Search

We describe COVID-19 cases among nonphysician healthcare personnel (HCP) by work location. The proportion of HCP with coronavirus disease 2019 (COVID-19) was highest in the emergency department and lowest among those working remotely. COVID-19 and non–COVID-19 units had similar proportions of HCP with COVID-19 (13%). Cases decreased across all work locations following COVID-19 vaccination.

Objective:Patients admitted to the hospital may unknowingly carry severe acute respiratory coronavirus virus 2 (SARS-CoV-2), and hospitals have implemented SARS-CoV-2 admission screening. However, because SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) assays may remain positive for months after infection, positive results may represent active or past infection. We determined the prevalence and infectiousness of patients who were admitted for reasons unrelated to COVID-19 but tested positive for SARS-CoV-2 on admission screening.Methods:We conducted an observational study at the University of Iowa Hospitals & Clinics from July 7 to October 25, 2020. All patients admitted without suspicion of COVID-19 were included, and medical records of those with a positive admission screening test were reviewed. Infectiousness was determined using patient history, PCR cycle threshold (Ct) value, and serology.Results:In total, 5,913 patients were screened and admitted for reasons unrelated to COVID-19. Of these, 101 had positive admission RT-PCR results; 36 of these patients were excluded because they had respiratory signs/symptoms on admission on chart review. Also, 65 patients (1.1%) did not have respiratory symptoms. Finally, 55 patients had Ct values available and were included in this analysis. The median age of the final cohort was 56 years and 51% were male. Our assessment revealed that 23 patients (42%) were likely infectious. The median duration of in-hospital isolation was 5 days for those likely infectious and 2 days for those deemed noninfectious.Conclusions:SARS-CoV-2 was infrequent among patients admitted for reasons unrelated to COVID-19. An assessment of the likelihood of infectiousness using clinical history, RT-PCR Ct values, and serology may help in making the determination to discontinue isolation and conserve resources.

Background The COVID-19 pandemic has affected infection prevention and control (IPC) programs worldwide. We evaluated the impact of COVID-19 on the University of Iowa Hospitals & Clinics IPC program by measuring the volume of calls to the program, changes in healthcare-associated infection rates, and team member perceptions. Methods We retrieved the IPC call log and healthcare-associated infection trends for 2018-2020. We defined 2 periods: pre-COVID-19 (2018-2019) and COVID-19 (January-December 2020). We also conducted one-on-one interviews and focus group interviews with members of the IPC program and describe changes in their working conditions during the COVID-19 period. Results A total of 6,564 calls were recorded during 2018-2020. The pre-COVID-19 period had a median of 71 calls and/or month (range: 50-119). During the COVID-19 period, the median call volume increased to 368/month (range: 149-829), and most calls were related to isolation precautions (50%). During the COVID-19 period, the central line-associated bloodstream infection incidence increased significantly. Infection preventionists reported that the ambiguity and conflicting guidance during the pandemic were major challenges. Conclusions Our IPC program experienced a 500% increase in consultation requests. Planning for future bio-emergencies should include creative strategies to increase response capacity within IPC programs.

We described the epidemiology of bat intrusions into a hospital and subsequent management of exposures during 2018–2020. Most intrusions occurred in older buildings during the summer and fall months. Hospitals need bat intrusion surveillance systems and protocols for bat handling, exposure management, and intrusion mitigation.

The incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure in shared patient rooms was low at our institution: 1.8 per 1,000 shared-room patient days. However, the secondary attack rate (21.6%) was comparable to that reported in household exposures. Lengthier exposures were associated with SARS-CoV-2 conversion. Hospitals should implement measures to decrease shared-room exposures.

Background: Central-line–associated bloodstream infection (CLABSI) rates have steadily decreased as evidence-based prevention bundles were implemented. Bone marrow transplant (BMT) patients are at increased risk for CLABSI due to immunosuppression, prolonged central-line utilization, and frequent central-line accesses. We assessed the impact of an enhanced prevention bundle on BMT nonmucosal barrier injury CLABSI rates. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center that houses the only BMT program in Iowa. During October 2018, we added 3 interventions to the ongoing CLABSI prevention bundle in our BMT inpatient unit: (1) a standardized 2-person dressing change team, (2) enhanced quality daily chlorhexidine treatments, and (3) staff and patient line-care stewardship. The bundle included training of nurse champions to execute a team approach to changing central-line dressings. Standard process description and supplies are contained in a cart. In addition, 2 sets of sterile hands and a second person to monitor for breaches in sterile procedure are available. Site disinfection with chlorhexidine scrub and dry time are monitored. Training on quality chlorhexidine bathing includes evaluation of preferred product, application per product instructions for use and protection of the central-line site with a waterproof shoulder length glove. In addition to routine BMT education, staff and patients are instructed on device stewardship during dressing changes. CLABSIs are monitored using NHSN definitions. We performed an interrupted time-series analysis to determine the impact of our enhanced prevention bundle on CLABSI rates in the BMT unit. We used monthly CLABSI rates since January 2017 until the intervention (October 2018) as baseline. Because the BMT changed locations in December 2018, we included both time points in our analysis. For a sensitivity analysis, we assessed the impact of the enhanced prevention bundle in a hematology-oncology unit (March 2019) that did not change locations. Results: During the period preceding bundle implementation, the CLABSI rate was 2.2 per 1,000 central-line days. After the intervention, the rate decreased to 0.6 CLABSI per 1,000 central-line days (P = .03). The move in unit location did not have a significant impact on CLABSI rates (P = .85). CLABSI rates also decreased from 1.6 per 1,000 central-line days to 0 per 1,000 central-line days (P < .01) in the hematology-oncology unit. Conclusions: An enhanced CLABSI prevention bundle was associated with significant decreases in CLABSI rates in 2 high-risk units. Novel infection prevention bundle elements should be considered for special populations when all other evidence-based recommendations have been implemented.Funding: NoneDisclosures: None

We compared the incidence of Clostridioides difficile infection before and after the discontinuation of Ultraviolet light used in addition to bleach in terminal disinfection of hospital rooms. We found no difference in C. difficile infection rates but found a decreased turn over time. The benefit of Ultraviolet light may be diminished in hospitals with a high thoroughness of manual cleaning.

