OBJECTIVE:To characterize institutional masking policies for healthcare personnel (HCP) and identify factors informing masking decisions in the post-COVID-19 pandemic era. DESIGN:Cross-sectional, survey-based study. SETTING:Healthcare institutions participating in the Society for Healthcare Epidemiology of America (SHEA) and Association for Professionals in Infection Control and Epidemiology (APIC) Research Networks. PARTICIPANTS:One representative per institution, including infection preventionists, hospital epidemiologists, or healthcare administrators, knowledgeable about organizational masking policies. METHODS:A structured, web-based survey was distributed through the SHEA/APIC Research Networks. Survey domains included institutional characteristics, masking strategies outside of transmission-based precautions, epidemiologic and operational factors influencing masking decisions, and mask types required. Responses were collected anonymously via REDCap over a six-week period and analyzed descriptively. RESULTS:A total of 172 unique healthcare institutions completed the survey (41% response rate, n = 172/425). Most respondents were infection preventionists (65%) or hospital epidemiologists (25%). The most common masking approach was a seasonal or situational risk-based strategy (57%), while 7% of institutions reported no formal masking policy. Among institutions using seasonal or situational masking, decisions were most frequently informed by outbreaks or clusters (37%), public health guidance (33%), and HCP illness/absenteeism (27%). Most institutions reported no fixed epidemiologic thresholds for masking decisions. When masking was required, surgical masks were most commonly used (98%). CONCLUSIONS:Masking policies and decision-making criteria vary widely across healthcare institutions, reflecting a lack of standardized operational guidance. These findings underscore the need for consensus-based, data-driven frameworks to support consistent, transparent, and evidence-informed masking policies in healthcare settings.

BACKGROUND:/Purpose: Environmental surfaces that interface with hand hygiene may serve as underrecognized sites of microbial contamination. Paper-towel dispensers are frequently used but are often excluded from routine cleaning and surveillance. This study aimed to assess the prevalence and burden of bacterial contamination on paper-towel dispensers, compare contamination between manual and touch-free units, and characterize recovered organisms. METHODS:We conducted a cross-sectional environmental surveillance study at a tertiary care hospital, sampling 40 paper-towel dispensers (30 manual, 10 touch-free) in public and staff bathrooms, hallway sinks, public kitchenette/nutrition station areas, and break areas. Dispenser apertures were swabbed using premoistened ESwabs. Samples were cultured on blood agar and assessed semi-quantitatively. Organisms were identified via MALDI-TOF. Contamination prevalence and CFU burden were compared between dispenser types using Fisher's exact and Mann-Whitney U tests. RESULTS:Surveillance cultures identified bacterial contamination in 70% (28/40) of paper-towel dispensers. Contamination was more frequent among manual dispensers than touch-free dispensers (80% vs. 40%; relative risk 2.0, 95% confidence interval 0.92-4.36; Fisher's exact test, P=0.04). The most commonly recovered organisms were Bacillus spp. and Coagulase-negative staphylococci. Organisms of clinical or IPC concern were identified in 14% of dispensers, with most located in the emergency department. No multidrug-resistant organisms were detected. CONCLUSION:Although the findings should be interpreted with caution given the wide confidence interval and exploratory design of the analysis, they indicate that paper-towel dispensers may harbor bacterial contamination at the hand hygiene interface. These observations may guide future environmental hygiene policies and the development of targeted infection prevention interventions in healthcare settings.

