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Background The use of peripherally inserted central catheters (PICCs) has increased in the past decade. PICCs are central lines (CLs) commonly used for venous access. Midline catheters (MLs) can provide access when the need for a CL, such as vasopressors, is no longer present. MLs have a lower rate of BSI compared to PICCs and CLs, while providing dwell times comparable to PICCs. We established a project prioritizing ML use. Methods This is a quasi-experimental study in a 151-bed safety net community hospital. The pre-intervention period was January-December 2018 and post period was January 2019-December 2021. MLs were prioritized when new PICCs are requested without CL indications, such as total parenteral nutrition, hyperosmolar solutions and vasopressors. PICCs and CLs are transitioned to a ML once indications are no longer met and peripheral IVs are not feasible. Data on utilization and complications, such as deep venous thrombus (DVT) and BSIs, were reviewed and compared. Results A total of 63 peripherally inserted lines occurred prior to the intervention, of which 55 (87%) were PICC and 8 (13%) were ML (Figure 1). Post-intervention, 76 lines were placed the first year, of which 48 were ML (63%). This upward trend was sustained throughout the pandemic, with 116 lines in 2020 (80% ML) and 96 in 2021 (88% ML). No BSIs occurred during the pre-intervention and first post-intervention year. During the pandemic, 8 BSIs in MLs and 3 in PICCs occurred. The most common organism was Candida (Figure 2). The majority had COVID-19 (72%) and all (100%) BSIs were in the setting of shock. Case review demonstrated suspected secondary sources other than central venous catheters (CVCs). All BSIs with ML would have met NHSN criteria if CL present. No upper extremity DVTs were found. Conclusion A midline prioritization project was successfully implemented and sustained during the COVID-19 pandemic. The decline of PICC use from 87% to 12% suggests use for access without CL needs. High acuity during the pandemic led to BSIs that were likely secondary to shock and complications of COVID-19. All cases would have met NHSN criteria for CLABSI. The cost of a CLABSI is estimated at $48,108. Thus, this midline prioritization project may have led to CLABSI avoidance and an estimated cost savings of $384,864. Disclosures All Authors: No reported disclosures.

Background The United States (US) is one of the most affected countries by the COVID-19 pandemic. A disproportionate burden of COVID-19 deaths is seen in Black, Asian, and Latinx groups. COVID-19 vaccines are the primary mitigation strategy to reduce morbidity and mortality. However, vaccine hesitancy is high in these communities due to factors such as low health literacy, language barriers, and other health inequities. Our objective was to implement a culturally sensitive, multi-lingual, community outreach model to promote vaccine education and facilitate vaccine administration. Methods Community healthcare workers or “promotoras” were deployed to high traffic areas such as supermarkets, laundromats, churches, and commercial hubs from February-May 2021. The promotoras provided culturally sensitive vaccine counseling to individuals in their preferred language and facilitated vaccine appointments at our hospital. Our data was compared with publicly available data from other facilities organized by ZIP codes defined by the Department of Public Health as low, medium, or high-vulnerability to COVID-19. Results A total of 109 outreach workers were hired, of which 67% (73) were Latinx, 27% (29) Black and 6% (7) Asian. Overall, 8,806 individual encounters led to 6,149 scheduled appointments and 3,192 completed first doses (Figure 1). A total of 14,636 individuals were vaccinated. Average age was 45.5 (range 12-98). Preferred language was 54% Spanish, 38% English, and 8% Chinese. Ethnicity was mostly Hispanic (66%) with race mostly white (54%) (Figure 2). High and medium-risk ZIP codes represented 69.4% of vaccinations at our facility (Figure 3). Figure 1. Education encounters and appointments made by community outreach workers and associated vaccinations. Figure 2. Racial distribution of vaccinated individuals at our facility Figure 3. Comparative vaccinations by zip codes from hospitals in our area. Conclusion We successfully implemented a culturally sensitive community outreach model which resulted in higher vaccination rates from at risk ZIP codes when compared to other hospitals. Promotoras encouraged vaccination in native languages, thereby increasing vaccine awareness and appointment faciliation. Barriers to vaccine access remain in these vulnerable communities. This model educated the community via its own members and may help reduce barriers, increase vaccine awareness and vaccination rates. Disclosures All Authors: No reported disclosures

