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Recruitment of skilled professionals for the infection preventionist (IP) role is an ongoing priority for organizations. The objective of this study was to understand differences in recruitment, hiring and training by facility setting and discuss targeted strategies for diverse organizations.A survey study investigated recruitment, hiring and training practices for IPs and stratified by facility location (multi-location health system (MLHS), urban, suburban and rural), specifically pertaining to job description requirements, background of candidates interviewed and hired and training programs.A Master's in Public Health degree was significantly more frequently listed on MLHS and urban facility job descriptions (37.3%, 43.7%, respectively) than suburban (27.4%) and rural facility job descriptions (17.2%)(P.01). Respondents from MLHS (41.3%), urban facilities (47.0%), suburban facilities (41.7%) were more likely to interview public health professionals than rural facilities (20.3%, P = .003). Respondents from MLHS, (73.3%), urban (68.4%), and suburban (62.2%) facilities were significantly more likely to use local Association for Professionals in Infection Control and Epidemiology chapter for training compared to rural facilities (32.4%)(P.001).Our results identified differences in facility setting with recruitment, hiring and training practices. Optimizing recruitment and training best practices will result in a large and well trained IP workforce and patient safety.

Background Surgical site infection (SSI) prevention bundles have proven successful in decreasing infections. Surgeon and nurse engagement and endorsement are essential for success. The objective of this quality improvement project was to develop, implement and sustain a colon SSI prevention bundle and determine which bundle components are most strongly associated with prevention of SSI. Methods The bundle was developed and implemented in a 525 bed Level I trauma hospital and included pre-, intra- and postoperative components. Bundle adherence and SSI rate were continually tracked and communicated to surgeons and nursing staff throughout project. Univariate and multivariate analyses were performed to determine the components associated with lowest SSI rates. Results There were 280 elective and urgent/emergent colon surgeries between October 2015 and March 2018. Over 60% had preoperative components, 76.5% had intraoperative components and 55.6% had postoperative bundle components with a nonsignificant decreasing trend in SSI rate of −0.5 SSI/100 procedures per quarter. The multivariate analysis suggested that use of 2% chlorhexidine gluconate/70% alcohol skin prep, use of wound protector and change of gloves for fascial closure were associated with fewer SSI. Discussion The implementation of a colon SSI prevention bundle in a Level I trauma hospital with pre-, intra- and postoperative components was described. Future directions include focusing implementation efforts on bundle components that significantly prevent SSI to improve adherence.

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.

This brief report explores why Infection Preventionists (IPs) leave their positions and strategies implemented to retain and professionally develop IPs. National survey data of over 500 APIC members found turnover is due to personal reasons, professional advancement opportunities and work-life balance challenges. In addition, IPs are retiring in great numbers. The creation of career pathways and providing an environment that supports work-life balance are novel strategies that could retain and professionally develop IPs.

Background: The U.S. Centers for Disease Control and Prevention recommend bathing prior to surgery, surgical skin antisepsis, peri-operative antibiotic administration, normothermia throughout the p...

Background:Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program.Methods:Prospective, quasi-experimental study utilizing an interrupted time-series design. Intervention placards depicting an image of eyes, a social norms message, or a control placard were placed near soap and alcohol-based hand-rub dispensers on 2 hospital units. Placards were alternated every 10 days. Hand hygiene opportunities and adherence rates were assessed electronically via the CenTrak Hand Hygiene Compliance Solution.Results:A total of 166 nurses and certified nursing assistants (74 on a medical-surgical unit and 92 on a progressive care unit) were monitored electronically over the 4-month study period. In total, 184,172 electronic observations were collected (110,903 on a medical-surgical unit and 73,269 on a progressive care unit). The median daily number of electronic observations was 1,471 (interquartile range, 1,337–1,584). The preintervention baseline hand hygiene adherence rate was 70%. No statistically significant increase in hand hygiene adherence was observed as a result of either intervention.Conclusion:Displaying eye images or a social norms message in the hospital environment did not result in measurable improvements in HH adherence in a cohort of healthcare providers participating in an electronic monitoring and feedback program.

Background When patients with COVID-19 began presenting to hospitals in early 2020, medical professionals were unprepared to handle the severity of disease and the number of severely ill patients. Local Problem In response to critical needs of patients with COVID-19 and the threat of nurse burnout, a special operations team comprising physical and occupational therapists was convened to (1) provide help to intensive care unit nurses, (2) help therapists be productive, and (3) use therapists’ specialties for critical patients. Methods Two therapists teamed up each shift to work with every critical patient with COVID-19, performing numerous nursing and therapy activities. Activity frequency was documented by the therapists daily, and duration was estimated and data were summarized by nursing leadership. Results During the 9-week program, 35 critical patients with COVID-19 were included in the special operations program. During the program, the teams performed 10 activities, including prone positioning, turning, and mobilization, 1937 times with the patients with COVID-19. The partnership saved between 5 and 40 minutes of intensive care nurse time per activity, which resulted in a total of 677.2 hours of nursing time saved. Discussion Implementation of the special operations program had a positive impact on patients, nurses, and therapists. Patients benefited both clinically and socially from additional time with special operations teams. Nurses benefited from having help caring for critical patients, and therapists benefited from increased productivity during redeployment. Conclusion Deployment of nonnursing clinical staff could be an effective strategy to leverage available resources while maintaining clinical standards of care and reducing nursing burden during a pandemic or crisis surge.