ImportanceBlood culture (BC) use benchmarks in US hospitals have not been defined.ObjectiveTo characterize BC use in adult intensive care units (ICUs) and wards in US hospitals.Design, Setting, and ParticipantsA retrospective cross-sectional study of BC use in adult medical ICUs, medical-surgical ICUs, medical wards, and medical-surgical wards from acute care hospitals from the 4 US geographic regions was conducted. Critical access hospitals, less than 6 months of BC data, and non-US hospitals were excluded. The study included BC use data from September 1, 2019, to August 31, 2021. Data were analyzed from February 23 to July 14, 2024.Main Outcomes and MeasuresThe primary outcome was BC use per 1000 patient-days. Adjusted means with 95% CIs were calculated using mixed-effects negative binomial regression models adjusted for unit type, hospital bed size, geographic region, seasonality, and state COVID-19 case load, with random intercepts accounting for clustering at unit and hospital levels. Secondary outcomes included blood culture positivity, single BCs, BC contamination, and minimum threshold for BC use where blood culture positivity would be optimized.ResultsA total of 362 327 blood cultures were analyzed from 27 medical ICUs, 35 medical-surgical ICUs, 121 medical wards, and 109 medical-surgical wards from 48 hospitals in 19 states and the District of Columbia. The adjusted mean BC use per 1000 patient-days was 273.1 (95% CI, 270.2-275.9) for medical ICUs, 146.0 (95% CI, 144.5-147.5) for medical-surgical ICUs, 80.3 (95% CI, 79.8-80.7) for medical wards, and 65.1 for medical-surgical wards. Blood culture use was significantly higher across all 4 unit types in hospitals with more than 500 beds compared with 500 or less beds and in the West-Midwest compared with other regions. Single blood culture and positive blood culture rates were below 10% across all 4 unit types. Of the 292 units, 97% had a mean BC contamination rate within 3% of the recommended threshold, and 51% were within 1%. The minimum BC use thresholds (ie, BC use below this number may represent undertesting) were 120 BCs per 1000 patient-days for medical ICUs, 80 BCs per 1000 patient-days for medical-surgical ICUs, and 30 BCs per 1000 patient-days for medical-surgical wards.Conclusions and RelevanceThe findings of this study suggest that blood culture positivity may help determine appropriate BC use for individual unit types.

Abstract Background Overutilization of diagnostic tests results in inappropriate antibiotic use, increased hospital length of stay, higher healthcare costs, overdiagnosis of healthcare-associated infections, and antimicrobial resistance. Table 1 Participant Characteristics Methods From January 3 – February 26, 2024, we conducted two prospective surveys focused on the evaluation of febrile inpatients at Rhode Island Hospital. One survey was of medical providers trained in internal medicine, surgery, pediatrics, emergency medicine, and neurology and the other was of nursing staff in inpatient areas and the emergency department (ED). Results 70 providers (9%) and 178 nursing staff (12%) completed their respective surveys. When asked about evaluating febrile inpatients, 64% of providers (n=43) reported “always” or “often” ordering full fever workups or ‘panculturing’ and 67% of providers (n=47) reported “always” or “often” physically evaluating febrile patients at the bedside (Table 2). In contrast, only 45% of nursing staff (n=80) reported that providers “always” or “often” evaluate febrile patients in person. 76% of nursing staff (n=135) responded providers “always” or “often” order full fever workups. When asked about hand-off practices for febrile patients, 71% of providers (n=50) reported “always” or “often” receiving written hand-offs. 86% of providers (n=60) reported the hand-offs are “always” or “often” accurate; however, only 17% of providers responded these were “always” accurate. 77% of providers (n=54) reported “always” or “often” following hand-off instructions to obtain a full fever workup if a patient becomes febrile, regardless of a patient’s clinical status. Responses differed significantly by nursing unit type (Table 3) and by provider specialty and position (Tables 3 & 4). Table 3 Nursing Staff Responses by Unit Type Conclusion This study elucidates drivers of inefficient and excessive utilization of diagnostic studies at RIH and identifies potential targets for diagnostic stewardship interventions. Table 4 Provider Responses by Specialty and Position Disclosures Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)