Background The use of anti-Pseudomonal β-lactam (APBL) agents has significantly increased in the past decade, carrying higher costs and contributing to antimicrobial pressure. Antimicrobial stewardship (ASP) can promote evidence-based antimicrobial selection and mitigate excess APBL use. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback (PAF) at an urban community hospital. The goal of this study is to assess the impact of syndrome-based PAF on APBL use, C. difficile rates and cost. Methods ASP with all CDC core elements was implemented at a 151-bed community hospital in October 2017. Syndrome-based guidelines and PAF was established and overseen via direct communication with an ID physician. Days of therapy (DOT), cost and C. difficile rates were assessed 12 months before and after ASP. DOT for APBL and non-APBL utilization was tabulated by unit and paired t-test performed. Results Most cases reviewed by PAF (51%) were represented in our syndrome-based treatment guidelines (Figure 1). Soft tissue (33%) and intra-abdominal (24%) infections were the most common syndromes. Change to guideline was the most common PAF intervention (62%) followed by de-escalation (30%). At 12 months, total DOT/1,000 increased (392.5 vs. 404) while the proportion of parenteral antimicrobials used decreased (71% vs. 65%). Antibiotic expenditures decreased by 23%, with a reduction in APBL of 20% and non-APBL of 10% (Table 1). Statistically significant reductions APBL use in non-ICU settings (P = 0.0139) and statistically significant increases in non-APBL in ICU settings occurred (P = 0.0001) (Figure 2 and 3). C difficile rates decreased from 21% (3.27 vs. 2.56). Conclusion Syndrome-based PAF was successfully implemented. A reduction in APBL use was seen in non-ICU settings, where evidence-based de-escalation may be more feasible. APBL use remained high in the ICU but was guideline consistent. A rise in non-APBL use also occurred. Certain critical illness syndromes warrant APBLs, but PAF may promote culture-directed and syndrome-specific treatments. ASP increased guideline-based therapy and contributed to decreased broad-spectrum antimicrobial use, antimicrobial expenditures and C difficile rates. Syndrome based PAF can be successfully implemented in community settings. Disclosures All authors: No reported disclosures.

Background Indwelling urinary catheters (IUC) may cause inflammation and colonization, decreasing the diagnostic yield of urinalysis and urine cultures (UC). Indiscriminate testing can lead to misinterpretation of positive results as a catheter associated urinary tract infection (CAUTI), increasing antibiotic use and CAUTI rates. We studied the burden of UC and implemented a UC stewardship initiative (UCSI) as part of a comprehensive CAUTI reduction program. Methods A retrospective review of cases with IUC and positive UC in 2014 was performed. UCSI was implemented in March 2017 (Figure 1). Nursing staff were instructed to contact the infectious diseases physician when UC from IUC were ordered. Cases were reviewed and, if no UC indication based on IDSA guidelines was met, cultures were discontinued after conferring with ordering physician. Twelve months pre- and post-intervention data were collected; including case description, catheter days, UC ordered, alternative cause of fever, and recommendations. Results The pre-USCI cohort had 23 UC in 19 cases. One UC (4%) met indication (Figure 2). Three (16%) met NHSN criteria for CAUTI and did not meet UC indication. The USCI cohort had 21 UC orders in 13 cases. Most UC did not meet indication and were cancelled (90%, 19/21). Alternative causes for fever were found in all cases with cancelled UC orders (19/19), including pneumonitis, pneumonia, pancreatitis and tuberculosis. Antimicrobials were used in 53% (7/13). UC orders per hospitalization ranged 1–4 (average 1.7). IUC days ranged from 3 to 18 days (average 8). In both cohorts, UC with indication (3) did not meet NHSN criteria for CAUTI and did not receive antimicrobials. Figure 1. UCSI Implementation. Figure 2. Characteristics of cohorts pre and post-USCI. Conclusion Patients with IUC frequently underwent UC without evidence-based indications. This may lead clinicians down the wrong diagnostic path and contribute to antimicrobial use. Critically ill patients with inflammatory conditions are at high risk of UC testing. USCI is a cost-effective intervention that reduced indiscriminate testing, antibiotic use and CAUTIs. USCI can play an important role in CAUTI prevention strategies and antibiotic stewardship programs. Disclosures All authors: No reported disclosures.

