181. Potential Benefit of Masking and other COVID-19 Infection Prevention Measures on Late-Onset Infections in the NICU

Background Incidence of blood stream infections (BSI) among NICU admissions remains high, with associated mortality and morbidity. Due to COVID-19, there are increased infection prevention (IP) measures in NICUs including universal masking for all healthcare workers and families, social distancing, visitation restrictions, and increased attention to hand hygiene. These measures may also affect late-onset infection rates and offer understanding of novel interventions for prevention. Methods We examined infection rates during the 24 months prior to implementation of COVID-19 IP measures (PRE-period) compared to the months after implementation from April 2020 (POST-period). Late-onset infections were defined as culture-confirmed infection of the blood, urine, or identification of respiratory viral pathogens. An interrupted time series analysis of infection per 1000 patient days was performed based on a change-point Poisson regression with a lagged dependent variable and the number of patient days used as offsets. Each month was treated as independent with additional analysis using an observation-driven model to account for serial dependence. Results Multicenter analysis to date included all infants cared for at three centers (Level 3 and 4) from 2018-2020. Monthly BSI rates decreased in the POST-period at the three centers (Figure 1). At all centers actual BSI rate was lower than the expected rate in the POST-period (Figure 2). The combined BSI rate per 1000 patient days was 41% lower compared to the rate prior to implementation (95% CI, 0.42 to 0.84, P=0.004) (Table 1). In subgroup analysis by birthweight, infants< 1000g had a 39% reduction in BSI (P=0.023), for1000-1500g patients there was a 44% reduction (P=0.292) and in those > 1500g there was a 53% reduction (0.083). Figure 1. PRE and POST MASKING and other COVID Infection Prevention Measures and Monthly BSI Rates. Figure 2. PRE and POST MASKING and other COVID infection prevention measures and BSI Trends. At all centers actual BSI rate was lower than the expected rate for that center in the POST period. UVA and Duke showed a baseline decrease and Pennsylvania Hospital showed a downward trend in infection rates. There was an approximate decrease in expected bloodstream infection events at Pennsylvania Hospital by 7 events, at UVA by 22 events and at Duke by 23 events. Overall, all three centers saw a decrease in their expected infections after COVID-19 infection prevention measures were implemented. Table 1. Percent reduction in Bloodstream Infection at each center. Conclusion In this preliminary analysis, we found a reduction of BSI after the implementation of COVID-19 infection prevention measures. Additionally, there were fewer viral infections, though there were a limited number of episodes. Further analyses of multicenter data and a larger number of patients will elucidate the significance of these findings and the role some of these IP measures such as universal masking may have in infection prevention in the NICU. Disclosures All Authors: No reported disclosures

Civic Uplift

Chapter 6 addresses Franklin’s inherently sociable nature, which led him to join many organizations such as the Masons in Philadelphia. He founded the American Philosophical Society, and the Junto, out of which emerged the Library Company. These institutions were based on high-minded discussion of ideas and provisions for public health as well as ordinary efforts to improve Philadelphia’s physical conditions. The chapter outlines the founding of the College of Philadelphia, the Union Fire Company, and the Pennsylvania Hospital, as well as the improvement of sidewalks, installation of streetlights, and the creation of a private militia. It discusses Franklin’s commitment to life in Philadelphia—another connection to Protestantism which started as an urban faith and in much of its early development depended on institutions and churches located in cities.

“Let us, therefore, stimulate one another”: John Fothergill’s Letters and the Notion of Value and Professionalism

Around the middle of the eighteenth century, the London Quaker John Fothergill, M.D., established himself as an essential node in a transatlantic epistolary network. Via letter writing, Fothergill closed book deals, forwarded anatomical drawings, and exchanged botanical seeds and investment schemes that eventually culminated in the financial politics of the first North American hospital, the Pennsylvania Hospital in Philadelphia. He also provided books for the Hospital’s first Medical Library and made suggestions for people to be employed and teaching tools to be used in the first anatomical lectures in Philadelphia. Fothergill’s network sheds much needed light on transatlantic trade and the circulation and commercialization of medical print media in North America’s first regulated medical institutions. The many letters that he wrote provide insights into practices of knowledge production in these institutions. In this article, Fothergill’s epistolary web is represented as a semi-institutionalized network showing colonial medical practice to have been linked to semi-institutionalized spaces that were themselves connected to custodians of knowledge but also functioned as social networks. I argue that such networks were user-based and community-driven, and that they relied on a semi-authoritarian dispersion of knowledge.

Just Because (Most) Hospitals Are Publishing Charges Does Not Mean Prices Are More Transparent

Background The Centers for Medicare and Medicaid Services (CMS) recently mandated that all hospitals publish their charge description masters (CDMs) online, in a machine-readable format, by January 1, 2019. In addition, CMS recommended that CDM data be made available in a manner that was consumer friendly and accessible to patients. Objective This study aimed to (1) examine all hospitals across the state of Pennsylvania to understand policy compliance and (2) use established metrics to measure accessibility and consumer friendliness of posted CDM data. Methods A cross-sectional analysis was conducted to quantify hospital website compliance with the recent CMS policies requiring hospitals to publish their CDM. Data were collected from all Pennsylvania hospital websites. Consumer friendliness was assessed based on searchability, number of website clicks to data, and supplemental educational materials accompanying CDMs such as videos or text. Results Most hospitals (189/234, 80.1%) were compliant, but significant variation in data presentation was observed. The mean number of website clicks to the CDM was 3.7 (SD 1.3; range: 1-8). A total of 23.1% of compliant hospitals provided no supplemental educational material with their CDM. Conclusions Although disclosure of charges has improved, the data may not be sufficient to meaningfully influence patient decision making.

