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Background Hospital-acquired (HA) Clostridioides difficile infection (CDI) is among the most common hospital-acquired infections and is a leading cause of morbidity and mortality among hospitalized older adults. Oral vancomycin prophylaxis (OVP) has been demonstrated in recent studies to reduce the incidence of HA CDI. This study aims to evaluate the effectiveness of OVP in the prevention of HA CDI in a community hospital setting. Methods We developed a protocol to administer prophylactic oral vancomycin based on patients’ risk factors and implemented it at our community hospital in Evanston, Illinois, in September 2020. The intervention group consists of patients admitted to our hospital between October 1, 2020, to March 31, 2021, who received OVP. Patients admitted between October 1, 2019, to March 31, 2020, who had at least one risk factor of CDI and met the inclusion criteria of OVP protocol were selected as the control group. Electronic medical records were retrospectively collected and analyzed. Propensity score matching was performed for a one-to-one match between two groups. Logistic regression models were used to study the relationship between HA CDI and independent variables, including OVP, risk factors of CDI, and demographic characteristics. Table 1.Sample characteristics of the control and intervention groups A Student t-test was performed for continuous parameters. A Chi-square test was performed for categorical parameters. Non PPx = control group; OVP PPx = oral vancomycin prophylaxis group; SNF = skilled nursing facility; LOS = length of stay; PPI = proton pump inhibitor; H2RA = histamine 2 receptor antagonist. Results A total of 446 patients (267 in the intervention group and 179 in the control group) were included. The sample characteristics are summarized in Table 1. 4/175 (2.2%) patients in the control group developed HA CDI, compared with 12/255 (4.5%) in the intervention group. Before matching, patients who received OVP (OR=7.62, p=0.010) and had a longer length of stay (LOS, OR=1.11, p=0.002) were found to have increased odds ratios (OR) of development of HA CDI (Table 2). After propensity score matching, 4/176 (2.3%) patients in the control group developed HA CDI, compared with 5/176 (2.8%) (Figure 1). Patients from skilled nursing facilities (SNF, OR=15.41, p=0.021) and with longer LOS (OR 1.15, p=0.005) were found to be associated with higher OR of HA CDI (Table 3). Table 2.The odds ratio of development of hospital-acquired C.diff infection among control and intervention groups. A binary logistic regression model was used for this study. CI = 95% confidence interval. R2 Tujur = coefficients of determination (D); AIC = Akaike’s Information Criteria. OVP PPx = oral vancomycin prophylaxis group; SNF = skilled nursing facility; LOS = length of stay; PPI = proton pump inhibitor; H2RA = histamine 2 receptor antagonist. Figure 1.Propensity score matching of control and intervention groups. (A) Distribution of propensity scores between unmatched and matched control and intervention groups. (B) Distribution balance of propensity score before and after matching. Treatment o = control group; Treatment 1 = OVP intervention group. (C) The distribution balance of covariates used for propensity score calculation before and after matching. (D) Summary of propensity score matching results. HA CDI = hospital-acquired C.diff infection (after propensity score matching). Table 3.The odds ratio of development of hospital-acquired C.diff infection among control and intervention groups after propensity score matching. A binary logistic regression model was used for this study. CI = 95% confidence interval. R2 Tujur = coefficients of determination (D); AIC = Akaike’s Information Criteria. OVP PPx = oral vancomycin prophylaxis group; SNF = skilled nursing facility; LOS = length of stay; PPI = proton pump inhibitor; H2RA = histamine 2 receptor antagonist. Conclusion Prophylactic administration of oral vancomycin to patients with selected risk factors has no statistical significance in reducing or preventing HA CDI. A longer length of hospital stay may be associated with higher risk for developing HA CDI. Disclosures All Authors: No reported disclosures.

Background: There is no clear consensus on the preference for pharmacological cardioversion (PC) in comparison to electric cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients presenting to the emergency department (ED). Methods: A systematic review and meta-analysis was conducted to assess PC (whether being followed by EC or not) vs. EC in achieving cardioversion for hemodynamically stable NOAF patients. PubMed, PubMed Central, Embase, Scopus, and Cochrane databases were searched to include relevant studies until 7 March 2022. The primary outcome was the successful restoration of sinus rhythm, and secondary outcomes included emergency department (ED) revisits with atrial fibrillation (AF), hospital readmission rate, length of hospital stay, and cardioversion-associated adverse events. Results: A total of three randomized controlled trials (RCTs) and one observational study were included. There was no difference in the rates of successful restoration to sinus rhythm (88.66% vs. 85.25%; OR 1.14, 95% CI 0.35–3.71; n = 868). There was no statistical difference across the two groups for ED revisits with AF, readmission rates, length of hospital stay, and cardioversion-associated adverse effects, with the exception of hypotension, whose incidence was lower in the EC group (OR 0.11, 95% CI 0.04–0.27: n = 727). Conclusion: This meta-analysis suggests that there is no difference in successful restoration of sinus rhythm with either modality among patients with hemodynamically stable NOAF.

Creutzfeldt‐Jakob disease (CJD) can also be diagnosed in a resource‐limited setting through good clinical analysis. The diagnosis of CJD should be considered in patients with rapidly evolving neurological signs associated with cognitive disturbances even in countries with limited available sophisticated tools and where CJD was never reported before.

The study shows the status of biogas as a Renewable Energy Technology (RET) and its role in the conservation of environment by reducing the consumption of fuelwood and Greenhouse Gases (GHGs) emission. 95 household survey, 10 key informant interviews, 3 focus group discussion and direct observatory technique were used for primary data collection. Fuelwood was found to be dominant energy resource which comprises 93.73% of total energy and rest 6.27% of energy was supplied by other sources of energy. The fuelwood consumption was 71.29 GJ per year per household which emits 646.1 tCO2e. The study shows that the annual GHGs reduction was found 7.62 tCO2e per biogas plant. On the basis of population of the agriculture based livestock of the study area, there was the possibility of 84 biogas plants of size 6 m3 which can reduce the total 638.82 tCO2e of GHGs emission per year. The study showed that the use of biogas technology can save 46.67% of fuelwood which can conserve 217.32 tons of fuelwood per year per household. The simple payback period in term of fuelwood saved for the construction of 6 m3 biogas plant was found to be only 4.08 years. Thus, the reduction or substitution of fuelwood as a primary energy resource, reduction of the GHGs emission and high potentiality of biogas in the area with adequate number of agriculture based livestock clearly indicates that biogas is as a suitable RET in reducing GHGs emission and helps in mitigating climate change.