Background: Point prevalence surveys (PPS) organized by the European Centre for Disease Prevention and Control (ECDC) play a crucial role in assessing healthcare-associated infections (HAIs) and antimicrobial use (AU) in European acute care hospitals. In 2017, a crude prevalence of 28.1% (95% CI 27.3-29.0%) of inpatients receiving at least one antimicrobial was recorded in Belgium (patients ≥65 years: 29.6% (95% CI 28.5-30.7%), < 6 5 years : 26.5% (95%CI 25.3-27.6%)) . Following the challenges posed by the COVID-19 pandemic, the 2022 ECDC-PPS aimed to reassess AU levels. Method: A cross-sectional study was conducted between September and November 2022 in 57 representative acute care Belgian hospital sites (35 mergers), following the ECDC-PPS protocol version 6.0. All patients present in surveyed wards at 8 a.m. on the PPS day and not discharged at that time were included. Infection prevention and control teams collected comprehensive data on hospitals, wards, and AU, including agents and indications. Results: Among the 10,142 included inpatients, 29.3% (95%CI 28.4-30.2) were receiving at least one antimicrobial (patients ≥65 years: 31.1% (95% CI 29.7-32.4%), < 6 5 years : 27.1% (95%CI 25.6-28.6%)). Intensive care units (56.3%), surgical (38.7%), and medical wards (33.1%) demonstrated the highest AU prevalence, while psychiatric wards exhibited the lowest (3.0%). A total of 3,549 antimicrobials were recorded, commonly prescribed for treating community-acquired infections (48.6%) and HAIs (30.3%, including 4.2% of long-term care facility acquired infections), as well as for surgical and medical prophylaxis (12.4 and 6.6%, respectively). Notably, only 22.7% of surgical prophylaxis courses (n=100/440) lasted more than one day. The top three most used antimicrobial agents consisted of amoxicillin in combination with a beta-lactamase inhibitor (J01CR02, 20.0%), cefazolin (J01DB04, 9.8%) and piperacillin in combination with a beta-lactamase inhibitor (J01CR05, 9.6%). The most frequently reported diagnoses for medical antimicrobial treatment were pneumonia (25.7%) and urinary tract infections (17.1%). The reason for AU was available in 80.0% of the medical notes. Conclusion: The 2022 PPS reveals an increased AU prevalence (+1.2%) in Belgian acute care hospitals, especially in patients over 65 years of age (+1.5%). This increase was less pronounced in younger patients (< 6 5y) (+0.6%). Future investigations are crucial to delve into prescription attitudes and modifiable practices, emphasizing the urgent need for robust antimicrobial stewardship programs in these healthcare settings.

Background: Early identification of patients colonized with MDROs can help healthcare facilities improve infection control and treatment. We evaluated whether a model previously validated to predict carbapenem-resistant Enterobacterales (CRE) carriage on hospital admission (area under the curve [AUC]=0.86, Lin et al. OFID 2019) would generalize to predict a patient’s likelihood of CRE and non-CRE MDRO colonization at the time of medical intensive care unit (MICU) admission. Methods: We analyzed data collected previously in a retrospective observational cohort study of patients admitted to Rush University Medical Center’s MICU from 1/2017-1/2018 and screened within the first two days for rectal MDRO colonization. Organisms of interest included CRE, carbapenem-resistant Pseudomonas aeruginosa (CRPA), vancomycin-resistant enterococci (VRE), and third-generation cephalosporin-resistant Enterobacterales (3GCR-E). Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization at admission was determined by routine clinical screening. Each patient’s first MICU admission during the study period was linked to Illinois’ hospital discharge database and assigned a CRE colonization risk probability using the existing model. Model covariates were age, and during the prior 365 days, number of short-term acute care hospitalizations (STACH) and mean STACH length of stay, number of long-term acute care hospitalizations (LTACH) and mean LTACH length of stay, prior hospital admission with an ICD-10 diagnosis code indicating bacterial infection, and current admission to LTACH. Predictive value of the model was evaluated by receiver operating characteristic (ROC) curves. Results: We analyzed 1237 MICU admissions. MDRO admission prevalence is shown in the Table. The model performed well to predict carriage of healthcare-associated MDROs, including CRE, CRPA, composite CR-MDROs (CRE & CRPA), and VRE. However, the model performed poorly for MDROs with known community reservoirs, including 3GCR-E and MRSA (Table). In general, MDRO admission prevalence increased in parallel with predicted CRE colonization risk (Figure). The number needed to screen (NNS) to detect one healthcare-associated MDRO carrier was inversely related to the CRE colonization risk score. For example, NNS in the total cohort compared to those with CRE risk score of >0.5% was: CRE 111 vs 32 patients, CRPA 333 vs 42 patients, composite CR-MDRO 83 vs 18 patients, and VRE 12 vs 4 patients. However, higher CRE risk score cutoff was inversely related to screening sensitivity. Conclusion: A prediction model using prior healthcare exposure information successfully discriminated patients likely to harbor healthcare-associated MDROs upon MICU admission. Prediction scores generated by a public-health accessible database could be used to target screening/isolation or enact protective measures for high-risk patients.