Background Given the changing nature of infection prevention and control (IPC), appropriate infection preventionist (IP) staffing needs to be established. In this study, we aimed to describe current IP staffing levels and IPC department resources in U.S. acute care hospitals. Methods These data came from the 2015 MegaSurvey conducted by the Association of Professionals in Infection Prevention and Epidemiology. Descriptive statistics and bivariate analyses were conducted to examine differences in respondent, facility, and department characteristics by facility size (average inpatient census ≤100 vs >100). Results Data from 1623 respondents were included. Most (72%) had single-site responsibilities and dedicated 76%-100% of their job to IPC (68%). The overall median IP staffing was 1.25 IPs per 100 inpatient census (interquartile range = 1.81). Almost half (46%) represented facilities with daily inpatient census ≤100; the average number of IPs in these facilities was 1.1 (standard deviation = 0.7). The reported number of IPs increased steadily with higher patient census. Significant differences were observed in IP staffing, responsibilities, and support to the IPC department between smaller and larger hospitals. Conclusions This study represents the current snapshot of IP staffing and IPC resources in acute care hospitals. Findings indicate important differences between large and small facilities in staffing and IPC resources. The field of infection prevention would benefit from a comprehensive assessment of IPC department staffing and resource needs.

Background : Ventilator-associated pneumonia (VAP) results in significant increases in both hospital stay and morbidity. A Level I Trauma Center focused attention on VAP prevention following a notable increase over a two-year period. The goal of this project was to implement a new oral care program for vented patients to decrease VAP rates. Methods : Surveillance for VAP was completed for patients at a Level 1 Trauma Center utilizing National Healthcare Safety Network pneumonia definition for critical care patients admitted from 2017 through September 2020. Infection Prevention performed a comprehensive review of ventilated patient care and VAP bundle prevention through staff interviews and shadowing of critical care nursing staff and respiratory therapists. The VAP rate was calculated by the number of VAP/ventilator days x 1000. Results : A comprehensive review of vented patients determined there was variability with oral care practices, including products, number of times oral care occurred per day and oral care documentation. The oral care bundle included (1) increase from Q6 oral care to Q4 oral care for all vented patients, (2) integration and standardization of new oral care products, (3) addition of twice daily chlorhexidine gluconate oral care for seven days post-extubation, (4) Oral Care Road Show entitled “Brush Pneumonia Away” to educate on the importance of oral care and the changes with the process and (5) ability for respiratory therapy to document on VAP bundle prevention including oral care. A 65% decrease in VAP rate occurred between 2018/2019 (9.69) and 2020 (3.31). Conclusions : Implementation of an oral care bundle in a Level I Trauma Center with a significant daily census of critically ventilated patients improved VAP rate. Oral care interventions have been recognized as an effective method in reducing the risk of VAP in critically ill patients.

Background Nurses have historically occupied the infection preventionist (IP) role. As the knowledge and skills needed to advance the field expand, professionals from public health and the laboratory sciences have become IPs. Our study describes the characteristics of current IPs and assesses for relationships between background, certification, experience, and type of work performed. Methods The data were drawn from an existing dataset collected in the conduct of the Association for Professionals in Infection Control and Epidemiology (APIC) MegaSurvey. Descriptive statistics were computed. Associations were calculated using χ2 or Cochran-Mantel-Haenszel tests. Characteristics of IPs were stratified by work-related activities to allow for comparisons between groups. Results Of the 13,050 active APIC members, 4,079 participated in the survey (31% response rate). The primary job activity for nurses (97.9%; n = 2,434) was preventing and controlling the transmission of infectious agents or health care–associated infections, for laboratory scientists (97.5%; n = 307) it was the interpretation of surveillance data, and for public health professionals (96.1%; n = 136) it was management and communication: feedback. Conclusions Infection control departments would benefit from hiring IPs with diverse education and training to address the expanding roles and responsibilities of IPs. This may facilitate the implementation of novel and innovative processes that will impact patient care.

We implemented a cleaning process for mobile patient equipment (MPE) and determined its success using adenosine trisphosphate (ATP) monitoring and data feedback. Following education for staff and ATP data feedback, the data suggest that the MPE cleaning program we implemented was successful.

Background The National Healthcare Safety Network’s (NHSN) catheter-associated urinary tract infection (CAUTI) definition has changed multiple times in the previous decade with substantial changes occurring in 2009, 2013, and 2015. Efforts to improve the clinical relevance of this definition have been made, notably the exclusion of Candida species. This study quantifies the magnitude of discrepancy in CAUTI between the 2014 and 2015 definitions and determines which of these definitions has more clinical relevance. Methods This is a retrospective study at a 500 bed academic hospital. Eligible cases were identified by a query of our facility’s 2014 NHSN CAUTI cases. We reviewed cases to determine whether they met criteria for CAUTI using the 2014 and 2015 NHSN definitions and also to determine the clinical relevance of the CAUTI. Clinical CAUTI was defined as a provider documenting CAUTI in the progress notes or discharge summary. Subcategories of Clinical CAUTI included “Definite CAUTI”, the presence of UTI in clinical documentation without another documented etiology of fever, and “Possible CAUTI”, documentation of both UTI and another cause of fever. A positive urinalysis was defined as The presence of ≥10 WBC, moderate/large leukocyte esterase, or nitrites. Results There were 65 eligible CAUTI in 61 patients reported to NHSN in 2014. All met the 2014 definition, but only 38 (58%) met the 2015 definition. The median age was 57 years (IQR 51–67), and 54% (n = 33) were male. Clinical CAUTI was diagnosed in 44 patients (68%) meeting the 2014 definition and 33 patients (87%) meeting the 2015 definition (P < 0.001). Half of Clinical CAUTI identified by the 2014 definition were considered to be Definite CAUTI; similar results were found using the 2015 definition. Independent predictors of Clinical CAUTI included urine cultures positive for Gram-negative bacilli (OR 5.2, 95% CI 0.9 to 29.2), positive urinalysis (OR 7.1, 1.4 to 36.1), and use of the 2015 definition (OR 4.7, 0.9 to 23.4). Conclusion This data suggests that introduction of the 2015 definition may result in a 42% reduction in CAUTI. The 2015 definition was associated with more Clinical CAUTI. Further refinement of the 2015 CAUTI definition could be attained by excluding those cases attributed to other causes of fever. Disclosures All authors: No reported disclosures.

