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Ultraviolet (UV) light has destructive activity against pathogenic bacteria including Clostridioides difficile spores. Portable pulsed-xenon UV disinfecting devices were implemented for terminal room cleaning in 6 units of our academic hospital with high C. difficile infection (CDI) rates. CDI rates were measured in a 9-month period before and a 9-month period after device implementation. Despite documented administration of UV disinfection for 87% of terminal room cleaning, no impact on CDI rates was detected.

Background It is estimated that 223,900 cases of CDI occur annually in hospitalized patients resulting in 12,800 deaths and $1 billion in attributable costs. Antimicrobial use is a risk factor for CDI. Antimicrobials ordered for UTI have been identified as a factor in both recurrent CDI and community-acquired CDI. This RWD analysis seeks to explore the relationship between HA-UTI and hospital-onset CDI (HO-CDI). Methods An electronic infection surveillance system was the source of de-identified RWD from 290 hospitals. Algorithmically-derived measures of healthcare-associated infections (ADM-HAIs), and records of all-cause antimicrobial orders (AOs), for all inpatient admissions for the period 10/1/18–9/30/19 were analyzed. All patients who presented with a urine ADM-HAI suggestive of HA-UTI and no other healthcare-associated infection (Urine+ patients), were observed for subsequent HO-CDI. Urine+ patients were compared to patients with no HAI of any type, other than CDI (HAI-free patients), and relative risk (RR) was estimated. The analysis was repeated for the subgroup of patients who received an AO for any reason during their stay. Results 3,050,525 inpatient admissions were analyzed. 26,634 were identified as Urine+ patients. 188 of those patients subsequently presented with HO-CDI. 2,978,507 were identified as HAI-free patients. 6,238 of those patients presented with HO-CDI. The incidence of HO-CDI was significantly higher in Urine+ patients compared to HAI-free patients (RR=3.37, 95% CL[2.92, 3.89], p Conclusions The presence of a urine ADM-HAI, suggestive of HA-UTI, was associated with an increased risk of subsequent HO-CDI. This held when only patients with AOs were considered. These observations mirror findings from other published studies, however, other factors may have contributed to increased risk for both HA-UTI and HO-CDI.

Background Healthcare–associated Clostridium difficile infection (CDI) can result from organisms found on hospital environmental surfaces. Without proper cleaning of hospital environmental surfaces, cross-contamination can occur, resulting in a healthcare–associated infection. In 2011, an environmental services (EVS) model was developed in Hospital A that resulted in a reduction in healthcare–associated CDI. The purpose of this study was to determine if implementing Hospital A's EVS model in Hospital B would decrease healthcare–associated CDI incidence. Methods A quasi-experimental design was used. The study was conducted in Hospital B, a 53-bed acute care community-based hospital, between January 2013 and December 2017. A retrospective review of all CDI LabID A/B toxin enzyme immunoassay events was performed using the National Healthcare Safety Network surveillance definitions. The data were calculated based on incidence rates per 1,000 patient days and the National Healthcare Safety Network standard infection ratio formula. No new disinfectants, antibiotic restrictions, or new isolation techniques were instituted during this time period. Results There was a 100% reduction in healthcare–associated CDI in Hospital B from 2013’s baseline rate of 0.48 per 1,000 patient days to 0.00 per 1,000 patient days (0.48, 0.00, P = 0.020). Conclusions This study highlights the importance of EVS education and accountability as well as recognition of the role played by EVS in reducing healthcare–associated CDI within healthcare facilities.

Background Clostridium difficile infection (CDI) is the most common healthcare-associated gastrointestinal infection. Hospitals are required to report cases of healthcare facility-onset CDI (HO-CDI) using the National Healthcare Safety Network's CDI laboratory-identified (LabID) event definition. The aim of this study was to determine the extent of potential over-reporting due to the exclusion of important clinical data within LabID reporting definitions. Methods In 2015, retrospective chart review was performed on 212 HO-CDI cases reported from a large urban medical center. Cases had positive polymerase chain reaction test for the C. difficile toxin B gene from an unformed stool specimen collected >3 days after admission and >8 weeks after most recent LabID event. Cases were categorized into “clinical surveillance” groups: community-acquired infection, recurrence/relapse, asymptomatic colonization, colonization with self-limited symptoms, possible HO-CDI, and probable HO-CDI. Results Of the infections, 13.6% were community acquired, 2.8% were recurrent/relapse, 1.9% were asymptomatic colonization, 18.4% were symptomatic colonization, 38.7% were possible HO-CDI, and 24.5% were probable HO-CDI. Within 24 hours of testing, 34.1% of patients had received a stool softener and/or laxative. Conclusions Laxative use and failure to identify community-onset infection may contribute to misclassification of HO-CDI. Only 62% of reported cases met clinical surveillance criteria.

In a point-prevalence culture survey, 24 of 300 (8%) handles of electronic thermometers in 3 hospitals were contaminated with 1 or more potential pathogens. A DNA marker inoculated onto the handles of electronic thermometers in hospital and long-term care facility settings spread to surfaces in patient rooms, to other types of portable equipment, and to patients' hands. Our findings suggest that effective strategies are needed to reduce the risk for pathogen transmission by electronic thermometers.