Background: Incorporating diversity, equity, inclusion, and justice into healthcare ensures equitable opportunity to achieve optimal health. Infectious diseases, antimicrobial stewardship, and infection prevention teams rely on consultative recommendations to improve patient care which may be influenced by implicit and explicit biases of the recipient treatment teams. Little is known about how race, ethnicity, and other characteristics impact stewardship and infection control recommendations. Methods: A survey of infectious diseases, antimicrobial stewardship, and infection prevention practitioners was developed through the Society of Healthcare Epidemiology of America (SHEA) Antimicrobial Stewardship Committee. The survey was sent electronically to members of the SHEA Research Network and was promoted to attendees of two sessions at IDWeek 2022 and SHEA Spring 2023. Survey questions included demographics, awareness of (and participation in) unconscious bias and microaggression training at their institutions, antibiotic prescribing bias observations, and perceptions of how race, ethnicity, and other characteristics have influenced participants' antimicrobial stewardship and infection prevention recommendations. Descriptive statistics were performed using SAS V.9.4 . Results: Among 175 survey respondents, 75% (n=129) were White, 16% (n=27) were Asian, 4% (n=7) were Black, 85% (n=150) were non-Hispanic, 5% (n=8) were Hispanic, and 3% (n=5) reported ethnicity as multiethnic. 76% of respondents identified as female, and 2% as non-binary or gender-fluid. 29% of respondents had a medical degree, 12% had a nursing degree, 7% had a pharmacy degree, and 52% had a degree listed as other (7% had a PhD, 23% had an MPH/MSPH degree, and 15% had an MS degree). 65% and 49% of respondents had participated in unconscious bias and microaggression training, respectively. 18% (n=22) of White respondents, 43% (n=3) of Black respondents, and 30% (n=8) of Asian respondents reported witnessing antimicrobial prescribing influenced by race, ethnicity, or other characteristics. 17% and 15% of respondents felt that their antimicrobial stewardship and infection prevention recommendations, respectively, had not been accepted due to their race, ethnicity, gender identity, or other personal identifiers. Conclusion: This survey showed demographic characteristics of professionals working in infectious diseases and their perceptions of how certain aspects of their identity have influenced their recommendations. Differences between racial groups were observed in how frequently respondents witnessed inequities in antimicrobial prescribing, and many respondents felt their recommendations had not been accepted due to their identity. A limitation of this analysis is that few Black individuals completed the survey, which makes comparisons by race difficult; however, the respondents were consistent with SHEA membership demographics.

Background: Although self-contamination has been identified through relevant studies on the safe utilization of personal protective equipment (PPE) by healthcare personnel and the prevention of healthcare-associated infection transmission, there is a lack of in-depth understanding of self-contamination. This study aimed to review previous research on self-contamination and clarify the concept. By understanding this concept, healthcare personnel can improve their conscientiousness regarding self-contamination and gain a foundation for the requisite interventions to reduce self-contamination in healthcare settings. Method: MeSH terms such as “Health Personnel,” “Students, Health Occupations,” and keywords related to PPE combined with “contaminat*” and “self-contamination” to retrieve literature in OVID, EMBASE, Cochrane, CINAHL, and PsycINFO databases without time limits through December 2023 (Figure 1). The concept of self-contamination’s antecedents, attributes, and consequences were explained based on Rodgers’ evolutionary Results: After eliminating duplicates from the 2,195 studies that were initially searched, the authors reviewed the articles and determined eligibility independently. A total of 25 articles, published between 2006 and 2023, were included and analyzed. Antecedents to self-contamination were classified into three groups for each component (Figure 2). First, PPE factors included 1) types of PPE and/or ensemble choices, and 2) problems with PPE designs and/or their functions. Second, user factors involved 1) mistakes (errors of intent), 2) violations (deviations from recommendations), and 3) slips (natural flaws in humans). Third, organizational factors covered 1) unstandardized PPE protocol, 2) suboptimal and inconsistent PPE training, and 3) inadequate clinical environment. In total, five major concept attributes were the conveyance of organisms, unintentional behavior, preventable action, incidental contact, and difficulty discerning. Consequences were categorized into: 1) raising concerns about occupationally acquired infections, and 2) the potential transmission of the infection to the environment or other people (cross-contamination). Conclusion: While studies have raised questions about whether self-contamination causes infection, self-contamination was obvious among healthcare personnel when dealing with PPE. Considering the wide range of causes and potential results of self-contamination, multifaceted interventions, including improvement of the PPE design, tailoring protocols, and training for specific ensembles, should be implemented over an extended time period with suitable intervals to optimize interventions’ effectiveness.

