Objectives: Surgical site infection (SSI) is the most common healthcare-associated infection (HAI) in our gynecology and obstetrics hospital. SSI among patients following gynecological and obstetrical surgery not only results in increased morbidity but also has far-reaching implications. Thus, this study was conducted to determine the incidence, risk factors, and bacterial pathogens related to SSI. Methods: We conducted this retrospective study based on medical records from January 2019 to December 2020 at Hung Vuong Hospital. Results: Of 51,466 patients undergoing surgery, 581 patients (1.34%) developed an SSI after cesarean section and 145 patients (1.77%) developed an SSI after gynecological surgery. A multivariate logistic regression analysis identified the following risk factors among patients who underwent cesarean section: age (OR, 1.02; 95% CI, 1.01–1.04), emergency cesarean section (OR, 1.62; 95% CI, 1.36–1.93), operation time >60 minutes (OR, 2.04; 95% CI, 1.48–2.80), surgery during the night shift (OR, 1.29; 95% CI, 1.08–1.54), and prolonged hospital stay ≥2 days (OR, 1.51; 95% CI, 1.21–1.89). SSI risk factors for patients following gynecological surgery included age (OR, 1.03; 95% CI, 1.02–1.05), contaminated wound (OR, 3.44; 95% CI, 1.56–7.57), dirty wound (OR, 3.61; 95% CI, 1.44–9.05), vertical abdominal incision (OR, 2.49; 95% CI, 1.65–3.77), and duration of surgery >180 minutes (OR, 2.02; 95% CI, 1.24–3.29). Staphylococcus aureus was the most commonly identified SSI pathogen following cesarean section (49.56%), and Escherichia coli was isolated in 44.93% of SSIs among patients undergoing gynecological surgery. Conclusions: SSI interventions should target this high-risk group. Based on microbiology culture and susceptibility results isolated from SSI cases, novel antibiotic therapies are needed to treat SSIs.

Objectives: We aimed to reduce surgical site infections in Camarines Norte Provincial Hospital, Philippines, (1) by establishing SSI surveillance in the surgical departments, (2) by implementing quality improvement processes, and (3) by developing and implementing an SSI prevention care bundle. Methods: In partnership with Americares, SSI surveillance based on CDC criteria was instituted for all surgeries, excluding orthopedic surgeries. Staff were trained in applying quality-improvement methodology, infection prevention and control, and SSI prevention. A care bundle based on the WHO evidence-based interventions for SSI prevention was designed. Interventions included preoperative bathing, surgical hand preparation, intraoperative surgical-site preparation using 2% chlorhexidine isopropanol solution, and postoperative wound management. The model for improvement methodology was used to implement these changes for 12 months from May 2020 to May 2021. Results: In total, 718 surgeries were followed for SSI surveillance, with an average of 58 surgical patients per month in 2020, which increased to 90 patients per month in 2021. In 2020, the SSI incidence rate was 1.76%, and this rate increased 38.64% to 2.44% in 2021. A statistically significant increase in knowledge of 5.29 points (95% CI, 4.91–5.67) among 150 participants undergoing SSI training between pretest (+6.46) and posttest (+ 11.76) was achieved. SSI care-bundle checklists were used for 80% of eligible surgical patients by 2021. Compliance with the SSI care-bundle checklist increased from 0 to 87.69% (n = 718) by October 2021, subsequently decreasing by 2.75% by December 2021. Conclusions: A quality-improvement process embedded in routine surgical care can be a building block for reducing SSIs. However, we did not achieve an overall decrease in SSIs, likely due to increased reporting of SSIs through improved SSI surveillance. However, important gains were achieved in improved healthcare worker knowledge and practice through the implementation of an SSI care bundle. Fluctuations in checklist compliance reflected COVID-19 surges.

