scholarly journals 802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S495-S496
Author(s):  
Janice J Kim ◽  
Nancy E Turner ◽  
Emily Holman ◽  
Linda Lefrak ◽  
Fady A Youssef ◽  
...  
Keyword(s):  
Critically Ill ◽  
Acute Care Hospital ◽  
Chronically Ill ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Prevalence Survey ◽  
Environmental Cleaning ◽  
Contact Precautions ◽  
Corynebacterium Striatum ◽  
And Control

Abstract Background Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices. Methods A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq. Results Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2). Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021 Figure 2. Phylogenetic Tree Corynebacterium striatum Isolates Conclusion A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients. Disclosures All Authors: No reported disclosures

scholarly journals Candida auris Outbreak Control in Critical Care Units in a Tertiary-Care Hospital in Nairobi, Kenya

2020 ◽  
Vol 41 (S1) ◽  
pp. s147-s148
Author(s):  
Alice Kanyua ◽  
Rose Ngugi ◽  
Loice Ombajo ◽  
Joyce Mwangi ◽  
Bolivya Olasya ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Tertiary Care ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Single Patient ◽  
Candida Auris ◽  
Prevalence Survey ◽  
Contact Precautions ◽  
High Dependency ◽  
Contact Screening

Background:Candida auris is an emerging pathogen associated with nosocomial outbreaks. During January to May 2019, 11 invasive cases of C. auris were identified in the intensive care unit (ICU) and high-dependency unit (HDU) at a hospital in Nairobi, Kenya. We report on the interventions implemented to control the outbreak. Methods: Intensified infection prevention and control (IPC) interventions were implemented. All patients infected or colonized with C. auris were placed in single-patient rooms with strict contact precautions. Cleaning of the patient care environment was enhanced by instituting a 3-step procedure of cleaning with soap and water, disinfecting with 0.5% chlorine, and rinsing with water. Glo-Germ gel was used to evaluate the cleaning processes, and percentage of missed surfaces was calculated. Hand hygiene training and compliance observations were conducted to enforce adherence to hand hygiene. The IPC team provided training and observational feedback of IPC to staff, patients, and their families. The IPC interventions were guided by screening activities. To monitor ongoing transmission, a biweekly point-prevalence survey (PPS) was performed to screen all previously negative ICU and HDU patients for C. auris. Furthermore, admission and contact screening were added to guide patient placement. Screening was conducted by collecting a composite swab from the bilateral axilla and groin. Samples were incubated in salt dulcitol broth for 5 days at 40°C then subcultured onto Sabouraud dextrose agar. Colony identification was performed using a Vitek 2 system (bioMérieux). Results: In total, 177 patients were placed in single-patient rooms under contact precautions during May–August 2019. We conducted 123 environmental cleaning observations, and the percentage of missed surfaces decreased from 71% (10 of 14) in June to 7% (1 of 16) in August. Hand hygiene compliance among ICU and HDU staff was 79% (204 of 257) in May, 71% (159 of 223) in June, 73% (170 of 233) in July, and 81% (534 of 657) in August. In total, 283 screening swabs from 234 patients were processed during May–August 2019. Overall, 18 of 88 PPS swabs (20%), 13 of 180 admission screening swabs (7%), and 0 of 15 contact screening swabs (0%) were positive for C. auris. The PPS results showed a rapid decrease in colonization: 6 of 14 (43%) in May, 12 of 54 (22%) in June, 9 of 98 (9%) in July, and 1 of 70 (2%) in August. No new C. auris infections were identified from June to October 2019. Conclusions: The control of C. auris in a hospital outbreak requires multimodal interventions, including enhanced IPC interventions, PPS, admission and contact screening for colonization, rigorous monitoring, and team effort.Funding: NoneDisclosures: None

Prevalence of Colonization and Infection with Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusand ofClostridium difficileInfection in Canadian Hospitals

