Optimizing Sentinel Surveillance to Target Containment of Emerging Multidrug-Resistant Organisms in Regional Networks

Background: Successful containment of regional outbreaks of emerging multidrug-resistant organisms (MDROs) relies on early outbreak detection. However, deploying regional containment is resource intensive; understanding the distribution of different types of outbreaks might aid in further classifying types of responses. Objective: We used a stochastic model of disease transmission in a region where healthcare facilities are linked by patient sharing to explore optimal strategies for early outbreak detection. Methods: We simulated the introduction and spread of Candida auris in a region using a lumped-parameter stochastic adaptation of a previously described deterministic model (Clin Infect Dis 2019 Mar 28. doi:10.1093/cid/ciz248). Stochasticity was incorporated to capture early-stage behavior of outbreaks with greater accuracy than was possible with a deterministic model. The model includes the real patient sharing network among healthcare facilities in an exemplary US state, using hospital claims data and the minimum data set from the CMS for 2015. Disease progression rates for C. auris were estimated from surveillance data and the literature. Each simulated outbreak was initiated with an importation to a Dartmouth Atlas of Health Care hospital referral region. To estimate the potential burden, we quantified the “facility-time” period during which infectious patients presented a risk of subsequent transmission within each healthcare facility. Results: Of the 28,000 simulated outbreaks initiated with an importation to the community, 2,534 resulted in patients entering the healthcare facility network. Among those, 2,480 (98%) initiated a short outbreak that died out or quickly attenuated within 2 years without additional intervention. In the simulations, if containment responses were initiated for each of those short outbreaks, facility time at risk decreased by only 3%. If containment responses were initiated for the 54 (2%) outbreaks lasting 2 years or longer, facility time at risk decreased by 79%. Sentinel surveillance through point-prevalence surveys (PPSs) at the 23 skilled-nursing facilities caring for ventilated patients (vSNF) in the network detected 50 (93%) of the 54 longer outbreaks (median, 235 days to detection). Quarterly PPSs at the 23 largest acute-care hospitals (ie, most discharges) detected 48 longer outbreaks (89%), but the time to detection was longer (median, 716 days to detection). Quarterly PPSs also identified 76 short-term outbreaks (in comparison to only 14 via vSNF PPS) that self-terminated without intervention. Conclusions: A vSNF-based sentinel surveillance system likely provides better information for guiding regional intervention for the containment of emerging MDROs than a similarly sized acute-care hospital–based system.Funding: NoneDisclosures: None

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539. Canaries in a Coal Mine?: Early Identification of Regional Spread of Novel Multidrug-resistant Organisms (MDROs) Using Sentinel Surveillance in Skilled Nursing Facilities Caring For Ventilated Patients (vSNFs)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.608 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S257-S258

Author(s):

Prabasaj Paul ◽

Rachel Slayton ◽

Maroya S Walters ◽

John A Jernigan

Keyword(s):

Real Time ◽

Acute Care ◽

Clinical Microbiology ◽

Acute Care Hospitals ◽

Sentinel Surveillance ◽

Point Prevalence ◽

Care Hospital ◽

Real Time Monitoring ◽

Healthcare Facilities

Abstract Background Regional containment of novel or targeted MDROs depends on detecting their presence as soon as possible following their introduction. Prior modeling studies suggest that after importation to a region, novel MDROs appear relatively quickly in certain high-risk post-acute long-term care facilities via patient movement. Sentinel surveillance in such facilities might facilitate early detection of emergent MDROs, thereby enhancing the effectiveness of containment efforts. Methods We simulated the introduction and spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region using an adaptation of a previously described susceptible-infectious-susceptible model (Clin Infect Dis. 2019 March 28 doi: 10.1093/cid/ciz248). The model includes the patient sharing network among healthcare facilities in an exemplar US state, using claims data and the Minimum Data Set from the Centers for Medicare & Medicaid Services for 2015. Disease progression, transmission and testing rates were estimated for CRE using data from the literature. Each simulated outbreak was initiated with a single importation to a Dartmouth Atlas of Health Care hospital referral region. The predicted timing of first CRE detection using two different data sources was compared: (1) real-time monitoring of clinical microbiology test results, or (2) results from quarterly point prevalence colonization surveys (PPSs). For each data source, the timing of earliest detection was compared according to availability of data from: (a) all healthcare facilities statewide, (b) only long-term acute care hospitals, (c) only vSNFs, or (d) only the largest acute care hospitals in the state (n = 23). Results Compared with real-time monitoring of clinical microbiology testing results from all facilities statewide, quarterly PPSs at all facilities detected CRE 446 days (median; range 312–608 days) earlier, while PPSs at only vSNFs (representing 4.4% of inpatient beds statewide) detected CRE 385 days (range 194–553 days) earlier (figures). Conclusion Regular point prevalence surveys in vSNFs may detect new MDROs in a region approximately one year sooner than real-time monitoring of clinical microbiology results, and may be an efficient strategy for early regional detection and subsequent containment. Disclosures All authors: No reported disclosures.