The US biomedical research workforce suffers from systemic barriers causing insufficient diversity and perpetuating inequity. To inform programming enhancing graduate program access, we implemented a formative mixed-method study to identify needed supports for program applications and graduate program success. Overall, results indicate value in added supports for understanding application needs, network development, critical thinking, time management, and reading academic/scientific literature. We find selected differences for underrepresented minority (URM) students compared to others, including in the value of psychosocial supports. This work can inform broader efforts to enhance graduate school access and provides foundation for further understanding of URM students’ experiences.

This study contributes to understanding mainstream parties' room for maneuver in the immigration domain by exploring the impact of moralization as a rhetorical strategy. Research has found anti-immigrant messages to be more effective than pro-immigrant messages in shaping public opinion. However, a pre-registered survey experiment with Danish respondents reveals that moral rhetoric enhances policy support for pro-immigrant communication, rendering it as effective as anti-immigrant messages. Partisan-motivated reasoning influences reactions to all messages except the non-moral anti-immigrant message, suggesting that when appealing to out-party supporters, mainstream parties still meet least resistance with an exclusive platform.

Background: The Colorado Department of Public Health and Environment (CDPHE) detected an increase in Klebsiella pneumoniae carbapenemase-producing carbapenem-resistant Enterobacterales (KPC-CRE) infections in October 2022. We investigated patient epidemiological links and isolate relatedness to characterize interfacility transmission of KPC-CRE in the Denver metro area and inform regional prevention strategies. Methods: We defined a case as polymerase chain reaction detection of KPC from clinical or screening specimens collected during January 2022 – January 2023. Cases were identified through statewide CRE surveillance and carbapenemase testing at the CDPHE laboratory and counted once within a 30-day period. Medical records were reviewed to identify healthcare facility admissions and patient facility overlap in the 12 months prior to sample collection. Whole genome sequencing (WGS) was performed for 34 patients with available KPC-CRE isolates using short- and long-read sequencing techniques. We performed multi-locus sequence typing, generated genome phylogenetic trees, and compared plasmid contig sequences to identify relatedness between KPC-CRE isolates. Clusters were defined as ≥2 genetically related isolates of the same organism or carbapenemase plasmid, from different patients. Results: We identified 48 cases (34 clinical and 14 screening) among 39 patients (figure). Patients had a mean age of 52 years (range 16-86) and median of three healthcare facility admissions (range 1-14). Twenty-eight patients (72%) were male. We identified 16 (41%) patients with epidemiological links to one acute care hospital (ACH), 11 (28.2%) patients to one long-term acute care hospital (LTACH), and four (10.2%) patients to each of two ventilator-capable skilled nursing facilities (vSNF). Five distinct clusters of KPC-CRE were identified by WGS among 23 patients (E. hormaechei, two distinct E. cloacae clusters, K. pneumoniae, and K. oxytoca) with linkages to ten healthcare facilities, including two vSNFs, two LTACHs, and six ACHs. Three distinct KPC genes were identified among the clusters: KPC-2, KPC-3, and KPC-4. Genomes assembled from long reads identified identical or similar KPC-gene-containing plasmids across different species or sequence types, suggesting horizontal gene transfer of KPC. Conclusions: Multiple KPC-CRE strains co-circulated and were associated with patient movement between acute and post-acute care settings. WGS allowed us to identify multi-facility clusters. Time and location of carbapenemase acquisition were challenging to determine for genetically related isolates when epidemiologic links could not be determined from medical records. This could be due to undetected cases. We notified healthcare facilities of their shared transmission risk and advocated for improved attention to infection control, carbapenemase screening, and communication upon patient transfer.