2013 ◽  
Vol 34 (7) ◽  
pp. 687-693 ◽  
Author(s):  
Andrew E. Simor ◽  
Victoria Williams ◽  
Allison McGeer ◽  
Janet Raboud ◽  
Oscar Larios ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Prevalence Ratio ◽  
Infection Prevention And Control ◽  
Prevalence Survey ◽  
Control Policies ◽  
Environmental Cleaning ◽  
Prevalence Estimates ◽  
Healthcare Associated ◽  
And Control ◽  
Occupancy Rates

Objective.To determine the prevalence of methicillin-resistantStaphylococcus aureus(MRSA), vancomycin-resistant enterococci (VRE), andClostridium difficileinfection (CDI) in Canadian hospitals.Design.National point prevalence survey in November 2010.Setting.Canadian acute care hospitals with at least 50 beds.Patients.Adult inpatients colonized or infected with MRSA or VRE or with CDI.Methods.The prevalence (per 100 inpatients) of MRSA, VRE, and CDI was determined. Associations between prevalence and institutional characteristics and infection control policies were evaluated.Results.One hundred seventy-six hospitals (65% of those eligible) participated. The median (range) prevalence rates for MRSA and VRE colonization or infection and CDI were 4.2% (0%–22.1%), 0.5% (0%–13.1%), and 0.9% (0%–8.6%), respectively. Median MRSA and VRE infection rates were low (0.3% and 0%, respectively). MRSA, VRE, and CDI were thought to have been healthcare associated in 79%, 96%, and 84% of cases, respectively. In multivariable analysis, routine use of a private room for colonized/infected patients was associated with lower median MRSA infection rate (prevalence ratio [PR], 0.44 [95% confidence interval (CI), 0.22–0.88]) and VRE prevalence (PR, 0.26 [95% CI, 0.12–0.57]). Lower VRE rates were also associated with enhanced environmental cleaning (PR, 0.52 [95% CI, 0.36–0.75]). Higher bed occupancy rates were associated with higher rates of CDI (PR, 1.02 [95% CI, 1.01–1.03]).Conclusions.These data provide the first national prevalence estimates for MRSA, VRE, and CDI in Canadian hospitals. Certain infection prevention and control policies were found to be associated with prevalence and deserve further investigation.

scholarly journals Interfacility Spread of OXA-23–Producing Carbapenem-Resistant Acinetobacter—Connecticut, 2018–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s304-s304
Author(s):  
Sydney Jones ◽  
Meghan Maloney ◽  
Anu Paranandi ◽  
Dana Pepe ◽  
Elizabeth Nazarian ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Environmental Cleaning ◽  
Healthcare Facilities ◽  
Contact Precautions ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant gram-negative bacterium, can cause difficult-to-treat infections with mortality in approximately half of CRAB cases. CRAB can spread among healthcare facilities after transfer of an infected or colonized patient. Strategies to limit CRAB spread include adherence to contact precautions, environmental cleaning with bleach, and screening to identify colonized patients. During July–September 2018, the Connecticut Department of Public Health (DPH) worked with an acute-care hospital (hospital A) to contain an outbreak of OXA-23–producing CRAB (OXA-23 is an enzyme that confers resistance to carbapenems). During November 2018–March 2019, statewide CRAB surveillance identified additional cases of related OXA-23–producing CRAB at other healthcare facilities. DPH, Connecticut State Public Health Laboratory (SPHL), and the Antibiotic Resistance Laboratory Network (ARLN) investigated to prevent additional cases. Methods: Since January 2017, CRAB isolates have been routinely sent to SPHL and ARLN for carbapenemase gene detection and whole-genome sequencing (WGS) to determine isolate relatedness. During November 2018–March 2019, DPH collected patient healthcare history for patients with CRAB isolates to identify outbreaks and provide assistance in infection control and prevention to healthcare facilities reporting CRAB cases. Beginning May 2019, DPH and ARLN offered facilities screening to identify patients colonized with OXA-23–producing CRAB. Results: Of 10 OXA-23–producing CRAB isolates reported to DPH during November 2018–March 2019, 3 were closely related to the 9 isolates from hospital A’s outbreak by WGS (single-nucleotide polymorphism difference range, 1–16). One isolate was from a patient who had been admitted to hospital A during July 2018. All 3 patients with CRAB isolates shared a history of residence at long-term–care facility A (LTCF A). Two patients received a CRAB infection diagnosis upon admission to hospital B after transfer from LTCF A. Both LTCF A and hospital B performed environmental cleaning with bleach and placed CRAB-identified patients on contact precautions. LTCF A declined screening patients for CRAB, whereas hospitals B and C, which receive frequent transfers from LTCF A, screened all patients on admission from LTCF A. During May–September 2019, among 6 patients screened, 1 was colonized with OXA-23–producing CRAB and was placed on contact precautions. Conclusions: Transfer of patients who are infected or colonized with CRAB among hospitals and LTCFs can facilitate the regional spread of CRAB. Strategies for containing the spread of carbapenemase-producing organisms include adherence to contact precautions, colonization screening, interfacility communication, and collaboration with public health.Funding: NoneDisclosures: None