Background: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 RNA can be detected by real-time reverse-transcription polymerase chain reaction (RT-PCR) for several weeks after infection. Discerning persistent RT-PCR positivity versus reinfection is challenging and the frequency of COVID-19 reinfections is unknown. We aimed to determine the frequency of clinically suspected reinfection in our center and confirm reinfection using viral whole-genome sequencing (WGS). Methods: The University of Iowa Hospitals and Clinics (UIHC) is an 811-bed academic medical center. Patients with respiratory complaints undergo COVID-19 RT-PCR using nasopharyngeal swabs. The RT-PCR (TaqPath COVID-19 Combo kit) uses 3 targets (ORF1ab, S gene, and N gene). We identified patients with previous laboratory-confirmed COVID-19 who sought care for new respiratory complaints and underwent a repeated SARS-CoV-2 test at least 45 days from their first positive test. We then identified patients with median RT-PCR cycle threshold (Ct) values. Results: During the study period, 13,603 patients had a SARS-CoV-2– positive RT-PCR. Of these, 296 (2.2%) had a clinical visit for new onset of symptoms and a repeated RT-PCR assay >45 days from the first test. Moreover, 29 patients (9.8%) had a positive RT-PCR assay in the repeated testing. Ct values were available for samples from 25 patients; 7 (28%) had Ct values. Conclusions: In patients with a recent history of COVID-19 infection, repeated testing for respiratory symptoms was infrequent. Some had a SARS-CoV-2–positive RT-PCR assay on repeated testing, but only 1 in 4 had Ct values suggestive of a reinfection. We confirmed 1 case of reinfection using WGS.Funding: NoDisclosures: None

Background: The COVID-19 pandemic has affected healthcare systems worldwide, but the impact on infection prevention and control (IPC) programs has not been fully evaluated. We assessed the impact of the COVID-19 pandemic on IPC consultation requests. Methods: The University of Iowa Hospitals & Clinics comprises an 811-bed hospital that admits >36,000 patients yearly and >200 outpatient clinics. Questions about IPC can be addressed to the Program of Hospital Epidemiology via e-mail, in person, or through our phone line. We routinely record date and time, call source, reason for the call, and estimated time to resolve questions for all phone line requests. We defined calls during 2018–2019 as the pre–COVID-19 period and calls from January to December 2020 as the COVID-19 period. Results: In total, 6,564 calls were recorded from 2018 to 2020. In the pre–COVID-19 period (2018–2019), we received a median of 71 calls per month (range, 50–119). The most frequent call sources were inpatient units (n = 902; 50%), department of public health (n = 357; 20%), laboratory (n = 171; 9%), and outpatient clinics (n = 120; 7%) (Figure 1). The most common call topics were isolation and precautions (n = 606; 42%), outside institutions requests (n = 324; 22%), environmental and construction (n = 148; 10%), and infection exposures (n = 149; 10%). The most frequent infection-related calls were about tuberculosis (17%), gram-negative organisms (14%), and influenza (9%). During the COVID-19 period, the median monthly call volume increased 500% to 368 per month (range, 149–829). Most (83%) were COVID-19 related. The median monthly number of COVID-19 calls was 302 (range, 45–674). The median monthly number of non–COVID-19 calls decreased to 56 (range, 36–155). The most frequent call sources were inpatient units (57%), outpatient clinics (16%), and the department of public health (5%). Most calls concerned isolation and precautions (50%) and COVID-19 testing (20%). The mean time required to respond to each question was 10 minutes (range, 2–720). The biggest surges in calls during the COVID-19 period were at the beginning of the pandemic (March 2020) and during the hospital peak COVID-19 census (November 2020). Conclusions: In addition to supporting a proactive COVID-19 response, our IPC program experienced a 500% increase in consultation requests. Planning for future bioemergencies should include creative strategies to provide additional resources to increase response capacity within IPC programs.Funding: NoDisclosures: None