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Regional Infection Control Assessment of Antibiotic Resistance Knowledge and Practice

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2014.78 ◽

2015 ◽

Vol 36 (4) ◽

pp. 381-386 ◽

Cited By ~ 8

Author(s):

Stephanie R. Black ◽

Kingsley N. Weaver ◽

Robert A. Weinstein ◽

Mary K. Hayden ◽

Michael Y. Lin ◽

...

Keyword(s):

Infection Control ◽

Acute Care ◽

Bacterial Resistance ◽

Multidrug Resistant ◽

Nursing Facilities ◽

Policy And Practice ◽

Healthcare Facilities ◽

Carbapenem Resistant ◽

Perceived Importance ◽

Multidrug Resistant Organisms

OBJECTIVEMultidrug-resistant organisms (MDROs) are an increasing burden among healthcare facilities. We assessed facility-level perceived importance of and responses to various MDROs.DESIGNA pilot survey to assess staffing, knowledge, and the perceived importance of and response to various multidrug resistant organisms (MDROs)SETTINGAcute care and long-term healthcare facilitiesMETHODSIn 2012, a survey was distributed to infection preventionists at ~300 healthcare facilities. Pathogens assessed were Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant (defined as bacterial resistance to ≥3 antibiotic classes) Pseudomonas, and extended-spectrum β-lactamase-producing Escherichia coli.RESULTSA total of 74 unique facilities responded, including 44 skilled nursing facilities (SNFs) and 30 acute care facilities (ACFs). While ACFs consistently isolated patients with active infections or colonization due to these MDROs, SNFs had more variable responses. SNFs had more multi-occupancy rooms and reported less specialized training in infection control and prevention than did ACFs. Of all facilities with multi-occupancy rooms, 86% employed a cohorting practice for patients, compared with 50% of those without multi-occupancy rooms; 20% of ACFs and 7% of SNFs cohorted staff while caring for patients with the same MDRO. MRSA and C. difficile were identified as important pathogens in ACFs and SNFs, while CRE importance was unknown or was considered important in <50% of SNFs.CONCLUSIONWe identified stark differences in human resources, knowledge, policy, and practice between ACFs and SNFs. For regional control of emerging MDROs like CRE, there is an opportunity for public health officials to provide targeted education and interventions. Education campaigns must account for differences in audience resources and baseline knowledge.Infect Control Hosp Epidemiol 2015;00(0): 1–6

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1268. Transmissibility of Candida auris by Type of Inpatient Healthcare Facility

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1101 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S386-S387

Author(s):

Prabasaj Paul ◽

Kaitlin Forsberg ◽

Snigdha Vallabhaneni ◽

Shawn R Lockhart ◽

Anastasia P Litvintseva ◽

...

Keyword(s):

Acute Care ◽

Reproduction Number ◽

Acute Care Hospital ◽

Healthcare Facility ◽

Control Measures ◽

Care Hospital ◽

Candida Auris ◽

Healthcare Facilities ◽

Colonization Pressure ◽

Facility Type

Abstract Background Candida auris is a multidrug-resistant yeast causing outbreaks in healthcare settings. Stopping the spread of C. auris requires rapid identification of healthcare facilities at risk of higher transmission to help targeted implementation of infection control measures. We used data collected during public health investigations to quantify transmissibility of C. auris by type of healthcare facility. Methods In two states, 3,159 patient swabs were collected during 96 C. auris point prevalence surveys conducted at 36 inpatient healthcare facilities in November 2016 and April 2018. We estimated facility transmissibility and facility reproduction number (number infected by one index colonized patient per day, and per stay, respectively, at the facility) of C. auris based on estimated colonization pressure, a count of newly colonized patients between successive surveys at the same facility, and mean lengths of stay at facilities (estimated from CMS administrative data). The results were summarized by facility type: acute care hospital (ACH), long-term acute care hospital (LTACH) or ventilator unit at skilled nursing facility (VSNF), and were compared with previous estimates for transmissibility of carbapenem-resistant Enterobacteriaceae (CRE). Results Swabs were collected from 13 ACHs, 12 LTACHs, and 11 VSNFs. The C. auris facility reproduction number may exceed the critical value of 1 in both ACHs and VSNFs, and may exceed that for CRE in ACHs (table). Conclusion Transmissibility of C. auris is comparable to that of CRE. The transmissibility within VSNFs emphasizes their potential role as amplifiers in the outbreak. Understanding transmissibility by facility type helps evaluate the potential impact of interventions in various settings. Disclosures All authors: No reported disclosures.

