infection transmission rates and a low-cost disposable element. These data underscore the importance of cost calculations that account for the potential for infection transmission and associated patient morbidity/mortality.

Assessment of the effectiveness of ultraviolet-C disinfection on transmission of hospital-acquired pathogens from prior room occupants.

To evaluate the effectiveness of ultraviolet-C (UV-C) disinfection as an adjunct to standard chlorine-based disinfectant terminal room cleaning in reducing transmission of hospital-acquired multidrug-resistant organisms (MDROs) from a prior room occupant. A retrospective cohort study was conducted to compare rates of MDRO transmission by UV-C status from January 1, 2016, through December 31, 2018. Acute-care, single-patient hospital rooms at 6 hospitals within an academic healthcare system in Pennsylvania. Transmission of hospital-acquired MDRO infection was assessed in patients subsequently assigned to a single-patient room of a source occupant with carriage of 1 or more MDROs on or during admission. Acquisition of 5 pathogens was compared between exposed patients in rooms with standard-of-care chlorine-based disinfectant terminal cleaning with or without adjunct UV-C disinfection. Logistic regression analysis was used to estimate the adjusted risk of pathogen transfer with adjunctive use of UV-C disinfection. In total, 33,771 exposed patient admissions were evaluated; the source occupants carried 46,688 unique pathogens. Prior to the 33,771 patient admissions, 5,802 rooms (17.2%) were treated with adjunct UV-C disinfection. After adjustment for covariates, exposed patients in rooms treated with adjunct UV-C were at comparable risk of transfer of any pathogen (odds ratio, 1.06; 95% CI, 0.84-1.32; P = .64). Our analysis does not support the use of UV-C in addition to post-discharge cleaning with chlorine-based disinfectant to lower the risk of prior room occupant pathogen transfer.

821. Changes in Cleaning Practices and Non-conventional Personal Protective Equipment Use due to SARS-CoV-2 and Association with Increases in Multi-drug Resistant Organism Cases

BackgroundDuring the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), policy at a Minnesota hospital changed to state that environmental services would not clean rooms of patients with confirmed or suspected SARS-CoV-2 infections, requiring nursing staff to perform these duties. Investigation of a cluster of carbapenem-resistant Enterobacterales (CRE) in patients hospitalized in the same or adjoining rooms on the medical intensive care unit (MICU) raised concern over whether SARS-CoV-2 cleaning practices and non-conventional personal protective equipment (PPE) use led to transmission of multi-drug resistant organisms (MDROs). MethodsInfection Prevention conducts passive surveillance for MDRO acquisition in inpatient units. Passive surveillance of SARS-CoV-2 was performed early in the pandemic. Active surveillance SARS-CoV-2 testing on admission was initiated in July 2020 and active surveillance testing for admitted patients every 7 days was initiated in December. Incident cases of vancomycin-resistant Enterococcus (VRE), extended-spectrum-β-lactamase-producing organisms (ESBL), methicillin-resistant S. aureus (MRSA), and CRE were determined for hospitalized patients between March 1, 2020 and February 28, 2021, excluding patients with infection on admission. Rates of hospitalized patients testing positive for SARS-CoV-2 per 100 patient days were compared to rates of patients testing positive for VRE, ESBL, MRSA, and CRE per 100 patient days respectively. The same rate comparisons were completed for the MICU. Using the F-Test Two-Sample to determine variance, the Two-Sample T-test assuming unequal variances was applied to each comparison. ResultsCorrelation was significant between rates of SARS-CoV-2 and VRE (p< 0.005), ESBL (p< 0.005), MRSA (p< 0.005), and CRE (p< 0.005) (Table 1). MICU correlation was significant between rates of SARS-CoV-2 and VRE (p< 0.005), ESBL (p< 0.005), MRSA (p< 0.005), and CRE (p< 0.005) (Table 2). Table 1: Two-sample T-test results assuming unequal variances: Hospital COVID rates per 100 patient days vs. rates of incident positive tests for VRE, ESBL, MRSA, and CRE per 100 patient days Table 2: Two-sample T-test results assuming unequal variances: MICU COVID rates per 100 patient days vs. rates of incident positive tests for VRE, ESBL, MRSA, and CRE per 100 patient days ConclusionThe relationships between the rates of SARS-CoV-2 and four MDROs were statistically significant. It can be inferred from this data that changes in hospital cleaning and non-conventional PPE use may have led to an increase in transmission of MDROs in this facility. Disclosures All Authors: No reported disclosures

803. The Impact of Bundled Interventions to Decrease Transmission of Drug-Resistant Pseudomonas aeruginosa from Wastewater Drain Sites on a Hematologic Malignancy/Hematopoietic Stem Cell Transplant Unit