Background: Hospital semiprivate rooms may lead to coronavirus disease 2019 (COVID-19) patient exposures. We investigated the risk of COVID-19 patient-to-patient exposure in semiprivate rooms and the subsequent risk of acquiring COVID-19. Methods: The University of Iowa Hospitals & Clinics is an 811-bed tertiary care center. Overall, 16% of patient days are spent in semiprivate rooms. Most patients do not wear masks while in semiprivate rooms. Active COVID-19 surveillance included admission and every 5 days nasopharyngeal SARS-CoV-2 polymerase chain reaction (PCR) testing. We identified inpatients with COVID-19 who were in semiprivate rooms during their infectious periods during July–December 2020. Testing was repeated 24 hours after the first positive test. Cycle threshold (Ct) values of the two tests (average Ct Results: There were 16,427 semiprivate patient days during July–December 2020. We identified 43 COVID-19 inpatients who roommates during their infectious periods. Most infectious patients (77%) were male; the median age was 67 years; and 22 (51%) were symptomatic. Most were detected during active surveillance: admission testing (51%) and serial testing (28%). There were 57 exposed roommates. The risk of exposure was 3 of 1,000 semiprivate patient days. In total, 16 roommates (28%) did not complete follow-up testing. Of 41 exposed patients with follow-up data, 8 (20%) converted following their exposure. Median time to conversion was 5 days. The risk of exposure and subsequent conversion was 0.7 of 1,000 semiprivate patient days. Median Ct value of the source patient was 20 for those who converted and 23 for those who did not convert. Median exposure time was 45 hours (range, 3–73) for those who converted and 12 hours (range, 1–75) for those who did not convert. Conclusions: The overall risk of exposure in semiprivate rooms was low. The conversion rate was comparable to that reported for household exposures. Lower Ct values and lengthier exposures may be associated with conversion. Active COVID-19 surveillance helps early detection and decreases exposure time.Funding: NoDisclosures: None

Background: COVID-19 in hospitalized patients may be the result of community acquisition or in-hospital transmission. Molecular epidemiology can help confirm hospital COVID-19 transmission and outbreaks. We describe large COVID-19 clusters identified in our hospital and apply molecular epidemiology to confirm outbreaks. Methods: The University of Iowa Hospitals and Clinics is an 811-bed academic medical center. We identified large clusters involving patients with hospital onset COVID-19 detected during March–October 2020. Large clusters included ≥10 individuals (patients, visitors, or HCWs) with a laboratory confirmed COVID-19 diagnosis (RT-PCR) and an epidemiologic link. Epidemiologic links were defined as hospitalization, work, or visiting in the same unit during the incubation or infectious period for the index case. Hospital onset was defined as a COVID-19 diagnosis ≥14 days from admission date. Admission screening has been conducted since May 2020 and serial testing (every 5 days) since July 2020. Nasopharyngeal swab specimens were retrieved for viral whole-genome sequencing (WGS). Cluster patients with a pairwise difference in ≤5 mutations were considered part of an outbreak. WGS was performed using Oxford Nanopore Technology and protocols from the ARTIC network. Results: We identified 2 large clusters involving patients with hospital-onset COVID-19. Cluster 1: 2 hospital-onset cases were identified in a medical-surgical unit in June 2020. Source and contact tracing revealed 4 additional patients, 1 visitor, and 13 employees with COVID-19. Median age for patients was 62 (range, 38–79), and all were male. In total, 17 samples (6 patients, 1 visitor, and 10 HCWs) were available for WGS. Cluster 2: A hospital-onset case was identified via serial testing in a non–COVID-19 intensive care unit in September 2020. Source investigation, contact tracing, and serial testing revealed 3 additional patients, and 8 HCWs. One HCW also had a community exposure. Patient median age was 60 years (range, 48–68) and all were male. In total, 11 samples (4 patients and 7 HCWs) were sequenced. Using WGS, cluster 1 was confirmed to be an outbreak: WGS showed 0–5 mutations in between samples. Cluster 2 was also an outbreak: WGS showed less diversity (0–3 mutations) and ruled out the HCW with a community exposure (20 mutations of difference). Conclusion: Whole-genome sequencing confirmed the outbreaks identified using classic epidemiologic methods. Serial testing allowed for early outbreak detection. Early outbreak detection and implementation of control measures may decrease outbreak size and genetic diversity.Funding: NoDisclosures: None

Background: In December of 2019, the World Health Organization reported a novel coronavirus (severe acute respiratory coronavirus virus 2 [SARS-CoV-2)]) causing severe respiratory illness originating in Wuhan, China. Since then, an increasing number of cases and the confirmation of human-to-human transmission has led to the need to develop a communication campaign at our institution. We describe the impact of the communication campaign on the number of calls received and describe patterns of calls during the early stages of our response to this emerging infection. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center with >200 outpatient clinics. In response to the coronavirus disease 2019 (COVID-19) outbreak, we launched a communications campaign on January 17, 2020. Initial communications included email updates to staff and a dedicated COVID-19 webpage with up-to-date information. Subsequently, we developed an electronic screening tool to guide a risk assessment during patient check in. The screening tool identifies travel to China in the past 14 days and the presence of symptoms defined as fever >37.7°C plus cough or difficulty breathing. The screening tool was activated on January 24, 2020. In addition, university staff contacted each student whose primary residence record included Hubei Province, China. Students were provided with medical contact information, signs and symptoms to monitor for, and a thermometer. Results: During the first 5 days of the campaign, 3 calls were related to COVID-19. The number of calls increased to 18 in the 5 days following the implementation of the electronic screening tool. Of the 21 calls received to date, 8 calls (38%) were generated due to the electronic travel screen, 4 calls (19%) were due to a positive coronavirus result in a multiplex respiratory panel, 4 calls (19%) were related to provider assessment only (without an electronic screening trigger), and 2 calls (10%) sought additional information following the viewing of the web-based communication campaign. Moreover, 3 calls (14%) were for people without travel history but with respiratory symptoms and contact with a person with recent travel to China. Among those reporting symptoms after travel to China, mean time since arrival to the United States was 2.7 days (range, 0–11 days). Conclusion: The COVID-19 outbreak is evolving, and providing up to date information is challenging. Implementing an electronic screening tool helped providers assess patients and direct questions to infection prevention professionals. Analyzing the types of calls received helped tailor messaging to frontline staff.Funding: NoneDisclosures: None

We implemented serial coronavirus disease 2019 testing for inpatients with a negative test on admission. The conversion rate (negative to positive) on repeat testing was 1%. We identified patients during their incubation period and hospital-onset cases, rapidly isolated them, and potentially reduced exposures. Serial testing and infectiousness determination were resource intensive.