Background Foley catheter (FC) insertions in the Emergency Department (ED) create inherit infectious and non-infectious risks to patients due to the chaotic environment. Numerous FCs are placed in the ED due to convenience, lack of patient diagnosis and urgency. The objective of this study was to reduce the amount of FCs that are inserted in the ED, by utilizing a multidisciplinary team to implement practice changes based on real time data. Methods A cross-sectional study was performed from January 2018 – November 2019 in a Level I Trauma hospital. A multidisciplinary team including Infection Prevention (IP), Clinical Data Analytics and ED leadership developed a dashboard to determine FC insertions in the ED/1000 patients and common indications for Foley placement in the ED. Additionally, every FC that was placed in the ED was reviewed by IP and ED leadership for appropriateness. Any FC that were deemed inappropriate were then discussed with physicians and staff. Weekly and monthly reports were reviewed with ED leaders for trends. The number of FC insertions in the ED/1000 patient days in the pre-intervention period (January 2018 – December 2018) was compared to post-intervention (January 2019 – November 2019). A T-test was used to determine statistically significant change. Results A 22% reduction of FC insertions in the ED occurred between the pre- and post-intervention. During the pre-intervention period, the FC insertion rate was 11.62 FC insertions /1000 patients compared to 9.33 during the post intervention period (p Conclusions An engaged ED staff and clinical data analytics team were able to reduce risk to patients by decreasing FC insertions in the ED. Next steps will be to determine non-infectious poor outcomes to further reduce FC insertions in the ED.

Background Hand hygiene (HH) is the number one intervention to prevent hospital-associated infections. Accurate HH data is challenging to collect for multiple reasons including biased data collection, inconsistent training, and the Hawthorne effect. Inaccurate HH data makes it difficult for the Infection Preventionist to enact meaningful change for the facility to increase HH compliance. In a Level I Trauma Center, secret shoppers did not receive standardized HH data collection education and were frequently trained by the trainer. The objective of this study was to evaluate HH compliance before and after standardized education. Methods A pre-post study was utilized in a Level I Trauma Center to evaluate reported HH compliance before and after standardized education of secret shoppers. Infection Prevention trained a leader and at least one HH champion from each unit or ancillary service between March and May 2019. Any champion who continued to report high HH compliance were shadowed to determine the cause of their over-reporting to reduce bias in reporting. The 5 months of HH compliance pre- and post- intervention were compared utilizing a t-test. Results A total of 91 HH champions from 41 departments attended the standardized education. The average HH compliance was 97.5% (n = 1212) in the pre-intervention period compared to 75.9% (n = 2575) in the post-intervention period (p Conclusions Standardized education and bias follow-up significantly reduced over reporting of HH compliance. By moving to a standardized education model, Infection Preventionists collected more accurate HH data to better understand opportunities in their facility. With access to more accurate data, Infection Prevention will start to assess gaps in HH practices to improve compliance.

Highlights • We detected an outbreak of nosocomial human rhinovirus C in our neonatal intensive care unit. • Although the outbreak only consisted of 2 cases, it emphasizes the importance of hand hygiene in a neonatal intensive care unit to prevent the spread of infectious diseases to a susceptible population. • Laboratory techniques, such as respiratory panel polymerase chain reaction, improve the efficiency of test results, allowing clinicians the ability to detect outbreaks and detect them earlier., Nosocomial respiratory infections cause significant morbidity and mortality, especially among the extremely susceptible neonatal population. Human rhinovirus C is a common viral respiratory illness that causes significant complications in children

Factors affecting annual compensation and professional development support have been studied for various healthcare professions. However, there is little understanding of these factors for infection preventionists (IPs).Using secondary data from the Association for Professionals in Infection Control and Epidemiology 2015 MegaSurvey, we designed a descriptive, correlational study to describe IP annual compensation and professional development support. We tested for associations between demographic variables and annual compensation and investigated for predictors of higher annual compensation.Median salary for IPs was $75,000. IPs who indicated that their compensation was based on industry benchmarks reported a median salary of $85,000 (P .001). IPs with advanced degrees reported a median salary of $90,000. IPs with bachelor's degrees or lower reported a median salary of $50,000 (P .001). IPs with CIC® reported a median salary of $85,000. IPs without CIC® reported a median salary of $65,000 (P .001).This study can be used to develop recruitment and retention guidelines that lead to a well-educated, well-compensated, and competent IP workforce.

