574. Reporting of Vancomycin-Resistant Enterococcus Bacteremia among National Healthcare Safety Network Acute Care Hospitals

Abstract Background The National Healthcare Safety Network’s (NHSN’s) Multidrug-resistant Organism/Clostridioides difficile (MDRO/CDI) Module serves as a surveillance platform for tracking antibiotic-resistant laboratory-identified (LabID) organisms. LabID event surveillance, which does not require submission of clinical data to NHSN, provides proxy measures for MDRO burden. While surveillance of some organisms is federally mandated, these requirements do not extend to vancomycin-resistant Enterococcus (VRE). We sought to describe the extent of acute care hospital (ACH) participation in NHSN VRE surveillance and identify facility-level factors associated with VRE bacteremia. These could explain differences in VRE incidence and be used in preparation for a national risk-adjusted benchmark. Methods ACHs that reported at least one month of facility-wide inpatient (FacWideIN) VRE bacteremia LabID Event data to NHSN in 2017 were included in the analysis. LabID events were categorized as healthcare facility-onset (HO), defined as a laboratory result for a specimen collected ≥4 days after admission, or community-onset (CO), defined as a specimen collected < 4 days after admission. Monthly patient day and admission denominators were used to calculate FacWideIN HO incidence and CO prevalence rates. Univariate analyses were performed on facility-level factors from NHSN’s annual hospital survey to assess their relationship with HO VRE bacteremia. Results A total of 544 HO VRE bacteremia events were reported by 498 hospitals in 37 states. About 67% of reporting hospitals were located in California. The national rate of HO VRE bacteremia was 0.27 per 10,000 patient-days and the CO VRE bacteremia rate was 0.58 per 10,000 admissions. Major medical school affiliation, hospital type, larger number of beds and ICU beds, longer average length of stay and the presence of an oncology unit were significantly associated with HO VRE bacteremia (Table 1). Conclusion Based on the VRE data reported to NHSN, certain facility-level factors may contribute to a higher incidence of HO VRE bacteremia. Future analyses can allow us to determine whether these factors are independently associated with VRE. Risk-adjusted surveillance data can help guide facilities and states to compare their burden of VRE to a national benchmark. Disclosures All authors: No reported disclosures.

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Colonization with Vancomycin-Resistant Enterococcus faecium: Comparison of a Long-Term-Care Unit with an Acute-Care Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/647621 ◽

1997 ◽

Vol 18 (5) ◽

pp. 333-339 ◽

Cited By ~ 18

Author(s):

Hector F. Bonilla ◽

Marcus A. Zervos ◽

Michael J. Lyons ◽

Suzanne F. Bradley ◽

Sara A. Hedderwick ◽

...

Keyword(s):

Acute Care ◽

Enterococcus Faecium ◽

Long Term Care ◽

Acute Care Hospital ◽

Care Hospital ◽

Vancomycin Resistant Enterococcus ◽

Term Care ◽

Vancomycin Resistant

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Assessing The Impact of The National Healthcare Safety Network’s (NHSN’s) New Baseline on Acute Care Hospital Standardized Infection Ratios (SIRs)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.117 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S49-S50

Author(s):

Minn Soe ◽

Allan Nkwata ◽

Jonathan R Edwards ◽

Margaret Dudeck ◽

Daniel Pollock

Keyword(s):