We performed a retrospective analysis of the impact of using the International Classification of Diseases, Tenth Revision procedure coding system (ICD-10) or current procedural terminology (CPT) codes to calculate surgical site infection (SSI) rates. Denominators and SSI rates vary depending on the coding method used. The coding method used may influence interhospital performance comparisons.

Background: Hospitalized patients may unknowingly carry severe acute respiratory coronavirus virus 2 (SARS-CoV-2), even if they are admitted for other reasons. Because SARS-CoV-2 may remain positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for months after infection, patients with a positive result may not necessarily be infectious. We aimed to determine the frequency of SARS-CoV-2 infections in patients admitted for reasons unrelated to coronavirus disease 2019 (COVID-19). Methods: The University of Iowa Hospitals and Clinics is an 811-bed tertiary-care center. We use a nasopharyngeal SARS-CoV-2 RT-PCR to screen admitted patients without signs or symptoms compatible with COVID-19. Patients with positive tests undergo a repeat test to assess cycle threshold (Ct) value kinetics. We reviewed records for patients with positive RT-PCR screening admitted during July–October 2020. We used a combination of history, serologies, and RT-PCR Ct values to assess and qualify likelihood of infectiousness: (1) likely infectious, if Ct values were Results: In total, 6,447 patients were tested on hospital admission for any reason (persons under investigation or admitted for reasons other than COVID-19). Of these, 240 (4%) had positive results, but 65 (27%) of these were admitted for reasons other than COVID-19. In total, 55 patients had Ct values available and were included in this analysis. The median age was 56 years (range, 0–91), 28 (51%) were male, and 12 (5%) were children. The most frequent admission syndromes were neurological (36%), gastrointestinal (16%), and trauma (16%). Our assessment revealed 23 likely infections (42%; 14 definite, 9 possible) and 32 cases likely not infectious (58%). The mean Ct for patients who were likely infectious was 22; it was 34 for patients who were likely not infectious. Mean duration of in-hospital isolation was 6 days for those who were likely infectious and 2 days for those who were likely not infectious. We detected 8 individuals (1 healthcare worker and 7 patients) who were exposed to a likely infectious patient. Conclusions: SARS-CoV-2 infection in patients hospitalized for other reasons was infrequent. An assessment of the likelihood of infectiousness including history, RT-PCR Cts, and serology may help prioritize patients in need of isolation and contact investigations.Funding: NoDisclosures: None

Background: Bats are recognized as important vectors in disease transmission. Frequently, bats intrude into homes and buildings, increasing the risk to human health. We describe bat intrusions and exposure incidents in our hospital over a 3-year period. Methods: The University of Iowa Hospitals and Clinics (UIHC) is an 811-bed academic medical center in Iowa City, Iowa. Established in 1928, UIHC currently covers 209,031.84 m2 (~2,250,000 ft2) and contains 6 pavilions built between 1928 and 2017. We retrospectively obtained bat intrusion calls from the infection prevention and control program call database at UIHC during 2018–2020. We have also described the event management for intrusions potentially associated with patient exposures. Results: In total, 67 bat intrusions occurred during 2018–2020. The most frequent locations were hallways or lounges 28 (42%), nonclinical office spaces 19 (14%), and stairwells 8 (12%). Most bat intrusions (65%) occurred during the summer and fall (June–November). The number of events were 15 in 2018, 28 in 2019, and 24 in 2020. We observed that the number of intrusions increased with the age of each pavilion (Figure 1). Of 67 intrusions, 2 incidents (3%) were associated with potential exposure to patients. In the first incident, reported in 2019, the bat was captured in a patient care area and released before an investigation of exposures was completed and no rabies testing was available. Also, 10 patients were identified as having had potential exposure to the bat. Among them, 9 patients (90%) received rabies postexposure prophylaxis. In response to this serious event, we provided facility-wide education on our bat control policy, which includes the capture and safe handling of the bat, assessment of potential exposures, and potential need for rabies testing. We also implemented a bat exclusion project focused on the exterior of the oldest hospital buildings. The second event, 1 patient was identified to have potential exposure to the bat. The bat was captured, tested negative for rabies, no further action was needed. Conclusions: Bat intrusions can be an infection prevention and control challenge in facilities with older buildings. Hospitals may need animal intrusion surveillance systems, management protocols, and remediation efforts.Funding: NoDisclosures: None