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Effect of copper-impregnated linens on multidrug-resistant organism acquisition and Clostridium difficile infection at a long-term acute-care hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.196 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1384-1386 ◽

Cited By ~ 5

Author(s):

Gregory R. Madden ◽

Brenda E. Heon ◽

Costi D. Sifri

Keyword(s):

Clostridium Difficile ◽

Acute Care ◽

Acute Care Hospital ◽

Healthcare Facility ◽

Multidrug Resistant ◽

Resistant Organism ◽

Care Hospital ◽

Healthcare Settings ◽

Effect Of Copper

AbstractCopper-impregnated surfaces and linens have been shown to reduce infections and multidrug-resistant organism (MDRO) acquisition in healthcare settings. However, retrospective analyses of copper linen deployment at a 40-bed long-term acute-care hospital demonstrated no significant reduction in incidences of healthcare facility-onset Clostridium difficile infection or MDRO acquisition.

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Policies for Controlling Multidrug-Resistant Organisms in US Healthcare Facilities Reporting to the National Healthcare Safety Network, 2014

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.139 ◽

2016 ◽

Vol 37 (9) ◽

pp. 1105-1108 ◽

Cited By ~ 8

Author(s):

Lindsey M. Weiner ◽

Amy K. Webb ◽

Maroya S. Walters ◽

Margaret A. Dudeck ◽

Alexander J. Kallen

Keyword(s):

Acute Care ◽

Multidrug Resistant ◽

Healthcare Facilities ◽

Contact Precautions ◽

National Healthcare ◽

National Healthcare Safety Network ◽

Chlorhexidine Bathing ◽

Multidrug Resistant Organisms ◽

Using Data ◽

Facility Survey

We examined reported policies for the control of common multidrug-resistant organisms (MDROs) in US healthcare facilities using data from the National Healthcare Safety Network Annual Facility Survey. Policies for the use of Contact Precautions were commonly reported. Chlorhexidine bathing for preventing MDRO transmission was also common among acute care hospitals.Infect Control Hosp Epidemiol 2016:1–4

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1225. How Frequently Should Sink Drains Be Disinfected?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1088 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S440-S440

Author(s):

Jorge A Ramos-Castaneda ◽

Matthew L Faron ◽

Joshua Hyke ◽

Blake W Buchan ◽

Rahul Nanchal ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Horizontal Transmission ◽

Tertiary Care ◽

Multidrug Resistant ◽

Control Group ◽

Care Hospital ◽

Bacterial Reduction ◽

Post Intervention ◽

Bacterial Colony ◽

Healthcare Facilities

Abstract Background New evidence shows the relevance of sink drains in the horizontal transmission of multidrug-resistant organisms. We recently demonstrated that a peroxide-based disinfectant (product B) was better than bleach at disinfecting sink drains; however, we did not determine the duration of this effect. In this study, we evaluate the duration of bacterial reduction in sink drains treated with product B and compared it to an enhanced hydrogen peroxide agent (product A). Methods Testing was performed in a 26-bed medical intensive care unit at a 566-bed tertiary care hospital in Milwaukee, WI. Two disinfectants were compared: product A (hydrogen peroxide, octanoic acid, and peroxyacetic acid; Virasept, Ecolab) and product B (hydrogen peroxide-based disinfectant; Peroxide Multi Surface Cleaner and Disinfectant, Ecolab). Sinks were randomly assigned to product A, product B, and control (no disinfection). On day 0, baseline cultures were obtained and disinfectant agents were applied. On post-intervention days 1, 3, 5, and, 7, samples from each drain were collected using E-swabs (Copan, Italy). Quantitation of Gram-negative burden was determined by serial dilution in saline plated to MacConkey agar and dilutions that contained 20–200 colonies were used for bacterial colony-forming units (CFU). Multivariate multiple linear regression and analysis of variance were used to compare mean Ln(1+CFU) between groups using R v3.5.0. Environmental sampling, cultures, and statistical analyses were performed blinded to the disinfected used. Results All three groups had similar CFU counts at baseline (P > 0.05). On day 1, a statistically significant reduction in bacterial CFUs was observed in the group treated with product A compared with sinks treated with product B (P = 0.04) or the control group (P < 0.01). The same differences were observed on day 3 post-intervention. There were no significant reductions on days 5 and 7. Conclusion Product A was the most effective product at disinfecting sink drains but its effect disappeared at 5 days post-disinfection. These results suggest that treating sink drains every 5 days with a hydrogen peroxide mixture would be ideal for healthcare facilities dealing with sink drain contamination. Disclosures All authors: No reported disclosures.