Background: Presenteeism when ill in healthcare personnel (HCP) can contribute to the spread of respiratory illness among HCP and patients. However, during the COVID-19 pandemic and now, there are substantial challenges preventing HCP from staying home when ill. We examined these challenges using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Method: As part of a larger anonymous electronic survey between 3/11/2022 and 4/12/2022 at an academic tertiary referral center, in inpatient and ambulatory settings where respondents were asked to describe factors impacting presenteeism when ill, we analyzed free-text responses using the SEIPS categories of tasks, tools/technology, person, organization, and physical environment. Result: 522 comments were received in response to the open-ended survey question asking individuals to describe any factors that would assist them in remaining home and/or help them get tested for COVID-19 when they have symptoms of a respiratory illness; 21 were excluded due to absent or incomplete response. Of the remaining responses (N = 501, Figure 1), 82% were associated with a single SEIPS component such as organization (N = 409), while other responses discussed factors that involved two SEIPS components, in no particular order (N = 92). A majority of the responses (N = 324, 55%) reported organizational barriers, frequently citing a strict sick call-in policy as well as a lack of protected time-off for COVID-19 testing or related absences. The next two most commonly identified components were physical environment (N= 88, 15%) and tasks (N = 72, 12%), mentioning barriers such as far distances to testing centers and prolonged waiting periods for testing Results: The person and tools/technology components were less commonly identified, with a frequency of 9% each. Conclusion: A number of systems level factors were identified that may impact the ability of HCP to stay home when ill. Interventions to help overcome HCP perceived barriers to staying home when experiencing respiratory symptoms should focus on the policies and practices within an organization. Communication from leadership should support staying home with respiratory symptoms by creating plans for coverage and back up consistently across all employee types in direct care.

Artificial ground freezing is an effective method for underground constructions in deep alluvium. To study the compressive strength of frozen soil under high ground pressure and high hydraulic pressure, it is necessary to understand the mechanical behaviour of ice that is formed under triaxial compressive stress. A low-temperature triaxial test system was developed and used to study both formation and deformation of columnar ice under hydrostatic pressure. Cylindrical ice specimens 125 mm in height and 61.8 mm in diameter were prepared and tested under constant strain rates. At a strain rate of 5 × 10−5 s−1, the peak axial stress showed a linear increase as the confining pressure increased from 2 to 30 MPa, while the peak deviatoric stress exhibited a slight decrease. At a confining pressure of 30 MPa, the peak deviatoric stress showed a logarithmic increase with the strain rate increasing from 5 × 10−6 to 5 × 10−4 s−1, and the failure strain nearly doubled. A power law relationship between the time to failure and the strain rate was also observed. In this study, each test consistently demonstrated a ductile failure mode, with a noticeable reduction in cracking as the confining pressure increased. Due to the effect of the high confining pressure, crack propagation was suppressed, and an apparent recrystallization after peak stress was observed.

Background: Nucleic acid amplification tests (NAAT) do not distinguish between colonization and Clostridioides difficile (C.diff) associated diarrhea. On April 5th 2023 our laboratory introduced a new C. diff testing methodology. Previously, if a C. diff screen result was negative for toxin and positive for glutamate dehydrogenase (GDH), a second confirmatory test was conducted with NAAT. This confirmatory test was removed from our testing algorithm. NAAT testing may be ordered ad hoc when clinically relevant diarrhea persists, and alternative etiologies have been excluded. We wanted to evaluate the impact of change with testing methods. Method: Retrospective review of all inpatient hospital-acquired C.diff infections reported to NHSN database from Ascension Michigan Market which comprises 14 acute care hospitals from June 2019 to August 2023. Data for C diff was analyzed every quarter. The risk adjustments used to calculate the Standardized Infection Ratios (SIRs) for C. diff infections was set at 0.48 based on CDC mean SIR established for acute care hospitals in 2022. Results: A total of 14 acute care hospitals were included from which 866 C.diff cases were reported during this period. Overall, the SIR dropped from 0.59 from June-August 2019 to 0.32 reported from March-May 2023; 45.7 % decrease. The maximum reduction in SIR was seen post intervention at 0.21 from June-August 2023 which was 78.3% below the benchmark of 0.48. (Figure) Conclusions: Strategies to optimize current laboratory tests are critical to differentiate C. diff infection from colonization. The current strategy by changing the testing method led to substantial reduction in C-diff. Diagnostic stewardship studies should ideally include outcome measures targeted to post-intervention patients to determine clinical relevance and patient safety. Optimizing test utilization remains a critical component of quality healthcare delivery. Future NHSN updated surveillance definition will require incorporating clinical decision-making into the metric; that is including a combination of any positive C-diff test plus initiation of antibiotic therapy for C-diff.