Background The incidence of spine infections has increased due to the surge in injection drug use driven by the opioid epidemic. Few recent studies have evaluated the microbiology of spinal epidural infections among people who inject drugs compared to the microbiology of such infections among the general population.Methods We performed a retrospective chart review to identify patients with a spinal epidural abscess or phlegmon unrelated to recent spine surgery between 2015 and 2023.Results Of 346 initial records, 277 met inclusion criteria for demographic analyses. Of the 229 patients with microbiologic results, details regarding possible drug use were available in 227 patients. Patients with no documented history of drug use were categorized as non-PWUD, while patients who use drugs (PWUD) were separated based on whether drug use was active or not. Patients with prior histories of injection or noninjection drug use were categorized as nonactive PWUD, while those with injection or snorting drug use reported in the past 3 months were categorized as active PWUD. Thirty-nine percent of patients with spinal epidural infection had substance use disorder. Most patients with monomicrobial cultures were infected with gram-positive, aerobic bacteria (86%). Active PWUD were more likely to have methicillin-resistant Staphylococcus aureus compared to non-PWUD (36% vs 13%, respectively, P = .002). Nonactive PWUD were more likely to have non-Escherichia coli gram-negative bacterial infections than non-PWUD (18% and 4.4%, respectively, P = .01).Conclusions More than 1 in 3 patients with a spinal epidural infection unrelated to recent surgery had substance use disorder. These patients are more likely to have infections due to MRSA and gram-negative bacteria other than E coli such as Serratia marcescens. Many patients with spinal epidural abscess or phlegmon have substance use disorder and most of these patients' infections are due to methicillin-resistant Staphylococcus aureus and/or gram-negative bacteria other than Escherichia coli.

Objective: To examine practices of providers and nursing staff in evaluating febrile patients and identify drivers of excessive diagnostic testing. Design: Prospective multiple-choice surveys. Setting: Inpatient areas and the Emergency Department at Rhode Island Hospital (RIH) in Providence, RI. Participants & Methods: We conducted two surveys focused on the evaluation of febrile inpatients at RIH. One survey was of providers trained in internal medicine, surgery, pediatrics, emergency medicine, and neurology; the other survey was of nursing staff (registered nurses and certified nursing assistants), in inpatient areas and the emergency department. Results: 70 providers (9%) and 178 nursing staff (12%) completed the surveys. 64% of providers (n = 43) reported " always " or " often " ordering full fever workups and 67% of providers (n = 47) reported " always " or " often " physically evaluating febrile patients. Nurses were less likely than providers to report that providers " always " or " often " physically evaluate febrile patients (n = 80, 45%; P < 0.01) and more likely to report providers " always " or " often " order full fever workups (n = 135, 76%; P = 0.04). 71% of providers (n = 50) reported " always " or " often " receiving written handoffs. 86% of providers (n = 60) reported handoffs are " always " or " often " accurate; however, only 17% of providers responded these were " always " accurate. 77% of providers (n = 54) reported " always " or " often " following handoff instructions to obtain a full fever workup for febrile patients, regardless of clinical status. Responses differed significantly by unit type and provider specialty and position. Conclusions: This study elucidates drivers of inefficient and excessive utilization of diagnostic studies and identifies targets for diagnostic stewardship interventions.

Background: Proper hand hygiene is the most important practice to reduce the transmission of infections in healthcare settings. Despite this, healthcare institutions continue to struggle to achieve and maintain high rates of hand hygiene compliance among healthcare workers with some studies estimating national healthcare worker hand hygiene compliance to be approximately 50%. Methods: We conducted an anonymous one-time survey of our Lifespan Hospital System employees to evaluate barriers and facilitators to performing hand hygiene as well as interventions to improve hand hygiene compliance. The survey was designed with guidance from the Consolidated Framework for Implementation Research and input from Lifespan infection prevention staff. Result: Over four weeks 985 (6%) Lifespan employees completed the survey. Figure 1 shows the aggregate results of the first 4 survey questions which focused on hand hygiene infrastructure at Lifespan, including availability of sanitizer, staff to manage hand hygiene supplies, and educational materials/reminders. One significant finding was >70% of respondents reported that they either did not know if their unit/department has a person assigned to replace/monitor hand hygiene supplies, or if so, who that person is. We also asked employees to rate how effective different interventions would be at improving hand hygiene compliance. Figure 2 shows of five proposed interventions, three were rated as either “moderately effective” or “very effective” by >50% of respondents. These included displaying hand hygiene instructions, making hand hygiene data available to employees, and displaying materials/reminders promoting hand hygiene. There were also 977 free-text responses regarding “barriers or facilitators to proper hand hygiene”. Major barriers identified were a lack of staff to monitor and refill supplies, slow replacement of hand hygiene products, lack of sanitizer dispensers and sinks, inconsistency of sink location and dispenser placement, lack of hand hygiene reminders/educational materials, time constraints, skin irritation from sanitizer, and an inability to have dispensers in behavioral health units. Survey responses led us to enhance the following: educational materials and reminders in work areas; staff education; leadership involvement in hand hygiene initiatives; routine auditing and feedback; conveniently placed sanitizer dispensers and sinks at the point of care; and making hand hygiene compliance data readily available to staff. Conclusion: This survey identifies important barriers and facilitators to achieving high rates of hand hygiene compliance among healthcare workers and provides the basis for interventions aimed at improving hand hygiene compliance in a large multicenter academic hospital system.