scholarly journals Site Visits Reveal Common Gaps in Instrument Reprocessing and Sterilization at Philadelphia Dental Clinics

2020 ◽  
Vol 41 (S1) ◽  
pp. s389-s390
Author(s):  
Tiina Peritz ◽  
Susan Coffin
Keyword(s):  
Public Health ◽  
Infection Prevention And Control ◽  
Environmental Cleaning ◽  
Department Of State ◽  
Inappropriate Use ◽  
Dental Clinics ◽  
Point Of Use ◽  
Policies And Procedures ◽  
License Renewal ◽  
And Control

Background: Most dental clinics lack resources and oversight related to infection prevention and control (IPC) practices. Few dental clinics undergo inspections by regulatory authorities unless the state licensing authorities receive a specific complaint. Many states, including Pennsylvania, do not have continuing IPC education requirements for dental providers. In 2018–2019, the Philadelphia Department of Public Health (PDPH) received and responded to multiple complaints and concerns related to IPC practices at dental clinics. Complaints were investigated in collaboration with the Pennsylvania Department of State (PADOS). Methods: Unannounced site visits were conducted at 7 Philadelphia dental clinics from December 2018 through September 2019 as part of the public health responses. Clinic evaluations and observations by PDPH certified infection preventionists focused on (1) IPC policies and procedures, (2) staff IPC training, (3) hand hygiene, (4) personal protective equipment, (5) instrument reprocessing and sterilization, (6) injection safety, and (7) environmental cleaning and disinfection. The CDC and the Organization of Safety, Antisepsis and Prevention (OSAP) checklists were adapted for this purpose. Results: Most dental practices we visited were small, unaffiliated, owner-operated clinics. The most common gaps we identified were associated with instrument reprocessing and sterilization practices, including inadequate separation between clean and dirty work areas, limited space and availability of sinks, inappropriate use of glutaraldehyde products for instrument cleaning (n = 3, 43%), extended reuse of cleaning brushes (n = 5, 71%), sterilization or storage of sterilized instruments without appropriate packaging (n = 2, 29%), lack of spore testing or reviewing results (n = 2, 29%), and lack of documentation of sterilizer run cycles and maintenance (n = 7, 100%). Additionally, most clinics did not have well-developed IPC policies and procedures, and staff IPC trainings were neither documented nor conducted annually. Alcohol-based hand sanitizer was often not available at the point of use. Conclusions: In Philadelphia, dental clinics often lacked IPC support and oversight. Lapses across multiple key IPC domains were common. These findings suggest that public health may have a role in providing IPC support to unaffiliated dental clinics. Licensing entities can also serve a role in improving IPC practices by more widely mandating continuing IPC education as part of the dental license renewal process.Funding: NoneDisclosures: None

Study on Phenotypic Detection of Carbapenemase Producing Enterobacteriaceae in MBS Hospital, Kota

