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Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool—Kamishibai board (K-board)—during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs. [ABSTRACT FROM AUTHOR]

Objective Hospital acquired infections (HAIs) are one of the top 10 leading causes of death within the United States. While current standard of HAI risk prediction utilizes only a narrow set of predefined clinical variables, we propose a graph convolutional neural network (GNN)-based model which incorporates a wide variety of clinical features. Materials and Methods Our GNN-based model defines patients' similarity based on comprehensive clinical history and demographics and predicts all types of HAI rather than focusing on a single subtype. An HAI model was trained on 38 327 unique hospitalizations while a distinct model for surgical site infection (SSI) prediction was trained on 18 609 hospitalization. Both models were tested internally and externally on a geographically disparate site with varying infection rates. Results The proposed approach outperformed all baselines (single-modality models and length-of-stay [LoS]) with achieved area under the receiver operating characteristics of 0.86 [0.84–0.88] and 0.79 [0.75–0.83] (HAI), and 0.79 [0.75–0.83] and 0.76 [0.71–0.76] (SSI) for internal and external testing. Cost-effective analysis shows that the GNN modeling dominated the standard LoS model strategy on the basis of lower mean costs ($1651 vs $1915). Discussion The proposed HAI risk prediction model can estimate individualized risk of infection for patient by taking into account not only the patient's clinical features, but also clinical features of similar patients as indicated by edges of the patients' graph. Conclusions The proposed model could allow prevention or earlier detection of HAI, which in turn could decrease hospital LoS and associated mortality, and ultimately reduce the healthcare cost. [ABSTRACT FROM AUTHOR]

Central line-associated bloodstream infections (CLABSIs) are common healthcare-associated infections in pediatrics. Children's hospital CLABSI standardized infection ratios decreased when comparing 2016–2019 (−26%, 95% CI [−31%, −20%]), and increased from 2019 to 2022 (18%, 95% CI [9%, 26%]). Resilient pediatric CLABSI prevention initiatives are needed. [ABSTRACT FROM AUTHOR]

The author advises pharmacists about the importance of being proactive in the prevention of adverse events related to the use of intravenous access devices and of challenges associated with medication administration. Topics mentioned include the emergence of vascular access teams as a component of vessel health and preservation programs, and the role of pharmacists in vascular preservation. A list of the different types of catheters and their uses is also provided.

Background Central line–associated bloodstream infections (CLABSIs) are major sources of morbidity, death, and healthcare costs in patients who receive home parenteral nutrition (HPN). The majority of HPN-dependent children in southern Israel reside in poor communities with substandard living conditions, which creates significant challenges for the safe provision of HPN. We developed a pilot intervention that aimed to reduce the rates of CLABSI and central venous catheter (CVC) replacements in this vulnerable population in our region. Methods Between 2012 and 2014, all HPN-dependent children with intestinal failure who were treated in our center, received HPN through a Hickman catheter, and experienced at least 1 previous CLABSI episode participated in the intervention. The intervention included home visits to assess the caregivers' CVC-handling technique, instillation of prophylactic ethanol lock solution, and the convening of regular multidisciplinary staff debriefings. We calculated CLABSI and CVC-replacement rates before and after the intervention. Results Eight patients who served as their own historical controls were included in the intervention (total of 2544 catheter-days during the intervention period). The mean CLABSI rate decreased from 9.62 to 0.79 CLABSI episodes per 1000 catheter-days; the CVC-replacement rate decreased from 2.5 to 1.2 replacements per 1000 catheter-days in the preintervention and intervention periods respectively. The median hospital length of stay and individual monthly cost of medical care decreased compared to those found in the preintervention period. Conclusions The results of this study offer a proof of concept for a strategy to reduce CLABSI rates in pediatric patients who reside in remote and low-resource environments and are undergoing HPN. [ABSTRACT FROM AUTHOR]

At 128 US hospitals, from 2009–2014, a 17% decline occurred annually in central venous catheter tips sent for culture: a 6-fold decrease from blood culture sampling trends. The positive predictive value was low (23%). Tip culture use often does not conform to recommendations and offers limited independent treatment opportunities. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluated a randomized trial, the incidence of central line-associated bloodstream infections (CLABSI) and the frequency of thrombolytic treatment (TT). Topics discussed include the rates of overall infections and antibiotic use, baseline characteristics of patients, and the ability of investigational medical device (IMD) to reduce CLABSI.

