Assessing Antibiotic Stewardship Program (ASP) Implementation: Psychometric Properties of Survey measures based on the Consolidated Framework for Implementation Research (CFIR)

Abstract Background: Antibiotic stewardship programs (ASPs) are crucial to prevent the emergence of antibiotic resistance and to improve outcomes for patients. Few measurement instruments examine ASP implementation. A validated instrument rooted in implementation science theory will increase our understanding of ASP implementation and enable comparisons across studies. Methods: We used the Consolidated Framework for Implementation Research (CFIR) to guide development of ASP implementation measures. Survey questions were developed by infectious disease and survey design experts to assess 22 potential determinants of implementation across five domains of the CFIR. Survey items were reviewed by CFIR experts for face and content validity. Antibiotic stewards (infectious disease pharmacists and physicians) were recruited from 154 Veterans Affairs (VA) hospital and Intermountain Healthcare (IH) sites to complete the survey. Survey responses were aggregated by site, and results were determined at the site level. We conducted confirmatory factor analyses (CFA) to assess structural validity of measures and evaluated inter-item consistency. Results: A total of 182 stewards completed the survey (155 VA and 27 IH responses). At least one response was obtained from 126 hospitals (81.8%). CFAs for most CFIR constructs exhibited good fit (CFI > .90; TLI > .90; RMSEA< .05, SRMR < .08). Scale reliabilities ranged from .54-.96 indicating low to strong inter-item consistency. Determinants that were rated highly present at the sites (across site means ³ 4.0 or above) included Self-Efficacy, Engaging, Evidence Strength and Quality and Relative Advantage, indicating stewards found ASP evidence compelling and felt their personal involvement was effective in engendering positive results for the ASP. Conclusions: Psychometric properties measured via CFA indicate validity of our CFIR-based measure of determinants for ASP implementation outcomes. This is the first validated set of measures based on the CFIR for ASP implementation and the first to include measures for 4 out of five CFIR domains. These validated measures will help to provide much needed understanding of barriers and facilitators of ASP implementation. Research and quality improvement teams can use these measures to identify contextual determinants of ASP implementation and use this information to guide selection of strategies and compare results across multiple studies.

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Psychometric Properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C)

European Journal of Psychological Assessment ◽

10.1027/1015-5759/a000090 ◽

2012 ◽

Vol 28 (1) ◽

pp. 51-59 ◽

Cited By ~ 9

Author(s):

Anna Ogliari ◽

Simona Scaini ◽

Michael J. Kofler ◽

Valentina Lampis ◽

Annalisa Zanoni ◽

...

Keyword(s):

General Population ◽

Social Phobia ◽

Psychometric Properties ◽

Emotional Disorders ◽

Child Anxiety ◽

Self Report ◽

Public Performance ◽

Confirmatory Factor Analyses ◽

The Social ◽

General Populations

Reliable and valid self-report questionnaires could be useful as initial screening instruments for social phobia in both clinical settings and general populations. The present study investigates the factor structure and psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C) in a sample of 228 children from the Italian general population aged 8 to 11. The children were asked to complete the Italian version of the SPAI-C and the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire. Confirmatory factor analyses revealed that social phobia can be conceptualized as a unitary construct consisting of five distinct but interrelated symptom clusters named Assertiveness, General Conversation, Physical/Cognitive Symptoms, Avoidance, and Public Performance. Internal consistency of the SPAI-C total scores and two subscales was good; correlations between SPAI-C total scores and SCARED total scores/subscales ranged from moderate to high (Generalized Anxiety Disorder, for social phobia), with the SCARED Social Phobia subscale as the best predictor of SPAI-C total scores. The results indicate that the SPAI-C is a reliable and sensitive instrument suitable for identifying Social Phobia in the young Italian general population.