Background: Since October 2020, the Infection Prevention Resource and Assessment Team (IPRAT) has provided infection prevention guidance and support to congregate-care settings throughout Michigan. Specifically, outreach to skilled nursing facilities (SNFs) in response to reported positive COVID-19 resident and staff cases. Case rates provide limited data and do not factor in additional variables, such as staffing shortages, geographical location, or access to supplies, which can increase the vulnerability of staff and residents to outbreaks. To facilitate equitable outreach, a risk assessment was developed using variables related to infection prevention and poor COVID-19 outcomes utilizing local, state, and federal data reporting websites. Methods: A retrospective data review of IPRAT’s electronic data repository was performed, and 2 distinct periods were identified between November 6, 2020, and December 5, 2022. Outreach method 1 involved only using case counts from November 6, 2020, to September 24, 2021. Outreach method 2 (new risk-assessment–based outreach) involved additional data points from April 12, 2021, to December 5, 2022. Data included 17 self-reported items from the NHSN, 3 characteristics regarding facilities’ COVID-19 units, and 7 community-level variables derived from county vaccine rates, social vulnerability index (SVI), and COVID-19 community transmission level. The scoring of each data point ranged from 0–10, and outreach was prioritized to facilities with the highest overall scores. Successful referrals (resulting in a site visit) were compared to the SVI and healthcare emergency regional maps to determine whether the new outreach method reached more facilities in vulnerable communities. Results: Of 358 outreach attempts, IPRAT had a higher success rate with method 2 (6.9%) compared to method 1 (5.3%) and improved outreach in rural Michigan regions 7 and 8 (15% vs 3%). Site visits in counties with a high SVI rating with method 2 were 14.5% versus 10.6% using method 1. COVID-19 prevention referral success rates were higher (4.4% vs 3.1%) using method 2. Conclusions: The risk-assessment–based outreach method showed improvement in overall referral success rates among facilities in rural and higher-SVI counties. These communities tend to experience higher health disparities and poorer health outcomes. Incorporating the more nuanced data variables correlated with at-risk congregate-care settings receiving timelier outreach. The limitations of the study include sample size, period of data collected (2 years), and the complexity of objectively measuring equity.

Disclosures: None

Objectives: We aimed to reduce the overall surgical-site infection (SSI) rate to 0.2%. Methods: A new checklist protocol was developed based on the APSIC guidelines. The bundle for preoperative preparation was implemented: adequate preoperative bathing, proper time of hand-forearm washing, and sufficient contact time of antiseptic application. The compliance rate was monitored with a weekly control chart from December 2019 to November 2020. Results: In total, 9,995 cases were operated at Narasuan University Hospital (NUH) in 2020, classified by surgical wound type as follows: clean wound, 62.6%; clean-contaminated wound, 32.1%; contaminated wound, 0.8%; and dirty wound, 4.5%. According to surgical wound type, the mean compliance with preoperative bathing was 68.22% for clean wounds, 68.33% for clean-contaminated wounds, and 34.82% for contaminated wounds. Hand hygiene preparation compliance was higher for clean wound surgeries (mean, 94.01%) and clean-contaminated wound surgeries (mean, 95.05%) than for contaminated wound surgeries (mean, 88.30%). A high percentage was achieved by the 3 groups. The rate of skin antiseptic preparation compliance was higher in the clean wound group (mean, 89.05%) and the clean-contaminated wound group (mean, 90.70%) than the contaminated wound group (mean, 68.12%). The lower rate might be due to time constraints in contaminated wound operations. Only 0.18% of clean-wound operations had SSIs, and the clean-contaminated wound group had 0.19% SSIs, whereas no SSIs occurred in the contaminated and dirty wound groups. The overall SSI rate was 0.17%; thus, we achieved our goal. Conclusions: A bundle of preoperative infection-prevention preparations reduced the rate of SSI. Furthermore, the bundle had a highly tangible positive impact for both internal and external stakeholders, and it was effective in ensuring good practice regarding preoperative preparation.