Background Nosocomial bloodstream infections associated with intravascular catheters pose significant financial burden, morbidity, and mortality. There is much debate about whether or not blood cultures should be drawn through central venous catheters, and while guidelines advocate for catheter-drawn cultures when catheter infection is suspected, there is variable practice in this regard.Methods We performed a retrospective cohort study assessing episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures in tertiary care hospitals in the United States and Spain.Results We identified 143 episodes in 122 patients meeting inclusion criteria. Thirty percent of such episodes revealed growth of potential pathogens such as Staphylococcus aureus. Overall, 21% of follow-up percutaneously-drawn blood cultures obtained within 48 hours revealed growth of the same microbe after an episode of positive catheter-drawn blood cultures with negative concomitant percutaneously-drawn cultures (33% when potential pathogens were isolated; 16% when common skin contaminants were isolated). Patients with cultures growing pathogenic organisms were more likely to receive targeted antimicrobial therapy and have their catheters removed sooner.Conclusions Many episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures lead to growth from percutaneously-drawn follow-up blood cultures. Thus, such initial discordant results should not be disregarded. Our findings advocate for a nuanced approach to blood culture interpretation, emphasizing the value of catheter-drawn blood cultures in clinical decision making and management. For episodes of positive catheter-drawn blood cultures growing potential pathogens with negative concomitant percutaneously-drawn cultures, 21% of follow-up percutaneously drawn blood cultures obtained within 48 hours grew the same microbe. Thus, finding positive catheter-drawn cultures should not be disregarded.

