Background:Acute uncomplicated cystitis is common among outpatients and frequently leads to antibiotic prescriptions, making urinary tract infections (UTIs) an important area for antimicrobial stewardship initiatives. Infectious Disease Society of America (IDSA) guidelines promote alternative agents in place of fluoroquinolones for acute uncomplicated cystitis. Despite IDSA guidance, adherence to the guideline remains low in the United States (US). Several studies have described interventions to improve guideline-concordant prescribing for UTIs. However, the long-term sustainability and impact of fluoroquinolone (FLQ)-sparing strategies on community antimicrobial resistance and treatment outcomes are unknown. The objectives of this study were to characterize current antibiotic prescribing patterns, treatment failures and Escherichia coli resistance rates in a setting which instituted FLQ sparing strategies for UTIs in 2007. Methods:Retrospective cohort study of women aged ⩾ 18 diagnosed with acute uncomplicated cystitis based on International Classification of Diseases, 10th Revision (ICD-10) codes were included. Data were abstracted for ambulatory visits over a 6-month period, January 2018 to June 2018, at a large urban health care system. Treatment decisions were made by individual providers, and data were analyzed retrospectively. Nitrofurantoin (NFT) resistance was obtained from the institutional antibiogram and patient-level data. Treatment failure was defined as the need for a different antibiotic for UTI within 28 days of the original prescription. Results:NFT was the most frequently prescribed antibiotic (n = 386, 71.6%) of empiric antibiotic prescriptions for UTIs. FLQs comprised 4.6% of all antibiotic prescriptions (n = 25). Treatment failure rate was 2.3% in patients treated with NFT. Urine culture was ordered for only 26.8% of patients. Among the small group of patients with cultures ordered, E. coli remained 98.5% susceptible to NFT. Conclusions:This study is the first to report significantly low rates (4.6%) of FLQ prescribing for acute uncomplicated cystitis. Treatment failure rate was low with empiric NFT. Increased NFT resistance among E. coli was not observed at the institution or among the subset of patients with E. coli positive urine cultures. These findings support current IDSA treatment guidance for uncomplicated cystitis.

Background: Health care personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP. Methods: The Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction. Results: Among 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained research assistants in the workplace (P < .001). Conclusions: In this randomized clinical trial, take-home kits were an easily implemented, effective method to self collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples. (c) 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

OBJECTIVE:The implementation of mandatory influenza vaccination policies among healthcare personnel (HCP) is controversial. Thus, we examined the affect of mandatory influenza vaccination policies among HCP working in outpatient settings. SETTING:Four Veterans' Affairs (VA) health systems and three non-VA medical centers. METHODS:We analyzed rates of influenza and other viral causes of respiratory infections among HCP working in outpatient sites at 4 VA health systems without mandatory influenza vaccination policies and 3 non-VA health systems with mandatory influenza vaccination policies. RESULTS:Influenza vaccination was associated with a decreased risk of influenza (odds ratio, 0.17; 95% confidence interval [CI], 0.13-0.22) but an increased risk of other respiratory viral infections (incidence rate ratio, 1.26; 95% CI, 1.02-1.57). CONCLUSIONS:Our fitted regression models suggest that if influenza vaccination rates in clinics where vaccination was not mandated had equalled those where vaccine was mandated, HCP influenza infections would have been reduced by 52.1% (95% CI, 51.3%-53.0%). These observations, their possible causes, and additional strategies to reduce influenza and other viral respiratory illnesses among HCP working in ambulatory clinics warrant further investigation.

Background: Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases. Methods: Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated. Results: The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios. Conclusions: Attitudes toward medical masks and N95 respirators improved significantly between the begin-ning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study. Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.

Journal of Hospital MedicineVolume 15, Issue 6 p. 375-377 Perspectives in Hospital Medicine The Role of Hospitalists in Biocontainment Units: A Perspective Maria G Frank MD, FACP, SFHM, Corresponding Author Maria G Frank MD, FACP, SFHM maria.frank@dhha.org Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, ColoradoCorresponding Author: Maria G Frank, MD, FACP, SFHM; Email: maria.frank@dhha.org; Telephone: 303-602-5011.Search for more papers by this authorCaroline Croyle MPH, MPA, CPH, Caroline Croyle MPH, MPA, CPH Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Patient Safety & Quality, Denver Health and Hospital Authority, Denver, ColoradoSearch for more papers by this authorAdam Beitscher MD, Adam Beitscher MD Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, ColoradoSearch for more papers by this authorConnie Price MD, Connie Price MD Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, ColoradoSearch for more papers by this author Maria G Frank MD, FACP, SFHM, Corresponding Author Maria G Frank MD, FACP, SFHM maria.frank@dhha.org Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, ColoradoCorresponding Author: Maria G Frank, MD, FACP, SFHM; Email: maria.frank@dhha.org; Telephone: 303-602-5011.Search for more papers by this authorCaroline Croyle MPH, MPA, CPH, Caroline Croyle MPH, MPA, CPH Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Patient Safety & Quality, Denver Health and Hospital Authority, Denver, ColoradoSearch for more papers by this authorAdam Beitscher MD, Adam Beitscher MD Division of Hospital Medicine, Denver Health Hospital Authority, Denver, Colorado Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, ColoradoSearch for more papers by this authorConnie Price MD, Connie Price MD Biocontainment Unit, Denver Health Hospital Authority, Denver, Colorado Department of Medicine, University of Colorado School of Medicine, Aurora, ColoradoSearch for more papers by this author First published: 18 March 2020 https://doi.org/10.12788/jhm.3402Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume15, Issue6June 2020Pages 375-377 RelatedInformation