Background: Surveillance for surgical site infections (SSI) is recommended by the CDC. Currently, colon and abdominal hysterectomy SSI rates are publicly available and impact hospital reimbursement. However, the CDC NHSN allows surgical procedures to be abstracted based on International Classification of Diseases, Tenth Revision (ICD-10) or current procedural terminology (CPT) codes. We assessed the impact of using ICD and/or CPT codes on the number of cases abstracted and SSI rates. Methods: We retrieved administrative codes (ICD and/or CPT) for procedures performed at the University of Iowa Hospitals & Clinics over 1 year: October 2018–September 2019. We included 10 procedure types: colon, hysterectomy, cesarean section, breast, cardiac, craniotomy, spinal fusion, laminectomy, hip prosthesis, and knee prosthesis surgeries. We then calculated the number of procedures that would be abstracted if we used different permutations in administration codes: (1) ICD codes only, (2) CPT codes only, (3) both ICD and CPT codes, and (4) at least 1 code from either ICD or CPT. We then calculated the impact on SSI rates based on any of the 4 coding permutations. Results: In total, 9,583 surgical procedures and 180 SSIs were detected during the study period using the fourth method (ICD or CPT codes). Denominators varied according to procedure type and coding method used. The number of procedures abstracted for breast surgery had a >10-fold difference if reported based on ICD only versus ICD or CPT codes (104 vs 1,109). Hip prosthesis had the lowest variation (638 vs 767). For SSI rates, cesarean section showed almost a 3-fold increment (2.6% when using ICD only to 7.32% with both ICD & CPT), whereas abdominal hysterectomy showed nearly a 2-fold increase (1.14% when using CPT only to 2.22% with both ICD & CPT codes). However, SSI rates remained fairly similar for craniotomy (0.14% absolute difference), hip prosthesis (0.24% absolute difference), and colon (0.09% absolute difference) despite differences in the number of abstracted procedures and coding methods. Conclusions: Denominators and SSI rates vary depending on the coding method used. Variations in the number of procedures abstracted and their subsequent impact on SSI rates were not predictable. Variations in coding methods used by hospitals could impact interhospital comparisons and benchmarking, potentially leading to disparities in public reporting and hospital penalties.Funding: NoneDisclosures: None

Background: Manual cleaning is the recommended method of environmental disinfection; it plays a key role in the prevention of healthcare-associated infections. Recently, automated no-touch disinfection technologies, such as ultraviolet (UV) light, have been proposed as a supplement to manual cleaning. However, UV light adds time to the cleaning process and may decrease the quality of manual cleaning. We evaluated the impact of adding UV light on the quality of manual cleaning and on room turnover times. Methods: During January–September 2019, we assessed the thoroughness of disinfection cleaning (TDC) of environmental surfaces in rooms identified for discharge. According to hospital policy, contact precautions rooms use UV light after manual cleaning with an EPA-approved sporicidal agent (bleach). Non–contact precautions rooms are disinfected using quaternary ammonium only. Rooms were identified after patient admission, selected randomly, and marked once discharge orders were placed. Fluorescent markers were applied on high-touch surfaces before discharge and were assessed after the cleaning process was completed. TDC scores were defined as the percentage of cleaned surfaces of the total of examined surfaces. UV-light disinfection time is determined automatically based on room size. We compared TDC scores and manual cleaning times between contact precautions rooms and noncontact precautions rooms. We also calculated UV-light cycle durations. Results: We assessed 2,383 surfaces in 24 contact precautions rooms with UV-light disinfection and 201 noncontact precautions rooms without UV-light disinfection. The TDC score was similar in contact precautions rooms (243 of 273 surfaces) and noncontact precautions rooms (1,835 of 2,110 surfaces; 89% vs 87%). The median manual cleaning time for contact precautions rooms was 56 minutes (IQR, 37–79), and for noncontact precautions rooms the median manual cleaning time was 33 minutes (IQR, 22–43). UV-light use added a median of 49 minutes (IQR, 35–67) to the overall cleaning process. The median turnover time for contact precautions rooms was 156 minutes (IQR, 87–216) versus 58 minutes (IQR, 40–86) in noncontact precautions room. Conclusions: In a setting with an objective assessment of environmental cleaning, there was no difference in quality of manual cleaning between contact precautions rooms (UV light) and noncontact precautions rooms (UV light). Adding UV light following manual disinfection increased the overall cleaning time and delayed room availability.Funding: NoneDisclosures: None

Background: Including infection preventionists (IPs) in hospital design, construction, and renovation projects is important. According to the Joint Commission, “Infection control oversights during building design or renovations commonly result in regulatory problems, millions lost and even patient deaths.” We evaluated the number of active major construction projects at our 800-bed hospital with 6.0 IP FTEs and the IP time required for oversight. Methods: We reviewed construction records from October 2018 through October 2019. We classified projects as active if any construction occurred during the study period. We describe the types of projects: inpatient, outpatient, non–patient care, and the potential impact to patient health through infection control risk assessments (ICRA). ICRAs were classified as class I (non–patient-care area and minimal construction activity), class II (patients are not likely to be in the area and work is small scale), class III (patient care area and work requires demolition that generates dust), and class IV (any area requiring environmental precautions). We calculated the time spent visiting construction sites and in design meetings. Results: During October 2018–October 2019, there were 51 active construction projects with an average of 15 active sites per week. These sites included a wide range of projects from a new bone marrow transplant unit, labor and delivery expansion and renovation, space conversion to an inpatient unit to a project for multiple air handler replacements. All 51 projects were classified as class III or class IV. We visited, on average, 4 construction sites each week for 30 minutes per site, leaving 11 sites unobserved due to time constraints. We spent an average of 120 minutes weekly, but 450 minutes would have been required to observe all 15 sites. Yearly, the required hours to observe these active construction sites once weekly would be 390 hours. In addition to the observational hours, 124 hours were spent in design meetings alone, not considering the preparation time and follow-up required for these meetings. Conclusions: In a large academic medical center, IPs had time available to visit only a quarter of active projects on an ongoing basis. Increasing dedicated IP time in construction projects is essential to mitigating infection control risks in large hospitals.Funding: NoneDisclosures: None

