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Surveillance of surgical site infection after cesarean section is challenging due to the high volume of these surgeries. A manual chart review of women undergoing cesarean section between January and June 2017 (675 charts, 40 infections) was compared to charts identified via an algorithm (141 charts, 39 infections). The algorithm achieved 97.5% sensitivity and 83.9% specificity and reduced the workload of infection control personnel.

A nosocomial outbreak of SARS-CoV-2 Delta variant infected 42 patients, staff and family members; 39 were fully vaccinated. The attack rate was 10.6% (16/151) among exposed staff and reached 23.7% (23/97) among exposed patients in a highly vaccinated population, 16–26 weeks after vaccination (median: 25 weeks). All cases were linked and traced to one patient. Several transmissions occurred between individuals wearing face masks. Fourteen of 23 patients became severely sick or died, raising a question about possible waning immunity.

Evaluate the efficacy of retraining and catheter exit site care in reducing peritonitis rates. This interventional study included all prevalent PD patients from 1/2009 to 12/2017 from a single center. Peritonitis rates and causative organisms were assessed and compared in three periods: (1) Before intervention (01/2009–12/2014), (2) after educational intervention: assessment of training process by infection control nurse and repeat training every 3 months, after each peritonitis episode and after hospitalizations > 2 weeks (01/2015–02/2016), and (3) in addition to the measures in period 2, an exit site care protocol including postoperative care, topical antibacterial therapy and nasal Staph aureus screening and eradication was implemented (03/2016–12/2017). The study included 201 patients (149 men, 52 women), mean age was 65.1 ± 12.6 years. After both interventions, including educational and exit site care strategies, peritonitis decreased significantly from 1.05 episodes per patient-year (n = 113) to 0.67 (n = 54); P = 0.017 between periods 1 and 3. The percentage of peritonitis-free patients increased from 27.4 to 52.4 and 55.6%, respectively (P = 0.001 between period 1 vs. 2 and period 1 vs. 3.). Coagulase-negative staph was the most common pathogen, causing 7.56 peritonitis episodes per year, followed by pseudomonas at 4.33 episodes annually and staph aureus at 3.44 episodes per year. Enforcement of an educational program and strict adherence to an exit site care protocol was associated with a significant decrease in peritonitis rates.

Background Surgical site infections (SSIs) are among the most common healthcare-associated infections. Evaluating risk factors for SSIs among patients undergoing laparoscopic and open colorectal resections can aid in selecting appropriate candidates for each modality. Methods A cohort of all consecutive patients undergoing elective colorectal resections during 2008–2017 in a single center was analyzed. SSIs were prospectively assessed by infection control personnel. Patient data were collected from electronic medical records. Risk factors for SSIs were compared between patients who underwent laparoscopic and open surgeries. A multivariate analysis was performed for significant variables. Results During the study period, 865 patients underwent elective colorectal resection: 596 laparoscopic and 269 open surgeries. Mean age was 68.2 ± 15.1 years, weight 72.5 ± 18.3 kg and 441 (51%) were men. The most common indication for surgery was malignancy, in 767 patients (88.7%) with inflammatory bowel diseases and diverticulitis following (4.5% and 3.9%, respectively). Patients undergoing laparoscopic surgery were younger, had fewer comorbidities, shorter pre-operative hospitalizations, lower risk index scores, and lower rates of SSI, compared with open surgery. Independent risk factors for SSI following laparoscopic surgery were chronic obstructive pulmonary disease [odds ratio (OR) 2.655 95% CI (1.267, 5.565)], risk index ≥ 2 [OR 2.079, 95% CI (1.041,4.153)] and conversion of laparoscopic to open surgery [OR 2.056 95%CI (1.212, 3.486)]. Independent risk factors for SSI following open surgery were immunosuppression [OR 3.378 95% CI (1.071, 10.655)], chronic kidney disease [OR 2.643 95% CI (1.008, 6.933)], and need for a second dose of prophylactic antibiotics [OR 2.519 95%CI (1.074, 5.905)]. Conclusions Risk factors for SSIs differ between laparoscopic and open colorectal resections. Knowledge of specific risk factors may inform patient selection for these modalities.