Disclosure: Reese Cosimi: Advisory Board - Abbvie

Background: Candida auris, a multi-drug resistant fungal pathogen, was introduced to Tennessee in 2021. There are limited studies on the spread of C. auris in highly specialized care settings including outpatient dialysis facilities. Facilities are concerned that C. auris transmission is difficult to prevent in this setting due to patient vulnerability, treatment frequency and length, and isolation challenges. As a result, these facilities may reject patients based on their positive colonization status. In 2023, the Tennessee Department of Health (TDH) conducted two containment-driven colonization screenings in response to a colonized patient receiving dialysis treatment for one month without their status being known to the facility. Methods: An initial point prevalence survey (PPS) was conducted to assess for ongoing transmission among dialysis patients. Patient screening was prioritized for the cohort of patients who received dialysis at the same time as the index patient (Cohort A). The screening was broadened to include patients dialyzed directly before Cohort A (Cohort B) by request of the Cohort B patients. A second PPS was conducted 7 weeks later, targeting the same cohorts. Specimens were collected through supervised patient self-collection of a skin swab from the axilla and groin. Flocked Eswabs were used for collection and transferred in Amies transport media to the Tennessee State Public Health Lab. The presence of C. auris was detected via Polymerase Chain Reaction (PCR). Results: Twenty-three patients (12 from Cohort A; 11 from Cohort B) were screened in the first PPS. One patient from Cohort A tested positive. This colonized patient was determined to be a known C. auris case first detected four months prior, but the patient’s status was never communicated to the dialysis facility from the discharging acute care facility. Eleven patients, excluding the previously identified positives, participated (9 from Cohort A; 2 from Cohort B) in the second PPS; no positives were identified. Discussion: The index patient and an additional patient identified by the PPS both received dialysis at this facility for up to 4 months without facility knowledge. These results suggest that the standard infection control practices at this dialysis facility were adequate to prevent the transmission of C. auris among dialysis patients on multiple shifts. Additionally, patient self-collection identified a known C. auris patient. Future TDH work includes further evaluating the risk of C. auris transmission and developing targeted infection prevention and control practices for the outpatient dialysis setting.