2021 ◽  
Vol 10 (29) ◽  
pp. 2181-2185
Author(s):  
Pooja Jain ◽  
Naveen Saxena
Keyword(s):  
Critically Ill ◽  
Multi Drug Resistance ◽  
Environmental Cleaning ◽  
Beta Lactamases ◽  
Contact Precautions ◽  
Carbapenem Resistant ◽  
Surgical Ward ◽  
Study Results ◽  
Class B

BACKGROUND The Carbapenemase Resistant Enterobacteriaceae (CRE) are associated with high rates of morbidity and mortality particularly amongst critically ill patients. Hence rapid laboratory detection of CRE hospitalized patients is highly desirable. The vast majority of carbapenemases belong to three of the four known classes of beta lactamases namely Ambler class A, Ambler class B metallobetalactamases (MBL) and Ambler class Doxacillinases (OXAs). The purpose of this study was to determine the prevalence of carbapenemases producing Enterobacteriaceae in clinical isolates in MBS hospital, Kota. METHODS This study was conducted in the Department of Microbiology at MBS Hospital, Kota from June 2020 to December 2020. 68 non repeat isolates (MDR) that were resistant to imipenem (10 mg) according to CLSI breakpoint were included in the present study. RESULTS Out of 68 imipenem resistant Enterobacteriaceae, 52 were carbapenemase producing as detected by Modified Hodge Test. As per our study, the prevalence of carbapenemase producing Enterobacteriaceae was 20.8%. Most commonly seen in K. pneumoniae isolated from urine and swab of critically ill and debilitated patients of surgical ward. CONCLUSIONS Curbing irrational usage of antimicrobials in India is urgently required. Thus, aggressive infection control efforts have been effective at decreasing rates of infections with KPC-producing bacteria in intensive care units and long-term acute care hospitals. Bundled interventions including enhanced environmental cleaning, active surveillance culturing and contact precautions, as well as antimicrobial stewardship are important in controlling KPC-producing bacteria. KEY WORDS Multi Drug Resistance Enterobacteriaceae (MDRE), Klebsiella Producing Carbapenemase (KPC), Carbapenem Resistant Enterobacteriaceae (CRE), Metallo Beta Lactamase (MBL), Modified Hodge Test (MHT)

scholarly journals Microbiological surveillance of operation theatre in a tertiary care hospital in North East India

2017 ◽  
Vol 5 (8) ◽  
pp. 3448
Author(s):  
Monika Yadav ◽  
Rohan Pal ◽  
Somorjit H. Sharma ◽  
Sulochana D. Khumanthem
Keyword(s):  
Tertiary Care ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Bacterial Colony ◽  
Operation Theatre ◽  
Pseudomonas Spp ◽  
North East ◽  
Acinetobacter Spp ◽  
And Control ◽  
Microbiological Surveillance

Background: Good hospital hygiene is an integral part of infection control programme. “Microbiological surveillance” provides data about the factors contributing to infection. Bacterial counts in operation theatres are influenced by number of individual present, ventilation and air flow methods. Purpose of the study is to find out prevalence rate of microorganisms in Operation Theatre, to find out the frequency of contamination from various sites in operation theatre.Methods: The study was conducted in the department of microbiology, Regional institute of medical sciences, Imphal, Manipur, India. Air samples were taken by settle plate method in petri dishes containing blood agar and surface samples were taken by a sterile swab soaked in nutrient broth from all operation theatres. The samples were processed according to standard operative procedures.Results: Least bacterial colony forming unit (CFU) was shown by ophthalmology OT 17 CFU/mm3 and highest was shown by emergency OT 200 CFU/mm3. Isolated organism was divided into normal flora (CONS, micrococci), contaminant (bacillus species) and pathogenic organism e.g. Staphylococcus aureus, Acinetobacter spp., Pseudomonas spp. 15 (23.4%) swab samples out of a total of 64 swab samples were found to be growth positive. Out of that 4 CONS, 4 micrococci, 3 Bacillus spp, 2 Acinetobacter spp, 1 Enterobacter spp, 1 Pseudomonas spp. were isolated.Conclusions: Strengthening surveillance and laboratory capacity will surely enhance infection prevention and control. Routine sampling is strongly recommended for increasing awareness to identify and control all possible sources and types of infections.