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Nutritional Status Measurement Instruments for Diabetes: A Systematic Psychometric Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165719 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5719

Author(s):

Pedro Montagut-Martínez ◽

David Pérez-Cruzado ◽

José Joaquín García-Arenas

Keyword(s):

Nutritional Status ◽

Dietary Intake ◽

Psychometric Properties ◽

Premature Death ◽

Diabetes Mellitus Type 1 ◽

Measurement Properties ◽

Cochrane Library ◽

Individual Treatment ◽

Measurement Instruments ◽

Increased Risk

Background: Diabetes is a serious chronic disease associated with a large number of complications and an increased risk of premature death. A dietary evaluation is of utmost importance for health promotion, disease prevention and individual treatment plans in patients with diabetes. Methods: An exhaustive search was carried out in various databases—Medline, Web of Science, Open Gray Cochrane Library and Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN)—for systematic review of the measurement properties of instruments that evaluate the dietary intake of people with diabetes mellitus type 1 and/or 2 according to COSMIN standards. Results: Seven instruments were identified. There was no instrument measuring nutritional status for which all the psychometric properties were evaluated. The methodological quality for each of the psychometric properties evaluated was ‘inadequate’ or ‘doubtful’ for all instruments. The Food Frequency Questionnaire (FFQ) evaluated the most psychometric characteristics and with a better score in terms of quality of the evidence. Conclusions: Several instruments have been developed for the evaluation of dietary intake in people with diabetes. Evaluation of this construct is very useful, both in clinical practice and in research, requiring new knowledge in this area. The FFQ is the best instrument available to assess dietary intake in people with diabetes.

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Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates

Scientific Reports ◽

10.1038/s41598-020-80219-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hessa Saleh Alshehhi ◽

Areeg Anwer Ali ◽

Duaa Salem Jawhar ◽

Essam Mahran Aly ◽

Srinivas Swamy ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

United Arab Emirates ◽

Antibiotic Stewardship ◽

Secondary Care ◽

Care Hospital ◽

Surgical Prophylaxis ◽

Patient Profile ◽

Stewardship Program ◽

Prescribing Practice ◽

Surgical Antibiotic Prophylaxis

AbstractAntibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

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Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00913-y ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Bongyoung Kim ◽

◽

Myung Jin Lee ◽

Se Yoon Park ◽

Song Mi Moon ◽

...

Keyword(s):

Antibiotic Therapy ◽

Quality Indicators ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Republic Of Korea ◽

Cochrane Library ◽

Surgical Prophylaxis ◽

Modified Delphi ◽

Stewardship Program ◽

The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

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Determining the influence of intervention characteristics on implementation success requires reliable and valid measures: Results from a systematic review

Implementation Research and Practice ◽

10.1177/2633489521994197 ◽

2021 ◽

Vol 2 ◽

pp. 263348952199419

Author(s):

Cara C Lewis ◽

Kayne Mettert ◽

Aaron R Lyon

Keyword(s):

Systematic Review ◽

Psychometric Properties ◽

Systematic Reviews ◽

Quality Measures ◽

Measure Development ◽

Relative Advantage ◽

Design Quality ◽

High Quality ◽

Evidence Strength

Background: Despite their inclusion in Rogers’ seminal diffusion of innovations theory, few implementation studies empirically evaluate the role of intervention characteristics. Now, with growing evidence on the role of adaptation in implementation, high-quality measures of characteristics such as adaptability, trialability, and complexity are needed. Only two systematic reviews of implementation measures captured those related to the intervention or innovation and their assessment of psychometric properties was limited. This manuscript reports on the results of eight systematic reviews of measures of intervention characteristics with nuanced data regarding a broad range of psychometric properties. Methods: The systematic review proceeded in three phases. Phase I, data collection, involved search string generation, title and abstract screening, full text review, construct assignment, and citation searches. Phase II, data extraction, involved coding psychometric information. Phase III, data analysis, involved two trained specialists independently rating each measure using PAPERS (Psychometric And Pragmatic Evidence Rating Scales). Results: Searches identified 16 measures or scales: zero for intervention source, one for evidence strength and quality, nine for relative advantage, five for adaptability, six for trialability, nine for complexity, and two for design quality and packaging. Information about internal consistency and norms was available for most measures, whereas information about other psychometric properties was most often not available. Ratings for psychometric properties fell in the range of “poor” to “good.” Conclusion: The results of this review confirm that few implementation scholars are examining the role of intervention characteristics in behavioral health studies. Significant work is needed to both develop new measures (e.g., for intervention source) and build psychometric evidence for existing measures in this forgotten domain. Plain Language Summary Intervention characteristics have long been perceived as critical factors that directly influence the rate of adopting an innovation. It remains unclear the extent to which intervention characteristics including relative advantage, complexity, trialability, intervention source, design quality and packaging, evidence strength and quality, adaptability, and cost impact implementation of evidence-based practices in behavioral health settings. To unpack the differential influence of these factors, high quality measures are needed. Systematic reviews can identify measures and synthesize the data regarding their quality to identify gaps in the field and inform measure development and testing efforts. Two previous reviews identified measures of intervention characteristics, but they did not provide information about the extent of the existing evidence nor did they evaluate the host of evidence available for identified measures. This manuscript summarizes the results of nine systematic reviews (i.e., one for each of the factors listed above) for which 16 unique measures or scales were identified. The nuanced findings will help direct measure development work in this forgotten domain.

