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Abstract Background During the COVID-19 pandemic, healthcare facilities frequently adopted mandatory masking to protect patients and healthcare workers (HCWs). Although effective in preventing virus spread, prolonged masking can induce discomfort and fatigue among HCWs. As the pandemic progressed, the prolonged use of masks became a source of growing discomfort and presented increasing challenges with masking policy compliance. There is a paucity of data on masking fatigue among HCWs. Mask use in HCWs with mask fatigue Methods We performed an anonymous survey of at two hospitals in Chicago. An anomyous survey was sent via hospital list-servs to all HCWs. The survey was sent on May 23, 2023 and collected the clinical roles of participants, masking habits during the pandemic, masking fatigue, and self-reported influenza-like illness (ILI). Data was tabulated and descriptive statistics used. Differences in sickness frequency as a correlate of mask fatigue Results A total of 90 HCWs provided responses, with 66% experiencing mask fatigue throughout the study period. In 2020, among HCWs who reported mask fatigue, 46% of always wore their masks, while 3% never wore masks (Figure 1). In 2021, HCWs who always wore their masks decreased to 6%, while the percentage of HCWs who never wore their masks increased to 26% (p=0.0075). An statistically significant increase (p=0.0312) in reported ILI was seen among HCWs with mask fatigue in 2021 (Figure 2). Conclusion Masking fatigue was common during the pandemic and increased with time. Reduced masking due to this fatigue may have led to increased ILI in HCWs. Fatigue and non-compliance can contribute to HCW absenteeism and transmission to vulnerable patients. Finding strategies to mitigate mask fatigue and ensure consistent adherence to masking policies is critical during respiratory virus season or future respiratory pandemics. Disclosures All Authors: No reported disclosures
Abstract Background High community transmission of respiratory viruses can lead to employee illness, absenteeism, and the risk of spread to both patients and healthcare workers (HCWs). Masking in healthcare settings can mitigate these risks. Our hospital developed a policy to adjust the level of masking required based on current community transmission rates, intensifying or relaxing mandates as necessary. This study aims to evaluate the impact of our tiered masking policy on employee absenteeism. Weekly respiratory viral metrics and employee influenza-like illness for 2022 Methods Retrospective review of employee health data, public health respiratory virus surveillance metrics, and infection prevention masking requirements at a 151-bed safety-net hospital. Data from September to December 2022, when universal masking was in place, and September to December 2023, when our new masking policy was implemented was compared. In 2023, four masking levels were created: red always requires masks for HCWs and patients; orange requires them for HCWs; yellow requires masks for HCWs during patient contact; both orange and yellow recommends but doesn’t require masks for patients; green recommends but does not require masks for HCW and patients. Weekly public health respiratory surveillance data, masking requirements and employees reporting influenza-like illness (ILI) were tabulated and compared before and after our new masking policy. Weekly respiratory viral metrics and employee influenza-like illness for 2023 Results A total of 66 HCWs reported ILI during the 2022 respiratory viral season compared to 44 in 2023, a 33% reduction. Weekly respiratory viral metrics and HCW ILI is plotted in Figure 1 for 2022 and Figure 2 for 2023. When mask levels were raised to orange on October 6, HCW ILI slightly decreased. Masking changed to yellow on October 22 and correlated with a subsequent increase in ILI. Escalation to red on December 10 was followed by a decline in ILI. Conclusion A tiered masking policy in response to fluctuating community transmission appears to be an effective strategy in managing HCW absenteeism due to ILI. Despite higher percent positivity from multiple viruses, a 33% decrease in ILI occurred after implementation of the tiered masking policy, as compared the prior universal masking policy. A tiered masking policy based on percent positivity may be more effective than universal masking. Disclosures All Authors: No reported disclosures
Abstract Background The expansion of advanced practice providers (APPs) in the inpatient setting warrants understanding of their antimicrobial prescribing practices in these settings to help adapt antimicrobial stewardship (ASP) strategies. Variability in APP training programs further complicates the landscape. This study aims to investigate disparities in antibiotic prescription practices for complicated intra-abdominal infections (cIAI) between APPs and physicians. Figure 1 clAl severity and empiric antimicrobial selection by physicians and APPs Methods A retrospective review of antibiotic orders was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data from July 2022 to June 2023 was reviewed, including initial antibiotic selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians. FIgure 2 Empiric antimicrobial selection by physicians and APPs Results A total of 175 initial empiric PAF entries for cIAI were reviewed, of which 