Acute Care ◽

Risk Adjustment ◽

Acute Care Hospital ◽

Healthcare Facility ◽

Care Hospital ◽

Healthcare Associated Infection ◽

Quality Reporting ◽

National Healthcare ◽

Healthcare Associated ◽

The Impact

Abstract Background To more accurately measure the progress of healthcare-associated infection (HAI) prevention efforts, the CDC’s National Healthcare Safety Network (NHSN) surveillance system updated risk-adjustment models for computation of updated Standardized Infection Ratios (SIRs), the primary HAI summary measure by NHSN. This study sought to examine how the updated SIRs varied from the previous SIRs calculated using older baselines for acute care hospital HAIs. Methods We analyzed NHSN data for healthcare facility-onset laboratory-identified Clostridium difficile [CDI] and methicillin-resistant Staphylococcus aureus [MRSA] bacteremia reported in accordance with the CMS’ inpatient quality reporting program requirement. The unit of analysis was CMS certification number (CCN) facility reporting in 2015. We compared overall distributions of CCN-level SIRs (CCN-SIRs) between new risk-adjustment models using a 2015 baseline (SIR_NEW) and old models using a 2011 baseline (SIR_OLD) and tested location shift (median away from null) of pairwise differences. We also examined the magnitude of shift in SIR from old to new baseline. Results For each HAI, the national pooled mean SIR of the new baseline was ~1.0. For CDI, the overall distributions of CCN SIR_NEW and CCN-SIR_OLD were different, and the median of pairwise difference was away from null with CCN-SIR_NEW slightly higher. For MRSA, the SIR differences were not significant. Most CCN-SIRs (83% for CDI, 93% for MRSA) remained in the same significance category across the old and new baselines (“worse,” “better, ‘not different from national benchmark’), and few CCN-SIRs were reclassified to a less favorable category. For 75% of CCN-SIRs, their relative position in the quartile distributions of SIR_NEW and SIR_OLD remained the same. The discrepancies between SIR_NEW and SIR_OLD tended to be larger among CCNs with high SIRs. Conclusion The updated national pooled mean SIRs were close to 1.0, validating the potential use of new risk adjustment models and baseline as updated benchmarks for tracking CDI and MRSA prevention progress. The shifts in CCN-level SIRs between old and new baselines were not large, indicating a modest impact of new baselines at the CCN level, except among hospitals with high SIRs. Disclosures All authors: No reported disclosures.

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Colonization with Vancomycin-Resistant Enterococcus faecium: Comparison of a Long-Term-Care Unit with an Acute-Care Hospital

Infection Control and Hospital Epidemiology ◽

10.2307/30141227 ◽

1997 ◽

Vol 18 (5) ◽

pp. 333-339 ◽

Cited By ~ 52

Author(s):

Hector F. Bonilla ◽

Marcus A. Zervos ◽

Michael J. Lyons ◽

Suzanne F. Bradley ◽

Sara A. Hedderwick ◽

...

Keyword(s):

Acute Care ◽

Enterococcus Faecium ◽

Long Term Care ◽

Acute Care Hospital ◽

Care Hospital ◽

Vancomycin Resistant Enterococcus ◽

Term Care ◽

Vancomycin Resistant

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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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161. Prevalence and Risk Factors for Candida auris Colonization Among Patients in a Long-term Acute Care Hospital—New Jersey, 2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.031 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S14-S14

Author(s):

Faye Rozwadowski ◽

Jarred McAteer ◽

Nancy A Chow ◽

Kimberly Skrobarcek ◽

Kaitlin Forsberg ◽

...

Keyword(s):

Risk Factors ◽

Acute Care ◽

Acute Care Hospital ◽

Clinical Information ◽

Control Measures ◽

Resistant Organism ◽

Invasive Infection ◽

Care Hospital ◽

Candida Auris

Abstract Background Candida auris can be transmitted in healthcare settings, and patients can become asymptomatically colonized, increasing risk for invasive infection and transmission. We investigated an ongoing C. auris outbreak at a 30-bed long-term acute care hospital to identify colonization for C. auris prevalence and risk factors. Methods During February–June 2017, we conducted point prevalence surveys every 2 weeks among admitted patients. We abstracted clinical information from medical records and collected axillary and groin swabs. Swabs were tested for C. auris. Data were analyzed to identify risk factors for colonization with C. auris by evaluating differences between colonized and noncolonized patients. Results All 101 hospitalized patients were surveyed, and 33 (33%) were colonized with C. auris. Prevalence of colonization ranged from 8% to 38%; incidence ranged from 5% to 20% (figure). Among colonized patients with available data, 19/27 (70%) had a tracheostomy, 20/31 (65%) had gastrostomy tubes, 24/33 (73%) ventilator use, and 12/27 (44%) had hemodialysis. Also, 31/33 (94%) had antibiotics and 13/33 (34%) antifungals during hospitalization. BMI for colonized patients (mean = 30.3, standard deviation (SD) = 10) was higher than for noncolonized patients (mean = 26.5, SD = 7.9); t = −2.1; P = 0.04). Odds of colonization were higher among Black patients (33%) vs. White patients (16%) (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.3–9.8), and those colonized with other multidrug-resistant organism (MDRO) (72%) vs. noncolonized (44%) (OR 3.2; CI 1.3–8.0). Odds of death were higher among colonized patients (OR 4.6; CI 1.6—13.6). Conclusion Patients in long-term acute care facilities and having high prevalences of MDROs might be at risk for C. auris. Such patients with these risk factors could be targeted for enhanced surveillance to facilitate early detection of C. auris. Infection control measures to reduce MDROs’ spread, including hand hygiene, contact precautions, and judicious use of antimicrobials, could prevent further C. auris transmission. Acknowledgements The authors thank Janet Glowicz and Kathleen Ross. Disclosures All authors: No reported disclosures.