Background The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. Methods Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. Results Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs ( P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. Conclusions Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments.

Background The environmental contamination of Clostridium difficile in acute care hospital rooms is associated with increased risk of infection for subsequent patients. Patients that stay in a room following a patient with a C. difficile infection (CDI) have an increased risk of CDI compared with patients whose previous resident did not have CDI. The objective of this study was characterize the room movement of CDI patients in a Level 1 Trauma Medical Center. Methods A patient with CDI was defined as an inpatient with a positive C. difficile test through rapid serology, C. difficile polymerase chain reaction (PCR) or multiplex-stool PCR from March 2017 to March 2018. Patients were classified as either community-onset (CO, positive test Results There were a total of 244 CDI patients identified (172: CO, 72: HO) between March 2017 and March 2018. The mean time from admission to positive test was 12.4 hours post-admission for CO-CDI patients and 251.1 hours for HO-CDI patients. Almost 40% of HO-CDI patients (36.1%, n = 72) stayed in at least three rooms during their hospital admission compared with Conclusion The current state of room movement with CDI patients is suboptimal, resulting in increased infection risk for subsequent patients. A multi-faceted intervention to address this problem is essential to achieve an optimal goal of 1–2 rooms per hospital stay for a CDI patient. Quality improvement projects include (1) notification of patient movement to nursing leadership, (2) alerts to nursing supervisors of potential CDI patients before room transfer, and (3) earlier diagnosis of community-onset C. difficile. Disclosures All authors: No reported disclosures.

Background Soap and water is more effective than alcohol-based hand rub (ABHR) at removing Clostridium difficile spores from hands. Our institution mandates that healthcare workers (HCW) use soap and water after contact with the patient or their environment for any C. difficile infection (CDI); CDC and SHEA recommend this only in outbreak settings for three main reasons: lack of evidence that preferential soap and water use reduces CDI, concerns that inconsistent messaging may result in decreased hand hygiene overall, and that glove use obviates soap and water use. The objective of this study was to investigate hand hygiene practices after caring for CDI patients. Methods CDI cases from July 2016 to December 2017 residing in any of 4 units in the hospital (1 medical ICU, 1 stepdown, 2 med/surg) were identified. These units have an electronic hand hygiene (eHH) monitoring system. Using radio frequency identification badges worn by HCW and sensors on each dispenser, handwashing opportunities and washes are recorded. eHH after CDI patient contact and any patient contact were collected. eHH adherence (using an ABHR or soap dispenser within 1 minute of room exit) was calculated overall and stratified by soap and water vs. ABHR. The primary outcome was eHH adherence using soap and water vs. ABHR after contact with a CDI patient. The secondary outcome was eHH adherence after CDI patient contact compared with all patients with and without CDI. Results A total of 1,061,288 exit eHH opportunities were recorded. Seventy-three CDI cases were identified (none in December 2017), and 16,404 (2%) exit eHH opportunities were linked to rooms with CDI patients. eHH adherence after CDI patient contact (78%) was significantly higher than for any patient contact (73%) (P < 0.001). Mean eHH adherence using soap and water after CDI patient contact was 29%; no changes in trend were noted over time (Figure 1). Conclusion Low adherence to mandated soap and water use after CDI patient contact was observed; however, HCW maintained a high level of overall adherence. This may indicate that concerns of inconsistent messaging reducing overall adherence may not be founded. ABHR may be used more often than soap and water after CDI patient care because our glove use is high; further investigation will be necessary to determine whether this is the case. Disclosures All authors: No reported disclosures.

The CDC's National Healthcare Safety Network's (NHSN) current risk adjustment model for surgical site infections (SSI) following open reduction internal fixation (ORIF) of long bone fractures is a suboptimal predictor of risk. We hypothesized that by including variables known to be associated with SSI following ORIF, we would develop a model that would increase the accuracy and predictability of SSI risk.Patients who underwent ORIF of a long bone between January 1, 2012 and December 31, 2014 were included in the study (n=1543). Patient risk factors, injury risk factors and perioperative risk factors were considered in the development of this model. We developed a risk prediction model for SSI following ORIF and then applied this to a new dataset of ORIF to determine the expected number of infections. This was compared to the expected number of infections calculated using the NHSN risk adjusted model.The final multivariate model included age (odds ratio: 1.02, p-value0.001, 95% confidence interval: 1.00-1.04), lower leg fracture (2.63, 0.004, 1.40-4.93), open fracture (1.87, 0.07, 0.93-3.76), American Society of Anesthesiologists (ASA) (2.09, 0.02, 1.07-4.08) and history of methicillin-resistant Staphylococcus aureus (MRSA), which was the most important predictor of infection (7.20,0.001, 2.61-19.85). The c-index was 0.74 compared to 0.65 for the NHSN model, indicating that our model more accurate in estimating infection risk. When the developed model was used to predict the number of expected infections on a new dataset from 2015, 36.3 SSI were expected compared to 5.7 calculated by the NHSN model.The model that was developed uses five easily identifiable risk factors that result in a more accurate prediction of infection at our facility than the currently used model.Prognostic and epidemiologic study, level III.