OBJECTIVE:The primary aim of this retrospective study was to assess differences in the pathogens causing surgical site infections (SSIs) following craniectomies/craniotomies and open spinal surgery. The secondary aim was to assess differences in rates of SSI among these operative procedures. METHODS:ANOVA tests with Bonferroni correction and incidence risk ratios (RRs) were used to identify differences in pathogens by surgical site and procedure using retrospective, de-identified records of 19,993 postneurosurgical patients treated between 2007 and 2020. RESULTS:The overall infection rates for craniotomy/craniectomy, laminectomy, and fusion were 2.1%, 1.1%, and 1.5%, respectively, and overall infection rates for cervical, thoracic, and lumbar spine surgery were 0.3%, 1.6%, and 1.9%, respectively. Craniotomy/craniectomy was more likely to result in an SSI than spine surgery (RR 1.8, 95% CI 1.4-2.2, p < 0.0001). Cutibacterium acnes (RR 24.2, 95% CI 7.3-80.0, p < 0.0001); coagulase-negative staphylococci (CoNS) (methicillin-susceptible CoNS: RR 2.9, 95% CI 1.6-5.4, p = 0.0006; methicillin-resistant CoNS: RR 5.6, 95% CI 1.4-22.3, p = 0.02); Klebsiella aerogenes (RR 6.5, 95% CI 1.7-25.1, p = 0.0003); Serratia marcescens (RR 2.4, 95% CI 1.1-7.1, p = 0.01); Enterobacter cloacae (RR 3.1, 95% CI 1.2-8.1, p = 0.02); and Candida albicans (RR 3.9, 95% CI 1.2-12.3, p = 0.02) were more commonly associated with craniotomy/craniectomy cases than fusion or laminectomy SSIs. Pseudomonas aeruginosa was more commonly associated with fusion SSIs than craniotomy SSIs (RR 4.4, 95% CI 1.3-14.8, p = 0.02), whereas Escherichia coli was nonsignificantly associated with fusion SSIs compared to craniotomy SSIs (RR 4.1, 95% CI 0.9-18.1, p = 0.06). Infections with E. coli and P. aeruginosa occurred primarily in the lumbar spine (p = 0.0003 and p = 0.0001, respectively). CONCLUSIONS:SSIs due to typical gastrointestinal or genitourinary gram-negative bacteria occur most commonly following lumbar surgery, particularly fusion, and are likely to be due to contamination of the surgical bed with microbial flora in the perianal area and genitourinary tract. Cutibacterium acnes in the skin flora of the head and neck increases risk of infection due to this microbe following surgical interventions in these body sites. The types of gram-negative bacteria associated with craniotomy/craniectomy SSIs suggest potential environmental sources of these pathogens. Based on the authors' findings, neurosurgeons should consider using a two-step skin preparation with benzoyl peroxide, in addition to a standard antiseptic such as alcoholic chlorhexidine for cranial, cervical, and upper thoracic surgeries. Additionally, broader gram-negative bacterial coverage, such as use of a third-generation cephalosporin, should be considered for lumbar/lumbosacral fusion surgical antibiotic prophylaxis.

There is no practical way to definitively diagnose a catheter-related bloodstream infection in situ if blood cultures are only obtained percutaneously unless there is the rare occurrence of purulent drainage from a central venous catheter insertion site. That is why the Infectious Diseases Society of America guidelines for diagnosis and management of catheter-related bloodstream infections and Infectious Diseases Society of America guidelines for evaluation of fever in critically ill patients both recommend drawing blood cultures from a central venous catheter and percutaneously if the catheter is a suspected source of infection. However, central venous catheter-drawn blood cultures may be more likely to be positive reflecting catheter hub, connector, or intraluminal colonization, and many hospitals in the United States discourage blood culture collection from catheters in an effort to reduce reporting of central-line associated bloodstream infections to the Centers for Disease Control and Prevention. As such, clinical decisions are made regarding catheter removal or other therapeutic interventions based on incomplete and potentially inaccurate data. We urge clinicians to obtain catheter-drawn blood cultures when the catheter may be the source of suspected infection.

External ventricular drains (EVDs) are medical devices that are inserted into the ventricles of the brain to drain excess fluid, manage intracranial hypertension, monitor intracranial pressure, and administer medications. Unintentional disconnections and breaks or fractures (breaks) of EVDs or associated drainage system components can result in cerebrospinal fluid (CSF) leakage and increased risk for EVD-associated infections. After replacement of Integra Life Sciences EVD systems with Medtronic Duet EVD systems at Rhode Island Hospital in mid-September 2023, a threefold increase was observed in the prevalence of positive CSF cultures, from 2.8 per 1,000 days with an EVD in place (EVD days) during January-September 2023 to 11.4 per 1,000 EVD days during October 2023-January 2024 (rate ratio [RR] = 5.7; 95% CI = 1.5-22.0; p = 0.01) and an eightfold increase in the prevalence of infections, from 0.7 to 6.5 per 1,000 EVD days (RR = 9.8; 95% CI = 1.1-87.3; p = 0.04). An investigation by Rhode Island Hospital Infection Control during December 2023-January 2024 identified frequent reports of disconnections and breaks of the Medtronic Duet EVD system. A search of the Food and Drug Administration Manufacturer and User Facility Device Experience database identified 326 reports nationwide of disconnection and breaks of components of the Duet EVD system, including 175 during 2023. A Medical Product Safety Network report was filed. The Duet EVD product was ultimately recalled in January 2024, citing disconnections of the EVD system and reports of CSF leakage and infection. Given the widespread use of EVD systems by neurosurgery centers and the risk for EVD-associated infections, a strategy for future consideration by hospital infection prevention and control programs might be inclusion of EVD-associated infections in hospital surveillance programs to rapidly identify increases in these events and determine factors related to such infections to prevent additional infections.