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Pharmacist-Driven Antibiotic Stewardship Program in Febrile Neutropenic Patients: A Single Site Prospective Study in Thailand

Antibiotics ◽

10.3390/antibiotics10040456 ◽

2021 ◽

Vol 10 (4) ◽

pp. 456

Author(s):

Kittiya Jantarathaneewat ◽

Anucha Apisarnthanarak ◽

Wasithep Limvorapitak ◽

David J. Weber ◽

Preecha Montakantikul

Keyword(s):

Infectious Diseases ◽

Antibiotic Stewardship ◽

Empirical Therapy ◽

University Hospital ◽

Control Group ◽

Great Opportunity ◽

Stewardship Program ◽

Determine Role ◽

Neutropenic Patients ◽

Infectious Diseases Consultation

The antibiotic stewardship program (ASP) is a necessary part of febrile neutropenia (FN) treatment. Pharmacist-driven ASP is one of the meaningful approaches to improve the appropriateness of antibiotic usage. Our study aimed to determine role of the pharmacist in ASPs for FN patients. We prospectively studied at Thammasat University Hospital between August 2019 and April 2020. Our primary outcome was to compare the appropriate use of target antibiotics between the pharmacist-driven ASP group and the control group. The results showed 90 FN events in 66 patients. The choice of an appropriate antibiotic was significantly higher in the pharmacist-driven ASP group than the control group (88.9% vs. 51.1%, p < 0.001). Furthermore, there was greater appropriateness of the dosage regimen chosen as empirical therapy in the pharmacist-driven ASP group than in the control group (97.8% vs. 88.7%, p = 0.049) and proper duration of target antibiotics in documentation therapy (91.1% vs. 75.6%, p = 0.039). The multivariate analysis showed a pharmacist-driven ASP and infectious diseases consultation had a favorable impact on 30-day infectious diseases-related mortality in chemotherapy-induced FN patients (OR 0.058, 95%CI:0.005–0.655, p = 0.021). Our study demonstrated that pharmacist-driven ASPs could be a great opportunity to improve antibiotic appropriateness in FN patients.

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Measures of organizational culture, organizational climate, and implementation climate in behavioral health: A systematic review

Implementation Research and Practice ◽

10.1177/26334895211018862 ◽

2021 ◽

Vol 2 ◽

pp. 263348952110188

Author(s):

Byron J Powell ◽

Kayne D Mettert ◽

Caitlin N Dorsey ◽

Bryan J Weiner ◽

Cameo F Stanick ◽

...

