DESIGN, SETTING, AND PARTICIPANTS A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups.

ImportanceClinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections.ObjectiveTo compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP.Design, Setting, and ParticipantsA cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups.InterventionsOverall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness.Main Outcomes and MeasuresThe primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed.ResultsAmong 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group.Conclusions and RelevanceAmong outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.Trial RegistrationClinicalTrials.gov Identifier: NCT01249625.

BACKGROUND:Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers.METHODS:A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model.RESULTS:Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing "high-skilled tasks." Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another.CONCLUSION:Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.

Outpatient parenteral antimicrobial therapy (OPAT) requires patients and caregivers to infuse antimicrobials through venous catheters (VCs) in the home. The objective of this study was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of OPAT. The authors performed 40 semi-structured patient interviews and 20 observations of patients and caregivers performing OPAT-related tasks. Six overall goals were identified: (1) understanding and developing skills in OPAT, (2) receiving supplies, (3) medication administration and VC maintenance, (4) preventing VC harm while performing activities of daily living, (5) managing when hazards lead to failures, and (6) monitoring status. The authors suggest that patients and caregivers use teach-back, take formal OPAT classes, receive visual and verbal instructions, use cognitive aids, learn how to troubleshoot, and receive clear instructions to address areas of uncertainty. Addressing these goals is essential to ensuring the safety of and positive experiences for our patients.

Background: Outpatient parenteral antimicrobial therapy (OPAT) requires that patients and their caregivers administer antimicrobial medications in the home via venous catheters. Hazards from physical attributes of the home environment may impede safe performance of OPAT tasks. Methods: We performed a qualitative study, including semistructured telephone interviews and contextual inquiries, of patients performing OPAT tasks inside the home. Eligible participants were discharged from 2 academic medical centers in Baltimore, Maryland, on OPAT. We coded interview transcripts and contextual inquiry forms based on a model of healthcare work systems. Results: Twenty-nine patients underwent semistructured telephone interviews, and 14 patients underwent contextual inquiry. We identified hazards including bathing, animal or pets, extremes in temperature, household clutter, indoor soil and food exposures, outdoor soil, and travel. Patients often developed strategies to mitigate these hazards. Discussion: Multiple hazards related to the home environment could have led to harm, and in the absence of specific guidance, patients developed strategies to mitigate these hazards. Conclusions: Educational interventions to improve OPAT should incorporate an understanding of hazards that may occur in the home environment. (C) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Abstract Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT) Background Respiratory protection (RP) for healthcare personnel (HCP) is controversial and clinical studies are inconclusive about the effectiveness of N95 respirators (N95) and medical masks (MM) for protecting HCP from workplace viral respiratory infections and illnesses (VRII). Methods We conducted a cluster-randomized, investigator-blinded, multisite effectiveness study comparing N95 to MM in geographically diverse, high exposure outpatient settings between 2011 and 2016. Each year during VRII season, participants wore assigned devices when within 6 feet of patients with known or suspected respiratory illness. Respiratory swabs were collected from symptomatic and asymptomatic participants. Diaries detailed VRII exposures, influenza vaccination, adherence to RP and hand hygiene, and manifestations of illness. The primary and secondary outcomes were the incidence of laboratory-confirmed influenza (LCI) using polymerase chain reaction (PCR) and hemagglutinin inhibition assays (HAI), and acute respiratory illness (ARI), influenza-like illness (ILI), laboratory-confirmed respiratory illness (LCRI), and laboratory-detected respiratory infection (LDRI) (figure). Intervention protective effects were estimated using unadjusted odds and incidence rate ratios. Results 5,180 HCP seasons enrolled and randomized (2,243 to N95 and 2,446 to MM), with 4,689 (91%) completing the study. In the intention-to-treat cohort (ITT), among participants in the N95 and MM groups, respectively, 207 (8.2%) and 193 (7.2%) were diagnosed with LCI (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.93–1.40); 1,556 (61.9%) and 1711 (64.1%) were diagnosed with ARI (relative risk (RR) 0.99, CI 0.92–1.06); 128 (5.1%) and 166 (6.2%) were diagnosed with ILI (RR 0.87, CI 0.68–1.10), 371 (14.8%) and 417 (15.6%) were diagnosed with LCRI (RR 0.97, CI 0.84–1.12); and 679 (27.0%) and 745 (27.9%) were diagnosed with LDRI (RR 0.99, CI 0.89–1.09). The adjusted ITT and per-protocol analyses yielded similar results. Conclusion In this outpatient-based, cluster-randomized, controlled trial, neither N95 nor MM resulted in superior protection from LCI or VRII. Disclosures C. Gaydos, BioFire: Consultant, Consulting fee. Cepheid: Speaker’s Bureau, Speaker honorarium. Becton Dickinson: Speaker’s Bureau, Speaker honorarium.

