Objectives: Bacterial coinfection occurred in 3.5% of COVID-19 patients, and secondary bacterial infection occurred in 14.3% of patients. In Indonesia, one of the guidelines for COVID-19 therapy is to administer azithromycin 500 mg per 24 hours for mild and moderate cases and azithromycin 500 mg per 24 hours and levofloxacin 750 g per 24 hours for severe cases with suspected secondary bacterial infection. At the beginning of the pandemic, many antibiotics were used, even without proven or suspected bacterial infection. We sought to determine changes in the resistance of “ESKAPE” bacteria (ie, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp) to the antibiotics levofloxacin and azithromycin prior to and during the COVID-19 pandemic. Methods: The study was conducted retrospectively by examining the culture and sensitivity test results of “ESKAPE” bacteria to levofloxacin and azithromycin antibiotics in 2019 (before the pandemic) and April 2020–April 2021 (during the pandemic) in 4 hospitals in Yogyakarta. The number of samples represents all cultures completed within the specified period to detect antibiotic sensitivity patterns. Results: In a top referral hospital, resistance to levofloxacin and azithromycin increased significantly for E. faecium and P. aeruginosa, but at a private hospital, an increase in resistance to azithromycin and levofloxacin occurred for A. baumannii and for Enterobacter spp and resistance to levofloxacin increased significantly. At an academic hospital, there was a considerable decrease in S. aureus and E. faecium resistance to levofloxacin and azithromycin. At the government hospital, S. aureus, K. pneumoniae, P. aeruginosa, Acinetobacter baumannii, and Enterobacter spp developed resistance to levofloxacin. Conclusions: Resistance to azithromycin and levofloxacin by different ESKAPE bacteria increased on average during the COVID-19 pandemic.

Background: Central-line–associated bloodstream infections (CLABSIs) are linked to increased morbidity and mortality, longer hospital stays, and significantly higher healthcare costs. Infection prevention guidelines recommend line placement in specific insertion locations over others because of the relative risk of infection. The purpose of this study was to assess CLABSI rates by line type to determine whether some central lines had a lower risk of infection and should be recommended over others given similar clinical indications. Methods: At UNC Hospitals, data were obtained on central lines across a 3-year period (FY20–FY22) from the EMR (Epic Systems). Central lines were categorized as apheresis catheters, CVC lines (single, double, or triple lumen), hemodialysis catheters, introducer lines, pulmonary artery (PA) catheters, PICC lines (single, double, or triple lumen), port-a-catheters, trialysis catheters, or umbilical lines. The line type(s) associated with each CLABSI during the same period were recorded, and CLABSI rates by line type per 1,000 central-line days were calculated using SAS software. If an infection had >1 central-line device type associated, the infection was counted twice when calculating the CLABSI rate by line type. We calculated 95% CIs for each point estimate to assess for statistically significant differences in rates by line type. Results: During FY20–FY22, there were 264,425 central-line days and 458 CLABSIs, for an overall CLABSI rate of 1.73 CLABSIs per 1,000 central-line days. Also, 16% of patients with a CLABSI had >1 type of central line in place. Stratified data on CLABSI rates by each central-line type is presented in the Figure. CLABSI rates were highest in patients with apheresis lines (6.22; 95% CI, 3.96–9.35) and PA catheters (6.22; 95% CI, 3.54–10.20), and the lowest CLABSI rates occurred in patients with PICC lines (1.44; 95% CI, 1.19–1.73) and port-a-catheters (1.14; 95% CI, 0.89, 1.45). For both CVC and PICC lines, as the number of lumens increased from single to triple, CLABSI rates increased, from 0.91 to 2.63 and from 0.57 to 1.20, respectively. Conclusions: At our hospital, different types of central lines were associated with statistically higher CLABSI rates. Additionally, a higher number of lumens (triple vs single) in CVC and PICC lines were also associated with statistically higher CLABSI rates. These findings reinforce the importance of considering central-line type and number of lumens to minimize risk of CLABSI while ensuring that patients have the best line type based on their clinical needs.