Objectives: This study aims to examine the prevalence and risk factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sero-positivity in health care workers (HCWs), a main risk group, and assess the sero-incidence of SARS-CoV-2 infection between the first and second waves of coronavirus disease 2019 (COVID-19) in Israel.Methods: A longitudinal study was conducted among 874 HCWs from nine hospitals. Demographics, health information, and blood samples were obtained at baseline (first wave—April–May 2020) and at follow-up (n = 373) (second wave—September–November 2020). Sero-positivity was determined based on the detection of total antibodies to the nucleocapsid antigen of SARS-CoV-2, using electro-chemiluminescence immunoassay (Elecsys® Anti-SARS-CoV-2, Roche Diagnostics, Rotkreuz, Switzerland).Results: The sero-prevalence of SARS-CoV-2 antibodies was 1.1% [95% confidence intervals (CI) 0.6–2.1] at baseline and 8.3% (95% CI 5.9–11.6) at follow-up. The sero-conversion of SARS-CoV-2 serum antibody was 6.9% (95% CI 4.7–9.9) during the study period. The increase in SARS-CoV-2 sero-prevalence paralleled the rise in PCR-confirmed SARS-CoV-2 infections among the HCWs across the country. The likelihood of SARS-CoV-2 sero-prevalence was higher in males vs. females [odds ratio (OR) 2.52 (95% CI 1.05–6.06)] and in nurses vs. physicians [OR 4.26 (95% CI 1.08–16.77)] and was associated with being quarantined due to exposure to COVID-19 patients [OR 3.54 (95% CI 1.58–7.89)] and having a positive PCR result [OR 109.5 (95% CI 23.88–502.12)].Conclusions: A significant increase in the risk of SARS-CoV-2 infection was found among HCWs between the first and second waves of COVID-19 in Israel. Nonetheless, the sero-prevalence of SARS-CoV-2 antibodies remains low, similar to the general population. Our findings reinforce the rigorous infection control policy, including quarantine, and utilization of personal protective equipment that should be continued together with COVID-19 immunization in HCWs and the general population.

Objectives We aimed to compare the prevalence of asymptomatic coronavirus disease 19 (COVID-19) among clinical staff in designated COVID-19 units versus that among staff in similar units with no known or suspected COVID-19 patients. Methods We conducted a cross-sectional survey of healthcare workers (HCWs) in eight Israeli general hospitals. The survey involved a questionnaire and a PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We surveyed HCWs in COVID-19 units and comparison units (internal medicine and cardiology) between 30th April and 7th May 2020. Results There were 522 participants: 291 from COVID-19 units and 231 from comparison units. Only one participant (0.2%, 95%CI: 0.005–1.1%)—an asymptomatic nurse on a COVID-19 unit—tested positive for SARS-CoV-2. In participating COVID-19 units there were two symptomatic HCWs with confirmed COVID-19 in the 2 weeks before the survey; both were infected by contact with a co-worker outside of the COVID-19 unit. Conclusions The low prevalence of asymptomatic COVID-19 among HCWs, coupled with an absence of symptomatic COVID-19 acquired during patient care, suggest that Israel's national guidelines for personal protective equipment, which are consistent with those of the World Health Organization, adequately protect HCWs.

Objectives To evaluate the effectiveness of a modified bundle of preventative measures to decrease ventilator-associated pneumonia (VAP) in chronically ventilated long-term care facility (LTCF) residents. Design Cohort before-and-after study. Setting Geriatric hospital ward. Participants LTCF residents on long-term ventilation. Intervention The modified bundle included hand hygiene before patient care, elevation of the head of the bed to more than 30° for individuals who are supine, chlorhexidine oral care at the beginning of each nursing shift, keeping tracheostomy cannula balloon pressure at 20 to 30 cm H2O, and measuring nasogastric food remnants before every meal for individuals fed through a nasogastric tube. Measurements Number of VAP episodes was determined prospectively, and rates were calculated as episodes per 1,000 ventilation days. Results VAP rate decreased from 5.97 before the intervention to 2.34 after the intervention (P

The purpose of this investigation was to assess the effect of empirical antibiotic treatment on 30-day mortality among debilitated inpatients with dementia and Gram-negative bacteremia. A retrospective cohort study in the years 2005–2007 was undertaken. Data were collected through patient chart review. The association between individual variables and 30-day mortality was assessed through univariate analysis. Variables significantly associated with mortality (p