Keyword(s):

Organizational Culture ◽

Organizational Climate ◽

Psychometric Properties ◽

Behavioral Health ◽

Implementation Research ◽

Learning Climate ◽

Evidence Based ◽

Implementation Climate ◽

Relative Priority ◽

Evidence Based Practices

Background: Organizational culture, organizational climate, and implementation climate are key organizational constructs that influence the implementation of evidence-based practices. However, there has been little systematic investigation of the availability of psychometrically strong measures that can be used to assess these constructs in behavioral health. This systematic review identified and assessed the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs as defined by the Consolidated Framework for Implementation Research (CFIR) and Ehrhart and colleagues. Methods: Data collection involved search string generation, title and abstract screening, full-text review, construct assignment, and citation searches for all known empirical uses. Data relevant to nine psychometric criteria from the Psychometric and Pragmatic Evidence Rating Scale (PAPERS) were extracted: internal consistency, convergent validity, discriminant validity, known-groups validity, predictive validity, concurrent validity, structural validity, responsiveness, and norms. Extracted data for each criterion were rated on a scale from −1 (“poor”) to 4 (“excellent”), and each measure was assigned a total score (highest possible score = 36) that formed the basis for head-to-head comparisons of measures for each focal construct. Results: We identified full measures or relevant subscales of broader measures for organizational culture ( n = 21), organizational climate ( n = 36), implementation climate ( n = 2), tension for change ( n = 2), compatibility ( n = 6), relative priority ( n = 2), organizational incentives and rewards ( n = 3), goals and feedback ( n = 3), and learning climate ( n = 2). Psychometric evidence was most frequently available for internal consistency and norms. Information about other psychometric properties was less available. Median ratings for psychometric properties across categories of measures ranged from “poor” to “good.” There was limited evidence of responsiveness or predictive validity. Conclusion: While several promising measures were identified, the overall state of measurement related to these constructs is poor. To enhance understanding of how these constructs influence implementation research and practice, measures that are sensitive to change and predictive of key implementation and clinical outcomes are required. There is a need for further testing of the most promising measures, and ample opportunity to develop additional psychometrically strong measures of these important constructs. Plain Language Summary Organizational culture, organizational climate, and implementation climate can play a critical role in facilitating or impeding the successful implementation and sustainment of evidence-based practices. Advancing our understanding of how these contextual factors independently or collectively influence implementation and clinical outcomes requires measures that are reliable and valid. Previous systematic reviews identified measures of organizational factors that influence implementation, but none focused explicitly on behavioral health; focused solely on organizational culture, organizational climate, and implementation climate; or assessed the evidence base of all known uses of a measure within a given area, such as behavioral health–focused implementation efforts. The purpose of this study was to identify and assess the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs that have been used in behavioral health-focused implementation research. We identified 21 measures of organizational culture, 36 measures of organizational climate, 2 measures of implementation climate, 2 measures of tension for change, 6 measures of compatibility, 2 measures of relative priority, 3 measures of organizational incentives and rewards, 3 measures of goals and feedback, and 2 measures of learning climate. Some promising measures were identified; however, the overall state of measurement across these constructs is poor. This review highlights specific areas for improvement and suggests the need to rigorously evaluate existing measures and develop new measures.

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Antibiotic Stewardship for Nursing: Can E-learning Be a First Step?

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.625 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s118-s118

Author(s):

Mary T. Catanzaro

Keyword(s):