Background: Antimicrobial prophylaxis is one of the strongest surgical site infection (SSI) prevention measures. Current guidelines recommend the use of cefazolin as antimicrobial prophylaxis for abdominal hysterectomy procedures. However, there is growing evidence that anaerobes play a role in abdominal hysterectomy SSIs. We assessed the impact of adding anaerobic coverage on abdominal hysterectomy SSI rates in our institution. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center that serves as a referral center for Iowa and neighboring states. Each year, ~33,000 major surgical operations are performed here, and on average, 600 are abdominal hysterectomies. Historically, patients have received cefazolin only, but beginning November 2017, patients undergoing abdominal hysterectomy received cefazolin + metronidazole for antimicrobial prophylaxis. Order sets within the electronic medical record were modified, and education was provided to surgeons, anesthesiologists, and other ordering providers. Procedures and subsequent SSIs were monitored and reported using National Healthcare Safety Network (NHSN) definitions. Infection rates are calculated using all depths (superficial, deep and organ space) and by deep and organ space only, as this is how they are publicly reported. We used numerator (SSIs) and denominator (number of abdominal hysterectomy procedures) data from the NHSN from January 2015 through September 2019. We performed an interrupted time-series analysis to determine how the addition of metronidazole was associated with abdominal hysterectomy SSIs (all depths, and deep and organ space). Results: From January 2015 through October 2017, the hysterectomy SSI rates were 3.2% (all depths) and 1.5% (deep and organ space). After the adjustment was made to antimicrobial prophylaxis in November 2017, the rates decreased to 1.6% (all depths) and 0.6% (deep and organ space). Of the SSIs with pathogens identified, the proportion of anaerobes decreased from 59% to 25% among all depths and from 82% to 50% among deep and organ-space SSIs. The rate of SSI decline after the intervention was statistically significant (P = .01) for deep and organ-space infections but not for all depths (P = .73). Conclusions: The addition of anaerobic coverage with metronidazole was associated with a decrease in deep and organ-space abdominal hysterectomy SSI rates at our institution. Hospitals should assess the microbiology of abdominal hysterectomy SSIs and should consider adding metronidazole to their antimicrobial prophylaxis.Funding: NoneDisclosures: None

Background: The CDC recently updated recommendations on tuberculosis (TB) screening in healthcare facilities, suggesting the discontinuation of annual TB screening. However, hospitals may opt to continue based on their local TB epidemiology. We assessed TB infection control parameters in our facility to guide the implementation of the new CDC recommendations. Methods:We retrieved data for patients with an International Classification of Disease, Tenth Revision (ICD-10) code for TB treated at the University of Iowa Hospitals and Clinics during 2016–2019. We supplemented our search with microbiology data: culture or PCR for Mycobacterium tuberculosis. Based on manual chart review, we adjudicated each patient as active TB, latent TB, previously treated TB, unclear history, or no TB. We further labeled active TB cases based on their risk of transmission (pulmonary or extrapulmonary cases that underwent an aerosol generating procedure). We then calculated the number of exposure events associated with those patients and tuberculin skin test (TST) conversion rates among the exposed. Results: During 2016–2019, we identified 197 patients based on ICD-10 codes. In total, 10 additional patients were detected by microbiology data review. Of these 207 patients, 48 (23.2%) had active TB: lung, n = 24 (50%); lymph node, n = 9 (19%); bone or spine, n = 5 (10%); eye, n = 3 (6%); disseminated, n = 2 (4%); pleura, n = 2 (4%); skin abscess, n = 2 (4%); and meningitis, n = 1 (2%). Of the 24 pulmonary patients, 6 (25%) had either a positive smear or a cavity on imaging. In total, 159 patients were excluded: no TB, n = 22 (14%); latent TB, n = 27 (17%); old or treated TB, n = 93 (58%); and unclear history, n = 9 (6%). Of the 48 cases with active TB, 31 (65%) were deemed potentially infectious. Also, 10 cases (32%) led to the exposure of 204 healthcare workers (HCWs). Baseline and postexposure TST were available for 179 HCWs (88%); 72 (35%) followed up in the employee health clinic within the 8–12 weeks after exposure. Of 161 HCWs with a negative TST at baseline, no conversions occurred. Of 18 HCWs with positive TST at baseline, no HCW developed symptoms during the observation period. Conclusions: Nearly one-third of infectious TB cases led to HCW exposures in a low-incidence setting. However, no TST conversions or active TB infections were seen. Exposure and conversion rates are useful indicators of TB infection control in healthcare facilities and may help guide implementation of the new CDC TB control recommendations.Funding: NoneDisclosures: None

BACKGROUND: Healthcare-associated infections (HAIs) are costly and impact patient morbidity and mortality. Environmental disinfection and cleaning plays a key role in the prevention of HAIs. We aimed to establish an objective evaluation of thoroughness of disinfection and cleaning (TDC) after patient discharge and to evaluate the impact of an assessment program on high-touch surfaces TDC. METHODS: In April 2018, we assessed baseline TDC of environmental surfaces. Fluorescent markers were used for monitoring high-touch surfaces in patient rooms after discharge. TDC scores were defined as the percentage of cleaned surfaces out of the total of examined surfaces. Subsequently, we established routine educational sessions with environmental services staff and developed visual guides where we emphasized the importance of disinfecting high-touch surfaces. A team of two people, one Infection Preventionist and one Environmental Services manager, evaluated TDC on randomly selected units. Direct feedback was provided to staff in rooms with missed opportunities. RESULTS: At baseline, we assessed 401 high-touch surfaces and the TDC score was 51%. After the implementation of the educational sessions, visual guides, and the assessment program, TDC scores increased to 87% (216/247 surfaces), 92% (245/267 surfaces), and 94% (193/205 surfaces) in the following three months. CONCLUSIONS: We improved cleaning of high-touch surfaces by implementing routine educational sessions paired with an objective assessment program. Prospective standardized assessment of cleaning is a key component of infection prevention in health care settings.