The objective of this study was to determine understanding of bed bathing practices over time after the implementation of a standardized bed bathing protocol. An online survey addressing bathing practices was administered preintervention and 6 and 18 months postintervention to all nurses and technicians caring for adult patients. Survey responses suggested that the intervention resulted in sustained understanding of the standardized bed bathing protocol.

Background Hand hygiene (HH) is a basic principle of infection control, yet national HH adherence rates are only 40%. Challenges to improving HH rates include finding effective ways to promote and sustain change and collecting unbiased observations to measure the success of interventions. Our institution implemented an electronic HH (eHH) monitoring system on select hospital units with the goal of using this technology to both improve and measure HH rates. Methods In Apr 2016, Denver Health installed the HillRom Hand Hygiene Compliance Solution in 4 inpatient units (2 adult wards, 1 intensive care unit, and 1 progressive care unit). Sensors were installed on all HH dispensers and at the thresholds of patient rooms on the units. Registered nurses and certified nursing assistants wear badges that track HH upon entry and exit from the room. Appropriate eHH was defined as the use of waterless hand sanitizer or soap within 60 seconds before or after entering or exiting a room. Baseline data was collected for 2 months; a series of interventions, including public recognition of top performers, private individualized feedback, and posters emphasizing social pressures, were undertaken beginning in June 2016 (Figure 1). Descriptive statistics, chi-squared tests, and interrupted time series analyses were used to analyze the data. Results The median number of total daily observations was 4083 (IQR 3801–4437). The mean eHH adherence rate in the baseline period (Apr/May 2016) was 46% (IQR 44%-49%) and increased to 76% (IQR 75%-78%) in Mar 2017. Over the study period, there was a significant decreasing trend in the proportion of nurses with eHH rates Conclusion eHH provides thousands of objective observations per day. eHH rates improved over the study period both due to an increase in nurses with eHH ≥80% and a decrease in the proportion of nurses with eHH Disclosures All authors: No reported disclosures.

In the United States, tickborne diseases occur focally. Missouri represents a major focus of several tickborne diseases that includes spotted fever rickettsiosis, tularemia, and ehrlichiosis. Our study sought to determine the potential risk of human exposure to human-biting vector ticks in this area. We collected ticks in 79 sites in southern Missouri during June 7-10, 2009, which yielded 1,047 adult and 3,585 nymphal Amblyomma americanum, 5 adult Amblyomma maculatum, 19 adult Dermacentor variabilis, and 5 nymphal Ixodes brunneus. Logistic regression analysis showed that areas posing an elevated risk of exposure to A. americanum nymphs or adults were more likely to be classified as forested than grassland, and the probability of being classified as elevated risk increased with increasing relative humidity during the month of June (30-year average). Overall accuracy of each of the two models was greater than 70% and showed that 20% and 30% of the state were classified as elevated risk for human exposure to nymphs and adults, respectively. We also found a significant positive association between heightened acarologic risk and counties reporting tularemia cases. Our study provides an updated distribution map for A. americanum in Missouri and suggests a wide-spread risk of human exposure to A. americanum and their associated pathogens in this region.

Background More than 50% of catheter-associated urinary tract infections (CAUTI) occur within 5 days of urinary catheter (UC) insertion suggesting poor insertion technique. Breaks in sterile technique and inappropriate UC kit use were observed resulting in increased insertion-associated CAUTI (iCAUTI, CAUTI occurring ≤5 days post-UC insertion). Specific challenges with UC insertion were identified in the emergency department (ED, high patient flow) and critical care units (CCU, high acuity). The objective of the study was to change the UC insertion process in the ED and CCU to reduce iCAUTI. Methods The study included pre-intervention (August 2016–May 2017), implementation (June–December 2017) and post-intervention (January–March 2018) periods. The interventions were use of a buddy system for UC insertions and the reduction of UC insertions in the ED. The buddy system involved critical care nurses inserting UC catheters with another healthcare worker present to ensure correct process and identify breaches in sterile technique. The ED was notified of the patients who (1) received a UC within 24 hours of admission and (2) received the UC in the ED resulting in raised awareness and joint effort between ED and CCU. An iCAUTI rate was calculated for each of the three periods. The proportion of UCs inserted using the buddy system and the proportion of admitted patients with UCs inserted in the ED were calculated. Results The iCAUTI rate decreased by 75.8% between pre-intervention (0.33 iCAUTI/100 UCs inserted) and implementation period (0.08) and increased slightly in post-intervention period (0.16). The ED demonstrated the largest decrease in iCAUTI rate between pre-intervention (0.40) and post-intervention (0.0). Buddy system adherence was 47.3% for the implementation and 58.2% for the post-implementation period. Patients who had UCs inserted in the ED decreased from 59.8% in pre-intervention, to 42.4% in implementation to 35.1% in the post-intervention period. Conclusion A decrease in iCAUTI was observed with the implementation of a buddy system and reduction of UC insertions in the ED. Sustainability of the iCAUTI reduction program will be successful with the use of tools such as electronic medical records as well as culture change and staff buy in. Future directions will include expanding the program to acute care floors. Disclosures All authors: No reported disclosures.