Disclosures: None

The AWaRe classification categorizes antibiotics and is a tool for antimicrobial stewardship. To combat antimicrobial resistance, prescribers must adhere to the AWaRe framework, which promotes the rational use of antibiotics. Therefore, increasing political will, dedicating resources, building capacity, and improving awareness and sensitization campaigns may promote adherence to the framework.

Background: Oncology patients are at high risk for bloodstream infection (BSI) due to immunosuppression and frequent use of central venous catheters. Surveillance in this population is largely relegated to inpatient settings and limited data are available describing community burden. We evaluated rates of BSI, clinic or emergency department (ED) visits, and hospitalizations in a large cohort of oncology outpatients with peripherally inserted central catheters (PICCs). Methods: In this prospective, observational study, we followed a convenience sample of adults (age>18) with PICCs at a large academic outpatient oncology clinic for 35 months between July 2015 and November 2018. We assessed demographics, malignancy type, PICC insertion and removal dates, history of prior PICC, and line duration. Outcomes included BSI events (defined as >1 positive blood cultures or >2 positive blood cultures if coagulase-negative Staphylococcus), ED visits (without hospitalization), and unplanned hospitalizations (excluding scheduled chemotherapy hospitalizations). We used χ2 analyses to compare the frequency of categorical outcomes, and we used unpaired t tests to assess differences in means of continuous variable in hematologic versus solid-tumor malignancy patients. We used generalized linear mixed-effects models to assess differences in BSI (clustered by patient) separately for gram-positive and gram-negative BSI outcomes. Results: Among 478 patients with 658 unique PICC lines and 64,190 line days, 271 patients (413 lines) had hematologic malignancy and 207 patients (232 lines) had solid-tumor malignancy. Cohort characteristics and outcomes stratified by malignancy type are shown in Table 1. Compared to those with hematologic malignancy, solid-tumor patients were older, had 47% fewer clinic visits, and had 32% lower frequency of prior PICC lines. Overall, there were 75 BSI events (12%; 1.2 per 1,000 catheter days). We detected no significant difference in BSI rates when comparing solid-tumor versus hematologic malignancies (P = 0.20); BSIs with gram-positive pathogen were 69% higher in patients with solid tumors. Gram-negative BSIs were 41% higher in patients with hematologic malignancy. Solid-tumor malignancy was associated with 4.5-fold higher odds of developing BSI with gram-positive pathogen (OR, 4.48; 95% CI, 1.60–12.60; P = .005) compared to those with hematologic malignancy, after adjusting for age, sex, history of prior PICC, and line duration. Differences in gram-negative BSI were not significant on multivariate analysis. Conclusions: The burden of all-cause BSIs in cancer clinic adults with PICC lines was 12% or 1.2 per 1,000 catheter days, as high as nationally reported inpatient BSI rates. Higher risk of gram-positive BSIs in solid-tumor patients suggests the need for targeted infection prevention activities in this population, such as improvements in central-line monitoring, outpatient care, and maintenance of lines and/or dressings, as well as chlorhexidine bathing to reduce skin bioburden.

Disclosures: None

Objectives: We estimated the change to health-service costs and health benefits resulting from a decision to adopt temporary isolation rooms, which are effective at isolating the patient within a general ward environment. We assessed the cost-effectiveness of the decision to adopt temporary isolation rooms in a Singapore hospital. Methods: Existing data were used to update a model of the impact of adopting temporary isolation rooms on healthcare-associated infections. We predicted the expected change to health service costs and health benefits, measured in life years gained. Uncertainty was addressed using probabilistic sensitivity analysis, and the findings were tested with plausible scenarios to determine the effectiveness of the intervention. Results: We predicted 478 fewer HAIs per 100,000 occupied bed days resulting from a decision to adopt temporary isolation rooms. This decreased would result in cost savings of SGD$329,432 (US $247,302) and 1,754 life years gained. When the effectiveness of the intervention was set at 1% of cases of HAI prevented, the incremental cost per life year saved was SGD$16,519 (US $12,400), indicating that this would be a cost-effective measure in Singapore. Conclusions: We have provided evidence that adoption of a temporary isolation room would be cost-effective for Singapore acute-care hospitals. Using temporary isolation rooms may be a positive decision for other countries in the region with fewer resources for infection prevention and control.

