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Background Infants frequently excrete toxigenic C. difficile asymptomatically during their first year of life. Prior studies have demonstrated an association between acquisition of community acquired C. difficile infection in adults and contact with an infant, suggesting the latter is a reservoir of the organism. To probe this possibility further, we aimed to examine how frequently C. difficile is transmitted from infants to otherwise healthy adult caregivers. Methods Families presenting to a suburban pediatric clinic for their infants’ 4-month well-child visit were recruited. Consenting parents were instructed to mail soiled diapers every 2 weeks to a research laboratory with experience cultivating C. difficile, until their baby was 8 months old. Parents were requested to concomitantly send soiled toilet paper, or a rectal swab via a moistened wipe, from themselves. Samples were cultured for C. difficile by direct plating on selective media plus using a more sensitive broth enrichment method. For family groups with C. difficile colonization, PCR ribotyping was used to determine the relatedness of selected baby and parent isolates. Results To date 17 families have submitted at least 1 set of samples. Follow up has ranged from 2 to 16 weeks (median 8). In 15/17 families, at least 1 sample was positive for C. difficile: in 4/15 only a parent was positive, in 3/15 the baby plus 1 parent were positive, and in 8/15 all family members were positive. There were no families in which only the baby yielded the organism. The index was the mother in 6/15 families, and the baby in 3/15 families; in 6/15 families, the baby plus >/= 1 parent were initially positive simultaneously. Excretion tended to be prolonged in infants (up to 16 weeks) whereas positivity was more transient in the adults. Isolates from 10 families in which the baby and at least 1 adult were positive for C. difficile were subjected to ribotyping; in 8/10 families the baby’s ribotype was concordant with >/= 1 adults’. Conclusion C. difficile colonization is common among healthy household members caring for an infant. Longitudinal observation suggests that transmission is multidirectional, with the organism passed from adult to baby and from baby to adult. Disclosures All Authors: No reported disclosures.

Background Barriers are commonly installed in workplace situations where physical distancing cannot be maintained to reduce the risk for transmission of respiratory viruses. Although some types of barriers have been shown to reduce exposure to aerosols in laboratory-based testing, limited information is available on the efficacy of barriers in real-world settings. Methods In an acute care hospital, we tested the effectiveness of in-use plexiglass dividers in reducing exposure of staff to aerosolized particles. An aerosol sprayer was used to release 5% NaCl aerosol at 1 or 2 meters from staff members with and without the barrier positioned between the point of aerosol release and the hospital staff. Particle counts on the staff side of the barrier were measured using a 6-channel particle counter. A condensed moisture (fog) generating device was used to visualize the airflow patterns. Results Of 13 dividers tested, 6 (46%) significantly reduced peak aerosol particle counts detected behind the divider, 6 (46%) reduced peak particle counts only to modest non-significant degree, and 1 (8%) significantly increased particle counts behind the divider; the figure shows data for 3 dividers that illustrate the 3 types of results. For effective dividers, condensed moisture fog flowed around the divider toward outlet air vents positioned in the ceiling, whereas fog pooled immediately behind the divider that increased staff exposure before exiting in an outlet air vent positioned on the side wall. Effective divider reducing staff aerosol exposure Ineffective divider increasing staff aerosol exposure Minimally effective divider Conclusion In real-world settings, plexiglass barriers vary widely in effectiveness in reducing staff exposure to aerosols, and some barriers may increase risk for exposure. Devices that visualize airflow patterns may be useful as simple tools to assess barriers. Disclosures All Authors: No reported disclosures.

