COVID-19 Pandemic and Patients with Rare Inherited Metabolic Disorders and Rare Autoinflammatory Diseases—Organizational Challenges from the Point of View of Healthcare Providers

COVID-19 pandemic is an organisational challenge for both healthcare providers and patients. People with rare inherited metabolic disorders (IMD) and rare autoinflammatory diseases (AD) are vulnerable patients whose well-being is deeply connected with regular follow-ups. This study aimed to assess how e one year of coronavirus pandemic has impacted the treatment of patients with IMD and AD in Poland. Surveys were distributed to all healthcare providers that coordinate the treatment of IMD and AD patients. Thirty-two responders (55%) answered the survey. They provide care to 1726 patients with IMD/AD, including 246 patients on dedicated treatment. In 35% of units, the regular appointments were disrupted, primarily because of patient infection. In 18 hospitals, remote visits were implemented, but only 66.6% of patients used this form of consultation. In 14/32 hospitals, administration of the therapy was delayed (median: 17.4 days). Forty-four patients suffered from SARS-COV-2 infection, in majority with mild symptoms. However, four adult patients developed complications, and one died following a SARS-COV-2 infection. Although most hospitals managed to maintain regular visits during the pandemic, more comprehensive implementation of telemedicine and switch to oral therapy or home infusions would be a reasonable solution for the current epidemic situation.

Investigation of possible transmission of a susceptible microorganism through a contaminated duodenoscope; a case report

Background Despite compliance to extensive reprocessing protocols, duodenoscopes have been linked to outbreaks of susceptible and multi-drug resistant organisms (MDRO) due to persistent duodenoscope contamination. Duodenoscope-associated infections (DAIs) based on transmission of susceptible microorganisms are likely to be underreported due to detection bias. Case presentation We describe the retrospective detection of a DAI case caused by a susceptible microorganism which at the time of clinical infection was not recognized as such. During 2017 and 2018, duodenoscopes were cultured on a daily basis due to research activities. While analyzing this data, it was found that a duodenoscope had been contaminated with Enterobacter cloacae complex over a period of 3 months. We checked whether patients treated with this duodenoscope had developed infections and found one patient with an E. cloacae cholangitis 3 months after the ERCP (Endoscopic retrograde cholangiopancreaticography) procedure. The isolates on the duodenoscope and in the patients’ blood culture were indistinguishable by amplified fragment length polymorphism (AFLP). By classical multi-locus sequence typing (MLST), both strains were of the same (but novel) sequence type. Application of whole genome MLST showed 93 (out of 3757) allelic differences. Conclusion This case report describes a plausible link between a contaminated duodenoscope and a patient infection with E. cloacae. Transmission of susceptible E. cloacae was highly suspected from AFLP and MLST results; by WGS, 93 allelic differences were found which proves closely related strains. This report shows that DAIs by susceptible microorganisms can be easily missed and therefore its true prevalence remains underscored.

Trichomonas vaginalis detection in urogenital specimens from symptomatic and asymptomatic men and women using the cobas TV/MG test

Trichomonas vaginalis is a prevalent sexually transmitted infection (STI). Diagnosis has historically relied on either microscopic analysis or culture, the latter being the previous gold standard. However, these tests are not readily available for male diagnosis, generally only perform well for symptomatic women, and are not as sensitive as nucleic acid amplification tests (NAATs). Men are largely asymptomatic but carry the organism and transmit to their sexual partners. This multicenter, prospective study evaluated the performance of the cobas® T. vaginalis /Myocoplasma genitalium (TV/MG) assay for detection of T. vaginalis DNA compared with patient infection status (PIS) defined by a combination of commercially available NAATs and culture using urogenital specimens. A total of 2,064 subjects (984 men and 1,080 women, 940 [45.5%] symptomatic, 1124 [54.5%] asymptomatic) were evaluable. In women, sensitivity ranged from 99.4% (95% confidence interval [CI] 96.8–99.9%) using vaginal samples to 94.7 (95% CI 90.2–97.2%) in PreservCyt samples. Specificity ranged from 98.9–96.8% (95% CI 95.4–97.8%). In men, the cobas TV/MG assay was 100% sensitive for the detection of T. vaginalis in both male urine samples and meatal swabs, with specificity of 98.4% in urine samples and 92.5% in meatal swabs. The cobas TV/MG is a suitable diagnostic test for the detection of T.vaginalis, which could support public health efforts towards infection control and complement existing STI programs.