Urinary tract infections (UTIs) are one of the most common infections, associated with 10.5 million outpatient visits annually. Fast and accurate identification (ID) of bacteria causing a UTI would allow for immediate targeted therapy, as opposed to conventional methods which take one to three days. The Accelerate Pheno® system (ACC, Accelerate Diagnostics Inc., Tucson, AZ, USA) provides microbial ID and susceptibility (AST) from positive blood cultures. Our objective was to determine ACC’s potential to quickly ID bacterial pathogens directly from urine. Remnant urine samples with >100K colony forming units (CFU)/mL of gram-negative bacteria as determined by quantitative plating were obtained from the clinical lab. 1.5ml of urine was dispensed into a capsule and loaded onto the Accelerate PhenoPrep™ module. This module automatically performs wash steps to separate bacteria from human cells and other debris. The processed sample was loaded onto ACC for analysis using a custom designed assay which detects the presence of bacteria and employs an Enterobacteriaceae family specific FISH probe. The results were compared to standard of care ID results. There were 10 E. coli and 1 C. koseri among the eleven samples tested. Baseline concentration of samples immediately prior to testing ranged from 2.5 x 106 to 1.08 x 1010 CFU/mL (average 4.19 x 109). After specimen processing, average concentration was 2.14 x 109 CFU/mL and average recovery was 42.83%. ACC detected bacteria and identified it as Enterobacteriaceae in 11/11 samples (100%). Average sample prep time was 55 min. Average time to Enterobacteriaceae ID was 8.6 hrs. Average total time to ID, including specimen processing, was 9.5 hrs. Table 1: Results of Direct from Urine Testing ACC identified Enterobacteriaceae directly from remnant urine specimens in an average of 9.5 hours, approximately 24 to 48 hours faster than conventional methods. ACC was able to be adapted for use in urine samples. Future directions include improving the assay to identify bacteria to the species level and adding AST testing. This shows promise in providing fast actionable UTI diagnosis, allowing for tailored antibiotic therapy. *This information concerns a use that has not been approved or cleared by the Food and Drug Administration. Martin Fuchs, BSEE, MSEE, Accelerate Diagnostics (Employee) Steve Metzger, BA, Accelerate Diagnostics (Employee)

Antimicrobial resistance patterns in urinary

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.

Abstract Background Influenza (flu) and other respiratory viruses circulate regularly throughout healthcare systems, often placing healthcare personnel (HCP) at high risk for illness. Hemagglutination inhibition (HAI) titers are associated with protection from flu illness, though few studies have characterized HAI in HCP. The Respiratory Protection Effectiveness Clinical Trial (ResPECT), provided HAI titers and data to assess infection risk based on four flu seasons. Participants from multiple outpatient settings wore respiratory protection within six feet of symptomatic patients. Methods Serological samples obtained at the beginning and end of each season and anterior nasopharyngeal swabs were taken randomly and when participants reported respiratory symptoms were assessed. Our primary outcome was PCR-confirmed influenza. Results During 5,180 participant-seasons of observation, 128 PCR-confirmed influenza A infections (20 H1N1, 108 H3N2) and 34 PCR-confirmed influenza B infections. 4,041 (78%) reported receiving an annual influenza vaccine. Each log base 2 increase in titer subtype-specific titer reduced the hazard of influenza infection with A/H3N2 by 18%(Relative Risk (RR) 0.82 95% CI 0.72,0.94), by 28% for influenza B (RR 0.72 95% CI 0.56,0.92 and by 25% for influenza A H1N1 (RR 0.75 95% CI 0.57–1.0). After adjusting for HAI titers, age was not significantly associated with risk for any of the subtypes. Conclusion In this prospective cohort of monitored HCPs, these findings support the current literature demonstrating that HAI titers are associated with protection from influenza infection. The relationship between HAI titers, influenza, and vaccination is complex, however. Vaccination was not shown to be associated with infection outcome in our model, though their effect may be difficult to separate from their effect on HAI titers. Disclosures Trish M. Perl, MD, MSc, 7–11: Advisory Board; medimmune: Research Grant.

