The transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non–intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.

Clostridioides difficile infection (CDI) is prevalent in pediatric oncology patients, but the transmission risk to peers is unknown. In 224 children with CDI, multilocus sequence typing (MLST) identified only 7 alleged transmission events (18%) originating from children <3 years old. None of these events were corroborated by WGS.

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.

We describe transmission of Klebsiella pneumoniae carbapenemase-producing Escherichia coli sequence type (ST) 1193 in a group home. E. coli ST1193 is an emerging multidrug-resistant clone not previously shown to carry carbapenemases in the United States. Our investigation illustrates the potential of residential group homes to amplify rare combinations of pathogens and resistance mechanisms.

Background: A large healthcare system in Georgia went live with an enhanced electronic infection surveillance system in August of 2018. The system was employed at its facilities using a staggered approach. Prior to the implementation of this infection surveillance platform, the healthcare system performed healthcare-associated infection (HAI) surveillance using an in-house culture-based system. The NHSN estimates that culture-based surveillance misses 50%–60% of true surgical site infections (SSIs). Due to the lack of clinical-based detection methods (eg, radiologic imaging), we were unable to appropriately detect all patient harm using the old surveillance system. Method: A retrospective analysis was performed to assess the change in HAI for colon (COLO), abdominal hysterectomy (HYST), hip prosthesis (HPRO), and knee prosthesis (KPRO). SSI cases that met NHSN surveillance criteria were reviewed to determine whether they would have been identified prior to launching the new enhanced electronic surveillance system. Results: Systemwide, 8 of 26 COLO SSIs (31%) and 9 of 18 HYST SSIs (50%) would have not been detected using our old surveillance system. HPRO SSIs and KPRO SSIs identified by our new surveillance system were detected using our old surveillance system, and no change was observed. Conclusion: This analysis showed an increase in COLO SSIs and HYST SSIs from enhanced surveillance. Electronic surveillance systems are not considered as a risk factor in the NHSN annual facility survey that aids in calculating a facility’s standardized infection ratio (SIR). These data help support NHSN consideration of modifying the logistic regression calculation used for the complex SSI models. This revision would allow facilities to compare themselves equitably to those using electronic infection surveillance.

Funding: None

Disclosures: None

Engagement of frontline staff, along with senior leadership, in competition-style healthcare-associated infection reduction efforts, combined with electronic clinical decision support tools, appeared to reduce antibiotic regimen initiations for urinary tract infections (P = .01). Mean monthly standardized infection and device utilization ratios also decreased (P < .003 and P < .0001, respectively).

We characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing. Definitive prescribing of carbapenems decreased from 48.4% to 16.1% (P = .01) and β-lactam–β-lactamase inhibitor combination increased from 19.4% to 61.3% (P = .002). Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs.

Antimicrobial stewardship of anti-infectives prescribed upon hospital discharge was implemented to improve the rate of appropriate prescribing at discharge. Appropriate prescribing significantly improved from 47.5% to 85.2% (P < .001), antimicrobial days of therapy decreased, and 30-day readmission rates decreased. Discharge antimicrobial stewardship was effective in improving anti-infective prescribing practices.