Background Carbapenem-resistant A. baumannii (CRAB) is reportable in Colorado with three to 11 cases detected annually. Between December 2017 and February 2018, Denver Health Medical Center (DHMC) detected two inpatients with CRAB in urine. The hospital and the Colorado Department of Public Health and Environment (CDPHE) conducted an investigation to determine epidemiologic links and molecular relatedness of the isolates. Methods We reviewed medical records and performed infection control observations among staff. Pulsed-field gel electrophoresis (PFGE) was performed at CDPHE; antimicrobial susceptibility (AST) and carbapenemase testing was performed at CDC. Results Epidemiologic investigation: Both patients had neurogenic bladders managed by suprapubic catheters, stage IV decubitus ulcers, and recent surgery. Neither had traveled outside of Colorado. Although both received recent antibiotics, neither received a carbapenem in the 6 previous months. Both isolates were regarded to be asymptomatic bacteriuria. In November 2017, the patients overlapped for 7 days at DHMC on different units. During this week, the same nurse provided wound care for both patients on the same day. Observations of the wound care team revealed opportunities to improve hand hygiene prior to donning and after doffing gloves, the use of single-use scissors on multiple patients, and inconsistent cleaning of a mobile device used to photograph wounds. Microbiologic and molecular investigations: Isolates from the two patients were indistinguishable by PFGE. AST found both isolates susceptible to colistin, but resistant to all other antimicrobials tested (Table 1); both harbored OXA-23-like genes by a Research Use Only assay performed at CDC. Conclusion These are the first carbapenemase-producing A. baumannii strains identified in Colorado. We suspect that they were transmitted during the overlapping hospital admission, although we could not determine where the organism originated or the route of transmission. Opportunities to improve hand hygiene and low-level disinfection were identified. The emergence of previously undetected carbapenemases in Colorado is of great public health concern; collaboration between public health and healthcare facilities is critical to halt transmission of novel regional pathogens. Disclosures All authors: No reported disclosures.

The mating efficiencies (the percentage of females inseminated by males) of field-collected and laboratory-colonized Aedes triseriatus (Say) (Diptera: Culicidae) female mosquitoes transovarially infected or uninfected with La Crosse virus (LACV) were compared. The females were placed in cages with age-matched males, and the insemination rates (number of inseminated females of the total number of females examined) were determined daily by detection of sperm in the spermathecae. LACV-infected mosquitoes typically mated earlier than uninfected mosquitoes, i.e., insemination occurred earlier after the mixing of males and females. LACV load was not correlated with increased insemination.

Tularemia is a tick-borne zoonotic bacterial disease. In the United States, human tularemia infections are caused by Francisella tularensis subspecies tularensis (Type A, clades A1 and A2) or F. tularensis subspecies holarctica (Type B). We developed a mouse model that can be used to study the ability of ticks to acquire and transmit fully virulent strains of F. tularensis (A1, A2, and Type B). We showed that 1) bacteremia was evident by 2 days post-infection (dpi) for A1, A2, and B, 2) bacteremia was expected to reach levels of > 10 8 cfu/mL by 3 dpi for A1 and A2 but not until 4 dpi for Type B, and 3) illness onset was delayed for mice exposed to Type B compared with A1 and A2. To maximize the likeli- hood of ticks acquiring infection from laboratory-infected mice before they become moribund and must be euthanized, ticks should be placed on mice so that periods of rapid engorgement occur 3-4 dpi for A1 and A2 and 4-5 dpi for Type B. Rigorous experimental studies of tick vector competence and efficiency conducted under standardized conditions are required to address several significant public health issues related to preventing and controlling tularemia. Our study pro- vides the basis for a mouse model needed as the starting point to address these questions.

Endothelial cell (EC) and vascular smooth muscle cell (VSMC) interactions play critical roles in restenosis following vascular injury. We examined the effects of intracellular iron chelation on endothelial cell cycle progression and VSMC modulation of endothelial cell growth. A diffusible, lipid-soluble iron chelator that rapidly enters cells, desferri-exochelin 772SM (D-Exo), was studied in human endothelial cells and VSMCs. In both cell types D-Exo reversibly halted cell cycle progression from G0/G1 phase to S phase and from S phase to G2/M phase and increased expression of hypoxia-inducible factor 1alpha (HIF-1alpha). D-Exo increased secretion of vascular endothelial growth factor (VEGF), a downstream target of HIF-1alpha, in VSMCs, but there was no VEGF production in endothelial cells. D-Exo was 25-fold more potent than the lipid-insoluble iron chelator deferoxamine, which does not readily enter cells. Intracellular iron chelation with D-Exo directly inhibits endothelial cell growth but indirectly stimulates endothelial cell growth by increasing VEGF release by VSMCs.

VAP is among the most common health care-associated infections in intensive care units and is associated with high morbidity and mortality. VAP develops in 10%-20% of patients who are ventilated for more than 48 hours.2 There are a few established guidelines for VAP prevention in the literature, but what is available is nearly 10 years old and fails to include recent evidence; hence, the need for more current and relevant information. Additionally, the guidelines that are used in facilities are difficult to put into practice and it is challenging to maintain adherence. The study methodology was advantageous. The methodology incorporated a 2-step modified Delphi method to rate VAP-prevention interventions. The authors involved 171 health care providers to participate in the review of 65 possible interventions retrieved from existing guidelines and literature reviews. The Delphi participants included multidisciplinary content experts and front-line providers (ie, physicians, nurses, respiratory therapists, and infection preventionists [IPs]) from numerous health care settings (ie, academic, community, and rural) across the United States to gain a consensus on the final VAP-prevention bundle interventions. Each participant had the opportunity to anonymously rate (Likert scale 1-9) the interventions, according to perception of importance. The participants identified 19 interventions that were possible measures for VAP-prevention bundle components: 5 were process measures and 14were structural measures. The diversity and breadth of the participants’ experience and setting type enriched the scope, content, and credibility of the final VAP-prevention bundle components.