Objectives: Streptococcus mitis is a gram-positive coccus and is a common commensal found in the throat, nasopharynx, and mouth. In an immunocompromised host, S. mitis opportunistically multiplies and can translocate to other sites. At baseline, the prevalence of S. mitis remained stable among hematological patients, averaging ~1 case monthly. However, in August–September 2020, 5 S. mitis cases were documented in a hematology ward and included overlapping inpatient stays. In this descriptive cluster report, we sought to identify the reasons for the increased prevalence of S. mitis in our institution. Methods: A literature review was undertaken to gain a better understanding of the bacteriology of S. mitis. Subsequently, geographical mapping was performed to identify epidemiological links. Further culture and sensitivity testing was requested. Hand hygiene compliance, environmental audit, and handling of central lines within the ward were examined for any lapses in practice. Results: Based on geographical mapping, no epidemiological linkages were established between patients; they were admitted to different rooms and did not share any equipment. Moreover, based on the antibiogram, different bacteria sensitivities were recorded across the isolates from these patients. A hand hygiene and environmental audit result showed 100% compliance. Nurses performed care of central lines in accordance with guidelines. However, an investigation of changes in practice revealed that the use of a toothbrush had only recently been permitted as part of streamlining oral care for hematology patients. Because toothbrushes were not provided by the hospital, patients were utilizing their personal toothbrushes with no direct supervision of their oral care regimen. Conclusions: The prevalence of S. mitis in hematological patients was likely due to the neutropenic condition of patients. This report provides valuable information supporting the optimization of oral hygiene in immunocompromised patients while minimizing the risk of opportunistic infections.

Background: All critically ill patients are at risk for hospital-acquired bloodstream infection (HABSI). At any time, however, there is heterogeneity among patients in the ICU; some patients have the added complexity of end-of-life discussions. We sought to better understand the patients in our medical intensive care unit (MICU) with HABSIs that do and do not meet the NHSN definition for a central-line–associated bloodstream infection (CLABSI) event by evaluating for the presence of a do-not-resuscitate (DNR) order. Methods: The study was conducted at our 66-bed MICU at the Cleveland Clinic Main Campus between January 2021 and September 2022. Surveillance for HABSI to include determination of CLABSI is performed prospectively according to the NSHN definition. The electronic health record was queried for each patient with a HABSI for the presence of a DNR order. DNR orders were categorized as follows: prevalent (DNR orders present at the time of admission to the MICU), incident (orders entered after admission to the MICU), or no DNR (for patients without an order at any time during their MICU stay). For incident orders, time from order to HABSI was recorded. Time to event was calculated as days between ICU admission to HABSI. Results: During the observation period there were 36,477 MICU patient days and 4,815 admissions. There were 112 HABSIs, of which 48 (43%) were CLABSIs. Overall, 65 patients were categorized as incident DNR, 7 were categorized as prevalent DNR, and 40 were categorized as no DNR. For patients with an incident DNR order, 50 HABSIs occurred on the date of or before the order and 15 occurred after the order. In patients in whom HABSI occurred after the incident DNR order, the median number of days between DNR order and HABSI was 11 days (range, 1–69). Discussion: In our MICU, >50% of HABSIs and 60% of CLABSIs occurred in patients with a DNR order incident to their MICU stay. Interventions to prevent hospital-acquired bloodstream infection and the analysis of the events are inextricably linked to issues of end-of-life care for critically ill patients. Further exploration of patient characteristics easily obtainable from the EHR, such as DNR orders, is necessary to inform best practices for prevention and risk adjustment of bloodstream infection rates.