Background: Hospitals were affected by COVID-19, with significant concern regarding transmission from unidentified cases. Fraser Health, a Canadian regional health authority, implemented universal testing along with screening questions for emergency department (ED) admissions. We sought to determine which factors were associated with SARS-CoV-2–positive test on admission as well as patient outcome, stratified by screening question responses. Methods: This retrospective analysis included patients aged ≥6 years admitted through 12 hospital EDs between November 1, 2020, and June 30, 2022. Admission, laboratory, and screening data were extracted from electronic health records. Patients who had a first SARS-CoV-2 PCR–positive test in the prior 60 days collected within 48 hours of admission were classified as positive. Covariates included age, geographical region, and SARS-CoV-2 variant era. All questions were modeled using multinomial logistic regression, with components informed through crude analysis in R Studio software. Results: There were 88,511 unique eligible admissions, with 7,642 positive tests (8.6%). The positivity rate over the study period ranged from 0.6% to 21.8%, with a mean of 6.5%. Patients meeting screening criteria were 4.7 times (95% CI, 4.43–4.92) as likely to test positive as those who did not. Patients in the SARS-CoV-2 omicron variant era were 3.2 times (95% CI, 2.98–3.47) as likely to test positive as those in the earlier era of the pandemic. Patients later in the pandemic were less likely to be identified by screening questions than those in earlier eras, with patients in the SARS-CoV-2 omicron variant era only 14% (95% CI, 12%–17%) as likely as in the earlier stages of the pandemic to be identified by screening questions. Patients who tested positive were 1.5 (95% CI, 1.37–1.64) times as likely to die as patients who tested negative, whereas patients in later stages of the pandemic were less likely to die overall. Discussion: Patients who tested positive on admission were more likely to meet screening criteria; however, screening missed half of all positive cases. It is not known whether patients who tested positive without meeting screening criteria would have resulted in transmission. Conclusions: Due to changes in COVID-19 epidemiology, Fraser Health has discontinued universal admission screening. Although universal testing increased resource needs, more than half of patients who tested positive during the study period would not have been identified based on screening criteria alone, allowing for implementation of precaution measures to prevent possible transmission. Ultimately, the decision to conduct universal testing must be a balance of the resources required, community prevalence, and patient population.

Disclosures: None

A penicillin allergy testing service (PATS) assessed penicillin allergy in patients with hematologic malignancies; 17 patients who met criteria had negative skin testing. Patients who underwent penicillin challenge passed and were delabeled. Of delabeled patients, 87% received and tolerated β-lactams during follow-up. Providers found the PATS valuable.

Background: Nirmatrelvir-ritonavir received emergency use authorization (EUA) for the prevention of progression of COVID-19 in December 2021. Most data supporting this authorization are limited to the outpatient setting in unvaccinated patients, and high-quality head-to-head comparisons to other antivirals such as remdesivir are lacking. Patients at high risk of disease progression, such as advanced age, smokers, and those with cardiovascular disease, diabetes, obesity, or cancer continue to be admitted to acute-care settings for various indications, and some are incidentally found to have mild COVID-19. The objective of this project was to compare rates of progression of mild-to-moderate COVID-19 for inpatients treated with remdesivir versus nirmatrelvir-ritonavir. Methods: This study was a single-center, retrospective cohort study that included patients aged ≥18 years with PCR-confirmed SARS-CoV-2 infection who were initiated on nirmatrelvir-ritonavir within 5 days or remdesivir within 7 days of symptom onset between June 2022 and August 2022. The primary outcome was the worsening of symptoms via the WHO ordinal clinical severity scale for COVID-19. Secondary outcomes included escalation of care or readmission due to COVID-19, discharge prior to treatment completion, and any adverse drug reactions (ADRs). Within our institutional guidelines, prior approval is needed for COVID-19 treatment through collaboration between the primary team and antimicrobial stewards. Nirmatrelvir-ritonavir is the preferred agent for both in- and outpatients unless the patient had drug interactions or lack of enteral access, in which case remdesivir was considered. Results: In total, 58 patients were screened and 50 patients were included, 25 patients in each arm. Most were non-Hispanic, white males with at least 1 comorbidity. Compared to the remdesivir arm, the nirmatrelvir-ritonavir arm had more patients with at least a primary COVID-19 vaccine (44% vs 34%). Also, 88% of patients in each arm had a baseline ordinal score of 4, and 12% had a score of 5. Ordinal score changes between the start and end of therapy were similar between groups, and neither had an increase in oxygen requirements (Fig. 1). No readmissions were due to COVID-19, and both medications were well tolerated. Refer to Fig. 2 for secondary outcomes. Conclusions: Nirmatrelvir-ritonavir and remdesivir showed similar safety and efficacy in the treatment of hospitalized patients with mild-to-moderate COVID-19. Current evidence-based guidelines and treatment costs favor nirmatrelvir-ritonavir for patients who can receive this drug.

