Elizabeth Salsgiver

Surgical Site Infections following Spine Surgery for Non-idiopathic Scoliosis

Background: Surgical site infections (SSIs) following spine surgery in children and adolescents with nonidiopathic scoliosis are associated with increased morbidity and health care costs. Potentially modifiable risk factors for SSIs merit additional study in this population. Methods: A single-center, retrospective cohort study was performed from August 2008 through December 2013 in children and adolescents undergoing surgery for nonidiopathic scoliosis to determine the trends in SSI rate and causative microorganisms. A standardized perioperative antimicrobial prophylaxis regimen was developed from September-October 2008. Potential risk factors for SSIs were assessed by multivariable analysis using Poisson regression models. Fusion procedures and growing construct procedures were analyzed separately. Results: In all, 268 patients underwent 536 surgical procedures of whom 192 underwent 228 fusion procedures, 89 underwent 308 growing construct procedures, and 13 underwent both procedures during the study period. Twenty-one SSIs (3.9% of surgical procedures and 7.8% of patients) occurred within 90 days of surgery, 17 SSIs occurred after fusion procedures (4.5% of procedures and 8.9% of patients), and 4 SSIs occurred after growing construct procedures (1.3% of procedures and 4.5% of patients). There were 9 polymicrobial SSIs (42.9%). Of the 31 bacterial pathogens isolated, 48% were Gram-negative organisms. Among patients undergoing fusion procedures, SSIs were associated with underdosing of preoperative cefazolin [relative risk (RR)=4.99; 95% confidence interval (CI), 1.89-17.43; P=0.012] and tobramycin (RR=5.86; 95% CI, 1.90-18.06; P=0.002), underdosing of intraoperative (RR=5.65; 95% CI, 2.13-14.97; P=0.001) and postoperative (RR=3.86; 95% CI, 1.20-12.40; P=0.023) tobramycin, and any preoperative or intraoperative underdosing (RR=4.89; 95% CI, 1.70-14.12; P=0.003), after adjustment for duration of surgery. No factors were associated with SSIs in those undergoing growing construct procedures. During the study period, the SSIs rate declined (P<0.0001). Conclusions: Underdosing of tobramycin and preoperative cefazolin were associated with an increased SSI risk among patients undergoing fusion procedures. Future multicenter studies should further investigate the generalizability of these findings. Level of Evidence: Level II—retrospective study.

Exploring the Role of the Bedside Nurse in Antimicrobial Stewardship: Survey Results From Five Acute-Care Hospitals

occurrences were related to management and were therefore not reported as dispenser defects. In a cross-sectional survey-based study, Kohan et al described a defect rate of 2% (4 of 166) in mechanical HHDs after having been in use for 16 months; the authors concluded that mechanical HHDs, even from the same manufacturer, may differ considerably in their design and may not function similarly. Although well-functioning HHD systems may be seen as a basis for adequate hand hygiene compliance and careful evaluation of newly introduced products is important to guarantee cost-effective allocation of financial resources in healthcare institutions, defect rates of touchless HHDs have not been reported in the literature previously. Our study has 2 main limitations. First, we investigated defect rates of touchless and mechanical HHDs from a single manufacturer, which may limit the generalizability of the study results. Second, the definite cause of device or pump malfunctions could not be determined. In conclusion, we observed a significantly higher defect rate among touchless HHDs than among mechanical HHDs. The ease of use of touchless HHDs for visitors should be balanced with the additional resources required for maintenance. Mechanical HHDs may be better suited for healthcare workers due to their high reliability, low maintenance requirements, and battery-free function. An evaluation of touchless HHDs from other manufacturers is warranted.

Comparing the Bioburden Measured by Adenosine Triphosphate (ATP) Luminescence Technology to Contact Plate–Based Microbiologic Sampling to Assess the Cleanliness of the Patient Care Environment

The correlation between ATP concentration and bacterial burden in the patient care environment was assessed. These findings suggest that a correlation exists between ATP concentration and bacterial burden, and they generally support ATP technology manufacturer-recommended cutoff values. Despite relatively modest discriminative ability, this technology may serve as a useful proxy for cleanliness.Infect Control Hosp Epidemiol 2018;39:622-624.

Infection Prevention and Control Education for Environmental Services Workers (ESW): “Cleaner is Safer – ESW on the Front-line of Infection Prevention”

Abstract Background Studies suggest that improving environmental cleaning and disinfection reduces pathogen transmission and prevents healthcare-associated infections (HAIs). We designed and administered an educational program for hospital ESW based on findings from a 2015 knowledge, attitudes, and practices survey. Methods An interactive 5-part educational program was given to front-line ESW at 5 acute care hospitals from 7/16 to 3/17 using principles of adult learning theory. Audience response system (ARS), videos, demonstrations, role-playing, and graphics were used to illustrate concepts and emphasize the rationale for HAI prevention strategies. Topics included HAIs, hand hygiene, isolation precautions, personal protective equipment, daily and discharge cleaning, and strategies to overcome common challenges and barriers. Evaluation included ARS questions, written evaluations, and assessment of daily cleaning before and after education using the 3M™ Clean-Trace™ Hygiene Management System. Clean surfaces were those with <250 relative light units detected. Chi-square tests were performed, where appropriate. Results On average, 357 (range: 303-391) ESW attended each of the 5 program components. Most participants rated the presentations as ‘excellent’ or ‘very good’ (93%) and agreed they were useful (95%). After the program, participants indicated they were more comfortable donning/doffing PPE (91%), performing hand hygiene (96%), and better understood the importance of disinfecting high-touch surfaces (96%). The frequency of effective cleaning of high-touch surfaces in occupied patient rooms significantly improved following education (Table). Conclusion A novel educational program, designed using adult learning theory, that addressed ESW’s self-identified challenges was well-received and appears to have resulted in learning, behavior change, and improved daily cleaning. Future research will assess program sustainability and long-term impact on hospital cleanliness and patient outcomes. Surface Percentage of surfaces identified as clean (%) Pre-intervention Post-intervention Absolute % change Toilet seat 85 88 3 Toilet flush 60 82 22 Overbed table 29 87 58* Bed rail 8 50 42* Call box 5 65 60* Visitor chair 0 59 59* *P < 0.05. Disclosures All authors: No reported disclosures.

