Epidemiology Surveillance and Capacity Improvement: A Characterization of Texas, 2017

Objectives: In response to increasing caseloads of foodborne illnesses and high consequence infectious disease investigations, the Texas Department of State Health Services (DSHS) requested funding from the Texas Legislature in 2013 and 2015 for a new state-funded epidemiologist (SFE) program. Methods: Primary cross-sectional survey data were collected from 32 of 40 local health departments (LHDs) via an online instrument and analyzed to quantify roles, responsibilities, and training of epidemiologists in Texas in 2017 and compared to similar state health department assessments. Results: Sixty-six percent of SFEs had epidemiology-specific training (eg, master’s in public health) compared to 45% in state health department estimates. For LHDs included in this study, the mean number of epidemiologists per 100 000 was 0.73 in medium LHDs and 0.46 in large LHDs. SFE positions make up approximately 40% of the LHD epidemiology workforce of all sizes and 56% of medium-sized LHD epidemiology staff in Texas specifically. Conclusions: Through this program, DSHS increased epidemiology capacity almost twofold from 0.28 to 0.47 epidemiologists per 100 000 people. These findings suggest that capacity funding programs like this improve epidemiology capacity in local jurisdictions and should be considered in other regions to improve general public health preparedness and epidemiology capacity.

The Relationships Between State Health Department Practitioners’ Perceptions of Organizational Supports and Evidence-Based Decision-Making Skills

Objectives Evidence-based decision making (EBDM) allows public health practitioners to implement effective programs and policies fitting the preferences of their communities. To engage in EBDM, practitioners must have skills themselves, their agencies must engage in administrative evidence-based practices (A-EBPs), and leaders must encourage the use of EBDM. We conducted this longitudinal study to quantify perceptions of individual EBDM skills and A-EBPs, as well as the longitudinal associations between the 2. Methods An online survey completed among US state health department practitioners in 2016 and 2018 assessed perceptions of respondents’ skills in EBDM and A-EBPs. We used χ2 tests, t tests, and linear regressions to quantify changes over time, differences by demographic characteristics, and longitudinal associations between individual skills and A-EBPs among respondents who completed both surveys (N = 336). Results Means of most individual EBDM skills and A-EBPs did not change significantly from 2016 to 2018. We found significant positive associations between changes in A-EBPs and changes in EBDM skill gaps: for example, a 1-point increase in the relationships and partnerships score was associated with a narrowing of the EBDM skill gap (β estimate = 0.38; 95% CI, 0.15-0.61). At both time points, perceived skills and A-EBPs related to financial practices were low. Conclusions Findings from this study can guide the development and dissemination of initiatives designed to simultaneously improve individual and organizational capacity for EBDM in public health settings. Future studies should focus on types of strategies most effective to build capacity in particular types of agencies and practitioners, to ultimately improve public health practice.

965. Partnering with State Health Departments: A Road Map for Collaboration Using Public Health Enhanced HIV/AIDS Reporting System (eHARS)

Background Academic and public health partnerships are a critical component of the Ending the HIV Epidemic: A Plan for America (EHE). The Enhanced HIV/AIDS Reporting System (eHARS) is a standardized document-based surveillance database used by state health departments to collect and manage case reports, lab reports, and other documentation on persons living with HIV. Innovative analysis of this data can inform targeted, evidence-based interventions to achieve EHE objectives. We describe the development of a distributed data network strategy at an academic institution in partnership with public health departments to identify geographic differences in time to HIV viral suppression after HIV diagnosis using eHARS data. Figure 1. Distributed Data Network Methods This project was an outgrowth of work developed at the University of Alabama at Birmingham Center for AIDS Research (UAB CFAR) and existing relationships with the state health departments of Alabama, Louisiana, and Mississippi. At a project start-up meeting which included study investigators and state epidemiologists, core objectives and outcome measures were established, key eHARS variables were identified, and regulatory and confidentiality procedures were examined. The study methods were approved by the UAB Institutional Review Board (IRB) and all three state health department IRBs. Results A common data structure and data dictionary across the three states were developed. Detailed analysis protocols and statistical code were developed by investigators in collaboration with state health departments. Over the course of multiple in-person and virtual meetings, the program code was successfully piloted with one state health department. This generated initial summary statistics, including measures of central tendency, dispersion, and preliminary survival analysis. Conclusion We developed a successful academic and public health partnership creating a distributed data network that allows for innovative research using eHARS surveillance data while protecting sensitive health information. Next, state health departments will transmit summary statistics to UAB for combination using meta-analytic techniques. This approach can be adapted to inform delivery of targeted interventions at a regional and national level. Disclosures All Authors: No reported disclosures