Disclosures: None

The pace and trajectory of global and local environmental changes are jeopardizing our health in numerous ways, among them exacerbating the risk of disease emergence and spread in both the community and the healthcare setting via healthcare-associated infections (HAIs). Factors such as climate change, widespread land alteration, and biodiversity loss underlie changing human–animal–environment interactions that drive disease vectors, pathogen spillover, and cross-species transmission of zoonoses. Climate change–associated extreme weather events also threaten critical healthcare infrastructure, infection prevention and control (IPC) efforts, and treatment continuity, adding to stress to strained systems and creating new areas of vulnerability. These dynamics increase the likelihood of developing antimicrobial resistance (AMR), vulnerability to HAIs, and high-consequence hospital-based disease transmission. Using a One Health approach to both human and animal health systems, we can become climate smart by re-examining impacts on and relationships with the environment. We can then work collaboratively to reduce and respond to the growing threat and burden of infectious diseases.

Objectives: Based on Sardjito Hospital surveillance data in 2020, the incidence of SSI in orthopedic implant surgery was 46 cases (4.7%), mostly in the outpatient clinic. We evaluated some of the potential risks and proposed redesign of infection prevention and control measures in April 2021 to improve the overall clean care at the orthopedic outpatient clinic. Methods: We conducted an operational study to redesign various components of clean care using a before-and-after evaluation of infection risk. The study was led by an IPC nurse and was supported by all levels of stakeholders at Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia, during May–September 2021. Results: The redesigned components covered continuing professional development (CPD) through a workshop on clean care and wound care for doctors and nurses. The workshop also encouraged high-level management to make several important changes: (1) to redistribute medical staff schedules, (2) to start online patient registration to better distribute and decrease patient loads, (3) to set up the waiting room as well as the dressing room with strictly separate between dirty and clean areas, (4) to schedule daily general disinfection at noon during service hours, and (5) to perform routine air disinfection after daily clinic services as well as placing an additional portable HEPA filter for continuous air disinfection. After the these changes, during 2021, 7 SSIs occurred among postoperative orthopedic implant patients, a decrease of 85%. We observed more clean and neat rooms without patient overcrowding as well as easy and comfortable flow of patients and staff. Environmental pathogen germ counts decreased significantly. Conclusions: A redesign project at the orthopedic outpatient clinic reduced the incidence of postoperative SSIs and reduced the number of environmental pathogens. Overall clean care is a basic strategy in IPC for improving patient safety.