Disclosures: None

Objectives: Control of Clostridioides difficile infections (CDIs) in healthcare facilities presents significant challenges to infectious disease physicians, infection prevention and control practitioners, and environmental services staff. CDI is a common cause of infectious diarrhea and is associated with significant morbidity, mortality, and healthcare cost. A high infection rate was documented in our institution in 2017, higher than the national infection rate. Strategies to reduce hospital-onset CDI were implemented after review of international guidelines and relevant literature. The impact on hospital-onset CDI was assessed. Methods: The following strategies were implemented beginning early in 2018: (1) contact precautions for patients with diarrhea; (2) early recognition and diagnosis of C. difficile infection; (3) prompt isolation of C. difficile patients; (4) emphasis on hand hygiene and contact precautions; (5) enhanced environmental cleaning with chlorine-based disinfectant and use of UV-C and ionized hydrogen peroxide for equipment disinfection; (6) enhanced cleaning and disinfection using sporicidal wipes for shared high-risk equipment; (7) audit and feedback regarding compliance with practices and environmental cleaning; and (8) collaboration with antibiotics stewardship program (ASP) to reduce inappropriate antibiotic use. Hospital-onset CDI cases were tracked by infection prevention and control nurses using definitions from the Singapore Ministry of Health. Results: In total, 135 hospital-onset C. difficile infection cases occurred in 2017, a rate of 4.2 per 10,000 patient days. This rate gradually decreased to 3.0 in 2018 and to 2.3 in 2020, with an average of 87 infections per year. This rate further decreased to 1.8 infections per 10,000 patient days in 2021, with 61 clinical infections. Conclusions: Using multimodal strategies, CGH achieved a gradual and steady reduction in hospital-onset CDI over several years. These strategies require close collaboration among various departments to achieve the desired outcome.

This case–control study of 25 cases with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with vancomycin minimum inhibitory concentration (MIC) ≥ 2 µg/mL and 391 controls (MIC < 2 µg/mL) characterized the clinical characteristics, treatments, and outcomes associated with elevated vancomycin MIC. Elevated vancomycin MIC was associated with baseline hemodialysis, prior MRSA colonization, and metastatic infection.

Background: We describe the components of an improved and easy-to-implement strategy to reduce CLABSI events in the NICU implemented during July–September 2021 in a tertiary-care healthcare center. These strategies were added to an existing institutional protocol created following CDC guidelines. Methods: During the previous timeframe of the implementation of new strategies, CDC insertion-related prevention measures [ie, hand hygiene, use of personal protective equipment (PPE), catheter size selection, standard chlorhexidine gluconate (CHG) antisepsis, maintenance related Curos disinfecting caps, and scrubbing the hub] were part of an existing protocol at our institution. We introduced the following key elements along with the previous ones: decrease length of umbilical vein catheter (UVC) utilization from 14 days to 5–7 days, change of dressing materials from BIOPATCH to 3M Tegaderm CHG chlorhexidine gluconate IV securement transparent dressing, enhanced compliance of an existing artificial nail policy, and restricted blood draw from central lines. Results: After optimization of the previous protocol through these additional strategies, we achieved a significant reduction in the NICU CLABSI rates from 12 CLABSI events between July 2020 and June 2021 to only 3 CLABSI events between July 2021 and June 2022. Conclusions: Revision of CLABSI bundle prevention protocols should be performed frequently to allow improvement opportunities to be added to diminish infection rates. The addition of simple and easy-to-implement key elements interventions to the existing CLABSI bundle had an important impact on the CLABSI rate at our institution.