Infectious Disease ◽

Antimicrobial Stewardship ◽

Antibiotic Stewardship ◽

Online Survey ◽

Interdisciplinary Approach ◽

Healthcare Team ◽

Learning Modules ◽

E Learning ◽

Unit Culture ◽

Infection Preventionists

Background: The CDC and The Joint Commission have called for an interdisciplinary approach to antibiotic stewardship implementation. The healthcare team should consist of infectious disease physicians, pharmacists, infectious disease pharmacists, infection preventionists, microbiologists, and nurses. The scant literature to date has looked at nurses’ attitudes and beliefs toward participating in antibiotic stewardship and have identified several factors that contribute to the lack of uptake by nurses: lack of education around stewardship, poor communication among healthcare providers, and hospital or unit culture, among others. Additionally, nurses’ lack of interest in what would be more work or not within their scope of work was put forth as an additional factor by infection preventionists and pharmacists as a barrier to implementation. Method: An investigator-developed online survey was used to assess the usefulness of 3 investigator-developed educational e-learning modules that encompassed the role of nurses in antibiotic stewardship, pharmacy and laboratory topics related to antimicrobial stewardship, as well as the nurses’ attitudes toward their participation in such activities. Results: Participants took the survey after review of the 3 e-learning modules. The results indicate that, contrary to what pharmacists and infection preventionists thought, 82% of nurses felt they should contribute to and be part of the antimicrobial stewardship team. Additionally, after completing the modules, 73% felt more empowered to participate in stewardship discussions with an additional 23% wanting more education. 100% felt that they learned information that they could utilize in their everyday work. Barriers to implementation of stewardship activities on their unit included lack of education (41%), hospital or unit culture (27%), with only 4% citing they did not feel it was their job or that they had anything to contribute to a discussion. Also, 24% felt that there were no obstacles to participation. Conclusions: Surprisingly, most nurses who took this educational series and survey felt that they should be part of the antibiotic stewardship team. As cited previously from the literature, education and culture need to be addressed to overcome the nurses’ barriers to stewardship involvement. E-learning can provide an easy first step to educating nurses when time permits and can provide a good springboard for discussion on the units and with physicians and pharmacists. For a copy of the modules, please contact the author.Funding: NoneDisclosures: None

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Validation and psychometric properties of the Indonesian version of the Fear of Missing Out Scale in adolescents

Psicologia: Reflexão e Crítica ◽

10.1186/s41155-021-00181-0 ◽

2021 ◽

Vol 34 (1) ◽

Author(s):

Dian Veronika Sakti Kaloeti ◽

Ayu Kurnia S ◽

Valentino Marcel Tahamata

Keyword(s):

Psychometric Properties ◽

General Health ◽

Goodness Of Fit ◽

Online Survey ◽

General Health Questionnaire ◽

Factor Analyses ◽

Confirmatory Factor Analyses ◽

Fear Of Missing Out ◽

Confirmatory Factor ◽

Fit Index

Abstract Background This study’s main purpose was to examine the psychometric properties of FoMOs’ adaptation among the Indonesian adolescents’ population. The second aim was to investigate the concurrent validity of the Indonesian version to provide evidence for the validity. Also, FoMOs’ difference level between demographic variance analyses was performed. Method The study involved a cross-sectional online survey design with 638 Indonesian adolescents aged 16–24 (M = 19.08, SD = 14.70). FoMO was measured by a 16-item that has been modified from the original 10-item. Exploratory and confirmatory factor analyses were carried out to study its scores’ evidence of structural validity. Besides, to study its scores’ evidence of convergent, discriminant, and predictive validity concerning other variables such as stress, anxiety, and depression (Depression and Anxiety Stress Scale-21), and general health condition (General Health Questionnaire Scale-12), correlation analyses were conducted. To study the sensitivity, we assessed the effect of sociodemographic and social media use on the scale’s ability to identify the population’s risk to the FoMO by conducting analyses of variance. The Cronbach alpha values (α = .93) indicated that internal consistency of the scale was at an adequate level. Results Exploratory factorial analyses revealed adequate adjustment for the new version of the scale showing the three factorial structures. Confirmatory factor analyses showed that the 12-item of Indonesian FoMO had a good fit (χ2/df = 289.324/51; goodness-of-fit index (GFI) = 0.928; RMSEA = 0.086; comparative fit index (CFI) = 0.915; normed fit index (NFI) = 0.899; parsimony normed fit index (PNFI) = .695; Tucker–Lewis index (TLI) = 0.890). Conclusion This study has shown that the modified 12-item Fear of Missing Out Scale is a valid and reliable instrument for Indonesian adolescents. It showed that the Indonesian version of Fear of Missing Out Scale has adequate psychometric properties to measure Indonesian adolescents’ online behavior.

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Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.742 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s199-s200

Author(s):

Matthew Linam ◽

Dorian Hoskins ◽

Preeti Jaggi ◽

Mark Gonzalez ◽

Renee Watson ◽

...

Keyword(s):

Hand Hygiene ◽

Antibiotic Stewardship ◽

Infection Prevention ◽

Tertiary Care ◽

Bloodstream Infections ◽

Central Line ◽

Contact Precautions ◽

Stewardship Program ◽

Tract Infections ◽

The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

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