Background: Since the start of the COVID-19 pandemic, many variables have contributed to surges in cases such as the presence of variants, vaccination status, and comorbid medical conditions. However, other factors can be considered including temperature, precipitation, and periods in large congregations. The spike in SARS-CoV-2 infections during the winter has made it seem plausible that transmission may be affected by meteorological factors. A study by Birukov et al demonstrated that a 1°C increase in temperature was associated with a 3.08% reduction in daily new cases and a 1.19% decrease in daily new deaths. We propose that SARS-CoV-2 transmission will decline more rapidly when either precipitation or temperature is higher; thus, in warmer regions with less precipitation daily cases, hospitalizations and deaths will be lower. Methods: This is a retrospective study of statewide data in Hartford County, Connecticut, collected from May 2020 to June 2022 assessing percent positivity reported in daily case count, hospitalizations for COVID-19, and deaths from COVID-19 collected from the Connecticut Department of Public Health COVID-19 database. Information on weather conditions, including temperature and precipitation, were collected from the National Weather Service pertaining to Hartford County. Trends in variables related to patient outcomes were compared to weather conditions within the county of Hartford. Moreover, certain periods within the various seasons that typically involve large gatherings and public holidays (eg, New Year’s Day, Memorial Day, 4th of July, Labor Day, Thanksgiving, and Christmas Day) were further analyzed. Results: There appears to be an inverse correlation coefficient of −0.422, between confirmed daily cases and mean temperature in Hartford County, indicating that as temperature increases, confirmed cases decrease. This phenomenon is also observed with confirmed daily deaths and mean temperature, with a correlation coefficient of −0.463. Moreover, there is an even more significant relationship between hospitalization cases and mean temperature, with a correlation coefficient of −0.667. Furthermore, the year-end holidays (Christmas Day and New Year’s Day) were associated with a significant spike in confirmed daily cases, hospitalizations, and deaths.

However, the relationship between confirmed daily cases, hospitalized cases, and confirmed deaths against mean precipitation in Hartford County demonstrated no significant relationship, reporting correlation coefficients of −0.042, −0.044, and −0.044, respectively. Conclusions: Our available COVID-19 and weather data show that temperature is inversely correlated with daily cases, hospitalizations, and deaths. However, with regard to precipitation, there was no discernable relationship between the variables.

Disclosures: None

Objectives: Improper reprocessing of endoscopes may result in healthcare-associated infections. Regular microbiological surveillance is an important means of evaluating the quality of endoscope reprocessing. We evaluated the effectiveness of reprocessing endoscopes (including the protocols on steps to be taken in the event of any positive microbiological results) in a sterile supply unit (SSU) and an endoscopy unit in a Singapore tertiary-care academic hospital. Methods: Singapore General Hospital (SGH) is a 1,750-bed, tertiary-care, academic medical center in Singapore with 2 main SSUs: 1 inpatient endoscopy unit and 1 outpatient endoscopy unit. We reviewed microbiological surveillance results from endoscopes following reprocessing from January 2018 to December 2021. In total, 160 endoscopes (27 bronchoscopes, 58 gastroscopes, 52 colonoscopes, 6 duodenoscopes, 5 echoscopes, 5 cystoscopes, 5 rhinolaryngoscopes, and 5 enteroscopes) and 15 automated endoscope reprocessors (AERs) were evaluated for the presence of microorganisms. Samples were obtained by swabbing the tip of the scope and the biopsy channel. Fluid was flushed from the biopsy channel after reprocessing, and this water from the AERs was sampled after waterline disinfection. Results: Of the 15,783 samples collected, 15,667 (99.3%) yielded no growth; 36 (0.2%) were positive for gut and environmental flora; and 80 (0.5%) were positive for low-concern organisms such as skin flora. Conclusions: Microbiological surveillance yielded a high percentage of negative results confirming the effectiveness of endoscope reprocessing. This quality-assurance process is necessary and beneficial in achieving patient safety.