Epidemiology of carbapenem-resistant organisms (CRO) has focused on transmission in acute care hospital or long-term care facility (LTCF) settings. Few investigations have examined community-associated (CA)-CRO, with no consensus about common exposures. To explore possible exposures, the New York City (NYC) Department of Health and Mental Hygiene investigated suspected CA-CRO cases through routine surveillance among NYC residents with specimens collected during December 2020-May 2023. CA-CRO cases were defined as urine or skin specimens with bacterial cultures exhibiting carbapenem resistance, among individuals aged ≤70 years with no international travel, hospitalization, or LTCF stays within 12 months before specimen collection. Inclusion was determined by reviewing data from health information exchanges, when available electronic medical records, and telephone screening for those not excluded through record review. We identified 426 suspected cases for review, those not meeting the case definition were excluded; 44 individuals were not reached for screening. A preliminary questionnaire was fielded with 12 individuals and then refined to capture additional potential exposures. Analyses were completed with 23 individuals interviewed with the refined questionnaire. Of the 23, 70% were female; 39% were Hispanic, 17% Black, and 17% White; their median age was 60 years (range: 26-70 years). Further, 83% reported an outpatient appointment, 48% reported an outpatient procedure/surgery, and 9% reported having a hospitalized household member, all within 12 months before specimen collection; 26% had a urinary catheter or indwelling device within 2 days of specimen collection. Additionally, 30% reported taking antibiotics within 3 months of specimen collection, 52% denied taking antibiotics, 9% were unsure about antibiotic use, and 9% did not answer the question. Whole genome sequencing (WGS) was performed on 14 available isolates from CA-CRO cases by the NYC Public Health Laboratory or Wadsworth Center (WC), of which only 7 could be compared with isolates previously sequenced at WC (2017-2023). Six isolates were separated by >50 mutation events, suggesting no close genomic relationship. One isolate from 2021 was 11 mutation events from a 2018 isolate from the same individual, consistent with the expected evolutionary rate. While infrequent, CA-CRO cases occur in NYC. Outpatient healthcare, antibiotic use, and urinary catheters or indwelling devices were common self-reported exposures. Analyses were limited by screening non-response. Increased specimen availability for WGS could enhance investigation of CA-CRO exposure patterns. Health information exchange data were often incomplete and future surveillance could benefit from healthcare and public health partnerships and better documentation for more complete electronic medical histories.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common causes of procedure-related, skin, and soft-tissue infections. Hospitalized patients who are colonized with MRSA are at a higher risk of developing invasive infections after discharge. Chlorhexidine, an antiseptic/disinfectant, has been used to reduce carriage and prevent infections in these patients. Studies have shown chlorhexidine resistance among MRSA strains. Chlorhexidine resistance is associated with qac genes, which encode multidrug efflux pumps that increase bacterial tolerance to disinfectant agents. The global distribution and prevalence of qacA and qacB genes are highly variable. One study reported that qacA and qacB genes could be found in 0.9% - 83.3% of clinical MRSA isolates worldwide. The goal of this study was to determine the prevalence of chlorhexidine resistance and identify the resistance-associated genes from our MRSA samples using whole genome sequencing (WGS). Methods: 474 MRSA samples were obtained from hospitals in Detroit, MI (287) and Cleveland, OH (187). Whole genome sequencing was performed using the NextSeq (Illumina Inc., CA) platform. The sequencing data was analyzed using ResFinder 4.1, a publicly available database that can be used to identify acquired genes and chromosomal mutations mediating antimicrobial resistance. The output was organized into a data sheet to visualize the presence of the genes of interest. Results: The qacA gene was present in only one MRSA sample from the Cleveland area hospital. In the samples from Detroit, 14 out of 287 showed disinfectant resistance genes. The qacA, qacB, and qacD were present in 1, 6, and 7 samples, respectively. The prevalence of any qac gene in the Cleveland area samples was 0.5%. Meanwhile, the prevalence of any qac gene in Detroit area samples was 4.9%. Among the 7 samples that have qacD gene, 6 samples have more than one copy of qacD. Conclusions: The prevalence of the “qac” gene varied widely based on the origin of the samples. Detroit area samples had more qac genes prevalence than Cleveland area samples. Chlorhexidine is a widely used antiseptic/disinfectant, and it plays a vital role in reducing carriage and preventing infection among hospitalized patients colonized with MRSA. Monitoring and addressing MRSA-reduced susceptibility to chlorhexidine is imperative for maintaining the effectiveness of infection control practices such as decolonization.

This study aimed to evaluate the impact of the COVID-19 pandemic on antimicrobial consumption (AMC) in Belgian hospitals from 2017 to 2021, using data from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and the Belgian Hospitals Surveillance of Antimicrobial Consumption (BeH-SAC). Antimicrobial volume was quantified in Defined Daily Doses (DDDs), and AMC was expressed in DDDs/1000 inhabitants/day (DIDs), DDDs/1000 patient days and DDDs/1000 admissions. Linear regressions were employed to analyze 5-year trends for the ATC J01 group, at the ATC-3 level and for broad-spectrum antimicrobials. Broad-spectrum antibiotics included combinations of penicillins, incl. beta-lactamase inhibitors (J01CR), second-generation cephalosporins (J01DC), third-generation cephalosporins (J01DD), macrolides, lincosamides and streptogramins (J01F, excluding erythromycin J01FA01), and fluoroquinolones (J01MA). The compound annual growth rate (CAGR) calculated for the years preceding the pandemic was used to forecast 2020 and 2021 AMC, enabling a comparison with the actual use. Hospital AMC measured as DIDs decreased by 12% from 2019 to 2020. In contrast, when expressed as DDDs/1000 patient days and DDDs/1000 admissions, a 5% and 7% increase was observed, respectively. Antibacterials for systemic use (J01) showed a significant decrease over the 5 years only when expressed in DIDs. Notable trends included a negative trend for quinolone antibacterials (J01M) when expressed in the three incidence units, as for amphenicols (J01B) when using hospital denominators only. Positive trends were observed for sulfonamides and trimethoprim (J01E) using hospital denominators and for other beta-lactam antibacterials (J01D) with the ‘patient days’ denominator. While the consumption of all J01 antimicrobial subclasses deviated negatively from predicted use both in 2020 and 2021 when expressed in DIDs, positive deviations were recorded using hospital denominators, except for macrolides (J01F). The use of broad-spectrum antimicrobials showed a notable decrease between 2017 and 2021 when expressed in DIDs. However, when using hospital denominators, the observed use of broad-spectrum antimicrobials exceeded the forecasted values in 2020, to regress below the forecasted levels in 2021 (Figure 1). Contrary to results obtained using the widely applied country’s population as the denominator, a notable surge in AMC, particularly for broad-spectrum antimicrobials, was observed in 2020 when using hospital-specific denominators. This increase coincided with the onset of the COVID-19 crisis. These findings emphasize the need for a national hospital surveillance system that uses denominators that accurately represent the specific population being monitored. Implementing robust hospital-specific surveillance mechanisms would improve the precision of evaluations and facilitate targeted interventions aimed at optimizing antimicrobial utilization.

