1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

Background The 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol. Methods This was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay. Results A total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups. Conclusion An educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results. Disclosures All Authors: No reported disclosures

Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children

Blood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures. Efforts are needed to improve decision making at the time that acquisition of blood cultures is under consideration and promote percutaneous blood draws over indwelling lines.

Hotel Industry – Requirements for Hotel Business Managers’ Participatory Culture Acquisition

The paper aims at viewing meeting the requirements of hotel business managers functioning and training. As their successful employment and functions performing largely depends on participatory culture acquisition, the paper addresses the research questions: what groups of skills hotel business managers’ participatory professional skills (PPS) consist of; what activities might be used to teach PPS to future hotel business managers; what is the activities’ impact on teaching PPS to future hotel business managers. Case study and pedagogical experiment (the pretest-post-test control and experimental group design) have been applied in the research. Data have been gathered through conversational interviewing. Data source triangulation has been implemented to prove the validity of conversational interviewing questions. The research results in enlisting profession skills as the core of participatory culture. The traditions of the higher school and the requirements of partners participating in future hotel business managers training have been taken into consideration to teach PPS to future hotel business managers. The paper presents the results of testing the impact of the suggested activities program on the level of PPS. Statistical data processing is performed in the MS Excel 2010 environment using the chi-square test with a sample size (n ≥ 100). It shows that the program of activities meets the requirements to the future hotel business managers’ participatory culture acquisition.

A Cultural Trans-generational Process on Low-Carbon Society in Family with Parents with Different First Language: Indonesian and Javanese

Building low-carbon society must be promoted from the earliest stage in life. This article aims at elaborating how to do it to a very small baby. This is done to a family whose parents with different first language. The problem is that how the parents can be successful in transfering the values since they have different first language namely Indonesian and Javanese. What language is exposed to the child will be another problem. Obervation and interview supported by note-taking technique were used to collect the data. Referential and inferential methods were used to analyze them. The result indicates that language or culture comprehension happens in the first six months, then the production occurs in the second six months. Indonesian is exposed to the child. This is supported by the parents' policy supporting the strategy to raise the status and function of Indonesian. It is used for transfering the values of minimizing the use of carbon in life to support living environmentally healty through developing children's vocabulary or speech. This study focuses on the child at the age of 0 to 1 year as the beginning of language and culture acquisition.