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1263. Managing an Influenza Outbreak Which Spilled Over to an Acute Care Hospital from a Behavioral Health Unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1096 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S385-S385

Author(s):

Colleen M Clay ◽

Leonardo Girio-Herrera ◽

Faheem Younus

Keyword(s):

Behavioral Health ◽

Acute Care ◽

Influenza A ◽

Average Length ◽

Acute Care Hospital ◽

Control Measures ◽

Care Hospital ◽

Prevention Measures ◽

Influenza Outbreak ◽

Hospital Acquired

Abstract Background Behavioral health units (BHU) have been implicated in influenza outbreaks due to group activities, low availability of alcohol-based hand gels and unique host factors. We describe the management of an unusual influenza outbreak, which started in the BHU and then spilled over to the acute care hospital (ACH). Methods University of Maryland Harford Memorial Hospital is a 95-bed ACH with a 14-bed closed-door adult BHU located on the fifth floor. Two cases each of hospital-acquired influenza were identified in our BHU during 2016 and 2017. In January 2018, however, hospital-acquired influenza cases in the BHU spilled over to the adjacent ACH to cause an outbreak. A case was defined as a patient with fever of >100.4°F, presence of influenza-like illness, and a positive influenza test >72 hours after admission. Outbreak control measures included twice daily fever screening, enhanced droplet precautions, visitor restrictions, discontinuing community activities, enforcing hand hygiene at all hospital entrances, and hospital-wide chemoprophylaxis with oseltamivir. Results On January 15, 2018, the index patient developed influenza in the BHU followed by a second case in BHU 4-days later. Over the next 10 days, five more patients on the third and fourth floors of ACH tested positive. Attack rate was 3% and average length of stay was 8.9 days. Chemoprophylaxis with oseltamivir 75 mg orally once a day was given to 71% of all eligible hospitalized patients for a week (at a cost of $17,000). All seven patients yielded influenza A, subtype H3N2 and were successfully treated with oseltamivir 75 mg orally twice a day for 7 days. The outbreak lasted 11 days. Figure 1 shows the epidemiologic curve. Conclusion Special attention should be paid to influenza prevention in the BHUs due to the risk of spillover effect to sicker patients in the adjacent ACH. A short, 7-day course of hospital-wide oseltamivir chemoprophylaxis, in addition to promptly implementing the infection prevention measures was effective in controlling the outbreak. Disclosures All authors: No reported disclosures.

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Patient Recommendations to Improve the Implementation of and Engagement With Portals in Acute Care: Hospital-Based Qualitative Study

Journal of Medical Internet Research ◽

10.2196/13337 ◽

2020 ◽

Vol 22 (1) ◽

pp. e13337 ◽

Cited By ~ 1

Author(s):

S Ryan Greysen ◽

Yimdriuska Magan ◽

Jamie Rosenthal ◽

Ronald Jacolbia ◽

Andrew D Auerbach ◽

...

Keyword(s):

Acute Care ◽

Qualitative Data ◽

Average Length ◽

Acute Care Hospital ◽

Outpatient Setting ◽

Bring Your Own Device ◽

Inpatient Setting ◽

Successful Implementation ◽

Care Hospital ◽

Patient Portals

Background The inclusion of patient portals into electronic health records in the inpatient setting lags behind progress in the outpatient setting. Objective The aim of this study was to understand patient perceptions of using a portal during an episode of acute care and explore patient-perceived barriers and facilitators to portal use during hospitalization. Methods We utilized a mixed methods approach to explore patient experiences in using the portal during hospitalization. All patients received a tablet with a brief tutorial, pre- and postuse surveys, and completed in-person semistructured interviews. Qualitative data were coded using thematic analysis to iteratively develop 18 codes that were integrated into 3 themes framed as patient recommendations to hospitals to improve engagement with the portal during acute care. Themes from these qualitative data guided our approach to the analysis of quantitative data. Results We enrolled 97 participants: 53 (53/97, 55%) women, 44 (44/97, 45%) nonwhite with an average age of 48 years (19-81 years), and the average length of hospitalization was 6.4 days. A total of 47 participants (47/97, 48%) had an active portal account, 59 participants (59/97, 61%) owned a smartphone, and 79 participants (79/97, 81%) accessed the internet daily. In total, 3 overarching themes emerged from the qualitative analysis of interviews with these patients during their hospital stay: (1) hospitals should provide both access to a device and bring-your-own-device platform to access the portal; (2) hospitals should provide an orientation both on how to use the device and how to use the portal; and (3) hospitals should ensure portal content is up to date and easy to understand. Conclusions Patients independently and consistently identified basic needs for device and portal access, education, and usability. Hospitals should prioritize these areas to enable successful implementation of inpatient portals to promote greater patient engagement during acute care. Trial Registration ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT01970852