Background Data on the incidence of hospital-wide acquired bloodstream infection (BSI) and the best ways to reduce it are lacking. Our aim was to increase hospital-wide awareness and decrease incidence of hospital-acquired (HA)-BSI through self-investigation. Methods Meir Medical Center is a 740-bed hospital. Beginning in January 2016, reports of HA-BSI events were sent daily to the wards with requests to investigate the source of infection, and preventability using a structured questionnaire. The infection control staff gave immediate feedback to the wards regarding their investigation. A summary of the results was sent to all wards and to hospital management quarterly. Interrupted time series analysis was used to compare the monthly rate of HA-BSI before and after the intervention. We estimated the number of cases prevented by the intervention by applying the HA-BSI rate in 2015 to the number of admissions in 2016–2017 and comparing the observed number of cases to the expected if the rate had not changed. Results In 2016, 64% of HA-BSI underwent investigation by the wards; this increased to 78% in 2017. As illustrated in the figure, before the intervention, the HA-BSI rate per 1,000 admissions increased by 0.11 per month (not significant P = 0.15). In the first month of the intervention, the HA-BSI rate decreased significantly by 0.43 (P = 0.04, 95% CI: −0.84 to −0.02). The HA-BSI rate continued to decrease (relative to the pre-intervention period) by 0.045 per month (P = 0.05, 95% CI: −0.09 to 0.00). During these 3 years, there was no significant change in the rate of community-acquired BSI (8.46, 8,88, 8,58, P for trend = 0.83) or in the rate of blood cultures drawn. During the intervention, the rate of HA-BSI decreased in both ICU units and in non-ICU wards. The number of HA-BSI caused by Enterobacteriaceae decreased from 170 in 2015 to 116 in 2017. S. aureus decreased from 51 to 30 and Candida from 11 to 0. The most common sources of BSI were urinary tract infection (31.4%) and central line associated BSI (16.4%). All-cause 30-day mortality for patients with HA-BSI was 30%. We estimated that in 2016–2017, 200 cases of HA-BSI and 60 deaths were prevented. Conclusion Increase awareness to HA BSI through self-investigation by the wards led to hospital-wide significant reduction in HA-BSI. Disclosures M. Chowers, GSK: Grant Investigator, Research grant

Objectives.To evaluate the influence of performance of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on the incidence of nosocomial MRSA bacteremia in an endemic hospital.Design.Before-after trial.Setting.A 700-bed hospital.Patients.All patients admitted to the hospital who were at high risk for MRSA bacteremia.Intervention.Performance of surveillance cultures for detection of MRSA were recommended for all patients at high risk, and contact isolation was implemented for patients with positive results of culture. Each MRSA-positive patient received one course of eradication treatment. We compared the total number of surveillance cultures, the percentage of surveillance cultures with positive results, and the number of MRSA bacteremia cases before the intervention (from January 2002 through February 2003) after the start of the intervention (from July 2003 through October 2004).Results.The number of surveillance cultures performed increased from a mean of 272.57 cultures/month before the intervention to 865.83 cultures/month after the intervention. The percentage of surveillance cultures with positive results increased from 3.13% before to 5.22% after the intervention (PP< 0.001).Conclusions.Active surveillance culture is important for identifying hidden reservoirs of MRSA. Contact isolation can prevent new colonization and infection and lead to a significant reduction of morbidity and healthcare costs.

Introduction Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. Methods We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. Results An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. Conclusions A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.

Summary The aim of this study was to assess the value of surveillance cultures in identifying extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL) carriers upon admission to hospital, and to identify risk factors for carriage. This prospective cross-sectional study included all hospital admissions over one week. Of 525 patients screened, 56 were positive for ESBLs. Half were only identified through screening. Four independent risk factors were identified: nursing home residency, hospitalization in the previous year, prior antibiotic treatment and prior ESBL carriage. Over 50% of the screened patients had at least one risk factor. By screening this targeted population, 87.5% of positive patients would have been identified.