Background The degree to which daily intensive care unit (ICU) cleaning practices impacts bacterial burden is controversial. The study aimed to assess the utility of using adenosine triphosphate (ATP) bioluminescence assays for monitoring effectiveness of daily cleaning in ICU environments. Methods We sampled 364 total samples from 57 patient rooms and 18 common areas in 3 medical ICUs over 12 weeks, before and after routine daily cleaning. Endpoints were ATP levels (relative light units, RLU) and bacterial bioburden (colony forming units, CFU). Results High-touch surfaces in ICU patient rooms and common areas were contaminated before and after cleaning. Routine cleaning significantly reduced bacterial burden in patient rooms (0.14 log10 CFU reduction, P = .008; 0.21 log10 RLU reduction, P 20 CFUs, the proportion of sites with ATP readings >250 RLU was significantly higher than those with ATP readings ≤250 RLU (90.0% vs 10.0%, P Conclusion Routine cleaning significantly reduced bacterial burden on ICU environment surfaces. Although not an alternative to culture methods, ATP assays may be a useful technique to provide rapid feedback on surface cleanliness in ICU settings.

Background Clostridioides difficile infection (CDI) causes significant morbidity in nursing home residents. Our aim was to describe adherence to a bundled CDI prevention initiative, which had previously been deployed nationwide in Veterans Health Administration (VA) long-term care facilities (LTCFs), and to improve compliance with reinforcement. Methods A multicenter pre- and post-reinforcement of the VA bundle consisting of environmental management, hand hygiene, and contact precautions was conducted in 6 VA LTCFs. A campaign to reinforce VA bundle components, as well as to promote select antimicrobial stewardship recommendations and contact precautions for 30 days, was employed. Hand hygiene, antimicrobial usage, and environmental contamination, before and after bundle reinforcement, were assessed. Results All LTCFs reported following the guidelines for cleaning and contact precautions until diarrhea resolution pre-reinforcement. Environmental specimens rarely yielded C difficile pre- or post-reinforcement. Proper hand hygiene across all facilities did not change with reinforcement (pre 52.51%, post 52.18%), nor did antimicrobial use (pre 87–197 vs. post 84–245 antibiotic days per 1,000 resident-days). LTCFs found it challenging to maintain prolonged contact precautions. Discussion Variation in infection prevention and antimicrobial prescribing practices across LTCFs were identified and lessons learned. Conclusions Introducing bundled interventions in LTCFs is challenging, given the available resources, and may be more successful with fewer components and more intensive execution with feedback.

In a cohort of 480 patients admitted to an acute care hospital, 68 (14%) had positive perirectal cultures for toxigenic Clostridioides difficile on admission. Of the 11 patients (2%) diagnosed with healthcare-associated C. difficile infections, 3 (27%) had genetically related admission and infection isolates, based on whole-genome sequencing.

OBJECTIVEContaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).DESIGNProspective, randomized, double-blinded, crossover studySETTINGThree ICUs at a large teaching hospitalPARTICIPANTSIn total, 51 HCWs involved in direct patient care were enrolled in and completed the study.METHODSAll HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4–7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.RESULTSOn bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; PCONCLUSIONSIn comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.CLINICAL TRIAL IDENTIFIERClinicaltrials.gov identifier NCT02258412Infect Control Hosp Epidemiol 2018;39:267–271

Background Sink drainage systems are a potential reservoir for the dissemination of pathogens in healthcare facilities. Pouring of liquid disinfectants down drains may have limited efficacy due to inadequate contact time and suboptimal penetration into areas harboring biofilm-associated organisms. We hypothesized that a foam application of a disinfectant would enhance sink drain decontamination in comparison to pouring of the same disinfectant. Methods We compared the antimicrobial efficacy of 300 mL of a hydrogen peroxide-based liquid disinfectant applied to sink drainage systems (N = 30 sinks per treatment group) using a hand-pumped foaming device vs. poured down the drain. Swabs were used to collect quantitative cultures from the proximal sink drain to depth of 1 inch below the strainer before treatment and at 15 minutes and 1, 2, 3, and 7 days after treatment. We also investigated the efficacy of the foam when applied every 3 days for a 2-week period (N = 10 sinks). Results As shown in the figure, pouring the hydrogen peroxide-based disinfectant down the drain significantly reduced the bacterial load on day 0 and day 1, but the bioburden returned to baseline levels within 2 to 3 days. In comparison, the foaming application of the disinfectant resulted in significantly greater reductions in bacterial recovery on days 0, 1, 2, and 3 (P < 0.01). With repeated foam treatments every 3 days, there was a progressive decrease in the bacterial load recovered from sink drains. Application of the foam required ~3 minutes per sink. Conclusion An easy-to-use foaming application of a hydrogen peroxide-based disinfectant was effective in suppressing recolonization of the proximal drainage system of sinks for at least 3 days. Intermittent application of the foaming disinfectant could potentially reduce the risk for dissemination of pathogens from sink drains. Disclosures All authors: No reported disclosures.