Background A severe 2017–2018 influenza season was expected for the United States. We hypothesized that a surge in influenza cases paired with decreased vaccine effectiveness could increase healthcare worker (HCW) absenteeism. Because of a potential public health emergency during the 2017–2018 season, we offered oseltamivir post-exposure prophylaxis (PEP) to exposed HCWs regardless of vaccination status. We describe PEP uptake, cost, and impact on absenteeism at the University of Iowa Hospital and Clinics (UIHC). Methods UIHC serves as a referral and safety net health system for Eastern Iowa. Influenza seasons were defined as the period between Week 40 from 1 year to Week 13 of the following year. During the 2016–2017 season, PEP (75 mg/day for 7 days) was offered free of charge to unvaccinated exposed HCWs. Exposure was defined as proximity within 3 ft of a confirmed influenza-infected person for ≥10 minutes without mask protection, or direct contact with respiratory secretions. During the 2017–2018 season, PEP was expanded to all exposed HCWs regardless of vaccination status. We reviewed surveillance, employee health, pharmacy, and human resources records for the 2016–2017 and 2017–2018 seasons. We defined PEP uptake as prescriptions picked up/all referrals and absenteeism rate as sick-leave requests/scheduled hours. Results During the 2016–2017 and 2017–2018 seasons, we detected 373 and 427 confirmed influenza cases among patients at UIHC. HCW vaccination rates were similar: 89.7% and 90.9%. PEP was recommended in 49 exposures during 2016–2017 and 280 exposures during 2017–2018. A total of 22 (44.9%) and 133 (47.5%) HCWs picked up oseltamivir from the pharmacy during the 2016–2017 and 2017–2018 seasons. The estimated cost of oseltamivir was $1,791 and $10,828, respectively. Overall, 6,187 sick-leave requests (median = 12 hours, absenteeism rate = 3.2%), and 6,174 sick-leave requests (median = 12 hours, absenteeism rate = 3.4%) were reported during the 2016–2017 and 2017–2018 seasons. Conclusion Influenza case counts mildly increased from the 2016–2017 to the 2017–2018 season. Expanding PEP to all exposed HCWs, regardless of vaccination status, had moderate uptake and was costly. Absenteeism rates remained similar during both seasons. Disclosures All authors: No reported disclosures.

The development of numerical human models is a topic of current interdisciplinary research. In the field of automotive safety these models can be applied for the optimization of protection systems. In forensic research human models can be used for the investigation of injury mechanisms and for the prediction and reproduction of injury patterns. However, up to now human models have been validated on the basis of PMHS tests without considering the effects of muscle activity. This paper shows two experimental volunteer test set-ups for the generation of experimental validation data. In a pendulum set-up the influence of muscle activity on the human kinematics was investigated. A drop test set-up was developed for the analysis of the effects of muscle activity on impact response characteristics of muscle tissue. Experimental results, presented in this paper, can be used for the validation and optimization of active numerical human models.

Objective.To determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among healthcare workers (HCWs).Design.Before-after intervention trial.Setting.The University of Iowa Hospitals and Clinics (UIHC), a large, academic medical center, during 2005.Subjects.Staff members at UIHC.Methods.UIHC conducted a pandemic influenza preparedness drill that included a goal of vaccinating a large number of HCWs in 6 days without disrupting patient care. Peer vaccination and mobile vaccination teams were used to vaccinate HCWs, educational tools were distributed to encourage HCWs to be vaccinated, and resources were allocated on the basis of daily vaccination reports. Logit models were used to compare vaccination rates achieved during the 2005 vaccination drill with the vaccination rates achieved during the 2003 vaccination campaign.Results.UIHC vaccinated 54% of HCWs (2,934 of 5,467) who provided direct patient care in 6 days. In 2 additional weeks, this rate increased to 66% (3,625 of 5,467). Overall, 66% of resident physicians (311 of 470) and 63% of nursing staff (1,429 of 2,255) were vaccinated. Vaccination rates in 2005 were significantly higher than the hospitalwide rate of 41% (5,741 of 14, 086) in 2003.Conclusions.UIHC dramatically increased the influenza vaccination rate among HCWs by conducting a pandemic influenza preparedness drill. Additionally, the drill allowed us to conduct a bioemergency drill in a realistic scenario, use innovative methods for vaccine delivery, and secure administrative support for future influenza vaccination campaigns. Our study demonstrates how a drill can be used to improve vaccination rates significantly.

Eine Leiche wird in unkenntlichem Zustand aufgefunden. Wie gelingt es Rechtsmedizinern und Kripo, die Identitat des/der Toten aufzuklaren? Rontgenaufnahmen geben Aufschluss uber das Alter, DNA-Analysen uber das Geschlecht, stabile Isotope in Haaren und Nageln lassen auf die Herkunft schliesen, Gesichtsrekonstruktionen mit Plastilin oder am Computer sind wichtige Hilfen fur die polizeiliche Ermittlung.