Background Hospital-acquired bloodstream infections and the subclass of central line-associated bloodstream infections (CLABSI) are associated with considerable morbidity, mortality, and healthcare costs. The burden of central line-associated bloodstream infections (CLABSI) in Israeli intensive care units (ICUs) has not been previously described. The present study aimed to assess the impact of implementing the NHSN practice recommendations for CLABSI prevention in Israeli ICUs. Methods A prospective, national, ongoing interventional program was conducted from January 2012 until December 2016 in all adult and pediatric ICUs in Israel, The NHSN practice recommendations were introduced and implemented during 2012, including of insertion and maintenance bundles, education, outcome surveillance and feedback on CLABSI rates. The Israeli national nosocomial surveillance program is a mandatory, confidential system. Data on CLABSI and non CLABSI events were collected monthly. Feedback was disseminated to all hospitals twice yearly. Between January 2012 and December 2015, definitions were based on the 2012 NNIS/NHSN system; they were updated in 2016. Results 114 ICUs in 30 hospitals contributed to 1,727,000 patient-days (PD). During the study period, a total of 6741 acquired BSI events were reported, 63% were non-CLABSI. In total, 2488 cases of CLABSI were observed over 447,436 central line days (CLD). The pooled mean baseline total BSI and CLABSI rates were 5/1000 PD and 7.4/1000 CLD, respectively, and these decreased significantly to 3.3/ 1000PD (P < 0.001) and 4/1000 CLD (P < 0.001), respectively in 2016. (graph 1 and 2). Conclusion Following a national intervention, significant decreases in both total BSI and CLABSI rates were observed. The large proportion of non-CLABSI BSI highlights the necessity to evaluate causes of non-CLABSI events and implement prevention measures. Figure 1: Mean incidence rates of CLABSI and non-CLABSI per ICU type in 114 ICUs, Israel, 2012–2016 Figure 2: Mean incidence rates of CLABSI per ICU type in 114 ICUs, Israel, 2012–2016 Disclosures All authors: No reported disclosures.

Background. Elderly travel to the developing world is increasing. Little information is available regarding risk behaviors and health during and after travel in this population. Methods. We compared the risk factors and occurrence of travel-related diseases in two populations of Israelis, travelers aged 60 years and older and travelers in the age group of 20 to 30 years. Only people traveling for less than a month were included. Pre-travel, each person received routine counseling regarding travel-associated health risks, was immunized, and given anti-malarial prescriptions as needed. Travelers were surveyed by telephone 6 to 12 months following travel about underlying medical conditions, current medications, and travel history. Risk and preventive behaviors, compliance with anti-malarial prophylaxis, and history of illness during and after travel were assessed. Results. Of patients who visited the clinic from January to June 2008, 191/208 (91%) travelers aged 60 and older and 203/291 (69%) travelers aged 20 to 30 years were contacted by phone and recruited. Fewer elderly travelers drank open drinks, compared to young travelers (8% vs 35%, p < 0.01), and fewer purchased street food compared to young travelers (16.2% vs 37.9%, p < 0.01). More elderly travelers were fully compliant with their anti-malarial chemoprophylaxis regimen (60.7% vs 33.8%, p < 0.01). More elderly travelers took organized tours (61% vs 2%, p < 0.001). Young travelers more often backpacked (50.7% vs 10.4%, p < 0.001). Illness, most commonly diarrhea, was reported by 18.8% of elderly travelers compared to 34.0% of the young travelers (p = 0.001). In a logistic regression model only travel to East Asia (OR 4.66) (95%CI 1.93–11.22) and traveling under basic conditions (OR 1.94) (95% CI 1.42–3.29) remained significantly associated with illness, irrespective of age. Conclusions. Because elderly travelers tend to comply with health-related recommendations better and use less risky travel modes, their risk for illness during travel was lower. Traveling to East Asia and travel mode are associated with illness during travel, irrespective of age.

Background. Decreased antimicrobial susceptibility after increased antibiotic use is a known phenomenon. Restoration of susceptibility once antimicrobial use is decreased is not self-evident. Our objective was to evaluate, in a community setting, the impact of quinolone restriction on the antimicrobial resistance of E. coli urine isolates. Methods. We conducted a retrospective, quasi-experimental ecological study to assess the proportion of quinolone-susceptible E. coli urine isolates in the periods before, during, and after a nationwide restriction on ciprofloxacin use was implemented. We used an interrupted time interval analysis for outcome evaluation. Results. We found a significant decline in quinolone consumption, measured as defined daily doses (DDDs) per month, between the preintervention and intervention periods (point estimate, -1827.3 DDDs per month; 95% confidence interval [CI], -2248.8 to -1405.9 DDDs per month; P

We investigated the influence of different interventions (active surveillance, contact isolation, monitoring, and rapid diagnostic testing) on the number of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia cases. An interrupted time-series analysis was used. MRSA bacteremia cases were reduced by 70% when all interventions were in place. We proved monitoring to be an essential component.