Background: Alberta Health Services (AHS) measures hand hygiene compliance through direct observations performed by trained site-based reviewers (SBRs) and facilitated by the Infection Prevention and Control (IPC) program. Within AHS there are >100 acute care facilities, ranging in bed size from four beds to more than 1,000, with catchment populations ranging from one million. A time-in-motion study using trained AHS IPC staff was proposed to validate the completeness and accuracy of data being collected by the SBRs. Methods: The AHS IPC staff performed direct observations at pre-selected facilities across all five zones and four different unit types (emergency, medical, surgical, and intensive care) for four 30-minute periods during weekdays between June and September 2023. An iPad app was used to capture results from all four moments of hand hygiene. The reviewer indicated the day and time of the review and captured as many representative hand hygiene moments and healthcare providers as possible. The distributions of the four moments of hand hygiene, healthcare provider group and overall compliance were compared at the unit type and facility level (tertiary, large urban, regional, pediatric, and small sites) between this time-in-motion study and SBR data collected June-September 2023. Results: The study collected 175 reviews and 4,683 observations from 14 facilities and 48 units. Between June and September 2023, SBRs collected 2,625 reviews and 61,506 observations from these same facility and unit types. Across all facility and unit types, the distribution of the four moments was similar between the study and SBRs. Similar proportions of healthcare providers were also observed. However, the overall hand hygiene compliance collected in the study was approximately 10% lower across all unit types as compared to that collected by the SBRs (study: 63%-84%; SBRs: 75%-92%). Conclusions: In public health surveillance, completeness and accuracy are two characteristics of high-quality data. A time-in-motion study identified that the hand hygiene observations collected by SBRs were complete, as the range of healthcare providers observed, and the distribution of their moments, mirrored that collected in the study. However, the SBRs reported higher compliance than the study participants and the true hand hygiene compliance is likely lower than what is currently being reported. Since this difference was seen consistently across all unit and facility types, trending data over time should still identify areas in need of improvement and may help to suggest causes of the over-reporting.

Background: Clostridioides difficile infections (CDI) are a crucial public health threat becoming a worldwide problem. In 2017, there were 223,900 incident cases and 12,800 deaths in the United States. Underlying conditions, such as diabetes mellitus (DM), put individuals at a greater risk for developing an infection. Whereas CDI was once believed to be mostly healthcare-associated, increasing evidence points to transmission in community settings (CA). We investigated characteristics of CA CDI and associations between pre-existing conditions and CA incident CDI cases using data from Tennessee’s CDI surveillance program, an active population- and laboratory-based surveillance system conducted through CDC’s Emerging Infections Program. CA incident CDI case data were downloaded from the Incident Case Management System from 2017 to 2021. Count and percentages were determined for each underlying condition, number of underlying conditions, and biological sex. Chi-square analyses determined associations between underlying conditions and sex. Statistical analyses were conducted using SAS v9.4. 2,326 CA incident CDI cases were identified from the catchment area. The case rates per 100,000 population between 2017 and 2021 were 79.7, 81.9, 73.7, 50.7, and 49.6. A total of 39% of the cases were 65 years or older. Most cases were women (64.8%). The overall prevalence for any underlying condition among CA CDI cases was 67.4%. A total of 29.4% of incident cases had one condition, 18.5% had two conditions, and 19.4% had three or more conditions. The most frequently reported pre-existing conditions was DM (22.9%) and gastrointestinal disease (21.7%). We looked at the prevalence of underlying conditions separated in men and women. Men with CA CDI were more likely to have chronic kidney disease (CKD) (19.1% vs 12.7%), DM (26.0% vs 21.2%), immunocompromised conditions (6.4% vs 3.6%), liver diseases (6.5% vs 2.8%), and plegias (1.0% vs 0.2%) than women with CA CDI. Women with CA CDI were more likely to have chronic lung diseases (17.4% vs 12.6%) and connective tissue diseases (4.9% vs 2.2%) than men with CA CDI. Although the incident CA CDI case rate in Davidson County decreased from 2018 to 2021, it remains a significant threat. In this analysis, underlying conditions in persons with CA CDI were highly prevalent. Men were more likely to have underlying conditions in general, and specifically CKD and DM, than women. Improving understanding of the prevalence of these conditions with CA CDI cases, along with their antibiotic use and community exposures, can help drive prevention strategies to mitigate CA CDI transmission.