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Mathematical modeling of the SARS-CoV-2 epidemic in Qatar and its impact on the national response to COVID-19

10.1101/2020.11.08.20184663 ◽

2020 ◽

Cited By ~ 4

Author(s):

Houssein H. Ayoub ◽

Hiam Chemaitelly ◽

Shaheen Seedat ◽

Monia Makhoul ◽

Zaina Al Kanaani ◽

...

Keyword(s):

Mathematical Modeling ◽

Acute Care ◽

Hospital Admissions ◽

Deterministic Model ◽

Infection Prevalence ◽

Care Hospital ◽

Healthcare Needs ◽

National Response ◽

The Impact ◽

Second Wave

AbstractBackgroundMathematical modeling constitutes an important tool for planning robust responses to epidemics. This study was conducted to guide the Qatari national response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic. The study investigated the time course of the epidemic, forecasted healthcare needs, predicted the impact of social and physical distancing restrictions, and rationalized and justified easing of restrictions.MethodsAn age-structured deterministic model was constructed to describe SARS-CoV-2 transmission dynamics and disease progression throughout the population.ResultsThe enforced social and physical distancing interventions flattened the epidemic curve, reducing the peaks for incidence, prevalence, acute-care hospitalization, and intensive care unit (ICU) hospitalizations by 87%, 86%, 76%, and 78%, respectively. The daily number of new infections was predicted to peak at 12,750 on May 23, and active-infection prevalence was predicted to peak at 3.2% on May 25. Daily acute-care and ICU-care hospital admissions and occupancy were forecast accurately and precisely. By October 15, 2020, the basic reproduction number R0 had varied between 1.07-2.78, and 50.8% of the population were estimated to have been infected (1.43 million infections). The proportion of actual infections diagnosed was estimated at 11.6%. Applying the concept of Rt tuning, gradual easing of restrictions was rationalized and justified to start on June 15, 2020, when Rt declined to 0.7, to buffer the increased interpersonal contact with easing of restrictions and to minimize the risk of a second wave. No second wave has materialized as of October 15, 2020, five months after the epidemic peak.ConclusionsUse of modeling and forecasting to guide the national response proved to be a successful strategy, reducing the toll of the epidemic to a manageable level for the healthcare system.

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2480. Communication During Patient Transfers: Describing Gaps in the Infectious Status Information Pipeline

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2158 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S859-S859

Author(s):

Jeanmarie Mayer ◽

Roberta Horth ◽

Madison Todd ◽

Randon Gruninger ◽

Allyn K Nakashima

Keyword(s):

Acute Care ◽

Skilled Nursing Facility ◽

Multidrug Resistant ◽

The State ◽

Cross Sectional ◽

Skilled Nursing ◽

Patient Transfers ◽

Healthcare Facilities ◽

Additional Information ◽

Infection Preventionists

Abstract Background Fragmented communication of patients’ infectious status across healthcare networks impact regional spread of multidrug-resistant organisms (MDRO). This study aimed to quantify gaps in communication of patient MDRO status across Utah healthcare facilities and to identify opportunities to improve. Methods This is a cross-sectional retrospective mixed-methods study of patient transfers from three purposively selected healthcare facilities: an acute care (ACF), long-term acute care (LTAC), and skilled-nursing facility (SNF). Patients with known MDRO transferred out of these facilities over the previous week were identified in bimonthly samples spanning 2 months. Infection preventionists and admission nurses from facilities receiving these patients were interviewed. Results Of 293 patients transferred to another facility, 13% (n = 38) had an active infection or colonization with an MDRO. These 38 patients were transferred to 26 healthcare facilities within the state (4 ACF, 3 LTAC, 19 SNF). Gram-negative organisms with resistance to a carbapenem accounted for 15.8% of those transferred with an MDRO. There was no documentation of the state infection control transfer form (ICTF) at the sending facility for 68.5% of MDRO patient transfers. Of 22 admitting nurses interviewed, 19 (86.4%) did not receive an ICTF, 6 (27.3%) received no communication regarding patients’ infectious status, and 11 (50%) had to contact the sending facility for additional information. Moreover, 18.2% of patients had not been put on appropriate precautions. Several nurses expressed confusion with MDRO definitions and lack of guidance regarding care of MDRO colonized patients. Among infection preventionists asked about general MDRO transfers (n = 26), 26.9% reported that communication on infectious status of MDRO patients was received in under 40% of incoming transfers. When asked about a planned statewide MDRO registry, 80.8% felt that such a system would be actively searched at their facility, and 96.2% felt that a system that pushes out alerts would be useful. Conclusion Given the widespread gaps in communication of infectious status of patients with MDROs transferred across the healthcare facilities sampled, efforts to standardize and improve MDRO communication in the region is warranted. Disclosures All authors: No reported disclosures.

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