Robyn Kay, MPH, CIC, Clinical Epidemiologist, Baptist Medical Center Jacksonville; Michelle Cox, RN, BSN, Clinical Nurse Manager, Baptist Medical Center; Blanca I. McKean, MSN, RN, NE-BC, Director of Adult Tower, Critical Care, Bariatrics, Orthopedics, Baptist Medical Center Jacksonville; Jacqueline Gunning, RN, MSN, Clinical Nurse Manager of Behavioral Health Inpatient, Baptist Medical Center; Nan Hucker, LMHC, Manager of IOP/PHP, Baptist Medical Center; Kenneth Meyer, MD, Infectious Disease Hospital Epidemiologist, Baptist Medical Center; Mary Elizabeth Briand, Pharm. D., BCPSAQ ID, CNSC, Clinical Pharmacist, Bapstist Medical Center

Yukie Mishima Certified Nurse in Infection Control, Subdirector of Department of Infection Control, Jikei University Hospital; Ms. Ayako Saito, Department of Infection Control, JIkei University Hospital; Mr. Taku Tamura, Department of Infection Control, JIkei University Hospital; Mr. Toshiaki Okutsu, Department of Infection Control, JIkei University Hospital; Mr. Yasushi Nakazawa, Director of Department of Infection control, JIkei University Hospital; Mr. Seiji Hori, Department of Infectious Disease and Infection Control, Jikei University School of Medicine

2% chlorhexidine gluconate and 70% isopropyl alcohol solution as surgical site scrub Decrease skin pathogens Multiple studies and meta analyses Most effective product available for reducing skin pathogens, 48 hours of persistence not inactivated by proteinaceous materials Decrease in SSI Pediatric: over 1,000 grams and . 2 weeks old. (Per ALGH Procedure "Peripherally Inserted Central Line Cather (PICC) . "reviewed 10/2009, approval NICU Clin Ed and CNE. Antimicrobial island dressings impregnated with a 0.2% Polyhexamethylene Biguanide (PHMB) Antimicrobial Island dressing sterile, no need of tape to secure Fluid resistant 9 published studies Decrease in SSI rates (CAB G study) 38%. (Vascular study) 91% Decreases in SSI Island dressing too small for full length steri-strips Not fluid impervious

cultures that were contaminated decreased from 84/5274 (1.6%) in P1 to 42/4960 (0.8%) in P2 and 21/4245 (0.5%) in P3 (p< 0.001). The proportion of BCs drawn from central lines that were contaminated decreased from 44/921 (4.8%) in P1 to 3/227 (1.3%) in P2 and 0/39 in P3 (p 1⁄4 0.008). Estimated annualized excess costs of contaminated blood cultures decreased from $504,000 in 2010 to $126,000 in 2012, for an estimated cost savings in 2012 of $378,000 when compared to 2010. CONCLUSIONS: Developing strict protocols for drawing BCs from central lines and reducing the number of BCs drawn from central lines significantly reduced the number of contaminated blood cultures and hospital costs. Reducing the number of contaminated BCs, as part of a multidisciplinary program, may have contributed to a significant reduction in reported CLABSIs.

ISSUE: This Army medical center has seen a marked increase in healthcare-associated resistant (r) Acinetobacter baumanii (Acb) acquisitions since mid-2003, due to the volume of colonized military personnel admitted from Iraq and Afghanistan. Since June 2003, there has been a large influx of patients colonized or infected with rAcb. Additionally, there have been 47 healthcare-associated (HA) acquisitions. PROJECT: Since June 2003, prospective surveillance has been conducted on over 800 inpatient military personnel returning from Iraq and Afghanistan. Patients were placed on contact precautions on admission, pending results of surveillance cultures. HA transmission of rAcb was monitored using standard infection control methodology. All cases of patients with rAcb were placed on contact precautions when identified. A large-scale epidemiologic investigation involving cultures of environmental surfaces, providers' hands, and patients was conducted as part of a performance improvement initiative. Pulsed-field gel electrophoresis (PFGE) was conducted on a sample of isolates. RESULTS: From June 2003 through January 2004, there were approximately 215 (27%) military personnel identified with rAcb on admission. Forty-seven cases of HA acquisitions were identified. Sites of infection included bloodstream, respiratory tract, urine, and wounds. The mean length of stay until acquisition was 30 days and mean age was 50. The epidemiologic investigation revealed two positive environmental samples, no positive growth on providers' hands, and three hemodialysis outpatients not previously identified as colonized. PFGE on patient samples showed no single epidemic strain and no geographically associated strain. LESSONS LEARNED: The presence of a large admission reservoir and in-house reservoir of rAcb resulted in significant HA transmission. As a result of these findings, education was increased to all levels of staff, patients, and families; patient education brochures were developed; surveillance activities were increased; and monitoring of compliance with hand hygiene and contact precautions was initiated. Results of monitoring showed that more assertive action on compliance is needed. These aggressive infection control practices reduced but did not eliminate transmission, probably due to the continued influx of colonized patients.