Quantitative Assessment of the Bioburden of High-Touch Environmental Surfaces in Pediatric Operating Rooms

Abstract Background Previous studies have linked healthcare-associated infections to bacterial pathogens in the operating room (OR) environment. The purpose of this study was to determine the bioburden on OR surfaces to guide future quality improvement efforts and optimize OR cleanliness. Methods This study was performed in the pediatric ORs of a 200-bed, academically affiliated, children’s hospital with ~6000 general and subspecialty surgical procedures annually. Immediately after cases were finished, but prior to cleaning, the 3M Clean-Trace Clinical Hygiene Monitoring System was used to quantify bioburden (in surface ATP concentration) on 24 surfaces in each of 8 ORs. These 24 surfaces were previously identified by the Association of periOperative Registered Nurses as high-touch surfaces and various disciplines are responsible for their cleaning. Each OR was sampled 1–4 times. A surface passed the test of cleanliness if the result was <250 relative light units (RLUs). Results In all, 364 surfaces were tested. The median RLUs were <250, 250–850, and >850 RLUs for 7, 11, and 6 surfaces, respectively. Of the 24 surfaces tested, all demonstrated bioburden ≥250 at least once. Median RLUs for each surface ranged from 39-2282 and median RLUs for each OR ranged from 196 to 1534. The highest bioburden occurred following cardiac surgery (median 1534, range 24-13275 RLU) and the lowest bioburden occurred after neurosurgery (median 196, range 23-2475 RLU). The surfaces with the highest bioburden were the anesthesia keyboards (median 2282, range 347-38376 RLU) and core door handles (median 1471, range 140–6788 RLU) and those with the lowest bioburden were the Mayo stand (median 39, range 19-765 RLU) and back table (median 39, range 17-406 RLU). Conclusion ATP testing demonstrated that most OR surfaces were contaminated with organic material. While OR surfaces prior to cleaning are expected to be contaminated, these data highlight the importance of cleaning/disinfection. These findings are being used to develop educational tools and interventions for the interdisciplinary OR team, which will focus on delineation of cleaning responsibilities, the use of appropriate cleaning products, and audits of end-of-case cleaning and terminal cleaning. Disclosures All authors: No reported disclosures.

Knowledge, Attitudes, and Practices Regarding Antimicrobial Stewardship Among Antimicrobial Prescribers at Five Acute Care Hospitals

 The survey results will be used to develop and implement clinical AS interventions at NYP. Future research efforts will focus on the identification of changes in antimicrobial prescribing practices and clinical outcomes associated with enhanced AS educational initiatives and increased postprescription review and feedback resources. CONCLUSION Contact Information: Elizabeth Salsgiver, MPH Weill Cornell Medical College Phone: 802-598-6065 Email: ELS7021@med.cornell.edu

451Case Finding for Invasive Aspergillosis in Children

Background. Invasive aspergillosis (IA) continues to pose a serious threat to immunocompromised children. We sought to determine the recent epidemiology of IA and compare the utility of multiple diagnostic strategies for IA case finding. Methods. A retrospective case series of patients ≤18 years of age with proven, probable or possible IAdiagnosed from 2004-2013 was performed at NewYork-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, NY. Case finding was performed by review of positive cultures and serum galactomannan and by natural language processing to detect relevant pathology findings from autopsy or surgery (e.g., septated hyaline branching, angioinvasion) and from radiographic findings (e.g., halo, air-crescent, nodules). Results. Twenty-one children were identified by culture (n = 8), galactomannan (n = 10), pathology (n = 14), and/or radiology (19) of whom 13, 4, and 4 cases met criteria for proven, probable, and possible IA, respectively. Natural language processing detected 6 additional cases not detected by either culture or galactomannan. Of the 21 children, 9, 2, and 2 had undergone bone marrow (BM), heart, and liver transplant, respectively, of whom 2 had both BM and solid organ transplant. The remainder were on chemotherapy (n = 5) or had other comorbid conditions including lupus (n = 2). IA rates were 2.8%, 0.9%, and 1.2% in BM, heart, and liver transplant recipients (p = 0.2). The most common sites of infection were lung (n = 12), sinuses (n = 3), and heart (n = 3); 5 patients had multi-site infections. Most (81%) had received antifungal agents within 90 days of IA diagnosis. Prior use of antifungal agents was similar in those with (n = 7/8) and without (10/13) positive cultures. Crude mortality was 67% at 3 months and 86% at 6 months. Conclusion. In this 10 year study, IA rates appeared to be lower than previously reported, although crude mortality was similar. The use of natural language processing for case finding could improve IA surveillance efforts. De Pauw B, et al. Clin Infect Dis 2008; 46:1813-21. Disclosures. All authors: No reported disclosures.