Surgical site infection (SSI) surveillance techniques for colon surgery and hysterectomy among Colorado infection preventionists were characterized through an online survey. Considerable variation was found in SSI surveillance practices, specifically varying use of triggers for SSI review, including laboratory values, healthcare personnel communication, and postoperative visits.Infect Control Hosp Epidemiol 2014;00(0): 1–3

Surgical site infection (SSI) surveillance methods vary among infection preventionists. An online survey regarding SSI surveillance technique was administered to infection preventionists and linked to superficial and complex colon SSI rates. Higher superficial but not complex SSI rates were reported when more SSI surveillance techniques were used (P Infect Control Hosp Epidemiol 2015;00(0): 1–3

Background Mobile patient equipment (MPE) such as Dynamap machines (i.e., blood pressure monitoring devices, thermometer and pulse-oximeter), ultrasound machines, electrocardiogram (EKG) bladder scanners and language line translator phones may be significant fomites for the transfer of infections between patients in acute care settings. Baseline adenosine triphosphate (ATP) data from a Level 1 Trauma Center suggested that MPE are not cleaned regularly between patients. The objective of this quality improvement project was to implement a standardized, effective cleaning process for MPE and monitor success of implementation through the use of ATP monitoring and real-time data feedback. Methods A detailed cleaning process and schedule was developed MPE. Education was provided to staff on between use cleaning and an extensive cleaning process to be performed once daily. Cleanliness of MPE was tested through weekly ATP monitoring and the results were provided to floor educators and managers. Median ATP and passing rate were assessed. ATP pass/fail cut-off was set according to manufacturer’s recommendations. Passing ATP level was 500 RLU. Results The overall median ATP level of all MPE decreased from 755 RLU (N = 102) to 236 RLU (N = 425) 16 weeks post-intervention (Figure 1). The pass rate increased from 19.6% to 52.0%. The blood pressure cuff ATP level demonstrated a 78% decrease from 969.5 RLU (N = 12) to 219 RLU (N = 84). The pulse-ox ATP level also decreased by 78% from 1884 RLU (N = 9) to 407 RLU (N = 86) post-intervention. An 84% reduction in ATP level was identified in the language line translator phone (1,284 RLU to 198 RLU). Conclusion Sixteen weeks post-implementation of this quality improvement project demonstrated that patient equipment is consistently being cleaned and the ATP levels are being maintained at a low level. Future directions include broadening the type of equipment that are assessed through ATP, expanding this project to outpatient settings and exploring the sustainability in the absence of ATP data feedback. The improvement of the cleanliness of the equipment potentially has the impact of decreasing infections throughout the hospital. Disclosures All authors: No reported disclosures.

Skin preparation products contribute to surgical site infection (SSI) prevention. In a case-control study, diabetes was associated with increased SSI (adjusted odds ratio [OR], 5.74 [95% confidence interval (CI), 1.22–27.0]), while the use of chlorhexidine gluconate (CHG) plus isopropyl alcohol versus CHG alone was found to be protective (adjusted OR, 2.64 [95% CI, 1.12–6.20]).Infect Control Hosp Epidemiol 2014;35(12):1535–1538

Background Algorithms leveraging electronic data may reduce manual review burden for surgical site infection (SSI) surveillance with little to no reduction in sensitivity. We developed an algorithm to identify colon and open reduction of fracture (FX) SSIs to reduce manual chart review. Methods A retrospective cohort of colon and FX procedures and associated SSIs was constructed. Potential SSIs were identified by positive microbiologic cultures or administrative data for diagnosis or treatment of wound infection. Sensitivity and specificity of the algorithm were assessed. The number of charts needing review to identify 1 SSI, and the potential time-savings from the algorithm, were calculated. Results Four hundred seventy-three colon (SSI rate = 7%) and 1081 FX (SSI rate = 3%) procedures were identified. The algorithm was 91% and 97% sensitive and 76% and 93% specific for colon and FX procedures, respectively. Overall, chart review would have been reduced by 24.3 hours per 100 procedures, decreasing the number of charts to review to identify 1 SSI from 23.9 for manual review to 3.9 with the algorithm. Conclusions The algorithm identified SSIs with excellent sensitivity and specificity, resulting in substantial reductions in manual chart review. This algorithm could be tailored and applied to other hospitals.

The American dog tick, Dermacentor variabilis (Say) (Acari: Ixodidae), has been implicated as a potential bridging vector to humans of Francisella tularensis, the etiological agent of tularemia. Since the initial studies evaluating vector competency of D. variabilis were conducted, F. tularensis has been subdivided into subspecies and clades that differ in their geographical distribution in the United States and in the severity of infections caused in humans. Here, we demonstrate that D. variabilis nymphs efficiently acquire, transtadially maintain, and transmit each of the strains tested (clades A1b and A2, and type B). Transmission efficiency by adult females was similarly high among infection groups and ranged from 58% for type B to 89% for A2 infections. In addition, we demonstrated that transmission can occur shortly after tick attachment. These findings support the concept that D. variabilis adults may play a significant role in epizootic transmission of F. tularensis, and as a bridging vector to humans.