Abstract P187: When A Global Crisis Closes Your Clinic: A Telemedicine Approach for Transient Ischemic Attack and Minor Stroke Care During the Covid-19 Pandemic

Introduction: Recent work has demonstrated the safety and feasibility of rapid outpatient evaluation for presentations of TIA and non-disabling stroke. Our outpatient TIA and stroke clinic, Rapid Access Vascular Evaluation-Neurology (RAVEN) clinic, instituted in 2016, encountered unprecedented challenges in operations during the COVID-19 surge in New York City, leading to the creation of a telemedicine approach to minimize patient and staff exposure risk. To date, few virtual TIA/stroke clinics have reported on safety and feasibility outcomes. Hypothesis: We hypothesized that rapid follow-up of patients with suspected TIA and minor stroke via telemedicine would be feasible and safe during the pandemic. Methods/Results: We performed a retrospective chart review of patients with TIA and minor stroke who were referred to the virtual clinic from the emergency department (ED) between March and June 2020 (the local peak of the COVID-19 pandemic) when RAVEN in-person visits were suspended. A total of 24 patients were discharged early from the ED and referred for RAVEN evaluation with 20 patients evaluated as scheduled; 4 were lost to RAVEN follow-up. Ultimately, 60% of these patients were diagnosed with TIA or minor stroke after completing their remote evaluation; the rest were diagnosed as stroke mimics (seizure, migraine with aura, neuropathy, peripheral vertigo, stroke recrudescence). The median NIHSS calculated at initial ED evaluation was 1 with a maximum NIHSS of 5. A new medical intervention for secondary prevention was prescribed for 70% of patients prior to ED discharge. Amongst patients contacted by phone 3-5 months post-RAVEN evaluation, 4 of 15 had an increased modified Rankin score. Of the 24 patients referred for RAVEN evaluation, 7 returned to the ED within 90 days, with 3 patients citing neurologic complaints. On follow-up via phone conducted 2-5 months after RAVEN evaluation, 3 of 17 patients self-reported either a positive COVID-19 test or suspected COVID-19 diagnosis over the study period. Conclusion: A telemedicine-based approach to evaluate TIA and stroke in the RAVEN model helped limit patient infection risk, optimize resource allocation, establish accurate, timely diagnoses, and effectively implement secondary prevention strategies.

888. Improving outcomes with revised preoperative universal decolonization protocol

Background In order to improve outcomes, including reduced surgical infection rate and costs, a revised universal preoperative decolonization protocol was implemented on a trial basis. Methods In a 12 month before and after study at a public teaching hospital in southern California, an alcohol based nasal antiseptic was introduced in place of nasal povidone iodine (PVI) for all surgical patients pre-operatively, paired with chlorhexidine (CHG) bathing which was already in place. All surgical procedures were included, the most common being cholecystectomy, cesarean section and hip fracture. The alcohol nasal antiseptic was selected to replace the PVI nasal antiseptic based on efficacy, staff preference and cost. At the same time, surgical team members began self-application of the alcohol nasal antiseptic each day prior to surgical procedures. This was not mandatory and compliance was not tracked, though informal feedback and observation revealed most surgical team members were applying the nasal antiseptic prior to cases daily. Results In comparison to the 6 month baseline period where there were 27 SSI in 1188 procedures, during the 6 month study period there were 10 SSI in 1253 procedures, representing a 63% reduction (p=.0162) for all types of procedures. We have observed a reduction of 17 SSIs in 2019, compared to the previous year, during the 6 months period. That means a saving of $589,420 during the same period. Conclusion Preoperative universal decolonization with alcohol based nasal antiseptic in place of nasal PVI, paired with CHG bathing, was effective in reducing SSI rate and associated costs. Further study is needed to measure and assess the impact of surgical team member nasal decolonization on patient infection risk and rate. Disclosures All Authors: No reported disclosures

Duodenoscope Medical Device Reports Associated with Patient Infection, Patient Exposure, or Device Contamination