Background: The SARS-CoV-2 omicron variant has been associated with increased transmissibility and less severe disease than the SARS-CoV-2 delta variant. Low rates of secondary infections and excess empiric antimicrobial use were reported early in the pandemic. Comparisons between later variants are not as well documented. We evaluated outcomes for SARS-CoV-2 delta- and omicron-variant surges with emphases on COVID-19–related treatment, secondary infections, and antimicrobial utilization. Methods: A single-center, observational, retrospective study was conducted for SARS-CoV-2–positive patients admitted to our 548-bed community teaching hospital between November and December 2021 (SARS-CoV-2 delta-variant–predominant phase) and January–February 2022 (SARS-CoV-2 omicron-variant–predominant phase). Demographic and outcome data were obtained from the institutional data warehouse and were compared between groups. Secondary infections were defined as positive blood and respiratory culture results during admission, with likely contaminants excluded. Mann-Whitney U tests were used to evaluate continuous variables, and t tests were used to analyze categorical variables. P ≤ .05 was considered statistically significant. Results: In total, 1,297 patients were included: 787 (60.7%) in SARS-CoV-2 delta-variant–predominant phase and 510 (39.3%) in SARS-CoV-2 omicron-variant–predominant phase. Patients in SARS-CoV-2 omicron-variant–predominant phase were more often vaccinated (37.7% vs 55%; P < .001), required lower rates of ICU care (16.0% vs 11.6%; P = .025), and required less intubation (13% vs 6.3%; P < .001). Utilization of remdesivir (51.0% vs 32.2%; P < .001), dexamethasone (70.8% vs 43.3%; P < .001), and tocilizumab or baricitinib (14.5% vs 5.3%; P < .001) decreased during the SARS-CoV-2 omicron-variant–predominant phase. Length of stay (5 days vs 4 days; P < .001) and 30-day mortality also decreased during this period (16.40% vs 9.8%; P = .001). Infectious diseases consultation increased during the SARS-CoV-2 omicron-variant–predominant phase (39.8% vs 45.5%; P = .042). There was no significant difference in patients with positive blood cultures (3.4% vs 1.8%; P = .074), but there was a significant decrease in positive respiratory cultures (5.8% vs 2.7%; P = .009), combining for an overall reduction (8.4% vs 4.1%; P = .003). The incidence of overall antimicrobial use increased during the omicron-predominant phase (36.1% vs 41.8%; P = .04), and duration was lower (5 days vs 4 days; P < .001). Antimicrobial class-specific duration was unchanged, with the exception of decreased gram-positive agents (3 days vs 2 days; P = .012). Conclusions: Our results confirm previous reports of reduced disease severity during the SARS-CoV-2 omicron-variant–predominant period. The incidence of secondary infections decreased, driven by a reduction in respiratory infections. Antimicrobials were used at increased rates and for shorter durations during the SARS-CoV-2 omicron-variant–predominant period.

Disclosures: None

Objectives: We evaluated the resterilization rate, user satisfaction, and cost of resterilization after rearranging and packing of reusable instrument sets. Methods: For 1 month in July 2018, we conducted an observational prospective study in 39 service departments for which sterilization and instrument packing was done by the central sterile supply department (CSSD). Common sterile instrument sets (eg, intercostal drainage (ICD) sets, bone-marrow aspiration sets, or suture sets) were analyzed to set up basic surgical instruments for common procedures and specific instruments for each procedure. Sets for common procedures were then packed and rearranged for use universally in various procedures separately from specific instruments. A questionnaire survey was delivered to all 39 service departments to evaluate user satisfaction. The resterilization rates and cost analyses before and after the rearranging and packing were compared for their effectiveness. The data were analyzed using descriptive statistics for percentage, mean, standard deviation, and inferential statistics. Categorical data were analyzed using the χ2 test and continuous data were analyzed using a t test with significance level of 0.05. Results: The resterilization rate decreased significantly from 7.1% to 0.1%. The cost of resterilization decreased from 76,500 Thai baht (US $2,287) to 4,800 Thai baht (US $143) within 1 month. Overall, user satisfaction regarding this intervention was 85.2%. Conclusions: This study highlights the need for the evaluation of process and customer demand to improve user satisfaction and reduce hospital cost by customizing the sterilization packaging and rearranging process.