Abstract Background Blood culture (BCx) contamination (BCxC) leads to unnecessary antibiotic exposure, increased hospital stay, and cost. Despite best practices, our health system’s BCxC rates remain above the 1% benchmark. Implementation of an initial specimen diversion device (ISDD) have demonstrated reduced BCxC rates. 3,4 We assessed the impact of the Kurin Lock® ISDD on BCxC and vancomycin utilization in adult emergency departments (EDs), intensive care and step-down units (ICU/SD). Methods The Kurin Lock® was implemented in 3 Lifespan health system hospitals (The Miriam Hospital [TMH] ED October2022; Rhode Island Hospital [RIH] and Newport Hospital [NH] EDs January 2023, and in all 3 hospital’s ICU/SD units June 2023). We included adult BCx obtained by nurses (all hospitals) or phlebotomists (NH only). BCx were drawn per protocol; growth was monitored with the BioMérieux VIRTUO System. BCxC rates were calculated dividing the number of contaminated cultures (per CDC NHSN commensal list) by the total number of BCxs/month. Mean BCxC rates prior to Kurin Lock® implementation (6 months) and after implementation (subsequent months through December 2023), excluding the month of implementation, were compared using the Wilcoxon rank-sum test. An interrupted time-series analysis was performed using binomial regression models; vancomycin days of therapy (DOT) for ’bacteremia’ was analyzed using generalized linear models. Results Overall mean BCxC rates for all hospitals and locations decreased from 3% to 1.9% after ISDD implementation (P=0.009). This decline was observed in all EDs but only statistically significant in RIH ICUs/SDs. In the time-series analysis, an abrupt 65% decline in BCxC was observed immediately after implementation in all hospitals and locations (P = 0.04). Lower BCxC rates were sustained after 200 days in the ICUs/SDs and 400 days in the EDs; however, an upward trend was observed with time. Vancomycin DOT was not significantly different pre- vs. post-Kurin Lock® implementation (41/1000 patient days vs. 37/1000 patient days, P=0.9). Conclusion A sustained decline in BCxC is achievable with the Kurin Lock® ISDD in academic and community hospital settings. But consistent education on best practices is key to guarantee the efficacy and cost-effectiveness of this intervention. Disclosures Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Abstract Background The anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications. Methods We retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization. The primary outcome was the required catheter dwell time, defined as the period between the first catheter insertion and removal of the last catheter for absence of utility. Predictors were identified in the training cohort (3SITES trial; 2336 patients) through multivariable analyses based on the subdistribution hazard function accounting for death as a competing event. Internal validation was performed in the training cohort by 500 bootstraps to derive the CVC-IN score from robust risk factors. External validation of the CVC-IN score were performed in the testing cohort (CLEAN, and DRESSING2; 2371 patients). Results The analysis was restricted to patients requiring mechanical ventilation to comply with model assumptions. Immunosuppression (2 points), high creatinine > 100 micromol/L (2 points), use of vasopressor (1 point), obesity (1 point) and older age (40–59, 1 point; ≥ 60, 2 points) were independently associated with the required catheter dwell time. At day 28, area under the ROC curve for the CVC-IN score was 0.69, 95% confidence interval (CI) [0.66–0.72] in the training cohort and 0.64, 95% CI [0.61–0.66] in the testing cohort. Patients with a CVC-IN score ≥ 4 in the overall cohort had a median required catheter dwell time of 24 days (versus 11 days for CVC-IN score < 4 points). The positive predictive value of a CVC-IN score ≥ 4 was 76.9% for > 7 days required catheter dwell time in the testing cohort. Conclusion The CVC-IN score, which can be used for the first catheter, had a modest ability to discriminate required catheter dwell time. Nevertheless, preference of the subclavian site may contribute to limit the risk of intravascular complications, in particular among ventilated patients with high CVC-IN score. Trials Registration NCT01479153, NCT01629550, NCT01189682