The 2013-2016 epidemic of Ebola virus disease (EVD) that originated in West Africa underscored many of the challenges to conducting clinical research during an ongoing infectious disease epidemic, both in the most affected countries of Guinea, Liberia, and Sierra Leone, as well as in the United States and Europe, where a total of 27 patients with EVD received care in biocontainment units. The Special Pathogens Research Network (SPRN) was established in the United States in November 2016 to provide an organizational structure to leverage the expertise of the 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs); it was intended to develop and support infrastructure to improve readiness to conduct clinical research in the United States. The network enables the rapid activation and coordination of clinical research in the event of an epidemic and facilitates opportunities for multicenter research when the RESPTCs are actively caring for patients requiring a biocontainment unit. Here we provide an overview of opportunities identified in the clinical research infrastructure during the West Africa EVD epidemic and the SPRN activities to meet the ongoing challenges in the context of Ebola virus and other special pathogens.

Abstract Background Measuring changes in phase noise from bacteria on a quartz crystal resonator has been shown to effectively distinguish viable from non-viable E. coli. We report using this method to rapidly perform AST for E. coli isolated from a leftover clinical urinary tract infection (UTI) specimen. Methods An experimental system was designed to sense changes in bacterial mechanics through changes in phase noise generated by bacterial cells (Figure 1). The system includes a quartz-crystal resonator with thin-film gold electrodes on opposite surfaces housed within a module. The module provides electrical contact to the crystal’s electrodes, and incorporates channels through which fluids can be pumped (Figure 2). E. coli was isolated from a leftover positive urine culture specimen, cultured overnight and resuspended in phosphate-buffered saline (PBS). The suspension was run through the experimental system. E.coli cells were adhered to the surface of the quartz resonant crystal coated with a cationic polymer. After a growth phase, the cells were exposed to antibiotic (ampicillin). Phase noise was monitored throughout the test. The power spectral density of the noise was averaged each 5 minutes. E.coli was classified as ampicillin susceptible if the spectral power of the added phase noise was at least 50% lower compared with controls. Controls were in growth media only (Figure 3). Automated microscopy was utilized to monitor cell growth. Results The method correctly classified the E.coli as ampicillin susceptible. Power spectral density increased in untreated cells and dropped or stayed steady in cells treated with Ampicillin. Corresponding loss of E. coli viability was confirmed microscopically. Results were compared with standard of care antibiotic susceptibility testing. Conclusion The phase noise measurement method correctly identified ampicillin susceptible E.coli isolated from a leftover patient urine sample in three and one half hours. It shows promise for providing rapid AST results to treat UTIs. Disclosures All authors: No reported disclosures.

AbstractRecommending nitrofurantoin to treat uncomplicated cystitis was associated with increased nitrofurantoin use from 3.53 to 4.01 prescriptions per 1,000 outpatient visits, but nitrofurantoin resistance in E. coli isolates remained stable at 2%. Concomitant levofloxacin resistance was a significant risk for nitrofurantoin resistance in E. coli isolates (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.04–7.17).

Abstract Background Healthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015. Methods Swabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults. Results The main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses. Conclusion The risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections. Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.

Abstract Background Healthcare personnel (HCP) knowledge and attitudes toward Infection Prevention and Control (IPC) measures are important determinants of practices that can protect them from acquisition of infectious diseases from patients. We aimed to describe HCP knowledge and attitudes concerning IPC measures over time in the context of a clinical trial. Methods ResPECT was a multi-center, multi-season cluster randomized clinical trial designed to compare the effectiveness of medical masks (MM) and N95 respirators (N95) for preventing acute respiratory illnesses in HCP employed in outpatient clinical settings. At the beginning of each respiratory virus season, participants completed a survey instrument to measure IPC knowledge. At the beginning and end of each season participants completed a survey to assess attitudes and beliefs about IPC measures, especially MM and N95. Results A pre-study and post-study survey pair was available for 88.1% of participant seasons. There were no significant differences in demographic variables or job assignment between survey respondents and nonrespondents for each participant season. Participants correctly identified 59.8% to 63.4% of IPC measures that should be used by HCP when exposed to patients with symptoms of acute respiratory illness, or at high risk of infection. There was modest improvement in the knowledge score over time among providers who participated for multiple years in the study. In the first pre-study survey of IPC attitudes and beliefs, 88.5% and 87.9% of participants identified at least one reason to avoid using either MM and N95, respectively (Figure 1). At the post-season survey, the proportion of participants reporting a reason to avoid MM fell to 39.6% (IRR for pre- vs. post-season 0.15, 95% CI 0.13–0.17) and 53.6% reported a reason to avoid N95 (IRR 0.57, 95% CI 0.51–0.66). Conclusion HCPknowledge of IPC precautions was poor, suggesting a need for better IPC education and accountability in the outpatient setting. When given incentives to comply with processes toward which they had negative attitudes at baseline, HCP realized that medical masks and N95 respirators were comfortable enough to wear for patient encounters and interfered with their work processes less than expected. Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.