Background: The COVID-19 pandemic has placed an enormous strain on the healthcare system, including infection prevention and control. The response to the COVID-19 pandemic required extraordinary resources, which were often diverted from routine infection prevention and control activities and may have contributed to increased rates of HAI in the acute care setting. However, the impact of the COVID-19 pandemic on infection prevention and control departments, including staffing and resources, and on routine infection prevention and control activities is not well-described. The objective of this study was to describe the impact of the COVID-19 pandemic on IPC departments and department response to the pandemic. Methods: Between August and December of 2023, we conducted an electronic survey of all acute care facilities participating in the National Healthcare Safety Network. Survey data were analyzed using descriptive statistics. Results: Over 594 infection control departments participated in the survey, representing 1,400 NHSN facilities (20% response rate based on number of eligible NHSN facilities). Half of the respondents reported that their hospital experienced increases in the following HAI rates during the first two years of the pandemic: central-line associated bloodstream infections (54%), catheter-associated urinary tract infections (46%) and ventilator associated pneumonia (45%). When asked to identify the top three contributors to increased HAI rates in their facility, respondents cited the following factors: staffing shortages (70%), patient acuity (69%), use of travel nurses (48%), increased device utilization (37%), and reduced bedside acuity (31%). Respondents reported that their department utilized the following actions to decrease these HAI rates: increased rounding and monitoring of IPC procedures (81%), reeducation of frontline staff on IPC policies and procedures (77%), environmental care rounds (69%), monitoring of isolation compliance (66%), HAI Task Force/Committee (57%), nurse-driven catheter removal protocols (53%), and insertion prevention protocols (53%). When asked if the department experienced applied pressure or attempts to influence HAI reporting due to the increase in HAI rates in the facility experienced in the wake of the pandemic, 19% of respondents reported increased pressure from management/C-suite and 7% reported increased pressure from providers. Conclusion: The COVID-19 pandemic had a substantial impact on IPC departments in acute care hospitals and had a profound effect on IPC staffing, resources and routine IPC activities. Future work needs to identify best practices and lessons learned from the pandemic to inform future pandemic preparedness.

Background: Multi-drug resistant organisms (MDROs) are a common cause of healthcare-associated infections, particularly central line-associated bloodstream infections (CLABSIs). Prior research has shown that MDROs cause up to 67% of CLABSIs and have up to a 37% increase in 30 day readmission, which is higher than readmission rates for other conditions reported to the Centers for Medicare and Medicaid Services (CMS). The objective of the study was to determine overall 90-day readmission rates, and if there was a difference in readmission rate within 90 days post discharge for patients who had a MDRO as the causative pathogen of their CLABSI compared to patients who did not have an MDRO. Methods: A retrospective analysis of patient data from a nine-hospital system was performed on patients who had a CLABSI and were discharged alive between January 1st, 2018, and December 31st, 2019. Basic descriptive statistics were performed, and the potential differences in readmission rates were examined using Chi-square analyses. Results: The overall readmission rate for all CLABSIs was 46.9%. The chi-square analysis determined there was not a significant difference in readmission rates in patients who had a MDRO CLABSI compared to patients with a non-MDRO CLABSI (59.1% vs. 44.6%, x2= 1.564 , p= 0.211). Conclusion: There was not a significant difference in readmission rates between patients with an MDRO CLABSI compared to a non-MDRO CLABSI. However, the overall readmission rate for this patient population was much higher than seen in previous literature and other publicly reported readmission rates. Additional research is recommended to explore if the increased CLABSI readmission rates seen are a unique finding to this health system.