Effective use of personal protective equipment (PPE) is essential to protect personnel and patients in health care settings. However, in a survey of 222 health care personnel, PPE training was often suboptimal with no requirement for demonstration of proficiency. Fourteen percent of physicians reported no previous training in use of PPE.

Background Due to concerns for emergence of mupirocin resistance, there is an interest in use of topical antiseptics for nasal decolonization of Staphylococcus aureus. Alcohol-based nasal antiseptics have recently been developed as an alternative to mupirocin, but there is limited data on efficacy, particularly among patients where the burden of carriage is often high. Methods We evaluated the effectiveness of a one-time application of a commercial alcohol-based nasal sanitizer for reduction in nasal methicillin-resistant Staphylococcus aureus (MRSA) in MRSA-colonized patients. Patients received either a single dose or triple dose over 3 minutes; the triple dose is recommended for preoperative dosing. Swabs were used for quantitative culture of MRSA from the anterior nares and vestibule prior to and 10 minutes, 2 hours, and 6 hours after application. For a subset of patients, cultures for MRSA were collected from hands, clothing, groin, and chest/axilla. Results Of 34 MRSA carriers enrolled, 27 (79%) had MRSA detected in nares, 32 (94%) were male, and the mean age was 65. Of the 27 carriers positive for nasal MRSA, 15 (56%) received a single alcohol dose and 12 (44%) received a triple dose over 3 minutes. As shown in the figure, the single and triple dose applications significantly reduced MRSA concentrations at 2 hours post-treatment when the initial burden was low (i.e., Conclusion A single application of an alcohol nasal sanitizer significantly reduced nasal MRSA at 2 hours post-application when the initial burden of colonization was low, but not when a high burden of carriage was present. Additional studies are needed to determine whether higher alcohol doses or repeated applications might result in improved efficacy. Disclosures All authors: No reported disclosures.

Background Surfaces in healthcare facilities are typically cleaned by manual application of liquid disinfectants. However, thoroughness of cleaning is often suboptimal and application can be challenging and time-consuming when surfaces are irregular. Methods We tested the effectiveness of a novel spray disinfectant technology that uses an electrostatic sprayer to thoroughly apply a sporicidal disinfectant to surfaces after minimal pre-cleaning to remove visible soil. In a laboratory setting, we compared the effectiveness of the spray disinfectant vs. manual application of disinfectant for removal of Clostridium difficile spores inoculated onto the seat, armrest, and seat back of a wheelchair and measured the time required for each method of disinfection. In a healthcare setting, we tested the effectiveness of a 15-second spray application for reduction of C. difficile spores on 130 items with irregular or hard to clean surfaces, including 30 wheelchairs, 40 pieces of portable equipment, and 30 waiting room chair seats. Results In laboratory testing, application of disinfectant using the electrostatic sprayer was as effective as wiping in reducing C. difficile spores inoculated onto wheelchair surfaces, but required only one-fourth the time for application. C. difficile spore contamination was common on mobile equipment, wheelchairs, and waiting rooms chairs, and spray application of the sporicidal disinfectant was effective in reducing contamination (figure). Conclusion Commonly shared items such as wheelchairs, portable equipment, and waiting room chairs were frequently contaminated with C. difficile spores. Application of a sporicidal disinfectant using an electrostatic sprayer provided a rapid and effective means to reduce spore contamination on these surfaces. Disclosures All authors: No reported disclosures.