145 were from physicians and 30 from APPs. Guideline non-adherence was 10% (14) for physicians and 20% (6) for APPs. Additionally, 3% (5) of physician and 7% (2) of APP prescriptions were ineffective. Critical illness was higher for physician cases (Figure 1). Physicians prescribed more antipseudomonal beta-lactam (APBLs) than APPs (52% vs 30%). APPs prescribed more quinolones (FQ) than physicians (33% vs 26%). Of the patients treated with FQs by APPs, 37% had allergies to beta-lactams, compared to 22% of patients treated by physicians. Total DOT/1000 during the study period was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2). Conclusion Empiric antimicrobial selection for cIAI differed between APPs and physicians, with APP showing higher quinolone use, a non-preferred agent, and almost double the level of non-adherence to guidelines. These findings underscore the need for tailored ASP education and interventions that address the unique practices and educational backgrounds of APPs, aiming to standardizing and optimizing antimicrobial use. APPs may require specific education for cIAI and ASP guidance. Disclosures All Authors: No reported disclosures
Abstract Background Chicago's recent increase in migrant populations has placed new demands on public health systems, particularly in managing infectious diseases within community hospitals. This study examines the impact of migration on the incidence of infectious diseases in a community hospital's emergency department (ED). Understanding disease patterns in migrants can inform public health strategies and improve healthcare delivery. Figure 1. Chickenpox and measles cases per year Methods We conducted a retrospective review of infection prevention records from a 151-bed Chicago safety-net community hospital was conducted, focusing on migrant patient visits and infection prevention needs between 2022 and 2024. Descriptive statistics were used to evaluate the changes over the period. Figure 2. Infectious diseases cases in migrant populations per month Results In 2022, 2023 and 2024, the reported cases of chickenpox rose from 0 to 5 and then 11, respectively. This represents a 450% increase in chickenpox cases from 2023 to 2024 (Figure 1). No measles cases were reported in the first two years, increasing to 2 cases in 2024. From October 2023 to March 2024, a total 18 chickenpox cases, 2 measles cases and two cases of tuberculosis were reported (Figure 2). Airborne precautions in the ED were needed for 22 cases. Conclusion We report a notable increase in vaccine preventable conditions such as chickenpox and measles in a Chicago hospital associated with a migrant influx. Added needs for airborne precautions in the ED were required during this period. These trends highlight the need for public health measures, such as enhanced vaccination efforts and healthcare access for migrants, to prevent disease outbreaks and protect community health. Infection prevention readiness should involve clear protocols for identifying and isolating conditions requiring airborne precautions. Disclosures All Authors: No reported disclosures
Abstract Background Advanced practice practitioners (APPs) are increasingly working in inptient settings as hospitalists. Despite these trends, there's a paucity of data on APP antimicrobial prescribing practices. Antimicrobial stewardship programs (ASPs) can reduce antimicrobial overuse and misuse. One of the most common infections in the inpatient setting is urinary tract infections (UTIs). We examine antibiotic prescribing practices of APPs and physicians for treatment ofUTIs. Understanding prescribing practices can highlihgt stewardship gaps and help guide ASP efforts. Figure 1 UTI severity and empiric antimicrobial selection by physicians and APPs Methods A retrospective analysis of antimicrobial prescriptions was conducted at a 151-bed community hospital. ASP prospective audit and feedback (PAF) data for UTIs from July 2022 to June 2023 was reviewed, including initial antimicrobial selection, duration, and guideline concordance for APPs and physicians. Guideline adherence, antimicrobial effectiveness based on local antibiogram, and days of therapy (DOT) per 1000 patient days was compared between APPs and physicians. Figure 2 Empiric antimicrobial selection by physicians and APPs Results A total of 209 initial PAF events for UTIs were reviewed, of which, 161 were physicians and 48were APPs. Physicians’ initial empiric choice was 9% (15) guideline discordant and ineffective. APP initial choice was 17% (8) guideline discordant and ineffective. TMP-SMX was more commonly used by APPs (Figure 1). Total DOT/1000 was 145. DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were APBLs and 27% non-APBLs (Figure 2). DOT/1000 was 44 for physicians, of which 11% were anti-pseudomonal beta lactams (APBLs) and 34% non-APBLs. DOT/1000 was 21 for APPs, of which 19% were anti-pseudomonal beta lactams (APBLs) and 27% non-APBLs (Figure 2). Conclusion APPs more commonly chose guideline discordant or ineffective initial empiric choices for UTIs compared to physicians. Empiric selection of ineffective agents according to local antibiogramswas higher for APPs. This underscores the importance of targeted ASP education on UTI guidelines and local antibiogram interpretation to improve antibiotic prescribing practices among APPs. Disclosures All Authors: No reported disclosures
