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Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection in neonates is associated with significant morbidity, mortality, and hospital cost. Multiple studies have shown that these infections are often preceded by colonization, but no consensus has been established for MRSA surveillance. The impact of changing the surveillance strategy on vancomycin utilization has not been evaluated previously. Methods: Retrospective chart review of infants who underwent MRSA screening in a level IV NICU with all outborn neonates. A weekly surveillance PCR was obtained from the nares between July 2016 and June 2017 (phase 1) and only on admission and discharge between July 2017 and June 2018 (phase 2). Patients with a positive PCR were placed on contact precautions without decolonization. The χ2 test was performed to compare the 2 phases of screening, and the Student t test and the Fisher exact test were used to compare the characteristics of MRSA colonized infants. Vancomycin utilization was measured in days of therapy (DOT) per 1,000 NICU patient days. Results: In total, 689 infants underwent MRSA screening during the study period; 324 infants had weekly MRSA surveillance and 365 infants had screening at admission and discharge. There was no statistically significant difference in MRSA colonization rates (4.3% vs 3.0%) or MRSA colonization acquisition (negative to positive, 1.8% vs 1.0%) between the phases. Among MRSA-colonized patients, nearly 60% were colonized on admission. Nearly 40% of the infants became colonized with MRSA during their hospitalization, none of whom developed MRSA infections prior to discharge. Mean vancomycin utilization decreased from 38.55 to 30.16 DOT per 1,000 NICU patient days between the 2 study periods. Conclusions: In a level IV NICU with relatively low MRSA prevalence, the change in MRSA screening practice from weekly surveillance to surveillance upon admission and discharge demonstrated no difference in MRSA acquisition or infection. Overall vancomycin utilization also decreased during this period, suggesting a culture shift around antibiotic utilization. Further study is needed to evaluate the utility of MRSA screening, decolonization, and isolation practices in low-prevalence NICUs and to identify additional drivers of vancomycin utilization.Funding: NoneDisclosures: None

Background In April 2005, our Antimicrobial Stewardship Program (ASP) started to require prescribers to select an indication as part of an antimicrobial (AM) order. The ASP developed a list of approved indications for each AM with an unlimited number of options including “other.” In 2015–2016, we modified the indication lists to decrease the number of options. The goal of this project is to compare the frequency of indication “other” and the appropriateness of provider-selected indications before and after the intervention. Methods We performed a retrospective cohort study of cefepime, ceftriaxone, piperacillin/tazobactam, and ciprofloxacin (IV) orders for all children in our facility excluding orders placed in ambulatory locations and the emergency department. AM orders and provider-selected indications from January to March 2014 (preintervention) and 2017 (postintervention) were compared. Chart review was performed on a sample of pre- and postmodification orders to assess the appropriateness of provider-selected indications. An indication was considered appropriate if the provider-selected indication matched the clinical indication documented. Results A total of 747 orders were included in the data analysis, 350 and 397 orders from pre- and postintervention period, respectively. Ceftriaxone was the most commonly prescribed AM:13.7 and 17.2 orders per 1,000 inpatients-days during pre- and postintervention periods. The percent of indication “other” orders increased in the postintervention period for ceftriaxone while it decreased for ciprofloxacin and remained about the same for cefepime and piperacillin/tazobactam. Most prescribers who selected indication “other” for ceftriaxone during the postintervention period did not provide a reason (29.8%). The agreement between clinical and provider-selected indications was consistent in pre- and postintervention period except piperacillin/tazobactam (RR = 0.56). Conclusion Requiring selection of an indication encourages prescribers to evaluate their rationale for initiating an AM. Decreasing the number of indication options for some AMs was associated with increased use of indication “other,” suggesting that the prescriber could not find an indication that matched their needs. Disclosures All authors: No reported disclosures.

The Society for Healthcare Epidemiology of America (SHEA) guideline “Infection Prevention and Control in Residential Facilities for Pediatric Patients and Their Families” is the first infection prevention and control (IPC) guideline to address preventing transmission of infectious agents in “home away from home” residential settings, of which the Ronald McDonald Houses (RMHs) serve as a prototype. These types of facilities provide support services, including overnight lodging, for ill and injured children and their families. Food preparation occurs in common areas, and cleaning of rooms or apartments is performed by the occupants during their stay and before departure. Pediatricpatientsare frequent guests of the family-centered facilities while receiving or recovering from specialized medical therapy. Examples of high-risk populations served in these facilities include families of patients with cancer, recipients of stem cell or solid organ transplants, surgical and/or very-low-birthweight infants who receive care in neonatal intensive care units (NICUs), those with cystic fibrosis, and women with high-risk pregnancies awaiting delivery in a nearby medical center. Such facilities are located worldwide and vary in their physical structure and the predominant population served.