Background Ultraviolet-C (UV-C) light is increasingly used as an adjunct to standard cleaning in healthcare facilities. However, most facilities do not have a means to measure UV-C to determine whether effective doses are being delivered. We tested the efficacy of 2 easy-to-use colorimetric indicators for monitoring UV-C dosing in comparison to log reductions in pathogens. Methods In a laboratory setting, we exposed methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile spores on steel disk carriers with or without an organic load (5% fetal calf serum) to UV-C for varying times resulting in fluence exposures ranging from 10,000 to 100,000 µJ/cm2. The UV-C indicators were placed adjacent to the carriers. Log reductions were calculated in comparison to untreated controls and the change in color of the indicators was correlated with dose and log reductions. Results The UV-C doses required to achieve a 3-log reduction in MRSA and C. difficile were 10,000 and 46,000 µJ/cm2, respectively. For both indicators, there was a visible color change from baseline at 10,000 µJ/cm2 and a definite final color change by 46,000 µJ/cm2 (Figure 1). Organic load had only a modest impact on UV-C efficacy. The indicators required only a few seconds to place and were easy to read (Figure 2). Conclusion UV-C doses of 10,000 and 46,000 µJ/cm2 were required to achieve 3 log reductions of MRSA and C. difficile spores, respectively. The colorimetric indicators provide an easy means to monitor UV-C dosing. Disclosures All authors: No reported disclosures.

Background Asymptomatic carriage of toxigenic Clostridioides difficile strains is common in healthcare settings. However, the natural history of C. difficile colonization and infection is not well understood, particularly for patients with new acquisition of carriage. Methods In 3 tertiary care hospitals and affiliated long-term care facilities (LTCFs), we conducted a 6-month cohort study to identify patients with new acquisition of rectal carriage of toxigenic C. difficile and determined the duration and burden of carriage. Asymptomatic carriage was defined as transient if only 1 culture was positive with negative cultures before and after or persistent if 2 or more cultures were positive; clearance was defined as 2 consecutive negative rectal cultures. Results Of 4180 patients with negative initial cultures, 144 (3%) acquired asymptomatic carriage of toxigenic C. difficile, and 19 (13%) of these carriers subsequently were diagnosed with CDI. Of 50 asymptomatic carriers analyzed for duration of carriage, 33 (66%) had transient carriage of toxigenic C. difficile and 17 (34%) had persistent carriage. For persistent carriers, the estimated median time to clearance of colonization was 76 days (range, 41 to 95 days from acquisition). Ten of 17 (59%) persistent carriers had a high burden of carriage (defined as > 25 colonies recovered from 1 or more swabs) vs. only 1 of 33 (3%) transient carriers (P < 0.001). Conclusion Acquisition of asymptomatic carriage of toxigenic C. difficile carriage was common among patients in healthcare facilities, but most carriers had transient low-level carriage. Additional studies are needed to determine whether a higher burden of carriage predicts subsequent risk of transmission. Disclosures All authors: No reported disclosures.

Background Contaminated environmental surfaces contribute to transmission of healthcare-associated pathogens such as multidrug-resistant gram-negative bacilli. We hypothesized that medical procedures and patient care activities facilitate environmental dissemination of multidrug-resistant gram-negative bacilli in hospitalized patients. Methods We conducted a cohort study of hospitalized patients in contact precautions for carriage of extended-spectrum β-lactamase (ESBL)-producing or carbapenem-resistant gram-negative bacilli (CR-GNB) to determine the frequency of environmental shedding during procedures and care activities. Perirectal, wound, and skin were cultured for the gram-negative bacilli of interest. Prior to each procedure or activity, surfaces in the room and portable equipment used for procedures were disinfected. After procedures, high-touch surfaces and portable equipment were cultured; negative control cultures were collected after 1 hour in the absence of a procedure. Results Of 60 participants, 38 (63%) were in contact precautions for ESBL-producing gram-negative bacilli and 22 (37%) for CR-GNB. Thirty-four (57%) participants had positive perirectal, wound, or skin cultures. Contamination of surfaces with the colonizing multidrug-resistant gram-negative bacilli occurred frequently during procedures and activities such as wound care, assistance with meals, and urinary catheter or colostomy care (11% to 29% of procedures/activities), whereas contamination was rare in the absence of a procedure (1%). Contamination was recovered from 6 of 56 (10%) portable devices used for procedures. Conclusion Environmental shedding of multidrug-resistant gram-negative bacilli occurs frequently during medical and non-medical procedures in hospitalized patients. Our results suggest that there is a need for effective strategies to disinfect surfaces and equipment after procedures. Disclosures All authors: No reported disclosures.