Background: Recent evidence has shown that the updated COVID-19 bivalent booster is effective in preventing COVID-19 compared with no previous vaccination and prior monovalent vaccination. Despite its effectiveness, uptake has been poor, and a minority of eligible recipients have received the booster. Understanding healthcare worker (HCW) attitudes for and against voluntary uptake of the bivalent booster dose against COVID-19 can help guide communication strategy to maximize uptake. In this survey study, we investigated attitudes toward updated and/or bivalent booster uptake in a behavioral health hospital shortly after a COVID-19 outbreak. Methods: A survey tool was developed and sent to all HCWs at the Yale New Haven Psychiatric Hospital in December 2022. The survey queried demographic data, job category, history of COVID-19, prior COVID-19 vaccinations, perception of COVID-19 exposure, and updated and/or bivalent booster doses. The survey was administered several weeks after a COVID-19 outbreak on multiple inpatient behavioral health units. Receipt of the COVID-19 primary vaccination series and the first booster dose were mandated for HCWs; however, receipt of the bivalent booster was voluntary. Results: The survey was sent to 664 HCWs with primary assignments in behavioral health settings. In total, 182 (27.4%) provided complete responses to the survey and are included in these data. Moreover, 91 HCWs (50.0%) reported previously having COVID-19 at least once. Overall, 100 HCWs (55.0%) received the bivalent booster. The most identified reasons for receiving the bivalent booster were wanting to protect family and friends (n = 113), importance of staying healthy (n = 112), and protecting colleagues and patients (n = 103). The most identified reasons for not wanting to receive the bivalent booster dose were not thinking it provides additional protection (n = 33), “too many” shots already received (n = 31), and concern about side effects (n = 30). Discussion: Bivalent booster dose uptake in HCWs on behavioral health units shortly after a COVID-19 outbreak was greater than the general population. HCWs reported varying reasons for and against receipt of the bivalent booster dose, with the most common being protection of family and friends and perceptions of no additional protection, respectively. A limitation of this study was voluntary response bias, in which results are biased toward individuals more likely to receive a bivalent booster vaccine. It is unclear whether reasons for declining the vaccine are representative of HCWs who did not complete the survey. Assessing attitudes for the bivalent booster dose can assist in guiding communication and outreach strategies to increase vaccine uptake by HCWs.

Disclosures: None

Objectives: Dental instruments are contaminated by blood and saliva during dental procedures. To prevent cross infection, all contaminants should be removed from the surfaces of instruments. Inadequate cleaning can hinder disinfection and sterilization process. To compare the cleaning efficacy of an automated washer–disinfector versus an ultrasonic machine on dental instruments, adenosine triphosphate (ATP) measurements were compared. Methods: From National University Polyclinic Bukit Panjang Dental Services, we collected 2 loads of 40 dental instruments previously used in dental treatments: extraction forceps, high-volume suction tips, Coupland elevators, matrix band holders, and ultrasonic scaler tips. At the point of use, gross soil was wiped from instrument surfaces with water. Each instrument was swabbed after cleaning either using a washer–disinfector or an ultrasonic machine. The relative light units (RLU) on the luminometer indicated the amount of ATP contaminants and residue bioburden present on the instruments. Results: The mean RLU values across all instruments in the washer–disinfector group was 2.5 times lower than the mean value of the instruments in the ultrasonic group (35.4 vs 89.9 RLU). This difference was statistically significant for all instrument groups except for the high-volume suction tips. The Mann-Whitney U test indicated that the RLU in the ultrasonic group was higher than the RLU for the washer–disinfector group for extraction forceps (P < .001), ultrasonic scaler tips (P < .023), and matrix bands (P < .006). A t test indicated the same relationship for Coupland elevators (P < .005). Conclusions: The mean RLU values for both cleaning methods were lower than the manufacturer’s benchmark (RLU ≤ 150), suggesting that both methods can achieve effective cleaning. However, cleaning using an automated washer–disinfector is significantly more effective than an ultrasonic machine for nonlumen instruments. The effectiveness of cleaning using ultrasonic machine varied greatly among different types of instruments with different design complexities.

The incidence of seasonal infections due to respiratory viruses other than severe acute respiratory coronavirus virus 2 (SARS-CoV-2) has declined due to heightened public infection prevention measures against coronavirus disease 2019 (COVID-19). We describe an outbreak of human coronavirus OC43 infection that occurred at a long-term care facility and whose clinical features were indistinguishable from COVID-19.