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.

PREVIOUS PRESENTATION. Parts of this manuscript were presented as a poster at ID Week 2017 on October 6, 2017, in San Diego, California.© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3904-0011. DOI: 10.1017/ice. 2018.9 infection control & hospital epidemiology april 2018, vol. 39, no. 4 objective. To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). design. Retrospective observational cohort study. setting. This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. participants. The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory …

OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461

Detection of bacteremia directly from blood may improve time to clinical diagnosis and initiation of appropriate antibiotic therapy for hospitalized patients. Administration of empiric antibiotic therapy, whether prior to standard of care (SOC) or research study blood collection, adds to challenges in bacterial recovery. Strategies to improve detection were explored in this pilot study to inform future clinical trial design (CTD) on Enterobacteriaceae (ENT) detection directly from blood. One of the objectives was to assess effects of prior antibiotic administration on novel assay performance. Confirmed ENT bacteremic (Protocol A (P-A), n = 26), and suspected bacteremic (Protocol B (P-B), n = 25) participants were enrolled into one of two IRB approved protocols after obtaining informed consent. Fresh whole blood (20 mL) was collected within 12 hours of SOC blood culture positivity (P-A) or 20 hours of SOC blood culture collection (P-B), and divided: 10 mL inoculated into a lytic media collection vessel (P-A and B); and 10 mL into a BD BACTEC™ Bottle (P-A) as a control, or an Isolator™ lysis centrifugation tube (P-B) for quantification. For collection vessels, a 3-hour amplification step in lytic growth medium followed by cleanup and concentration steps was employed. Processed samples were tested using an investigational assay for universal bacterial detection on the Accelerate Pheno™ system. Results were analyzed manually and with proprietary software. Descriptive statistics were performed to inform future CTD. Empiric antibiotic therapy was initiated prior to blood collection in 89% (P-A) and 36% (P-B) of participants. Improved detection sensitivity was achieved in P-B over P-A, when a study sample was obtained prior to empiric antibiotic therapy initiation (Table 1). Prior antibiotic administration and low bacterial load in clinical samples affects ability to detect ENT directly from blood. Multiple factors are critical to address in future CTD to increase sensitivity of detecting ENT directly from blood including: (1) Targeting study samples prior to antibiotic therapy initiation and (2) Using enzymatic methods to neutralize antibiotics present in the blood. M. Fuchs, Accelerate Diagnostics, Inc.: Employee, Salary. S. Kim, Accelerate Diagnostics, Inc.: Employee, Salary. S. Metzger, NIH: Grant Investigator, Grant recipient. Accelerate Diagnostics, Inc.: Employee, Salary.

We analyzed data from health care personnel (HCP) participating in the multicenter, cluster randomized Respiratory Protection Effectiveness Clinical Trial (ResPECT) obtained over three viral respiratory (influenza) illness seasons (2012–2015) at three university health systems where influenza vaccination was mandated, and four Veterans Affairs (VA) health systems where it was encouraged but not mandated, to determine the incidence and duration of symptomatic influenza like illness (SILI) associated absenteeism. Participants reported SILI daily, vaccination status, and days absent from work due to SILI weekly throughout a 12 week period during the peak viral respiratory illness season each year. Adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. Overall 97.1%, 96.3%, and 92.1% of participants reported being vaccinated during each of the three study years where the vaccine was mandated, while 67.9%, 63.3%, and 60.4% reported vaccination at sites where it was encouraged but not mandated. The percent of HCP claiming any sick days at mandatory sites was estimated to be 5.9% lower than at non-mandatory sites (95% CI, -12.5, -1.4; P = 0.02). Among HCP who reported at least one sick day, the mean number of symptomatic sick days at mandatory sites was 0.74 lower than at non-mandatory sites (95% CI, -1.37, -0.37, P < 0.01). After adjusting for possible confounding factors (e.g., season, vaccination statues, mandatory or non-mandatory vaccination site, age, children at home) the relative rate of sick days taken by vaccinated compared with unvaccinated subjects was reduced in the entire cohort of HCP and in the vaccinated compared with unvaccinated subset of HCP from non-mandatory sites (see Figure). We conclude that influenza vaccination rates are increased and SILI-related absenteeism is decreased at sites where influenza vaccination is mandated and that this should be one of the factors taken into consideration when healthcare facilities make decisions about influenza vaccination policies. Adjusted Odds Ratio for Vaccination Status and Taking Any Sick Time, Adjusted Relative Rate of Sick Days Taken. All authors: No reported disclosures.