In a survey of two hospitals, soft surfaces were commonly present in inpatient and outpatient settings, and contamination with health care-associated pathogens was frequently detected. An improved hydrogen peroxide cleaner disinfectant was effective for decontamination of soft surfaces when applied as a spray with no mechanical wiping.

In a survey of 5 hospitals, we found that floors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the floor. Contact with objects on floors frequently resulted in transfer of pathogens to hands.

Background Preliminary data suggests that community-onset Clostridium difficile might be more common in rural areas. Thus, farms—specifically livestock farms—might be a major reservoir of C. difficile. Similarly, antibiotic exposures might predispose farm animals for colonization with multidrug resistant Gram-negative organisms. The aim of this study was to determine the prevalence of C. difficile and multidrug resistant gram-negative rods in the soil of Southeastern Wisconsin farms. Methods From July to September of 2016, soil samples were collected from farms with livestock animals. Soil samples were collected using gloves and sample containers. Soil samples were collected from farms specifically in or near Washington, Waukesha, and Milwaukee counties which are within the proximity of Milwaukee Metro area. Soil samples were cultured for C. difficile and Gram-negative rods on selective plates and by broth enrichment. Results A total of 20 farms participated in this study with a total of 40 soil samples. Out of the 40 soil samples, 20 were from an area where animals roam or where manure was used and the remaining 20 were from an area where animals are prohibited or where there was no manure. Out of the 20 soil samples where animals roam, 10 (50%), tested positive for C. difficile. Out of 20 soil samples where animals are prohibited, 13 samples (65%) tested positive for C. difficile. 2 of the 23 C. difficile isolates recovered were toxigenic. Eight (40%) of the 20 soil samples where animals roam tested positive for fluoroquinolone-resistant bacteria (FQR). While 5 (25%) of the 20 soil samples where animals are prohibited, tested positive for FQR bacteria. An Acinetobacter calcoaceticus was found to exhibit carbapenem-resistance. Conclusion We found soil colonization with C. difficile and FQR in 65% and 25%, respectively, where animals are prohibited. Where animals roam we found C. difficile and FQR 50% and 40%, respectively. Our study suggests that farms may be a significant community source for C. difficile and fluoroquinolone resistant organisms. Additional testing should be done to examine factors that might be increasing antibiotic resistance in farms (e.g., antibiotic exposure). Disclosures All authors: No reported disclosures.

OxyCide Daily Disinfectant Cleaner, a novel peracetic acid/hydrogen peroxide–based sporicidal disinfectant, was as effective as sodium hypochlorite for in vitro killing of Clostridium difficile spores, methicillin-resistant Staphylococcus aureus, and vancomcyin-resistant enterococci. OxyCide was minimally affected by organic load and was effective in reducing pathogen contamination in isolation roomsInfect Control Hosp Epidemiol 2014;35(11):1414–1416