The use of antimicrobial lock therapy for prevention of CRBSI in patients with long-term central venous catheters is based on the pathogenesis of such infections, in which microbial pathogens can migrate from a contaminated hub or connector down the lumen of a catheter into the bloodstream [2]. However, bloodstream infections in some patients with short bowel syndrome may emanate from translocation, which is not prevented by antimicrobial lock therapy. Noted below is summary data from meta-analyses regarding the administration of prophylactic antibacterial or antiseptic-containing lock solutions. Most cited data is from randomized, controlled trials. The outcome measure in all cited studies was CRBSI. Nearly all studies compared an antiseptic or antibiotic-containing lock solu-tion and a nonantiseptic/nonantibiotic-containing lock solution with few exceptions.

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.

Background: Directing COVID-19 diagnostic testing to healthcare workers (HCWs) who are likely to be infected has potential to reduce staffing shortages and decrease opportunity for in-hospital transmission; however, HCWs with COVID-19 may exhibit a range of symptoms. We assessed the burden of symptoms in relation to cycle threshold (Ct) values as a surrogate for viral shedding in vaccinated healthcare workers. Methods: We retrospectively reviewed employee health records of COVID-19–vaccinated employees who tested positive for SARS-CoV-2 between December 2020 and January 2022 at 2 academic hospital systems. We reviewed demographic data, reasons for testing including symptoms, exposure history, medical history, vaccination dates, Ct values, and genotypes when available. We compared mean Ct values between symptomatic and minimally symptomatic cases using independent sample t tests. Patients were defined as minimally symptomatic if they had no symptoms or a single symptom that is not cough, fever, or anosmia at the time of testing. Patients were defined as more symptomatic if they reported >1 symptom or cough, fever, or anosmia. Results: In total, 298 HCWs tested positive for COVID-19. Most positive cases were female (73%), white (78%), and had patient-facing roles (77%). Genotypic testing (n = 109) revealed that most genotypes belonged to the SARS-CoV-2 delta variant (AY lineages, B1.617.2). More cases were minimally symptomatic (62%) than were more symptomatic (38%). None required hospitalization during the study period. Mean Ct values (n = 141) showed no significant difference between more symptomatic and minimally symptomatic cases (19.8 vs 20.6; P = .40) (Fig. 1). Also, there was no significant difference in mean Ct value, comparing those with vaccination 90 days prior to positive (20.52 vs 19.88; P = .537). Conclusions: Our study shows no significant difference in cycle threshold values between minimally symptomatic and more symptomatic infections in vaccinated HCWs. In addition, HCWs exhibit high viral load even when infected within 90 days after vaccination. When considering whether to attend work, HCWs should be aware that mild symptoms and recent vaccination do not necessarily reflect low transmissibility and that they should follow CDC guidance regarding when to return to work. Disclosures: None

Background: Contamination of ventriculoperitoneal shunts (VPS) by cutaneous flora, particularly coagulase-negative staphylococci, is a common cause of shunt infection and failure, leading to prolonged hospital stay, higher costs of care, and poor outcomes. Glove contamination may occur during VPS insertion, increasing risk of such infections. Methods: We performed a systematic search of the PubMed database for studies published January 1, 1970, through August 31, 2021 that documented VPS infection rates before and after implementing a practice of double gloving with change or removal of the outer glove immediately prior to shunt insertion. Results: Among 272 reports screened, 4 were eligible for review based on our inclusion criteria. The incidence of VPS infection was reduced in all 4 quasi-experimental studies with an aggregate incidence of VPS infection of 11.8% before the change in intraoperative protocol and 4.9% after protocol change. One study documented reduced hospital stay with this change in protocol. Conclusion: The risk of VPS infection is reduced by removal or replacement of the outer surgical gloves immediately prior to intraoperative insertion of a VPS as part of an infection control bundle.