Implementing Admission Screening for Candida auris

Background:Candida auris is a globally emerging, multidrug-resistant fungal pathogen that causes serious, difficult-to-treat infections in hospitalized patients. C. auris cases in the United States have been linked to receipt of healthcare overseas. Outbreaks have also occurred in New York City, New Jersey, Chicago, and most recently in California. We provide care to patients from all 50 states and 138 countries; therefore, we are at risk for encountering C. auris in our facility. Setting: An academic, tertiary-care center with 1,297 licensed beds and >62,000 admissions each year. Methods: Infection prevention and control (IPAC) initiated a C. auris screening program in August 2019 in partnership with the State Health Department. A case-finding tool was created to identify adult patients admitted in the previous 24 hours from countries and areas of the United States (Chicago, New Jersey, and New York metropolitan areas) with known C. auris transmission based on the zip code of their primary address. IPAC sends an electronic communication via the electronic medical record (EMR) alerting the patient care team that the patient meets criteria for screening along with information on C. auris and links to a tool kit with additional resources to help answer questions. After obtaining verbal consent, the patient’s primary nurse collects a composite axilla–groin skin swab using a nylon-flocked swab (BD ESwab collection and transport system; Becton Dickinson, Sparks, MD). The sample is sent to the State Health Department laboratory for testing by polymerase chain reaction (PCR). Results are communicated back to IPAC and then scanned into the patient’s EMR. Results: From August 2019 to November 2019, 157 patients were identified for C. auris screening using the case-finding tool. Testing was performed on 95 patients; all tests were negative. The primary reasons for testing not to be performed on eligible patients were inability to obtain verbal consent and patient dismissal before sample could be obtained. The need for a special swab that is not routinely stocked on patient care units has been a limitation to timely specimen collection. Conclusions: The EMR can be leveraged for early identification and screening of patients at risk of C. auris colonization. Case finding tools can be effectively replicated and modified to respond to emerging infections and changing surveillance guidelines.Funding: NoneDisclosures: None

Health Department Authorities to Assist Healthcare Facilities with Outbreaks or High HAI Rates—Preliminary Assessment, 2018

Background: Health departments have been increasingly called upon to monitor healthcare associated-infections (HAIs) at the hospital- or facility-level and provide targeted assistance when high rates are identified. Health department capacity to effectively respond to these types of signals depends not only on technical expertise but also the legal and regulatory authority to intervene. Methods: We reviewed annual reports describing HAI and antibiotic resistance (HAI/AR) activities from CDC-funded HAI/AR programs for August 2017 through July 2018. We performed a qualitative data analysis on all 50 state health department responses to a question about their regulatory and legal authority to intervene or assist facilities without invitation when outbreaks are suspected (as determined by the health department) or high HAI rates have been identified (eg, based on NHSN data). Results: When an outbreak is identified, 31 health departments (62%) indicated that they have the authority to intervene without invitation from a facility and 8 (16%) did not specify. Among the 11 health departments (22%) that indicated that they do not have this authority, 5 (45%) states noted that they operate under decentralized systems in which the local health department can intervene in outbreak situations and the state health department is available to assist. When a health department identifies high HAI rates, 14 health departments (28%) indicated that they have the authority to intervene without invitation, 22 (44%) indicated that they do not, and 14 (28%) did not specify. Among those in the latter categories, 3 stated they can work through their local health departments, which do have this authority and 8 described working through partners (eg, State Hospital Association, n = 3 or State Healthcare Licensing Agency, n = 5). Discussion: Assistance from state health departments (eg, HAI/AR programs) in the context of outbreaks and high HAI rates has value that is usually well recognized and welcomed by healthcare facilities. Nonetheless, there are occasions when a health department might need to exert its authority to intervene. The preliminary analysis described here indicated that this authority was more commonly self-reported in the context of outbreaks than when high HAI rates are identified. These 2 situations are connected, as high rates might be indicative of unrecognized or unreported outbreak activity, and these issues may benefit from further analysis.Funding: NoneDisclosures: None