Background: Pseudomonas aeruginosa (PA) is a common cause of healthcare -associated infection (PA-HAI) in the intensive care unit (ICU). Aim: To describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and to identify episodes of sink -to -patient PA transmission. Methods: This was a prospective cohort study of patients in six ICUs from 2018 to 2019, with retrieval of PA clinical isolates, and PA -screening of antimicrobial -resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole-genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU -acquired PA was defined as PA isolated from specimens obtained >48 h after ICU admission in those with prior negative rectal swabs. Sink -topatient PA transmission was defined as ICU -acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to collection date of the relevant patient specimen. Findings: Over ten months, 72 PA-HAIs occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient -ICU -days; higher in patients who were PA -colonized on admission. PA-HAI was associated with longer stay (median: 26 vs 3 days uninfected; P < 0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICUacquired PA were identified, contributing 35/72 (48.6%) PA-HAIs. Four patients with five PA-HAIs (6.9%) had closely related isolates previously recovered from their room/bedspace sinks. Conclusion: Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PAHAIs were associated with sink -to -patient transmission. Sinks may be an under -recognized reservoir for HAIs.

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We enrolled 91 consecutive inpatients with COVID-19 at 6 hospitals in Toronto, Canada, and tested 1 nasopharyngeal swab/ saliva sample pair from each patient using real-time RT-PCR for severe acute respiratory syndrome coronavirus 2. Sensitivity was 89% for nasopharyngeal swabs and 72% for saliva (P = .02). Difference in sensitivity was greatest for sample pairs collected later in illness.

AbstractWe enrolled 53 consecutive in-patients with COVID-19 at six hospitals in Toronto, Canada, and tested one nasopharyngeal swab/saliva sample pair from each patient for SARS-CoV-2. Overall, sensitivity was 89% for nasopharyngeal swabs and 77% for saliva (p=NS); difference in sensitivity was greatest for sample pairs collected later in illness.

To compare sensitivity of specimens for COVID-19 diagnosis, we tested 151 nasopharyngeal/midturbinate swab pairs from 117 COVID-19 inpatients using reverse-transcriptase polymerase chain reaction (RT-PCR). Sensitivity was 94% for nasopharyngeal and 75% for midturbinate swabs (P = .0001). In 88 nasopharyngeal/midturbinate pairs with matched saliva, sensitivity was 86% for nasopharyngeal swabs and 88% for combined midturbinate swabs/saliva.

Abstract Background Hospital wastewater environments are recognized as reservoirs for multi-drug-resistant bacteria, and sink drains in ICUs have been implicated in numerous outbreaks. The mechanism of pathogen transmission to patients, and the best approach to risk mitigation remains unclear. We tested a new copper alloy sink drain for its effect on detection of gammaproteobacteria in sink drains and adjacent aerosols. Methods We randomized 90 sinks in 76 ICU rooms/bedspaces in 7 ICUs to new standard chrome or copper alloy drains. We sampled sinks on 4 occasions over 4 months. Drain tailpieces were sampled using cotton swabs of 140 cm2 of the interior surface, inserted into 1mL of Dey-Engley neutralizing broth, and cultured semi-quantitatively for gammaproteobacteria on Mac3CV. 850L samples of air adjacent to sinks were obtained by impaction onto Mac3CV. Faucet swabs were also cultured. Multivariable analysis adjusting for factors associated with growth in air and drains used conditional logistic regression, GEE with an exchangeable correlation matrix, a robust estimate of variance, negative binomial distribution and log link function. Results Gammaproteobacteria were detected in 247/424 (58%) tailpiece swabs, 137/456 (30%) air samples, and 31/456 (7%) faucet swabs. In multivariable analysis, growth was less likely from air adjacent to sinks with copper vs. chrome drains [IRR 0.50 (95% CI 0.35, 0.73), P < 0.0001], with reduced effect size observed when drain growth was included in the model [IRR 0.64 (95% CI 0.43, 0.94)], P = 0.025]. Growth in air was more likely when drain growth was 1–899 cfu/cm2 [IRR 2.38 (95% CI 1.46, 3.88), P = 0.001] or ≥900 cfu/cm2 [IRR 3.55 (95% CI 1.87, 6.86), P < 0.001] vs. no growth. Tailpiece swab growth was more likely if rooms were occupied compared with empty [IRR 1.85 (95% CI 1.25, 2.76), P = 0.002], and less likely from copper drains compared with swabs from chrome drains [IRR 0.51 (95% CI 0.47, 0.75), P ≤ 0.001]. Conclusion Sinks with new copper drains are less likely to have detectable gammaproteobacteria in adjacent air when compared with standard chrome drains, and results suggest this is mediated through reduced bacterial growth in the drains. Ongoing study is needed to determine whether this influences patient risk for hospital-acquired infection. Disclosures All authors: No reported disclosures.