BackgroundWastewater drain (WWD) sites are an important reservoir for amplification, propagation and transmission of multidrug resistant organisms. We observed an increase in the incidence of carbapenem and fluoroquinolone non-susceptible (CP-NS and FQ-NS) P. aeruginosa bloodstream infections (BSI) among patients on our hematologic malignancies (HM) and hematopoietic cell transplant (HCT) unit. The incidence of CP-NS/FQ-NS P. aeruginosa BSI from 2012 through May 2021 is represented in Figure 1. We sought to determine the impact of low-cost, low-barrier interventions targeting WWD sites on the prevalence of patient and environmental P. aeruginosa colonization and incidence of BSI.Figure 1. Incidence of P. aeruginosa BSI, 2012 through May 2021 MethodsBehavioral and structural interventions to limit acquisition from WWD sites were informed by an environmental analysis and rolled out in staged fashion beginning in September 2019. Pre- and post-intervention colonization surveys were performed on the unit to assess for patient and WWD site P. aeruginosa colonization. Whole genome sequencing (WGS) was performed on select isolates. A sensitivity analysis performed accounted for the unconfirmed patient isolates. BSI data was collected retrospectively. ResultsCharacteristics of the pre- and post-intervention groups are presented in Table 1. Five of 27 (18.5%) and 1 of 26 (3.8%) patients in the pre- and post-intervention point prevalence survey, respectively, were confirmed to be colonized with P. aeruginosa (Figure 2), corresponding to a prevalence rate ratio of 0.21 (0.03,1.66). If the two indeterminate samples in the pre-intervention period were positive, the prevalence rate ratio would instead be 0.15 (0.02,1.12). The most frequent P. aeruginosa strains identified by WGS from the patients and environment were 111, 308 and 446. At least 87% of rooms were colonized with P. aeruginosa from at least one WWD site, from pre- and post-intervention periods (Table 2). Table 1. Demographic and clinical characteristics of patients in each epoch. Results are given as percent (frequency) unless otherwise noted. Chi square test was used unless otherwise noted. Figure 2. Proportion of patients colonized with P. aeruginosa Positive: Colonized with P. aeruginosa, confirmed by WGS; Unknown: Phenotype of isolate suggestive of P. aeruginosa, WGS not performed; Negative: No growth on selective agar or non-P aeruginosa identification on WGS Table 2. WWD site colonization, by phenotypic and WGS determination. Fisher’s exact test was used unless otherwise noted. Conclusion P. aeruginosa WWD colonization on our HM/HCT unit may predispose patients to colonization and BSI. The prevalence of patient colonization decreased following implementation of the interventions, despite persistent environmental colonization. We will follow the incidence of P. aeruginosa BSI to determine the long-term impact of these interventions. Disclosures All Authors: No reported disclosures

Perioperative Infection Prevention Beyond COVID‐19

Perioperative Infection Prevention Beyond COVID‐19

Multifacility Outbreak of NDM/OXA-23–Producing Acinetobacter baumannii in California, 2020–2021

Background: NDM/OXA-23 carbapenemase-producing Acinetobacter baumannii isolates have been reported worldwide, but rarely in the United States. A California acute-care hospital (ACH) A identified 3 patients with pan-nonsusceptible A. baumannii during May–June 2020, prompting a public health investigation to prevent further transmission among the regional healthcare network. Methods: A clinical isolate was defined as NDM/OXA-23–producing A. baumannii from a patient at ACH A or B, or an epidemiologically linked patient identified through colonization screening during May 2020–January 2021. ACHs A and B are sentinel sites for carbapenem-resistant A. baumannii surveillance through the Antibiotic Resistance Laboratory Network (AR Lab Network), where isolates are tested for carbapenemase genes. The California Department of Public Health with 3 local health departments conducted an epidemiological investigation, contact tracing, colonization screening, and whole-genome sequencing (WGS). Results: In total, 11 cases were identified during May 2020–January 2021, including 3 cases at ACH A during May–June 2020, and 8 additional cases during November 2020–January 2021: 5 at ACH A, 1 at ACH B, and 2 at skilled nursing facility (SNF) A. Isolates from ACHs A and B were identified through testing at the AR Lab Network. Of the 11 patients (including the index patient), 4 had exposure at SNF A, where 2 cases were identified through colonization screening. Screening conducted at ACH A and 5 other long-term care facilities (LTCFs) identified no additional cases. WGS results for the first 8 cases identified showed 2–13 single-nucleotide polymorphism differences. Antibiotic resistance genes for all isolates sequenced included NDM-1 and OXA-23. On-site assessments related to a COVID-19 outbreak conducted at ACH A identified infection control gaps. Conclusions: Hospital participation in public health laboratory surveillance allows early detection of novel multidrug-resistant organisms (MDROs), which enabled outbreak identification and public health response. A high COVID-19 burden and related changes in infection control practices have been associated with MDRO transmission elsewhere in California. This factor might have contributed to spread at ACH A and hampered earlier screening efforts at SNF A, likely leading to undetected transmission. Extensive movement of positive patients among a regional healthcare network including at least 6 ACHs and 7 LTCFs likely contributed to the prolonged duration of this outbreak. This investigation highlights the importance of enhanced novel MDRO surveillance strategies coupled with strong infection prevention and control practices as important factors in identifying outbreaks and preventing further transmission in regional networks.Funding: NoDisclosures: None