In the United States, the American dog tick, Dermacentor variabilis (Say) is considered an important biological vector of Francisella tularensis, the etiologic agent of tularemia. In this study, we evaluated the vector efficiency of nymphal D. variabilis infected as larvae with differing clades and subspecies (A1b, A2, and type B) of F. tularensis. In all cases, D. variabilis larvae were able to acquire, maintain, and transstadially transmit F. tularensis. Significant replication of the bacteria also occurred in infected nymphs. Transmission of F. tularensis to Swiss Webster mice was not observed with A1b, and low rates were observed with A2 (8.0%) and type B (13.5%). Negative effects on tick survivorship were also observed for A1b, A2, and type B infections. Our results provide evidence of a high fitness cost and low transmission rates during the immature stages, suggesting that D. variabilis may play a limited role in enzootic maintenance of F. tularensis.

Francisella tularensis subspecies tularensis (type A) and holarctica (type B) are of clinical importance in causing tularemia. Molecular typing methods have further separated type A strains into three genetically distinct clades, A1a, A1b and A2. Epidemiological analyses of human infections in the United States suggest that A1b infections are associated with a significantly higher mortality rate as compared to infections caused by A1a, A2 and type B. To determine if genetic differences as defined by molecular typing directly correlate with differences in virulence, A1a, A1b, A2 and type B strains were compared in C57BL/6 mice. Here we demonstrate significant differences between survival curves for infections caused by A1b versus A1a, A2 and type B, with A1b infected mice dying earlier than mice infected with A1a, A2 or type B; these results were conserved among multiple strains. Differences were also detected among type A clades as well as between type A clades and type B with respect to bacterial burdens, and gross anatomy in infected mice. Our results indicate that clades defined within F. tularensis subsp. tularensis by molecular typing methods correlate with virulence differences, with A1b strains more virulent than A1a, A2 and type B strains. These findings indicate type A strains are not equivalent with respect to virulence and have important implications for public health as well as basic research programs.

Tularemia is a tick-borne zoonotic bacterial disease. In the United States, human tularemia infections are caused by Francisella tularensis subspecies tularensis (Type A, clades A1 and A2) or F. tularensis subspecies holarctica (Type B). We developed a mouse model that can be used to study the ability of ticks to acquire and transmit fully virulent strains of F. tularensis (A1, A2, and Type B). We showed that 1) bacteremia was evident by 2 days post-infection (dpi) for A1, A2, and B, 2) bacteremia was expected to reach levels of10(8) cfu/mL by 3 dpi for A1 and A2 but not until 4 dpi for Type B, and 3) illness onset was delayed for mice exposed to Type B compared with A1 and A2. To maximize the likelihood of ticks acquiring infection from laboratory-infected mice before they become moribund and must be euthanized, ticks should be placed on mice so that periods of rapid engorgement occur 3-4 dpi for A1 and A2 and 4-5 dpi for Type B. Rigorous experimental studies of tick vector competence and efficiency conducted under standardized conditions are required to address several significant public health issues related to preventing and controlling tularemia. Our study provides the basis for a mouse model needed as the starting point to address these questions.

The evolutionary success of La Crosse virus (LACV, family Bunyaviridae) is due to its ability to adapt to changing conditions through intramolecular genetic changes and segment reassortment. Vertical transmission of LACV in mosquitoes increases the potential for segment reassortment. Studies were conducted to determine if segment reassortment was occurring in naturally infected Aedes triseriatus from Wisconsin and Minnesota in 2000, 2004, 2006 and 2007. Mosquito eggs were collected from various sites in Wisconsin and Minnesota. They were reared in the laboratory and adults were tested for LACV antigen by immunofluorescence assay. RNA was isolated from the abdomen of infected mosquitoes and portions of the small (S), medium (M) and large (L) viral genome segments were amplified by RT-PCR and sequenced. Overall, the viral sequences from 40 infected mosquitoes and 5 virus isolates were analyzed. Phylogenetic and linkage disequilibrium analyses revealed that approximately 25% of infected mosquitoes and viruses contained reassorted genome segments, suggesting that LACV segment reassortment is frequent in nature.

The lipid-soluble iron chelator desferri-exochelin (D-Exo) causes reversible cell cycle arrest in normal human mammary epithelial cells (NHMEC) but triggers apoptotic cell death in human breast cancer cells. We studied the effects of iron chelation with D-Exo on cell cycle regulatory proteins in cultures of NHMEC and MCF-7 breast cancer cells. In co-immunoprecipitation studies, D-Exo inhibited binding of cyclins A and E to cyclin dependent kinase 2 (CDK2) in NHMEC, but in MCF-7 cells binding of these cyclins to CDK2 was enhanced. D-Exo treatment markedly increased expression of p53 and increased binding of p21 to CDK2 in the MCF-7 cells but not in NHMEC. Therefore differences in effects of iron chelation on cell cycle protein binding in cancer cells compared to normal cells may trigger apoptosis in cancer cells while normal breast cells are spared.

Conclusions: To our knowledge, this is the first description of CLABSI and CLD data submission to the NHSN using the CDA file generation and upload method. The use of an ESS coupled with CDA functionality streamlines the event documentation and data submission process. Early adopters of this practice and the resultant errors highlighted opportunities for improvement in ESS and NHSN compatibility. It also emphasized the need to eliminate the intermediary, user-driven steps and develop a fully automated submission method.