Background Portable equipment that is shared among patients can be a potential source of pathogen dissemination. In busy healthcare settings, cleaning of shared medical equipment may be suboptimal. In addition, equipment such as ultrasound probe heads present a challenge because sporicidal cleaning solutions such as bleach cannot be used. Methods We conducted a culture survey of ultrasounds in 15 intensive care units (ICUs) at a large tertiary care referral center, including medical, surgical, neurology, cardiology, and cardiovascular ICUs. Multiple high-touch surfaces on different types of ultrasound equipment used in the ICUs were swabbed to assess for the presence of Clostridium difficile and antibiotic-resistant Gram-negative bacilli. To assess cleaning, a fluorescent marker visible only under UV light was placed on high-touch surfaces on each of the cultured ultrasounds and a black light was used determine if the marker was removed after 24 hours and again after 1 week. Results Of 15 ultrasounds cultured, 7% were contaminated with C. difficile spores and 7% were contaminated with Gram-negative bacilli. Based on fluorescent marker removal, only 20% of the ultrasounds were cleaned within 24 hours and only 31% were cleaned within 1 week. Ultrasounds with touchscreens were cleaned more frequently than those with no touchscreen. For equipment with a combination of touchscreen features and knobs, the touchscreens were cleaned more often than the knobs which often had residual marker even after 7 days. Conclusion Ultrasound equipment can be a vector for transmission of C. difficile and other pathogens in critical care settings. In our facility, cleaning of ultrasound equipment was suboptimal, particularly for ultrasounds that did not have a touchscreen interface. Since ultrasounds are being employed in critical care settings with increasing frequency, there is a need for improved methods for cleaning and disinfection. Disclosures A. Deshpande, 3M: Investigator, Research grant. Clorox: Investigator, Research grant. STERIS: Investigator, Research grant.

OBJECTIVETo determine the effect of variation in test methods on performance of an ultraviolet-C (UV-C) room decontamination device.DESIGNLaboratory evaluation.METHODSWe compared the efficacy of 2 UV-C room decontamination devices with low pressure mercury gas bulbs. For 1 of the devices, we evaluated the effect of variation in spreading of the inoculum, carrier orientation relative to the device, type of organic load, type of carrier, height of carrier, and uninterrupted versus interrupted exposures on measured UV-C killing of methicillin-resistant Staphylococcus aureus and Clostridium difficile spores.RESULTSThe 2 UV-C room decontamination devices achieved similar log10 colony-forming unit reductions in the pathogens with exposure times ranging from 5 to 40 minutes. On steel carriers, spreading of the inoculum over a larger surface area significantly enhanced killing of both pathogens, such that a 10-minute exposure on a 22-mm2 disk resulted in greater than 2 log reduction in C. difficile spores. Orientation of carriers in parallel rather than perpendicular with the UV-C lamps significantly enhanced killing of both pathogens. Different types of organic load also significantly affected measured organism reductions, whereas type of carrier, variation in carrier height, and interrupted exposure cycles did not.CONCLUSIONSVariation in test methods can significantly impact measured reductions in pathogens by UV-C devices during experimental testing. Our findings highlight the need for standardized laboratory methods for testing the efficacy of UV-C devices and for evaluations of the efficacy of short UV-C exposure times in real-world settings.Infect Control Hosp Epidemiol 2016;37:555–560

Decontamination of gloves before removal could reduce the risk for contamination of hands of personnel caring for patients with Clostridium difficile infection. We demonstrated that a novel sporicidal formulation of ethanol rapidly reduced C. difficile spores on gloved hands without adverse odor, respiratory irritation, or staining of clothing.Infect. Control Hosp. Epidemiol. 2016;37(3):337–339

Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection.To determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination.We conducted a point-prevalence study and quasi-experimental intervention from October 28, 2014, through March 31, 2015. Data analysis began November 17, 2014, and ended April 21, 2015. Participants included a convenience sample of health care personnel from 4 Northeast Ohio hospitals who conducted simulations of contaminated PPE removal using fluorescent lotion and a cohort of health care personnel from 7 study units in 1 medical center that participated in a quasi-experimental intervention that included education and practice in removal of contaminated PPE with immediate visual feedback based on fluorescent lotion contamination of skin and clothing.The primary outcomes were the frequency and sites of contamination on skin and clothing of personnel after removal of contaminated gloves or gowns at baseline vs after the intervention. A secondary end point focused on the correlation between contamination of skin with fluorescent lotion and bacteriophage MS2, a nonpathogenic, nonenveloped virus.Of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion occurred in 200 (46.0%), with a similar frequency of contamination among the 4 hospitals (range, 42.5%-50.3%). Contamination occurred more frequently during removal of contaminated gloves than gowns (52.9% vs 37.8%, P = .002) and when lapses in technique were observed vs not observed (70.3% vs 30.0%, P .001). The intervention resulted in a reduction in skin and clothing contamination during glove and gown removal (60.0% before the intervention vs 18.9% after, P .001) that was sustained after 1 and 3 months (12.0% at both time points, P .001 compared with before the intervention). During simulations of contaminated glove removal, the frequency of skin contamination was similar with fluorescent lotion and bacteriophage MS2 (58.0% vs 52.0%, P = .45).Contamination of the skin and clothing of health care personnel occurs frequently during removal of contaminated gloves or gowns. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.