Background Adherence to the CMS sepsis core measure (SEP-1) has been a challenge for facilities nationwide. Checklists, electronic medical record (EMR) alerts and order sets have been shown to improve compliance. We implemented a comprehensive SEP-1 guideline with order sets, checklists and EMR alerts at an urban community hospital. Subsequently, a SEP-1 improvement team with an infectious disease physician and a nurse led a prospective audit and feedback (PAF) program to help improve adherence and reduce errors. We seek to understand the impact of PAF on SEP-1 compliance. Methods Quasi-experimental pre- and post-intervention study of SEP-1 compliance at a 151-bed urban community hospital from January 2015 to December 2018. PAF intervention was started on July 2017. Cases were reviewed, SEP-1 failures identified, and feedback given to nurses and clinicians involved within 48 hours of admission. Gaps in adherence are identified, education given, and corrective actions taken. SEP-1 adherence before and after PAF implementation was reviewed. Results A total of 307 cases met the SEP-1 inclusion criteria. PAF was successfully implemented. There were 169 SEP-1 cases before and 138 after implementation of PAF. The success rate increased from 44% to 52% with PAF (Figure 1). The most common reasons for failure were initial and repeat lactic acid on both groups (Figure 2). Conclusion Prospective audit and feedback for SEP-1 improved compliance rates at our facility. Prospective audit can help identify core measure failures early and provide immediate feedback to clinicians, nurses and laboratory personnel. Immediate feedback by the SEP-1 improvement team may help increase SEP-1 awareness, strengthen existing protocols and promote a culture of safety. SEP-1 is a complex core measure that may transition to pay-for-performance. An ID physician-led SEP-1 improvement team with PAF may be an area for future value-based care opportunities for ID physicians. Disclosures All authors: No reported disclosures.

Background Establishing antimicrobial stewardship programs (ASP) in community hospitals with limited resources can be challenging. Many hospitals do not have infectious disease (ID) trained pharmacists (PharmD) available. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback at an urban community hospital. Methods ASP was implemented at a 151-bed urban community hospital in October 2017. PharmD training on syndrome-based treatment guidelines, including definitions, severity, empiric regimens, de-escalation, and duration was created. Prospective audit by PharmDs was established. This program was implemented and overseen by an ID physician. Days of therapy per 1,000 patient-days (DOT/1,000) was assessed 3 months before and after ASP. Prospective audit and feedback data were reviewed. Results At 3 months, antimicrobial use decreased (370 vs. 350 DOT/1,000) while the proportion of oral antimicrobials used increased (32% vs. 43%). Antibiotic expenditures decreased by 11% ($42,500 vs. $37,900). Most cases reviewed by prospective audit (58%) fit pre-determined syndromes (Figure 1). Soft tissue and urinary tract infections were the most common syndromes. Interventions occurred in 53% of cases. De-escalation from broad-spectrum agents was more successful in noncritical care settings (Figure 2). Figure 1. ASP syndrome-based prospective audit and feedback. Figure 2. Antimicrobial use in medical surgical units after implementation of ASP. Conclusion Syndrome-based prospective audit and feedback was successfully implemented in an urban community hospital with non-ID trained PharmDs using ID physician leadership. Our program led to a decrease in antibiotic use, increase use of oral alternatives, and decreased antibiotic expenditures. Empiric use of broad-spectrum agents was common at our facility. ASP likely contributed to an increase in ceftriaxone and decrease in piperacillin–tazobactam use in medical-surgical floors. Stewardship in critically ill patients remains a challenge. Clear guidelines and access to an ID physician are necessary to provide adequate support for PharmDs without ID-specific training and can help curb antibiotic use. Expanding the list of syndromes may further impact antimicrobial use. Disclosures All authors: No reported disclosures.

Background Implementation of interventions to increase provider awareness of central venous catheters (CVC) and indwelling urinary catheters (IUC) and indications can impact device utilization rates. Device utilization rates (DUR) correlate with device-associated complications. We implemented a Daily Interdisciplinary Safety Huddle (DISH) involving all hospital units. Devices were reported and plans for removal reviewed. Barriers identified were addressed within 24 hours. The purpose of this study was to evaluate the impact of DISH on DUR and HAI at a 151-bed urban, community hospital. Methods This is a retrospective review of DUR for IUC, CVC and the relationship to HAI. DISH is a daily 15-minute meeting at 8am. Key participants include the chief nursing officer (CNO), infection control practitioner (ICP), and managers of all hospital units. CVC and IUC usage are reported by nurse managers. The ICP reviews indications, duration, and plans for device removal. When barriers for removal remain, such as provider preference, the CNO, Medical Director of Infection Control or Chief Quality Officer are involved. Data before and after implementation of DISH was compared. Paired T-test was used to assess for differences between DUR means of both groups. Results Mean DUR for CVC was reduced from 0.2858 to 0.178 (device days/patient-days, P