Point prevalence of healthcare-associated infections and antibiotic use in a tertiary care teaching hospital in Nepal: A cross-sectional study

2021 ◽  
pp. 175717742110358
Author(s):  
Sailesh Kumar Shrestha ◽  
Swarup Shrestha ◽  
Sisham Ingnam
Keyword(s):  
Prevention And Control ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Point Prevalence ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Prevalence Survey ◽  
Healthcare Associated ◽  
And Control

Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs—pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.

scholarly journals A six-years point prevalence survey of healthcare-associated infections in an Italian hospital

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Gentili ◽  
D I La Milia ◽  
D Vallone ◽  
M Di Pumpo ◽  
G Vangi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Acute Care Hospital ◽  
Point Prevalence ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Prevalence Survey ◽  
Point Prevalence Survey ◽  
The Moment ◽  
Healthcare Associated

Abstract Healthcare-Associated Infections (HAIs) are among the most serious public health problems in Europe representing the most frequent adverse event during care delivery. Despite their limitations, point prevalence surveys of HAIs are often preferred to prospective surveillance, since they provide a feasible estimate when resources are limited. The aim of this study was to analyze the results of a six-years point prevalence survey of HAIs in a teaching acute care hospital in Italy and to investigate the main risk factors of HAIs in the acute-care hospital. A point prevalence survey to detect HAIs was carried out in Gemelli Hospital during the last 6 years, from 2013 to 2018. Inpatients of any age in Gemelli Hospital were eligible for inclusion. Patients in outpatient areas were excluded. HAIs were identified according to diagnosis guideline from ECDC in 2011. Statistically significant differences were tested through t-test and Chi-square test. Multi-variate analysis was performed to evaluate the impact of regressor factors for predict HAI’s prevalence. The statistical significance level was set at p < 0.05. The point prevalence ranged from 3,16% in 2017 to 6,64% in 2013. Pneumonia and surgical site infections (SSI) were the most frequent HAIs during the 6 years, with a rate of 27,31% and 26,20% respectively of all HAIs. The multiple logistic regression showed that length of stay at the moment of detection, urinary catheter, CVC and antibiotic therapy are useful to meaningfully predict HAI prevalence, with a regression coefficient (adjusted R2) of 0.2780. Thanks to proper hospital policies, the point prevalence of HAIs does not seem to increase through the years, even though it is still too early to draw any conclusions. Pneumonia and SSI represented each one more than a quarter of all the HAIs, as reported also in literature. There is a strong association between length of stay at the moment of detection and HAIs but it is hard to understand which one is the cause of the other. Key messages Point prevalence from 2013 to 2018 seems to be stable. An accurate incidence survey is needed in order to identify the main risk factors of HAI and to realize more specific hospital programmes. Length of stay at the moment of detection is useful to meaningfully predict HAIs prevalence although the cause-and-effect relationship is still not clear.

scholarly journals Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series

2020 ◽  
Author(s):  
Sabrina Eggmann ◽  
Angela Kindler ◽  
Andrea Perren ◽  
Natalie Ott ◽  
Frauke Johannes ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Critically Ill ◽  
Acute Care ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Treatment Strategies ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Potential Treatment ◽  
Prone Positioning

Abstract Objective The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients. Methods We report 11 cases of patients with COVID-19 from five Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods and short-term response to treatment. Results Physical therapists actively treated patients with COVID-19 on wards and in the ICU. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who are critically ill developed severe weakness, post-extubation dysphagia, weaning failure or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies and lung function and physical strength improved over time. Conclusion Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning, early breathing exercises as well as post-COVID rehabilitation. Impact To date there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.

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