A portable booth designed to disinfect full-body coverage protective equipment before removal using ultraviolet-C radiation resulted in at least 3 log reductions in bacteriophage MS2 and methicillin-resistant Staphylococcus aureus within 3 minutes. The booth could be useful for disinfection of contaminated protective equipment before removal during care of Ebola patients.Infect Control Hosp Epidemiol 2015;36(10):1226–1228

OBJECTIVETo determine the effectiveness of a pulsed xenon ultraviolet (PX-UV) disinfection device for reduction in recovery of healthcare-associated pathogens.SETTINGTwo acute-care hospitals.METHODSWe examined the effectiveness of PX-UV for killing ofClostridium difficilespores, methicillin-resistantStaphylococcus aureus(MRSA), and vancomycin-resistantEnterococcus(VRE) on glass carriers and evaluated the impact of pathogen concentration, distance from the device, organic load, and shading from the direct field of radiation on killing efficacy. We compared the effectiveness of PX-UV and ultraviolet-C (UV-C) irradiation, each delivered for 10 minutes at 4 feet. In hospital rooms, the frequency of native pathogen contamination on high-touch surfaces was assessed before and after 10 minutes of PX-UV irradiation.RESULTSOn carriers, irradiation delivered for 10 minutes at 4 feet from the PX-UV device reduced recovery ofC. difficilespores, MRSA, and VRE by 0.55±0.34, 1.85±0.49, and 0.6±0.25 log10colony-forming units (CFU)/cm2, respectively. Increasing distance from the PX-UV device dramatically reduced killing efficacy, whereas pathogen concentration, organic load, and shading did not. Continuous UV-C achieved significantly greater log10CFU reductions than PX-UV irradiation on glass carriers. On frequently touched surfaces, PX-UV significantly reduced the frequency of positiveC. difficile, VRE, and MRSA culture results.CONCLUSIONSThe PX-UV device reduced recovery of MRSA,C. difficile, and VRE on glass carriers and on frequently touched surfaces in hospital rooms with a 10-minute UV exposure time. PX-UV was not more effective than continuous UV-C in reducing pathogen recovery on glass slides, suggesting that both forms of UV have some effectiveness at relatively short exposure times.Infect Control Hosp Epidemiol 2014;00(0): 1–6

Background Healthcare facility sinks have been implicated in transmission of bacterial pathogens, including multidrug-resistant Gram-negative bacilli. However, it is not known if sinks might also be an important source for dissemination of Candida species. Methods In 4 Cleveland area hospitals, we determined the frequency of dissemination of Candida species from sink drains to the sink bowl and countertop. The sink drain, bowl, and adjacent countertop were cultured; the sink bowl and countertop were then disinfected and additional cultures were collected from the sink bowl and countertop after running the water for 30 seconds. Candida species recovered were identified using MALDI-TOF. Results A total of 194 sets of cultures were collected from the 4 hospitals (range, 40 to 74 cultures per hospital). As shown in the figure, Candida species were frequently recovered from the sink bowls and countertops at baseline and dissemination to these sites occurred frequently when the water was run. Candida parapsilosis was the most frequent Candida species recovered, followed by Candida tropicalis and Candida lusitaneae. Conclusion Our findings suggest that sinks may be an under-appreciated reservoir for dissemination of Candida species in hospitals. Figure: Disclosures All authors: No reported disclosures.