Faces of Falls

Falls are a common and often devastating health threat for hospitalized patients, as they can cause serious injuries such as a hip fracture, and even lead to death. Falls in Pennsylvania continue to be one of the biggest contributors to patient harm and the fourth-most frequently reported event. An estimated 1 out of every 56 inpatients will fall in a Pennsylvania hospital.

Infection Rates in Autologous Hsct with Prbc Transfusion

Introduction: Infection remains a dominant source of morbidity/mortality for patients undergoing myeloablative chemotherapy and autologous stem cell transplant (ASCT). We sought to determine the relative risk of infection with the use of packed red blood cell (pRBC) transfusion to treat chemotherapy associated anemia. Methods: Patients who underwent ASCT at Pennsylvania Hospital between 1995 and 2019 were identified. Data on transfusion status and infection were obtained from patient discharge and transplant summary forms including: Participation in bloodless medicine program, number of units of pRBCs transfused, and documented post-transplant infection. Standard 2 variable relative risk analysis and odds ratio were calculated to assess association between transfusion use and post-transplant infection rate. Results: 306 patients were identified to have undergone ASCT with 176 (57.7%) participating in the bloodless medicine program, 46 (15.1%) having no need of pRBC, and 83 (27.1%) receiving at least 1 unit of pRBC. Median number of pRBC in transfused patients was 2 units. Rate of infection among those who did not receive pRBC was 33.3% while it was significantly higher in those who did at 49.4%. Patients who received pRBC were at higher risk of developing infection (Relative risk (RR) 1.48, odds ratio (OR) 1.95, 95% confidence interval (CI) 1.17-3.26, p=0.01) than those who did not. Further analysis showed that higher quantity of pRBC units further increased infection risk in patients who got 4 or more units of pRBC (RR=1.97, OR=4.14, CI=1.814-9.450, P=.0007). Conclusion: Infection after ASCT was more common with the use of pRBC transfusion to treat anemia while number of pRBC units was positively correlated with rates of infection. This area needs further study to better plot timelines of events as well multiple regression analysis to control for confounding variables such as relative levels of neutropenia before onset of infection. Disclosures No relevant conflicts of interest to declare.

Just Because (Most) Hospitals Are Publishing Charges Does Not Mean Prices Are More Transparent (Preprint)

BACKGROUND The Centers for Medicare and Medicaid Services (CMS) recently mandated that all hospitals publish their charge description masters (CDMs) online, in a machine-readable format, by January 1, 2019. In addition, CMS recommended that CDM data be made available in a manner that was consumer friendly and accessible to patients. OBJECTIVE This study aimed to (1) examine all hospitals across the state of Pennsylvania to understand policy compliance and (2) use established metrics to measure accessibility and consumer friendliness of posted CDM data. METHODS A cross-sectional analysis was conducted to quantify hospital website compliance with the recent CMS policies requiring hospitals to publish their CDM. Data were collected from all Pennsylvania hospital websites. Consumer friendliness was assessed based on searchability, number of website clicks to data, and supplemental educational materials accompanying CDMs such as videos or text. RESULTS Most hospitals (189/234, 80.1%) were compliant, but significant variation in data presentation was observed. The mean number of website clicks to the CDM was 3.7 (SD 1.3; range: 1-8). A total of 23.1% of compliant hospitals provided no supplemental educational material with their CDM. CONCLUSIONS Although disclosure of charges has improved, the data may not be sufficient to meaningfully influence patient decision making.

Thirty-Day Readmission Rates Following Deep Brain Stimulation Surgery

BACKGROUND: Deep brain stimulation (DBS) has emerged as a safe and efficacious surgical intervention for several movement disorders; however, the 30-day all-cause readmission rate associated with this procedure has not previously been documented. OBJECT: To perform a retrospective cohort study to estimate the 30-day all-cause readmission rate associated with DBS. METHODS: We reviewed medical records of patients over the age of 18 who underwent DBS surgery at Pennsylvania Hospital of the University of Pennsylvania between 2009 and 2014. We identified patients who were readmitted to an inpatient medical facility within 30 days from their initial discharge. RESULTS: Over the study period, 23 (6.6%) of 347 DBS procedures resulted in a readmission to the hospital within 30 days. Causes of readmission were broadly categorized into surgery-related (3.7%): intracranial lead infection (0.6%), battery-site infection (0.6%), intracranial hematoma along the electrode tract (0.6%), battery-site hematoma (0.9%), and seizures (1.2%); and nonsurgery-related (2.9%): altered mental status (1.8%), nonsurgical-site infections (0.6%), malnutrition and poor wound healing (0.3%), and a pulse generator malfunction requiring reprogramming (0.3%). Readmissions could be predicted by the presence of medical comorbidities (P < .001), but not by age, gender, or length of stay (Ps > .15). CONCLUSION: All-cause 30-day readmission for DBS is 6.6%. This compares favorably to previously studied neurosurgical procedures. Readmissions frequently resulted from surgery-related complications, particularly infection, seizures, and hematomas, and were significantly associated with the presence of medical comorbidities (P < .001).