Enterococcus hirae is a gram-positive coccus that is rarely implicated in human disease and has not been reported in pediatric patients. We report a case of catheter-associated bloodstream infection and prolonged bacteremia in a 7-month-old infant dependent on total parenteral nutrition. The species was identified by the VITEK2 system and confirmed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. The organisms was susceptible to ampicillin, vancomycin, and high-level gentamicin. The patient was treated with vancomycin and gentamicin with adjunctive vancomycin lock therapy but had persistent bacteremia. Therapy was changed to dual β-lactam therapy of ampicillin and ceftriaxone with synergistic gentamicin, which led to clearance of the enterococcal bacteremia. E hirae is an unusual species that may be difficult for the microbiology laboratory to identify. This is the first pediatric case and the second case of invasive E hirae in the United States. [ABSTRACT FROM AUTHOR]

Central venous catheters are associated with preventable bloodstream infections, leading to increased morbidity, length of stay, and costs. Quality improvement interventions aim to improve professional adherence to prevention measures. This meta-analysis provides evidence that quality improvement interventions decrease infection rates.This systematic review and meta-analysis examines the impact of quality improvement interventions on central line–associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995–June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before–after studies identified an infection rate decrease (OR, 0.39 [95% CI, .33–.46]; P < .001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95% CI, .10–.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to the prevention of central line–associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions. [ABSTRACT FROM AUTHOR]

Background Due to complex invasive medical procedures and compromised immunity, solid-organ transplant (SOT) patients are at high risk for infections. However, whether SOT patients are at higher risk than other hospitalized patients for selected healthcare-associated infections (HAI), such as central line-associated bloodstream infections (CLABSI) or catheter-associated urinary tract infections (CAUTI), or for infections with antimicrobial-resistant (AR) pathogens, is not well described. We analyzed data reported to the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN) from inpatient SOT units and compared CLABSI and CAUTI rates and AR in hospitals with both SOT and non-SOT units. Methods We analyzed 2015–2017 CLABSI and CAUTI data reported to NHSN from hospitals with adult or pediatric inpatient SOT units. We calculated CLABSI and CAUTI incidence rates per 1,000 central-line days (CLD) and urinary catheter days (UCD), respectively, and compared rates, pathogen distributions, and AR among events attributed to three unit types: (1) SOT units; (2) adult, pediatric, and neonatal critical care units; and (3) adult and pediatric medical, surgical, and combined medical-surgical wards. We compared proportions using χ 2 tests and determined statistical significance at P ≤ 0.05. Results CLABSI and CAUTI rates in SOT units were lower than rates in critical care units, but higher than rates in wards (table). Although the most common CLABSI and CAUTI pathogens were similar in all three unit types, the prevalence of individual pathogens differed (figure). Among CLABSI pathogens, Enterococcus faecium , Escherichia coli , and Klebsiella pneumoniae or oxytoca were significantly more prevalent in SOT compared with critical care units. Vancomycin resistance among CLABSI E. faecium was significantly lower (71.4% vs. 87.5%) and fluoroquinolone resistance among CAUTI E. coli was significantly higher (49.3% vs. 32.5%) in SOT compared with critical care units. Conclusion SOT units have lower CLABSI and CAUTI rates compared with critical care units. Differences in pathogens and AR among device-associated HAIs in SOT units should be considered when implementing infection prevention and treatment policies. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Central Line-Associated Blood Stream Infections (CLABSI) is a major healthcare dilemma, contributing to increased morbidity, mortality, and costs. We sought to reduce rates of CLABSI and device utilization by implementing a multidisciplinary Central Line Stewardship Program (CLSP). Methods In July 2017, the CLSP, multidisciplinary quality improvement project, was implemented at an academic medical center to ensure proper indication for all CVCs in the hospital and removal when no longer indicated. A CLSP team of executive leaders and infection preventionists performed daily rounds on all CVCs to review indications and maintenance. Nursing staff reported all CVCs daily. Information Technology modified the electronic health record to require daily physician documentation of CVC placement and indications, and to suggest alternatives to CVC when possible. In the event of a CLABSI, a root cause analysis was conducted within 72 hours, and feedback was shared with the clinical staff. A retrospective review was conducted 18 months before and after CLSP implementation. As a facility in a state with mandatory reporting of hospital-acquired infections, institutional data were readily available through the National Healthcare Safety Network (NHSN). To compare rates of CLABSI and device utilization pre- and post-CLSP, we reviewed the Incidence Density Rate (IDR), the standardized infection ratio (SIR), and standardized utilization ratio (SUR). Data from the NHSN website were analyzed using statistical tools provided by the NHSN analysis module. Two-tailed significance tests were conducted with α set at 0.05. Results Post-CLSP, there was a statistically significant decrease in SIR from 1.99 to 0.885, with risk reduction by 44.3% (P = 0.013, 95% CI 0.226 -0.831). CLABSI IDR per 1000 CVC days declined from 1.84 to 0.886 (P = 0.0213). CVC utilization per 1000 patient-days reduced from 155.08 to 142.35 (P < 0.001). There was also a trend toward fewer PICC line infections post-intervention (17 to 5). Conclusion With this novel CLSP, we achieved a significant reduction in rates of CLABSI and device utilization, suggesting that a multidisciplinary approach can promote sustainable prevention of line-associated infections through dedicated surveillance of CVC indications and maintenance. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Prolonged maintenance of central venous catheter including peripherally inserted central catheter (PICC) is a major risk factor for central line-associated bloodstream infection (CLABSI). Methods A single-center retrospective study was conducted in an 828-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. Patients were excluded if they: (1) were under 19 years old, (2) died, were discharged, or were transferred to other medical institutions within 3 days of PICC placement, and (3) had at least one result of absolute neutrophil count (ANC) under 500 cell/µL during catheterization. CLABSI was diagnosed using the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). For identifying the statistical correlation between catheter-days and PABSI, odd ratio for PABSI according to the continuous value of catheter-days was analyzed using restricted cubic spline splits with five knots. Receiver operating characteristic (ROC) curve was used to determine the diagnostic precision of applying catheter-days for PABSI. The optimal cut-off value of catheter-days was identified by maximizing the area under ROC curve (AUC). Results A total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Of them, 36 cases were confirmed as PABSI (3.5%, 36/1,014; 1.14 per 1,000 catheter days). In the restricted cubic spline regression, catheter maintenance days showed a dose-dependent relationship with the risk of PABSI. The ROC for developing PABSI according to catheter maintenance duration showed that the AUC was 0.715 (95% CI 0.639–0.790) and the optimal cut-off value was 25 days. Conclusion The incidence of PABSI was 1.14 per 1,000 catheter days and the optimal cut-off value of catheter-days for preventing PABSI was 25 days. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Long-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care. Methods A three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines. Results After 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%. Conclusion A multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Deciding whether to attempt salvage of an infected central venous catheter (CVC) can be challenging. While line removal is the definitive treatment for central-line associated bloodstream infection (CLABSI), salvage may be attempted with systemic antibiotics and antibiotic lock therapy (ALT). Weighing risk and benefit of CVC salvage is limited by uncertainty in the future viability of salvaged CVCs. If a CVC is likely to require subsequent removal (e.g. due to recurrent infection) salvage may not be beneficial, whereas discarding a viable CVC is also not desirable. Here we describe a machine learning approach to predicting outcomes in CVC salvage. Methods Episodes of pediatric CLABSI cleared with ALT were identified by retrospective record review between January 1, 2008 and December 31, 2018 and were defined by a single positive central blood culture of a known pathogen or two matching cultures of a possible contaminant. Clearance was defined as 48-hours of negative cultures and relapse was defined as a matching positive blood culture after clearance. Predictive models [logistic regression (LR), random forest (RF), support vector machine (SVM) and an ensemble combining the three] were used to predict recurrence-free CVC retention (RFCR) at various time points using a training and test set approach. Results Overall, 712 instances CLABSI cleared with ALT were identified. Demographic and microbiological data are summarized in Tables 1 and 2. Few (8%) instances recurred in the first 28 days. 58% recurred at any time within the study period. Rates of RFCR were 75%, 43%, 22% and 10% at 28, 91, 182 and 365 days. Machine learning (ML) models varied in their ability to predict RFCR (Table 3). RF models performed best overall, although no model performed well at 91 days. Conclusion ML models provide an opportunity to augment clinical decision making by learning patterns from data. In this case, estimating the likelihood of useful line retention in the future could help guide informed decisions on salvage vs. removal of infected CVCs. Limitations include the heterogeneity of clinical data and the use of an outcome capturing both clinical decision making (line removal) and infection recurrence. With further model development and prospective validation, practical machine learning models may prove useful to clinicians. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Healthcare-associated infections (HAI) remain the leading cause of morbidity and mortality among hospitalized children. Within community hospitals with targeted infection prevention efforts, participation in an infection control network has led to significant decreases in device or procedure-related infections among adult patients. The impact of these interventions has not been assessed in pediatric patients admitted to community hospitals. Methods We conducted a retrospective cohort study to describe the burden of HAI among hospitalized infants (< 1 year old) within 53 community hospitals participating in the Duke Infection Control Outreach Network (DICON) from 2013–2018. We determined the frequency of device-related HAI, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI) and hospital-associated pneumonia or ventilator-associated events (HAP/VAE) using National Healthcare Safety Network (NHSN) definitions; and the burden of HAIs among neonatal intensive care units (NICU) and non-NICU centers. The trend of HAI was analyzed with Spearman's correlation. Results Thirty hospitals reported 150 HAI among 141 infants over the 6-year period. Median (IQR) time to infection was 10 (4, 20) days after admission. Hospitals with a NICU (15) reported more HAI (median 5, (IQR: 3, 12)) than hospitals without a NICU (median 2 (IQR: 1, 2)) (P = 0.031). CLABSI represented 35% of HAI, HAP/VAE were 23% and CAUTI were 12%. The most frequently isolated primary organism for all HAI was Escherichia coli (22 HAI, 15%) which was also isolated in 39% of CAUTI. Methicillin-resistant and methicillin-susceptible Staphylococcus aureus (S. aureus) were the most commonly isolated organisms among CLABSI (17%) and HAP/VAE (33%). Nine centers with ≥4 years of NICU and Central line (CL) use data reported a median (IQR) rate of 1.2 (0, 2.4) CLABSIs/1,000 central line days. There was no change in median CLABSI rate over time (P = 0.47), Figure 1. Conclusion CLABSI, most commonly caused by S. aureus , represented the majority of HAI reported from hospitalized infants within community hospitals participating in an infection control network. Further research into device utilization practices may inform future interventions to reduce HAI. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population. Methods We performed a retrospective review of all neonates admitted to the 54-bed level IV NICU at Yale-New Haven Children's Hospital with a HABSI between January 1, 2013 and December 31, 2018. HABSI was defined as a positive blood culture at >72 hours of life growing an organism not considered a contaminant. Clinical definitions per treating NICU team and NHSN site-specific definitions were compared for source attribution using McNemar's Chi-square test. Results We identified 88 HABSIs with an incidence rate of 0.81 per 1,000 patient-days. Only 13% of these were central line-associated bloodstream infections (CLABSIs). Infants with a HABSI had median birth weight and gestational age of 830 grams and 26 weeks, respectively, with a high percentage requiring mechanical ventilation parenteral nutrition and vascular access (Table 1). Sepsis-related mortality was 24%. The majority of HABSIs were caused by gram-positive and gram-negative bacteria (Figure 1). Most were secondary to necrotizing enterocolitis, pneumonia or a source that was not identified (Table 2). NHSN definitions were less likely to identify a source compared with clinical definitions per NICU treating team (P < 0.001, Table 2). Fifty percent of patients without an identified source of infection by NHSN criteria were identified with a Mucosal Barrier Injury (MBI) organism, likely causing bacteremia from gut translocation. Conclusion HABSIs occur in premature babies with comorbidities, and are more prevalent than CLABSIs. Gut translocation with MBI organisms may be an important unidentified source of HABSIs in neonates. With the increasing focus on HABSI prevention, there is a need for better NHSN definitions for source attribution of bloodstream infections in neonates. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient's nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Optimizing use of urinary catheters (UCs) and central venous catheters (CVCs) is crucial to prevent catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and other complications. Despite education and adoption of catheter removal protocols, indwelling devices not meeting approved indications were still noted. Methods Twice a week, UC and CVC surveillance rounds were conducted by a team of directors from nursing, vascular access, infection prevention, and hospital epidemiology. Different hospital units were selected each week in random distribution. Rounds emphasized face-to-face discussion with nurses and device observations to identify any removal opportunities and appropriate maintenance. Device utilization was monitored using CDC National Healthcare Safety Network (NHSN) standardized utilization ratio (SUR) and CAUTIs and CLABSIs were monitored using NHSN definitions. Relative ratios of SURs during pre-intervention (pre-INT) and post-intervention (post-INT) time periods for UCs and CVCs were compared using an exact binomial test and mid-P 95% confidence interval (CI). CAUTI and CLABSI rates were compared using Fisher's exact test using mid- P value. Results A baseline time period A of 12 months pre-INT (June 2017-May 2018) was used to compare with the 10-month post-INT time period B (June 2018-March 2019). The UC SURs for periods A and B were 0.813 and 0.696 (Figure 1). The relative ratio shows a post-INT UC SUR that was 85.6% of the pre-INT period (95% CI: 84.1%, 87.2%, P < 0.001). CAUTI rates for periods A and B were not statistically significantly different at 2.276 vs. 2.164/1000 catheter days (P = 0.803). The CVC SURs for periods A and B were 1.244 and 1.081 (Figure 2). The relative ratio shows a post-INT CVC SUR that was 86.9% of the pre-INT period (95% CI: 85.7%, 88.0%, P < 0.001). CLABSI rates for periods A and B were statistically significantly different at 1.27 vs. 0.804/1000 central line days (P = 0.0335). Conclusion Leadership rounds were associated with a significant decrease in utilization of UCs and CVCs. A significant decrease was noted in CLABSI rates but not in CAUTI rates. Multidisciplinary oversight improved adherence to existing policies and should be considered for optimizing device utilization. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. In publications from India, it has already accounted for >5% of candidemia in a national survey of ICUs and as much as 30% of candidemia at individual hospitals,but data on treatment outcomes is scarce. This study reviews the various clinical syndromes in our case series, the treatment regimens we opted and their clinical outcomes. Methods The present study was a retrospective observational analysis of candida auris isolates obtained from patients admitted in a Aster Medcity, Kochi. Duration of study was 4 months (September 2018 to December 2018). Laboratory confirmation of the candida auris isolates was done as per CDC recommendations for Vitek2. Vitek2 was also used for obtaining the antifungal sensitivity pattern for these isolates. Results We had 18 cases of Candida auris identified. The most common syndrome was surgical site infections, 9 out of 18 (50%), followed by Catheter-Associated Urinary Tract Infection (CAUTI 5/18; 28%). We had 3 patients with Central Line-Associated Blood Stream Infections (CLABSI) and one patient who had secondary peritonitis. The overall mortality was 28% (5/18)—mostly contributed by the CLABSI. Considering breakpoints from CLSI as well as CDC, all isolates had their minimum inhibitory concentration (MIC) in the sensitive range for Caspofungin. Both Amphotericin b and Voriconazole had MICs in susceptible range for less than 50% of the isolates and almost all isolates were having very high MICs for Fluconazole, highlighting the increased levels of antifungal resistance which has made this Candida species notorious. Conclusion Candida auris is an emerging nosocomial pathogen in India with serious outbreak potential. The anti-fungal susceptibility is indicative of a multidrug-resistant pattern—with favorable MIC to Echinocandin and Voriconazole. Complicated bloodstream infections had high mortality inspite of early Echinocandin use. Of note, 6 patients out of 18, were managed successfully without any anti-fungal use; as they had either mild UTI (fever spikes resolved with catheter removal) or superfical SSI which could be treated with topical wound management. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background By IDSA guidelines, therapy for central line-associated bloodstream infections (CLABSI) due to Candida species requires catheter removal and administration of systemic antifungals. Despite this, in selected cases catheter salvage is desirable. The addition of antifungal lock therapy (ALT) has been proposed in these cases, but evidence for efficacy of this approach is limited. Here we report a retrospective analysis of ALT use for CLABSI due to Candida species at a single pediatric center. Methods All events of candidal CLABSI with ALT use were identified by retrospective record review between January 1, 2008 and December 31, 2018. CLABSI was defined by the growth of Candida from at least one central blood culture. Clearance was defined as a period of 48 hours with no positive cultures. Recurrence was defined as a subsequent positive blood culture with the same fungal organism either before or after line removal. Events were classified as "early removal" vs. "retained 7 days" depending on whether the line remained in place on day 7 after the first positive culture. Results Overall, 122 qualifying CLABSI were identified, 64 (52%) were retained 7 days or more (Table 1). Overall, 59% of CLABSI met criteria for clearance prior to line removal. Lines retained 7 days were likely to also remain in place at 28 days (72%) and had a low rate of relapse (8%) within 28 days. Lines in the early removal group had lower recurrence rates within 1 year (17% vs. 42%, P = 0.005), but this difference narrowed when considering recurrence at any time (31% vs. 47%, P = 0.1) or by Kaplan–Meier analysis (Figure 1) Additional microbiological and outcome data can be found in Tables 2 and 3. Conclusion This retrospective analysis is the largest described cohort of antifungal locks for line salvage in a pediatric population to our knowledge. These findings highlight the advantages of line removal, with lower recurrence at 1 year. However, when line salvage with antifungal locks is attempted, retention and recurrence rates in the first month are favorable, and recurrence rates converge in the long-term, presumably because the underlying risk factors remain. While line removal remains the standard therapy for candidal CLABSI, we find that ALT-based line salvage may be a viable alternative. Disclosures All Authors: No reported Disclosures. [ABSTRACT FROM AUTHOR]