Disclosures: None

Multistate methodology proves effective in analyzing hospitalized coronavirus disease 2019 (COVID-19) patients with emerging variants in real time. An analysis of 2,548 admissions in Freiburg, Germany, showed reduced severity over time in terms of shorter hospital stays and higher discharge rates when comparing more recent phases with earlier phases of the pandemic.

Background: Socioeconomic barriers or divergent implementation of prevention measures may impact risk of healthcare-associated infections by racial groups. We utilized a previously studied cohort of patients to quantify disparities in central-line–associated bloodstream infection (CLABSI) risk by race accounting for inherent differences in risk related to device utilization. Methods: In a retrospective cohort of adult patients at 4 hospitals (range, 110–733 beds) from 2012 to 2017, we linked central-line data to patient encounter data: race, age, comorbidities, total parenteral nutrition (TPN), chemotherapy, CLABSI. Analysis was limited to patients with >2 central-line days and <3 concurrent central lines. Patient exposures were calculated for each central-line episode (defined by insertion and removal dates); analysis of central-line episode-specific risk of CLABSI among Black versus White patients adjusted for clinical factors, duration of central-line episode, and central-line risk category (ie, low: single port, dialysis or PICC; medium: single temporary or nontunneled; or high: any concurrent central-lines) in Cox proportional hazards regression of time to CLABSI. Results: In total, 526 CLABSIs occurred a median of 14 days after insertion among 57,642 central-line episodes in 32,925 patients. CLABSIs occurred in similar frequency across racial groups: 217 (1.7%) among Black patients, 256 (1.6%) among White patients, and 11 (1.6%) among Hispanic patients (also 42 among unknown or other race). Duration of central-line episode was similar between racial groups (median, 5 days). Black patients were less likely to have medium-risk central lines (34%) compared to white patients (RR, 0.82; 95% CI, 0.79–0.84), but they had a similar frequency of high-risk central lines (21%; RR, 1.0; 95% CI, 1.0–1.1). Compared with low-risk central lines, risk of CLABSI was increased among medium-risk central lines (RR, 1.3; 95% CI, 1.0–1.7) and high-risk central lines (RR, 2.2; 95% CI, 1.8–2.7). CLABSIs were more likely in TPN central lines (RR, 2.3; 95% CI, 1.9–2.7) than others, but they were not more likely among Black patients than White patients (RR, 0.9; 95% CI, 0.1–1.1). In survival analysis, there were 24,700 central-line episodes among Black patients compared to 26,648 episodes among White patients; adjusting for central-line risk and TPN, the risk of CLABSI was similar during the first 21 days of central-line use (adjusted hazard ratio, 1.08; 95% CI, 0.88–01.32) (Fig. 1). Conclusions: After accounting for central-line configuration, Black patients did not have a higher risk of CLABSI within 21 central-line days. Further evaluation is warranted to assess racial disparities in risks of other healthcare-associated infections and to determine whether a lack of CLABSI-specific racial disparities can be replicated in other regions and healthcare systems.

Disclosures: None

Objectives: Surgical-site infections (SSIs) cause significant increases in mortality, morbidity, and prolonged hospitalization after cesarean deliveries. We assessed the effectiveness of the implementation of an SSI bundle in reducing postoperative infections in cesarean deliveries in a tertiary-care teaching hospital in Malaysia. Method: We conducted a quality-improvement study on all women who underwent labor and scheduled cesarean sections at the University Malaya Medical Center (UMMC) between May and December 2020. The preintervention period was May–June 2020 and the postintervention period was September–December 2020. Patients were followed for 90 days after their operation. Before the intervention, SSI rates and compliance with prevention practices were documented. A multidisciplinary team was formed, and education regarding the elements of the SSI prevention bundle was conducted before they were implemented. The care bundle focused on monitoring compliance with preoperative bathing, contact time for skin preparation, hair management, and antibiotics prophylaxis given within 60 minutes prior to incision, as well as patient education. Result: With the implementation of the SSI bundle, we observed a significant reduction in the SSI rate by 50%, from 7 per 100 procedures to 2 per 100 procedures. Compared with the preintervention period, overall compliance with bundle elements improved greatly for preoperative bathing (0 vs 95.7%) and contact time for skin preparation (0 vs 98.8%). In the postintervention period, the method of hair removal was documented, compared to no documentation during the preintervention period. The administration of prophylactic antibiotics within 60 minutes prior incision decreased from 99% to 92.3%. Conclusion: Implementation of an SSI prevention bundle successfully reduced the rate of SSI after cesarean section. The SSI prevention bundle together with improvements by multidisciplinary teams and a good patient-safety culture helped reduce SSI rates. Patient education on pre- and postoperative infection prevention also played an important role in reducing this infection rate.