Background Bleach (sodium hypochlorite) is an effective sporicidal disinfectant, but it is corrosive to many materials, irritating to some healthcare personnel and patients, and dries leaving a visible residue. We evaluated a new spray formulation of bleach that is purported to be as effective as regular bleach, but with less potential for adverse effects. Methods We examined the efficacy of the spray application of the new formulation of bleach (sodium hypochlorite 0.32%) in comparison to a spray application of a standard bleach product (sodium hypochlorite 0.65%) for killing Clostridium difficile spores, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Escherichia coli in 5% fetal calf serum on steel disk carriers. We assessed real-world materials compatibility of the products by repeated spray applications on a hospital mattress, formica bedside table, and textiles. Personnel trialing the products were interviewed to obtain information on tolerability and residue. Results Both bleach formulations reduced each of the pathogens by ≥6.0 log10CFU with a 2 minute contact time. With repeated applications, the standard bleach product caused rapid visible discoloration of the hospital mattress and textiles and gradual fading of the formica bedside table surface, whereas the new spray formulation caused minimal to no adverse effects with up to 60 applications. Personnel using the products reported that the new product left much less residue after use and was more tolerable than the standard bleach product. Conclusion A new spray formulation of bleach was as effective as a standard bleach product, but was less damaging to surfaces, more tolerable for users, and left less residue on surfaces. The new formulation of bleach may provide an alternative sporicidal disinfectant for facilities concerned about the adverse effects of standard bleach products. Disclosures All authors: No reported disclosures.

Background Environmental contamination may play a critical role in ARO (antibiotic-resistant organism) transmission. The objective of this study was to estimate facility-unit contamination in 6 healthcare facilities and determine if differences existed among facilities, unit types, and room contact precautions status. Methods In each facility, two units with patients with a recent positive test of a target ARO (MRSA, VRE, or carbapenem-resistant Gram-negatives in the previous 6 months or C. difficile in the previous 30 days) were randomly selected every 2 weeks for 8 cycles. Within units, surfaces were sampled in all contact precautions rooms of patients with a target ARO, 1–2 randomly selected non-contact precautions rooms per contact precautions room, and the nursing station. Multilevel logistic regression was used to model the association of facility, unit type and room type with risk of contamination. The inverse of sampling probability was used as weights in the regression. Results A total of 196 ARO contact precautions rooms and 221 non-precautions rooms were sampled from 24 units (9 ICUs; 13 acute care medicine/surgical units; 2 transplant units) totaling 1,448 specimens. Of 417 rooms sampled, 23% were positive for one or more of the target AROs. Fourteen percent of non-precautions rooms were positive for target AROs, and 17% of ARO precautions rooms were positive for AROs other than the known target ARO. In general, prevalence of environmental ARO contamination did not differ between facilities sampled. Compared with ICUs, odds of contamination on transplant and acute care units were 5.86 and 3.85 times higher, respectively. Non-precautions rooms and nursing stations were significantly less likely to be contaminated with AROs compared with contact precautions rooms (OR = 0.24, P < 0.001) and (OR = 0.34, P = 0.009), respectively. Conclusion Detection of target AROs in non-precautions rooms and at nursing stations suggests colonized patients may be going undetected, cleaning is not sufficiently removing contamination from prior ARO patients, or AROs are being transferred from infected patients to other locations within the unit. Additional intensive sampling may further illuminate priority areas for interventions within acute care facilities. Disclosures All authors: No reported disclosures.

Methods  A modification of protocol e2197 from the American Society for Testing and Materials (ASTM) was used to assess killing of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) on vertical polyester carriers  In two hospitals, we evaluated Clorox Hydrogen Peroxide Cleaner Disinfectant on 300 soft surface sites in patient rooms, physical therapy areas, and outpatient clinics Objective To evaluate the efficacy of Clorox Hydrogen Peroxide Cleaner Disinfectant containing 1.4% hydrogen peroxide for disinfection of hospital soft surfaces without mechanical wiping Results  On polyester carriers, Clorox Hydrogen Peroxide Cleaner Disinfectant resulted in ≥6 log10 colony-forming unit [CFU] reduction in VRE and MRSA with a1 minute contact time, with no significant reduction in the presence of organic load  On soft surfaces in patient care areas, Clorox Hydrogen Peroxide Cleaner Disinfectant significantly reduced mean aerobic and facultative colony counts (276 to 0.6 CFU, P