Background To strengthen state collaborative efforts and reduce common healthcare-associated infections (HAIs) in short-stay and long-term acute care hospitals, the Centers for Disease Control and Prevention (CDC) launched "States Targeting Reduction in Infections via Engagement" (STRIVE) - a national quality improvement program. Methods STRIVE consisted of a multimodal intervention implemented from November 2016 to May 2018 (Figure 1). Hospitals with excess Clostridioides difficile infection (CDI) and a high burden of at least one of the following HAIs - central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI) or methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection were targeted. Monthly aggregate HAI and device utilization ratios - according to CDC National Healthcare Safety Network definitions - were measured during the pre vs. post-intervention periods. Thematic analysis of qualitative interviews with state partners was conducted to understand the influence of the intervention. Results Overall, 387 hospitals from 23 states and the District of Columbia participated. Changes in HAI rates and catheter utilization are illustrated in Figure 2. From pre- to post-intervention, substantial changes in HAI rates above temporal trends were not observed (CDI, 7.0 to 5.7 per 10000 patient-days; CLABSI, 0.88 to 0.80 per 1000 catheter days; CAUTI, 1.12 to 1.04 per 1000 catheter days; MRSA bloodstream infection, 0.075 to 0.071 per 1,000 patient-days) Similarly, catheter utilization did not differ substantially between the pre- and post-intervention periods (24.05 to 22.07 central line days per 100 patient-days; 21.46 to 19.83 urinary catheter days per 100 patient-days). Qualitative analysis of 17 interviews with state partners showed that relationships among state partners and hospitals were strengthened, potentially facilitating collaboration on future infection prevention efforts. Conclusion Though HAI reductions were observed during STRIVE, these reductions were consistent with temporal trends. Hospitals struggling with high HAI rates may require additional novel approaches. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background There has been a rise in Enterococcus species Central Line-Associated Bloodstream Infections (CLABSI) ranking as the third overall causative organism according to the Center for Disease Control and Prevention (CDC) report issued in 2014. Central Venous Catheter (CVC) management including the need and timing of CVC removal is not well defined for enterococcus bacteremia (EB) in the 2009 Infectious Diseases Society of America (IDSA) management guidelines given the paucity of studies addressing CVC management. Methods We conducted a retrospective chart review on 543 patients diagnosed with EB between 2010 and 2018. We excluded patients without an indwelling CVC and those with mucosal barrier injury (MBI). We further evaluated 90 patients with EB that met the CDC definition for CLABSI without MBI or the IDSA definition for catheter-related bloodstream infections (CRBSI) and 90 patients with an indwelling CVC in place with documented non-CLABSI with another source. Results Early CVC removal (within 3 days of EB) was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (43% vs. 27%; P = 0.02). Microbiological eradication associated with early CVC removal within 3 days of EB was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (78% vs. 48%; P = 0.016). Complications were lower in the CLABSI without MBI/CRBSI compared with the non-CLABSI group (0% vs. 18%; P = 0.017). Defervescence, mortality (all-cause and infection-related mortality) and relapse were similar in both groups. Within each group, the outcome was similar irrespective of CVC management (removal within 3 days vs. retention). Conclusion In cases of EB, early CVC removal within 3 days of bacteremia is associated with a favorable outcome in the CLABSI without MBI/CRBSI group compared with the non-CLABSI group. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Minimal literature exists to demonstrate the quantitative impact of bedside nurses in antimicrobial stewardship (AMS). We initiated bedside nurse-driven AMS and infection prevention (AMS/IP) rounds on three inpatient telemetry units of a community regional medical center. Rounds were nurse-driven, involved an infectious diseases (ID) pharmacist and infection preventionist, and were designed to complement traditional ID pharmacist and ID physician AMS rounds. Rounds were focused on use of antibiotics, urinary catheters (UCs), and central venous catheters (CVCs). Recommendations from rounds were communicated by the bedside nurse either directly to providers or to the ID pharmacist and ID physician for intervention. Methods This was an observational, multiple-group, quasi-experimental study conducted over 3.5 years (July 2015 to December 2018) to characterize the impact of bedside nurse-driven AMS/IP rounds on antibiotic, urinary catheter and CVC use, hospital-onset C. difficile infection (CDI), catheter-associated urinary tract infections (CAUTI), and central line-associated bloodstream infections (CLABSI). Outcomes were assessed in two cohorts based on time of AMS/IP rounds implementation (Cohort 1 implemented on one telemetry unit in July 2016, Cohort 2 implemented in two telemetry units in January 2018). Results A total of 2,273 patient therapy reviews occurred (Cohort 1: 1,736; Cohort 2: 537). Of these reviews, 1,209 (53%) were antibiotics, 879 (39%) were urinary catheters, and 185 (8%) were CVCs. Pre- vs. post-intervention, significant reductions were observed in both cohorts for mean monthly antibiotic days of therapy per 1,000 patient-days (Cohort 1: 791 vs. 688, P < 0.001; Cohort 2: 615 vs. 492, P < 0.001), UC days per patient day (Cohort 1: 0.25 vs. 0.16, P < 0.001; Cohort 2: 0.19 vs. 0.14, P < 0.001), CVC days per patient day (Cohort 1: 0.15 vs. 0.11, = 0.002; Cohort 2: 0.09 vs. 0.07, p = 0.005), and CDI per 10,000 patient-days (Cohort 1: 17.8 vs. 7.1, p = 0.035; Cohort 2: 19.1 vs. 5.4, p = 0.003). Numerical reductions were observed in CAUTI and CLABSI per 10,000 patient-days. Conclusion Bedside nurses can improve AMS and IP outcomes in a scalable fashion when supported by an interdisciplinary AMS/IP team and are complimentary to traditional AMS and IP practices. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Over the last 2 decades, Gram-negative organisms have been on the rise as an etiology of bloodstream infections (BSI) in cancer patients. Management of the central venous catheter (CVC) in the setting of Gram-negative BSI remains challenging. The aim of our study was to evaluate cancer patients with different types of Gram-negative BSI, in the presence of an indwelling CVC, and assess the impact of line management on the outcome of the BSI. Methods We identified all the patients older than 14 years with CVC who had a documented BSI with a Gram-negative organism at M.D Anderson Cancer Center, from May 2017 until May 2018. Patients were divided into three groups. Group 1 (G1) included patients with central-line associated bloodstream infection and no mucosal barrier injury (non-MBI CLABSI) and/or those who met the catheter-related bloodstream infection (CRBSI) criteria; Group 2 (G2) consisted of patients who had a CLABSI with a mucosal barrier injury that did not meet the CRBSI definition; and Group 3 (G3) consisted of patients who had a non-line-related BSI. We assessed catheter management (CVC removed/exchanged or retained) at 2 days after the onset of bacteremia. We then determined the effect of line management on clinical and microbiologic outcomes through various measures. Results A total of 300 patients were included with 100 patients in each group. The univariate analyses showed that in G1, CVC removal within 2 days of bacteremia was significantly associated with higher rate of microbiologic eradiation of the bacteremia compared with delayed CVC removal (3 to 5 days) or CVC retention (98% vs. 72% vs. 78% respectively, P = 0.002; P < 0.001), and lower overall mortality rate at 3 months follow-up (3% vs. 22% vs. 17% respectively, P = 0.02; P = 0.01). By multivariate analysis, this association persisted (P = 0.018 and P = 0.016, respectively). CVC removal within 2 days of bacteremia did not affect the outcome of BSI in G2 and G3. Conclusion CVC removal within 48 hours of the onset of Gram-negative bacteremia significantly improved the infectious outcome and the overall mortality in adult cancer patients with definite CRBSI and CLABSI without MBI. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The use of peripherally-inserted central catheters (PICC) has grown substantially over time because of their ease of insertion, cost-effectiveness and relative safety. With increased use; however, there are increased complications including catheter-related bloodstream infections (CLABSI) and PICC line-associated deep vein thrombosis (DVT). To help decrease complications a meaningful use protocol was implemented based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to define appropriate indications for PICC line use. The objectives of this study were (1) to determine the rate of PICC line use at our hospital; (2) to determine rates of complications associated with PICC lines, including CLABSI and DVT; and (3) to compare the metrics listed above before and after implementation of the meaningful use protocol. Methods We performed a retrospective chart review of all inpatient admissions before (June 1, 2017 to September 1, 2017) and after the implementation of the meaningful use protocol (June 1, 2018 to September 1, 2018). Patients who had a PICC line inserted at another institution or in the outpatient setting were excluded. We compared the rate of insertion, patient demographics, characteristics of the use of PICC lines and complications from the two periods. Data were analyzed using the chi-squared test, Student's t -test, the Mann–Whitney U test and the z test for proportions. Results We reviewed 281 patient charts, 166 before the implementation of the meaningful use protocol and 115 after implementation. Overall, the mean age was 55.8 ± 17.9 years, 58.7% male and 54.1% white. There were no significant differences between groups with respect to demographics, comorbidities, source of admission, or complications. Post-implementation there was a significant reduction in lines used for unknown reasons as well as lines used for multiple blood draws (P < 0.0001). The overall rate of PICC line use decreased from 23 per 1,000 admissions to 17.2 per 1,000 admissions after the intervention (P = 0.007). Conclusion Implementation of a meaningful use protocol reduced the rate of PICC line use at our institution by 25%. The proportion of lines used for unknown reasons decreased as well. Widespread implementation could have a significant impact on the reduction of PICC line use. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality as well as increased medical costs. We sought to describe the impact of various quality improvement interventions on the incidence of CLABSI in a large 990-bed community teaching hospital from the period of January 1, 2013 to December 31, 2017. Methods Retrospective study of CLABSI events as defined by the CDC's National Healthcare Safety Network was completed. Between 2013 to 2017, we introduced mandatory real-time root cause analysis for each CLABSI event to identify defects that could be used for quality improvement interventions. We implemented a bundle of interventions for proper central venous catheter (CVC) insertion and maintenance based on CDC recommendations and the results of the internal analysis. Interventions included utilizing chlorhexidine gluconate (CHG) skin preparation and maximum sterile barrier precautions, optimal site selection (avoiding femoral site), using antimicrobial-coated CVCs and antithrombotic Bioflo peripherally inserted central catheters (PICC), minimizing multi-lumen CVC and PICC use, de-escalating CVC to midline or preferential use of midline catheters while minimizing unnecessary PICC and CVC insertion, adding Curos disinfection caps on central lines and other vascular access sites, weekly scheduled CVC site dressing changes with Tegaderm CHG I.V. Securement Dressing, CHG baths for patients with CVCs, avoidance of blood culture draws from central lines, and daily review of line necessity with timely removal. Medical staff members received ongoing education on the implementation of the CLABSI bundle. Both ICU and non-ICU CLABSI cases in the adult patient population were analyzed. Results A comparison of 2013 with 2017 shows a 69% decline in a number of CLABSI cases from 36 to 11 patients (Figure 1). There was a 30% decline in CVC days from years 2014 to 2017 (No CVC days data for 2013 due to change in data collection system). Over the same period, CLABSI events per 1,000 CVC days decreased from 0.624 to 0.362 (Figure 2)—a 42% decline. Conclusion Study findings show that our comprehensive bundle of interventions for CVC insertion and maintenance resulted in decreased rates of CLABSI. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Central line-associated bloodstream infections (CLABSIs) are challenging to prevent in the neonatal population due to the long-term necessity of central access for nutrition and medication. Neonates are a population at high risk for CLABSIs, and infections in this group are associated with prolonged hospitalization, greater healthcare costs, and increased mortality. Current bundles for CLABSI prevention include a friction scrub of the catheter hub prior to each use. Real-time audits of correct technique can be challenging. In July of 2018, our team developed a new strategy for auditing scrub technique in an attempt to reduce CLABSI rates. Methods This project took place in a NICU with 118 level 4 beds from July 2018 to February 2019. Our NICU is located in a large metropolitan area and serves as a referral center for complex neonates throughout the region. The intervention period encompassed 25,085 patient-days and 6,206 line days. Real-time friction scrub audits were performed for both dedicated line team staff as well as bedside nurses. In order to determine whether a healthcare worker's (HCW) scrub technique was successful, a colorless luminescent product was applied to a practice catheter hub that adhered to the hub, but was not visible to the HCW. The HCW would then demonstrate a friction scrub on the practice catheter, and the hub was placed under a black light to show where any residual product may be present. This process was repeated until the staff member was able to remove the product from the hub. Once the staff was successful, monthly real-time audits were continued to reinforce the correct technique. Results Between July 2018 and February 2019, compliance with scrub technique and ability to clear product from catheter hubs increased by 50%. The CLABSI rate in the first 9 months after intervention was 0.806 per 1000 line days as compared with 2.170 per 1000 line days in the previous fiscal year. Conclusion The number of CLABSI's during the intervention period was 63% less when compared with the previous fiscal year. This process, in conjunction with our other CLABSI prevention practices, has significantly decreased both our CLABSI rate and overall numbers. This project emphasizes the importance of focusing on the basics of infection prevention practices and continual auditing to prevent practice creep. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Umbilical vein catheters (UVC) are one of the most common types of vascular access device in the neonatal intensive care units. Central line-associated bloodstream infections were reported to be in the first place of healthcare-associated infections in preterm infants. In this study, we aimed to evaluate the effectiveness of the bundle applications in the prevention of umbilical vein catheter-associated bloodstream infections in neonates including premature infants. Methods This 40 months cross-sectional study included two periods, including pre-bundle period (from August 1, 2015 to March 31, 2017) and bundle period (April 1, 2017 to November 30, 2018). The umbilical vein catheter-related bloodstream infections, catheter line days, number of the patients were recorded and compared between the prebundle and bundle periods. Bundle steps were defined as education-training-assignment, evaluation of daily catheter indications, hand hygiene and aseptic technique while insertion, maximal sterile barrier precautions, closure of the catheter area with transparent semi-permeable membrane, using needless connectors in stead of 3-way stop-cocks, and single-use prefilled saline syringes for flushing. Results During the whole study period total umbilical vein catheter days were 2,228 days. During the prebundle period there was 10 and in the bundle period there was 2 umbilical vein catheter-related bloodstream infections (Table 1). While umbilical vein-associated bloodstream infection rate was 8.9 per 1,000 catheter days in the pre-bundle period, and significantly decreased to 1.79 in the bundle period (P < 0.05). After the introduction of bundle applications, it was observed that the rate of infection decreased by 68% (P < 0.05) Conclusion Our study showed that implementation of central line bundle including needless connectors and single-use prefilled syringes for umbilical vein-related bloodstream infections was effective for the prevention of catheter-related bloodstream infections in neonatal intensive care units. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Bloodstream infections due to Candida auris are an emerging public health concern due to high prevalence of antifungal resistance and significant rates of patient mortality. C. auris is typically azole-resistant; however, several strains have been identified with elevated MICs to all major classes of antifungals. Previously we reported that a synergistic combination of MEDTA+EtOH was highly effective in a clinical trial that evaluated salvage of catheters in patients with bacterial CLABSI. We have also previously reported in vitro studies that demonstrated this combination was capable of eradicating ordinary yeast CLABSI pathogens. In this study we evaluated the ability MEDTA+EtOH lock to rapidly eradicate C. auris biofilms. Methods Biofilm eradication of C. auris was evaluated in 10 strains. Candida auris biofilm was grown on silicone discs for 24 hours. Discs were then washed to remove any nonadherent organisms and exposed for 60 minutes to 1 mg/mL Minocycline + 30 mg/mL EDTA + 25% Ethanol (MEDTA+EtOH) lock solution. 1.35% Taurolidine + 3.5% Citrate + 1000U Heparin (TCH) lock solution was used as a comparator. Discs were exposed to Muller–Hinton broth as a control. Subsequently discs were sonicated for 15 minutes in 5 mL of saline and quantitatively cultured onto sabouraud dextrose agar. Plates were incubated at 37°C for 48 hours and counted for growth. All testing was conducted with 6 replicates. Results Median and range of recovered viable colonies are presented below. MEDTA+EtOH was significantly more efficacious compared with control (P = 0.002 for all strains) in completely eradicating all replicates in all 10 strains of C. auris tested. MEDTA+EtOH was also superior compared with TCH lock solution (P = 0.002) for all strains. Conclusion MEDTA+EtOH is highly effective and was superior to TCH and positive control in the rapid in vitro eradication of all 10 strains of C. auris biofilms tested. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background E. coli is a leading cause of healthcare-associated infections; clonal group ST131, which has expanded worldwide with notable increased severity of infections, is commonly resistant to extended-spectrum cephalosporins (ESC) and fluoroquinolones (FQ). Herein, we relate ESC and FQ resistance profiles from CDC's National Healthcare Safety Network (NHSN) with specific strain types from CDC laboratory surveillance collections. Methods NHSN isolate and antibiotic susceptibility testing data were collected from all E. coli associated with central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events, or surgical site infections from 2013–2017. Resistance was scored as non-susceptibility to at least one drug per class [susceptible (S); resistant (R)]. ESC and FQ susceptibilities and multilocus sequence types (ST) using the Achtman 7 loci scheme were determined for a contemporaneous set of E. coli isolates collected through CDC laboratory surveillance. Results Of 96,672 E. coli infections reported to NHSN, 13% were ESC-R/FQ-R, 23% ESC-S/FQ-R, 4% ESC-R/FQ-S, and 60% were ESC-S/FQ-S. Among 105 ESC-R/FQ-R and 21 ESC-S/FQ-R laboratory isolates, the majority (67.6% and 52.4%, respectively) were ST131, whereas of 38 ESC-R/FQ-S and 53 ESC-S/FQ-S isolates, ST131 was a minority (18.4% and 7.5%, respectively). The odds of an isolate being ST131 were 10.5 if FQ-R (P < 0.001), 3.4 if ESC-R (P < 0.001), and 6.0 if ESC-R/FQ-R (P < 0.001). Using the national distribution of resistance combinations from NHSN, and assuming static ST-resistance distribution, we can infer that ST131 was responsible for 25.8% (95% CI, 23.9%-27.6%) of all E.coli healthcare-associated infections in the United States in 2013–2017. Conclusion Molecular inferences generated by applying laboratory data to resistance signature data in reportable datasets may make national E. coli ST burden estimates possible. Further characterization of resistance combinations with strain type, infection rates, and clinical outcomes may inform targeted prevention strategies at the local/regional level. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Vancomycin is often used empirically for treatment of pediatric Staphylococcus aureus bacteremia while susceptibility testing is being performed. Reduced vancomycin susceptibility (RVS) occurs when the minimum inhibitory concentration (MIC) for vancomycin is elevated, potentially resulting in decreased efficacy. Patient factors associated with RVS in pediatric S. aureus infections have not been well studied. Methods Children aged <18 years admitted from 2012 to 2016 to two tertiary care children's hospitals with a blood culture positive for S. aureus were identified. Demographics, presence of comorbidities, hospitalizations in the year prior to the infection, surgical procedures in the 30 days prior to the infection, presence of a central venous catheter at diagnosis and methicillin-resistant (MRSA) vs. methicillin-susceptible S. aureus (MSSA) were abstracted from the electronic medical record using a structured data collection form. RVS was defined as a MIC >1 µg/mL as reported by the clinical microbiology laboratory. Wilcoxon rank-sum and Fisher's exact test to compare continuous and categorical variables, respectively. A multivariable logistic regression model was used to evaluate the association of RVS with patient factors, MRSA vs. MSSA, admitting hospital, and year. Results We identified 221 S. aureus bloodstream infections. Most (84%) had RVS though there were differences by the hospital, 74% vs. 87%, P = 0.037. Bloodstream infections in the setting of a musculoskeletal infection were most common (36%), followed by central line-associated bloodstream infections (22%). The median age was similar between RVS and non-RVS infections, 3 (25th, 75th %tiles: 0, 9) vs. 5 (0, 12) but, when adjusted for patient factors, younger children were more likely to have RVS infections than older children, aOR: 0.92 (0.85, 0.99). Black children were more likely to have RVS than white children on both univariate and adjusted analyses (table). Conclusion RVS is common among pediatric S. aureus bloodstream infections and appears to be influenced by patient age and race but not by the source of the infection or other clinical factors. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Rapid diagnostic testing paired with ASP intervention optimizes therapy and improves outcomes but few data guide ASP response in the absence of organism identification (ID). We describe the microbiology for organisms unidentified by Accelerate Pheno™ Gram-negative platform (AXDX) in order to inform ASP-provider team communication (PTC). Methods Consecutive, non-duplicate inpatient blood cultures with Gram-negative bacilli (GNB) following AXDX implementation at a single university hospital between April 2018 and March 2019 were included. Standard of care (SOC) ID and susceptibility followed AXDX. Clinical Microbiology emailed AXDX results to the ASP in real time; results were released into the EMR paired with telephone PTC or withheld after ASP review. Bloodstream Infections (BSIs) and patient outcomes for organisms labeled no/indeterminate ID by the AXDX were characterized. Results AXDX was performed on 351 blood cultures. Among 52 (15%) labeled no/indeterminate ID, SOC methods revealed: Enterobacteriaceae (40%; 9 monomicrobial with AXDX targets), anaerobes (21%), non-lactose fermenters (NLFs) other than Pseudomonas aeruginosa (21%), and fastidious GNB (10%). Frequent organisms without AXDX targets included: Raoultella planticola (4); Bacteroides fragilis , Cupriavidus spp. Haemophilus spp. Prevotella spp. , Providencia spp. non- aeruginosa Pseudomonas spp. Salmonella spp. (3 each); Pasteurella multocida , Stenotrophomonas maltophilia (2 each). BSI sources were most commonly intra-abdominal (21%), central line-associated (17%), or unknown (17%). CLABSIs were associated with immune suppression and/or substance abuse in all but 1 case. BSIs without active empiric therapy included: NDM-producing Providencia stuartii SSSI; OXA-48-producing R. planticola intraabdominal infection (IAI); Pandoraea spp. CLABSI after liver transplant; enteric fever; B. fragilis , Leptotrichia wadei , and S. maltophilia , each of unknown source. In-hospital mortality occurred in 4 of these cases. Conclusion When AXDX yields no/indeterminate ID, ASP chart review for possible anaerobic/IAI, unique environmental exposures, and travel history may assist in guiding empiric therapy. GNB with AXDX targets are not excluded. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Reports regarding the correlations between infection preventionist (IP) staffing levels and healthcare-associated infections (HAI) are scarce, conflicting, and crucial for resource allocation and effort prioritization. We evaluated such correlations from January 1, 2012 to March 1, 2019 at a 528-bed teaching hospital in Rochester, NY; a period when IP staffing levels fluctuated between the recommended ratio of 1 IP: 80 patients and a critically low of 1 IP: >375. Methods Standardized National Health Safety Network (NHSN) definitions, along with laboratory events, re-admissions, interactions with surgical teams, and an independent data management company were used for case finding of catheter-associated urinary tract infection (CAUTI), Clostridiodes difficile (CDI), central line-associated bloodstream infection (CLABSI), carbapenem-resistant Enterobacteria ceae, and methicillin-resistant Staphylococcus aureus (MRSA). Colon, prosthetic knee and hip joint, hysterectomies, and coronary artery bypass graft surgical site infections (SSI) were also studied. Standardized infection ratios (SIR) were extracted from NHSN. Staffing levels were grouped into low (/ = 7 FTE). Correlations between HAI rates, SIR, and staffing levels were examined using Poisson and T -tests with the R statistical package. Results The average daily census of 451 resulted in 1.18 million total patient-days of surveillance. Periods of low and recommended IP levels occurred at similar seasons and for similar durations. There were fewer CDI, CAUTI, CLABSI, and MRSA infections when IP staff were at recommended levels than when IP staff were at the lowest level, but only CDI and CLABSI rates were significantly lower (P = 0.003 and 0.005, respectively). CLABSI SIR was 1.07 and 0.64 during periods of low and recommended staffing levels, respectively (P = 0.004). No significant differences occurred in SSI, either by type or by combined. Conclusion Hospitals often cannot achieve or maintain recommended IP staffing levels. Our findings suggest that, during critical personnel shortages, IP may have more impact by focusing on the types of HAI that correlated with preventionist staffing levels. This is among the largest such study to date, and uniquely includes the most types of HAI. Disclosures All Authors: No reported Disclosures. [ABSTRACT FROM AUTHOR]