Background: Each year, the FDA receives more than a million reports of suspected device-associated deaths, serious injuries, and malfunctions. Medical device reports (MDRs) are submitted to the FDA by mandatory reporters (manufacturers, importers, and device user facilities) and voluntary reporters such as healthcare professionals, patients, and consumers. The FDA uses MDRs to monitor device performance, including monitoring reports of infection or device contamination to detect potential device-related safety issues and to share this information in public communications. In this analysis, the FDA presents MDRs for duodenoscopes, which are a type of flexible endoscope that have been associated with infections in patients. Methods: For this analysis, we searched the MDR database for duodenoscope reports submitted between January 2015 and July 1, 2019. MDRs were classified into clinical risk categories based on the MDR’s text narratives as patient infection (indicated the presence of infection in patients potentially transmitted by the device), patient exposure (indicated a contaminated device has been used in a patient, but the MDR lacks clear mention of patient infection), or device contamination (indicated that the device was contaminated, but no mention of device use in patients or patient infection). Results: Overall, 1,115 duodenoscope reports related to a patient infection, patient exposure, or device contamination for devices marketed inside and outside the United States were received from January 2015 to mid-2019. Among them, 79 MDRs were received for deaths in patient infection, patient exposure, or device contamination reports. The number of reported infections decreased from 247 MDRs in 2015 to 55 MDRs in the first half of 2019. Furthermore, the number of reported deaths decreased from 25 MDRs in 2015 to 2 MDRs reported in the first half of 2019. Conclusions: The MDR data indicate a decrease in the number of reported infections. The decrease in infections suggests that efforts to reduce the risk of infection from duodenoscopes have yielded improvements; however, additional improvements are necessary to further decrease the risk of infection.Funding: NoneDisclosures: None

CDC Consultations for Outbreaks and Infection Control Breaches Occurring in Dental Settings, 2010–2019

Background: Documented transmission of infectious agents involving dental care is uncommon. However, increasing attention to dental infection control, along with several recent outbreaks, have identified infection control gaps in dental settings. We describe CDC consultations involving outbreaks or infection control lapses occurring in dental settings to identify areas for prevention efforts. Methods: We reviewed internal CDC records from January 1, 2010, through October 1, 2019, to identify consultations involving investigations of potential or confirmed disease transmission and infection control lapses in dental settings. We determined yearly number of consultations, number of patients infected, how disease transmission or infection control breaches were identified, suspected mode of transmission, type of infection control breaches identified, and whether at-risk patients were notified. Results: We identified 41 consultations, among 27 states, involving investigation of possible disease transmission or infection control lapses in dental facilities. The number of consultations increased from 11 to 30 between the first half (2010–2014) and the second half (2015–2019) of the period and involved at least 113 infections confirmed or suspected to be associated with dental procedures. Most investigations (n = 29, 71%) began with identification of infection control breaches absent known patient infections; 8 (20%) investigations were initiated after identification of a single patient infection raised concerns for possible transmission associated with dental care (eg, single case of acute hepatitis B infection absent other risk factors). Moreover, 4 investigations involved >1 patient infection; 3 were outbreaks confirmed to be due to poor infection control practices. The most common infection control breaches were lapses in dental instrument reprocessing (n = 28, 78%), for example, failure to sterilize dental handpieces or failure to use biologic indicators. Of the 23 consultations where patient notification activities were discussed, 17 (74%) resulted in notification; >20,000 patients received information about their potential exposure, usually accompanied by advice on seeking screening tests. Conclusions: Dental-related consultations have increased in recent years, and they highlight the need for improved infection control training of dental healthcare personnel, especially related to dental instrument reprocessing. The CDC Division of Oral Health and the Organization for Safety, Asepsis, and Prevention offers tools, training, and other resources to help dental facilities improve infection control practices. Not all investigations resulted in notifying at-risk patients, but notification should be strongly considered, especially when serious breaches are identified, to promote transparency and help identify disease transmission that could otherwise go undetected.Funding: NoneDisclosures: None

SURGICAL TREATMENT OF ACUTE INTESTINAL OBSTACLATION CONDITIONED BY A NEUROENDOKRIN TUMOR OF THE THIN INTESTINE, ON THE BACKGROUND OF THE PATIENT INFECTION OF A NEW CORONOVIRUS INFECTION COVID-19

A clinical case of successful surgical treatment of acute intestinal obstruction due to a neuroendocrine tumor of the small intestine in a patient against a new coronovirus infection COVID-19 is described.