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Four Years of Surveillance Cultures at a Long-Term Acute Care Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/649226 ◽

2010 ◽

Vol 31 (1) ◽

pp. 59-63 ◽

Cited By ~ 14

Author(s):

L. Silvia Munoz-Price ◽

Alexander Sterner

Keyword(s):

Acute Care ◽

Rectal Swab ◽

Acute Care Hospital ◽

Multidrug Resistant ◽

Care Hospital ◽

Surveillance Cultures ◽

Vancomycin Resistant ◽

Culture Positive ◽

Control Initiative

Objective.To characterize the degree of colonization with multidrug-resistant organisms (MDROs) among patients admitted to a long-term acute care hospital.Design.Ecologie Study.Setting.A 70-bed long-term acute care hospital (a hospital within a hospital) in the greater Chicago area.Methods.As part of an infection control initiative, specimens were collected from all consecutively admitted patients for culture of MDROs within 72 hours of admission. Cultures from July 28, 2005, through November 1, 2008, were analyzed on the basis of the bodily site from which the isolate was recovered and the organisms identified. If MDROs were yielded by culture of specimens that were obtained from 24 hours to 30 days after collection of the patient's original set of specimens, these MDROs were removed from the analysis. In addition, repeat rectal swab samples were collected for culture at 2 weeks after admission for all consecutive patients admitted from January 1 through March 31, 2007.Results.A total of 1,739 patients with a total of 5,198 specimens met entry criteria. Of the corresponding 5,198 surveillance cultures, 1,580 (30%) were positive for MDROs. Of the 1,739 patients, 947 (54%) had a culture-positive specimen recovered from any site. Vancomycin-resistant Enterococcus was the organism most commonly isolated in cultures of rectal swab samples (in 38% of such cultures) and wounds (in 18% of such cultures). The rate of rectal carriage of vancomycin-resistant Enterococcus increased from 29% in 2005 to 44% in 2008.

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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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Length of stay patterns for patients of an acute care hospital: implications for nutrition and food services

Australian Health Review ◽

10.1071/ah070282 ◽

2007 ◽

Vol 31 (2) ◽

pp. 282 ◽

Cited By ~ 10

Author(s):

Angela P Vivanti ◽

Merrilyn D Banks

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Average Length ◽

Acute Care Hospital ◽

Tertiary Hospital ◽

Service Planning ◽

Care Hospital ◽

Large Patient ◽

Increased Risk ◽

Time Periods

Objective: Shortened hospital average length of stay (ALOS) has been used to justify rationalisation of some services, but, by definition, some patients stay for longer than the average. The objective of this study was to explore lengths of stay and proportions of hospital occupied bed-days (OBDs) of those admitted for longer time periods to inform service planning. Methods: The proportion and ALOS of overnight separations at an Australian tertiary hospital were assessed for admissions of up to 4 days and 4 days or more. This was repeated for 7, 14 and 28 days. The proportion of OBD?s for each time period was determined. Results: While the proportion of total hospital patients staying for 4, 7, 14 and 28 days or more is relatively small (21.9%, 13.5%, 6.2%, 2.6%, respectively), they represent a large proportion of OBD?s (74.9%, 67.2%, 50.8%, 34.2%) with an ALOS of 14.0, 20.3, 33.7, and 54.4 days, respectively. The majority of long-stay patients were in acute care. Conclusion: Substantial proportions of OBD?s are due to patients admitted for time periods far greater than reflected by ALOS. Hospitals need to rethink how to optimally accommodate the nutrition and food requirements of the large patient numbers admitted for longer time periods, many of whom are at increased risk of malnutrition.

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