Background: Data on the incidence and outcome of ventilator-associated pneumonia (VAP) and multidrug-resistant VAP (MDR-VAP) among COVID-19 patients are limited. We compared the incidence and incidence density (ie, number of VAP per 1,000 ventilatory days) of MDR-VAP prior to and during the COVID-19 period in an urban, tertiary-care hospital. Methods: A retrospective study was conducted to compare the incidence, profile, and outcomes of patients with MDR-VAP during the pre–COVID-19 period (2018–2019) and during the COVID-19 pandemic (2020–2021). Results: In total, 80 (22%) of 362 patients developed VAP and were included in the cohort: 27 (33.75%) from the pre–COVID-19 period and 53 (66.25%) from the COVID-19 period, respectively. Most were male [20 (74%) of 27 vs 34 (64%) of 53], with median ages of 66 years (range, 35–90) and 67 years (range, 32–92) in the pre–COVID-19 and COVID-19 periods, respectively. Comorbidities were similar between the 2 periods, except for cardiovascular disease (14 vs 11; P = .005) and chronic lung disease (14 vs 9; P = .0012), which decreased significantly from the pre–COVID-19 period to the COVID-19 period. Only 15 (56%) of 27 versus 37 (70%) of 53 patients developed MDR-VAP during the pre–COVID-19 and COVID-19 period, with incidence densities of 19.3 of 1,000 and 27.8 of 1,000 ventilator days (P = .0371), respectively. The median length of stay prior to VAP for the pre–COVID-19 and COVID-19 periods were 17 and 10 days, respectively (P < .0001). Extended-spectrum β-lactamase (ESBL) resistance increased significantly from 1 (3.7%) of 27 before COVID-19 to 15 (28.3%) of 53 during the COVID-19 period. Carbapenem-resistant Enterobacteriaceae (CRE) resistance was higher before COVID-19 than during the COVID-19 period: 15 (56%) of 27 versus 10 (19%) of 53. In both periods, Klebsiella pneumoniae and Acinetobacter baumannii were the most common pathogens isolated. Mortality was high in both periods at 93% and 83%, respectively. Only female sex was associated with MDR-VAP in the COVID-19 period on multivariate analysis (OR, 3.47; 95% CI, 1.019–11.824; P < .047). Conclusions: The frequency of VAP and MDR-VAP increased during the COVID-19 period, despite a shorter median hospital stay. Mechanisms of resistance differed in the pre–COVID-19 and COVID-19 periods. Mortality with VAP was extremely high. The factors associated with increased risk of VAP and COVID-19 need to be studied further, and measures to prevent VAP should be prioritized.