1756. Acute Respiratory Infections (ARIs) Among Outpatient Healthcare Personnel (HCP) Amanda Krosche, BS; Mary Bessesen, MD; Derek Cummings, PhD; Charlotte Gaydos, DrPH, FIDSA; Cynthia Gibert, MD, MSc, FIDSA; Geoffrey Gorse, MD, FIDSA; Jenna Los, MLA; Ann-Christine Nyquist, MD, MSPH, FPIDS; Connie Price, MD; Lewis Radonovich, MD; Nicholas Reich, PhD; Maria C. Rodriguez-Barradas, MD, FIDSA; Michael S. Simberkoff, MD, FIDSA; Trish M. Perl, MD, MSc, FIDSA, FSHEA; The ResPECT Study Team; Hospital Epidemiology and Infection Control, Johns Hopkins University, Baltimore, Maryland; VA Eastern Colorado Healthcare System, Denver, Colorado; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Medicine, Infectious Diseases, Johns Hopkins University, Baltimore, Maryland; Washington, District of Columbia, VA Medical Center, Washington, District of Columbia; VA St. Louis Healthcare System, St. Louis, Missouri; Medicine, Johns Hopkins University, Baltimore, Maryland; University of Colorado School of Medicine/Children’s Hospital of Colorado, Aurora, Colorado; Infectious Diseases, Children’s Hospital Colorado, Aurora, Colorado; Infectious Diseases, University of Colorado School of Medicine/ Denver Health and Hospital, Denver, Colorado; Department of Veterans Affairs Veterans Health Administration Office of Public Health, Gainesville, Florida; Department of Biostatistics and Epidemiology, School of Public Health, University of Massachusetts Amherst, Amherst, Massachusetts; Section of Infectious Diseases, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas; VA New York Harbor Healthcare System, New York, New York; Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland

BACKGROUND:Antibiotic use in industrial hog operations (IHOs) can support the emergence of antibiotic-resistant (ABR) Staphylococcus aureus. The extent of ABR S. aureus exposure in IHO workers and children living in their households remains unclear. OBJECTIVE:We investigated ABR S. aureus nasal carriage prevalence among adults with versus without occupational exposure to IHOs and among children living in their households. METHODS:In total, 198 IHO worker-child household pairs and 202 community referent (CR) adult-child household pairs completed a questionnaire and provided a nasal swab which was analyzed for S. aureus, methicillin-resistant S. aureus (MRSA), multidrug-resistant S. aureus (MDRSA), absence of scn (putative marker of livestock association), and spa type. RESULTS:S. aureus nasal carriage prevalence was higher among IHO (53%) compared with CR (31%) adults [adjusted prevalence ratio (aPR): 1.40; 95% confidence interval (CI): 1.07, 1.83], but MRSA nasal carriage prevalence was uncommon (2-3%) in IHO and CR adults. MDRSA nasal carriage prevalence was similar among IHO workers and CR adults (12% vs. 8%; aPR: 1.14; 95% CI: 0.56, 2.29). Nasal carriage prevalence was higher among IHO compared with CR children for S. aureus (49% vs. 31%; aPR: 1.50; 95% CI: 1.13, 1.99), MRSA (14% vs. 6%; aPR: 2.37; 95% CI: 1.14, 4.92), and MDRSA (23% vs. 8%; aPR: 2.64; 95% CI: 1.47, 4.75). We also found suggestive evidence of a higher prevalence of S. aureus, MRSA, and MDRSA among children living with an IHO worker who did versus did not report taking personal protective equipment (PPE) home from the IHO. Livestock-associated S. aureus nasal carriage predominated among IHO workers. CONCLUSION:Our findings support the importance of further research on the prevalence and potential sources of exposure to ABR S. aureus among children living with IHO workers.

Session: 139. Clinical Infectious Diseases: Respiratory Infections Friday, 28, Background . Acute respiratory infections (ARI) are common among healthcare personnel (HCP); however, the risk factors associated with ARI in this population are not well studied. While typically thought to be contracted through the mucous membranes of the nose and mouth, there has been speculation of transmission of respiratory viruses via the conjunctiva.

BACKGROUNDPatients are frequently discharged with central venous catheters (CVCs) for home infusion therapy.OBJECTIVETo study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications.DESIGNProspective cohort study between March and December 2015.SETTINGHome infusion therapy after discharge from academic medical centers.PARTICIPANTSOf 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal.METHODSPatients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications.RESULTSOf 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51–15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09–5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01–0.74]). Other environmental exposures were not associated with CVC complications.CONCLUSIONScomplications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients.Infect Control Hosp Epidemiol 2016;1–8