In den letzten Jahren steigt in Deutschland der Bedarf an morphologischen Identitatsgutachten stetig (mittlerweile mehrere tausend Falle pro Jahr). Der Grund hierfur liegt einerseits darin, dass das offentliche Leben zunehmend durch Kameras dokumentiert und uberwacht wird, andererseits und vor allem darin, dass Gerichte und andere Institutionen zunehmend den Nutzen der morphologischen Identifikation erkennen.

Graveyards have been a matter of controversial debate for many years in terms of the risk they pose to the environment. However, literature data are inconclusive and there are no systematic studies available from modern graveyards with special reference to soil found in the vicinity of the coffin. To our knowledge, the present study is the first to systematically investigate a comprehensive exhumation series (involving 40 graves) in order to determine burial-related changes in matter and element content. Human burials lead to the accumulation of certain elements, with higher than normal levels of N, C, Zn, Ba, Ca and Na being observed in soils below coffins. Decomposition material inside coffins has much higher levels of heavy metals and alkaline elements than the surrounding soil. However, the major problem observed was the large quantity of synthetic bedding material which is more likely to lead to the formation of adipocere under the moist conditions given. Adipocere formation, which is the result of the anaerobic bacterial hydrolysis of fat, is known to interrupt the natural decomposition process and delay the post-mortem release of elements. We assume that once the inhumed matter has completely decomposed, much higher than normal levels of pollutants will be released into and have an ecological effect on the soil and water environment.

The aim of the present study was to determine to what extent macroscopical parameters mentioned in the literature are suitable for the estimation of the post mortem interval (PMI) and particularly for the exclusion of the forensically relevant resting period for recent bone material. The macroscopical examination of recent bone material with a known PMI showed that only one published parameter (relics of adipocere in the cross section of the compacta) was consistent with our findings for this particular resting period (27-28 years). Other macroscopical parameters presented in the literature were contradictory to the results observed in this study. Among those are the rigidity of bones, the adhesion of soft tissue, the filling of the marrow cavity, and the permeation of the epiphyses with adipocere. Concerning the exclusion of the forensically relevant resting period, a similar result was observed. This study identified some diagnostic findings in bones with a resting period of less than 50 years which according to the literature should only be present after a resting period of more than 50 years. These features included the lack of macroscopical traces of adipocere, degradation of the compacta surface, detachment of the cortical substance, the ability of bone to be broken with bare hands, and superficial usures. Moreover, in one-third of our cases we identified some intra-individual differences not previously described in the literature. In addition to the other results, those intra-individual differences make an estimation of the PMI more difficult. However it should be noted that those published parameters were collected from bone material which was stored in a "relatively arid sand-grit-clay soil of the broken stone layer of Munich". The bones in the present study were stored in acidic and clayey-loamy soil, partly with lateral water flow. In conclusion, the present study demonstrates that one should use caution estimating the post mortem interval and excluding the forensically relevant resting period, even when all available results are considered.

The aim of this study was to find out whether the Hatze-model, which is specifically designed for adults, is suitable for calculations on children as well. By means of that program it is possible to calculate various parameters of the human body. After the collection of data and analysis of the results according to Hatze it becomes evident that this model provides good results only for the calculation of the total body mass. As regards the body segments, there are significant under- and overestimations. The same applies to the calculation of mean body density. Indeed there is a significant gender dimorphism indicating that girls have a higher fraction of body fat than boys. However, the values are far below those described in the literature. Due to the formula, the values of the centres of gravity are linear and congruent in both sides of the body. Interpretation of the results is difficult, as there are no valid reference values. Furthermore the program is not able to take characteristic shapes and proportions of children into account. For this reason 88% of the children are defined as either pregnant or obese. In summary, the study shows that the present model should not be used to calculate children and the human models have to be designed specifically for children.

ISSUE: One measure of hospital preparedness is the ability to respond to a bioemergency. Components of a response include the ability to efficiently mass vaccinate or provide prophylaxis to susceptible health care workers (HCW's). We wanted to test our ability to rapidly immunize HCW's using various methods. PROJECT: Our Disaster Emergency Group designed a drill to use the Annual Influenza Vaccination Campaign to test our ability to vaccinate 70% of direct patient care providers over 6 days. We tested our Mass Immunization/Prophylaxis Plan for Employees by using a scenario that required staff to respond to actual events and to implement decisions in real-time. A potential influenza pandemic scenario and plan was presented to the hospital emergency incident command system (HEICS). The proposed plan focused on the following components: communication, education and promotion, dispensing strategies, and real-time data collection. Dispensing strategies included using the Employee Health Clinic, a peer vaccination program, and mobile vaccination teams. RESULTS: 54% of direct patient care givers were immunized during the drill. Groups with the highest compliance were physicians 58%, residents and fellows 65%, and nurses 58%. Groups with lower vaccination rates were Radiology 43%, Pharmacy 42%, and Housekeeping 33%. During the drill peer vaccinators delivered 82% of vaccine, while Employee Health Clinic delivered 12% and mobile vaccination teams delivered 6%. 41% of vaccine given during the campaign was given in the first 2 days of the drill. LESSONS LEARNED: We learned that the peer vaccination strategy was very effective, but we need to improve information management systems so that we can identify staff that have direct patient contact in the event that we must quickly prioritize staff who should be vaccinated or given prophylaxis. We need to develop systems that allow us to collect real-time data so we can track those vaccinated and not vaccinated. This drill allowed us to use HEICS to optimize a routine annual influenza vaccination program in a life-like scenario and to increase support among staff and leadership. In addition, this drill demonstrated the importance of influenza vaccinations to hospital leadership and is now an institutional priority for the next year. We feel this is a drill format that others might consider for preparedness activities.