Disclosures: None

Objectives: In Australia, the prevalence of SSI is 3.6%, with a particularly high burden in colorectal procedures of 8.7%. ChloraPrep (2% chlorhexidine gluconate (CHG)–70% isopropyl alcohol formulation) is a preoperative sterile alcoholic CHG solution prefilled in a ready-to-use applicator. We compared the costs and SSI outcomes of adopting ChloraPrep versus a bulk aqueous povidone iodine (PVI) solution for colorectal procedures in a public hospital setting. Methods: We used a budget-impact tool to evaluate the clinical and economic impacts of skin preparation methods. The PVI SSI rate was assumed to be the baseline rate observed in Australia (8.7%). The ChloraPrep SSI rate was derived by applying the demonstrated ChloraPrep SSI reduction versus PVI (41%) to the PVI SSI rate. The cost of ChloraPrep was AU$8 (US $5.50) and the cost of PVI solution was AU$3 (US $2). The PVI equipment cost AU$2.13 (US $1.47). Additional average length of stay was 9.4 days, and the daily average cost was AU$2,347 (US $1,618). The average skin preparation time was 3.5 minutes using ChloraPrep and 8.5 minutes using PVI. The hospital-acquired complication (HAC) penalty for SSI was calculated using the national efficient price (AU $5,797 or US $3,996), national weighted activity unit (4.6261), and adjustment rate for patient complexity levels (high, 4.8%; moderate, 5.9%; and low, 7.9%). Results: The model estimated SSI rates were 5.1% using ChloraPrep and 8.7% for PVI. For every 1,000 patients, skin preparation cost was estimated to be AU$8,100 (US $5.583) using ChloraPrep and AU$5,200 (US $3.585) using PVI. SSI treatment cost was estimated to be AU$449,900 (US $310,127) for ChloraPrep and AU$762,500 (US $525,610) for PVI. In addition, 330 bed days could be avoided and at least 80 operating room hours could be saved with 35 SSIs avoided. With 35 SSIs avoided, a potential reduction of AU$26,500 (US $18,267) in HAC penalty could be expected. This intervention could yield an overall cost savings of AU$336,300 (US $231,820). Conclusions: Using ChloraPrep for skin preparation prior to colorectal procedures could result in lower SSI rates and cost savings from treating fewer SSIs. Operational efficiency might also be improved.

Background: In September 2021, the CMS mandated that long-term care facility (LTCF) healthcare workers be vaccinated for COVID-19 unless medically or religiously exempt. Vaccinating healthcare workers reduces transmission of COVID-19 among patients and workers, reducing the risk of illness among residents and patients. We examined the relationship between COVID-19 clusters and staff vaccination rates in Tennessee LTCFs. Methods: COVID-19 cluster data were collected using REDCap from January 3, 2021, to September 25, 2022, and LTCF vaccination rates were collected from the NHSN. Clusters were identified in facilities with 2 or more cases. The staff vaccination rate 2 weeks prior to the cluster was used, accounting for the lag time between vaccination dose and reaching full immunity. We selected 75% as the critical immunization threshold. The facility case rate was calculated per 100 beds. A test was performed to determine whether reaching the critical vaccination threshold was associated with cluster occurrence. The relationship between vaccination rate and case number was tested using Pearson correlation. Statistical analyses were conducted using SAS version 9.4 software. Results: The average staff vaccination rate when NHSN first required long-term care facilities to report rates rose from 47% in June 2021 to 83% in September 2022. In total, 806 clusters were identified with 20,868 combined weeks from all facilities being reported after merging facilities’ weekly vaccine percentage rates with cluster data. Most weeks from all facilities did not identify a cluster (n = 20,064, 96.15%) and did not meet the critical immunization threshold (n = 11,050, 52.95%). The association between a cluster occurring and a facility meeting the threshold was significant (χ2 = 5.41; df = 1; P 95% CI, .7327–.9740). The Pearson correlation coefficient between vaccination rate and case number was 0.05560 (P = .2894). Conclusions: There was a significant association between facilities not reaching the immunization threshold and presence of a COVID-19 cluster. The facility case rate was not correlated with staff vaccination rate; however, a limitation of this analysis was that resident vaccination was not tested. Another limitation was that medical and religious exemptions could not be differentiated. Healthcare staff should consider getting vaccinated, if able, to reduce the risk of COVID-19 and to keep staff and residents safe from COVID-19.

Disclosures: None