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1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital

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Abstract

Background Hand hygiene (HH) is the cornerstone of infection prevention and improved compliance has been associated with reduced healthcare-associated infections (HAIs). However, traditional methods for HH data collection have limitations and may not accurately reflect true compliance. We sought to evaluate whether an electronic hand hygiene monitoring system (HHMS) can improve data collection, compliance, and reduce HAIs. Methods A HHMS was implemented as part of a pilot at a single facility in June 2018 for all healthcare workers (HCWs) who entered patient rooms. The system prompted HCWs to perform HH with an audible and visual reminder emitted from a badge if a HH event had not been registered within specific timeframes of entering or exiting a patient room. The system captured compliance with preferential handwashing (soap and water) for at least 15 seconds upon exit of Clostridioides difficile (C. difficile) designated rooms. All HH data were collected by the HHMS. Hand hygiene compliance and HAI data were compared for the pre-intervention (June 2017-May 2018) and intervention periods (July 2018-March 2019). No changes were made to environmental cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices. Results HH compliance by direct observation in the pre-intervention period was 91% (1,612 observations). HH compliance with the HHMS during the intervention period was 97% (2,778,402 observations). The mean monthly HH opportunities recorded during the pre-intervention period was 134, while the HHMS captured 308,711, a greater than 2,300-fold increase. The incidence of healthcare facility-onset C. difficile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41 GDH+/Toxin+ laboratory-identified [labID] events/42,726 patient-days). With the HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID events/31,169 patient-days). No policy changes in environmental cleaning of high-touch surfaces were made or observed during the pilot. Conclusion The use of an HHMS facilitated more comprehensive HH data and improved compliance. The preliminary findings also support an association between more robust HH compliance data and a significant decrease in toxin-producing CDI. Disclosures All authors: No reported disclosures.
Poster Abstracts • OFID 2019:6 (Suppl 2) • S425
1185. Impact of Utilizing Drug Resistance in Pneumonia (DRIP) Score on
Management of Pneumonia
Avnish Sandhu, Doctor of Osteopathic Medicine1; Erin Goldman, DO2;
Jordan Polistico, MD1; Sarah Polistico, MD3; Ahmed Oudeif, Medical Student 2;
Anil Aranha, PhD. 2; KyleP. Murray, PharmD3; Jing Zhao, PhD4;
Ryan Mynatt, PharmD, BCPS-AQ ID3;
JasonM. Pogue, PharmD, BCPS, BCIDP5; Sorabh Dhar, MD6; 1Detroit Medical
Center, Wayne State University, Detroit, Michigan; 2Wayne State University, Oak
Park, Michigan; 3Detroit Medical Center, Detroit, Michigan; 4Analysis Group, Inc.,
Boston, Massachusetts; 5University of Michigan College of Pharmacy, Ann Arbor,
Michigan; 6Detroit Medical Center, Wayne State University, John D Dingell VA med-
ical center, Detroit, Michigan
Session: 143. HAI: Respiratory Infections (incl VAP, HAP)
Friday, October 4, 2019: 12:15 PM
Background. Pneumonia is a leading cause of infection-related admissions
and death. It is imperative that appropriate antibiotic therapy is selected. Traditional
scoring systems for identifying at-risk persons for drug-resistant pathogens– i.e.,
Healthcare-associated pneumonia (HCAP), have been inaccurate and oen lead to in-
appropriate antibiotic selection. Anovel pneumonia scoring system –“Drug Resistance
in Pneumonia (DRIP)” was implemented at the Detroit Medical Center (DMC) in
January 2018. e objective of this study was to evaluate the eectiveness of the DRIP
score in reducing the use of broad-spectrum antibiotics and the impact on key out-
comes in patients treated for pneumonia.
Methods. Aretrospective chart review of 89 patients admitted to the DMC
for treatment of pneumonia was conducted—45 patients prior to and 44 patients
post-implementation of the DRIP score. Basic demographics, signs and symptoms,
antibiotics data, pneumonia severity score (CURB – 65), Charlson co-morbidity
score, and outcome measures were compared. DRIP scores and HCAP risk fac-
tors were calculated for all patients. e denitions of broad-spectrum antibiotics
(BSA) were consistent with DMC guidelines for the treatment of pneumonia (anti-
biotics targeting nosocomial Gram-negative organisms and/or methicillin-resistant
Staphylococcus aureus).
Results. Demographics are shown in Table 1. 18 (40%) of the pre-implemen-
tation cohort had risk factors for resistance (HCAP risk factors) compared with 14
(32%) in the post. Conversely, 15 (33%) of the pre-implementation cohort had risk
factors for resistance (DRIP 4) compared with 8 (18%) in the post-implementation
period (Table 2). Adierence in BSA prescribing was seen in patients previously
characterized as having a high risk of resistance (HCAP) but with DRIP score <4 [5/7
(72%) vs.1/7 (16%) (Table 2)]. BSA use was 24 (53%) in the pre-implementation cohort
and 12 (27%) in post-implementation cohort, P = 0.03. Durations of antibiotics were
8.3days vs. 9.8days respectively, P = 0.04. Readmission with pneumonia at 30days was
3 (7.5%) for both groups.
Conclusion. e implementation of a novel DRIP scoring system resulted in
improved prescribing patterns and a signicant reduction of broad-spectrum antibiot-
ics by 26% as compared with traditional HCAPscore.
Disclosures. Al l authors: No reported disclosures.
1186. Decreased Laboratory-Identified Clostridioides difficile Infections with
Implementation of an Electronic Hand Hygiene Monitoring System in a Long-
Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile
Infections with Implementation of an Electronic Hand Hygiene Monitoring
System in a Long-Term Acute Care Hospital
Maureen Banks, RN, DNP,MBA, NEA-BC, FACHE1;
Andrew Phillips, PhD, RN2; Keith Chin, RN, BSN, CIC3;
Lou AnnBruno-Murtha, DO4; 1Spaulding Rehabilitation Network, Cambridge,
Massachusetts; 2MGH Institute of Health Professionals, Spaulding Rehabilitation
Network, Cambridge, Massachusetts; 3Spaulding Hospital Cambridge, Cambridge,
Massachusetts; 4Cambridge Health Alliance, Cambridge, Massachusetts
Session: 144. HAI: Hand Hygiene and Transmission - Based Precautions
Friday, October 4, 2019: 12:15 PM
Background. Hand hygiene (HH) is the cornerstone of infection prevention and
improved compliance has been associated with reduced healthcare-associated infec-
tions (HAIs). However, traditional methods for HH data collection have limitations
and may not accurately reect true compliance. We sought to evaluate whether an elec-
tronic hand hygiene monitoring system (HHMS) can improve data collection, compli-
ance, and reduceHAIs.
Methods. AHHMS was implemented as part of a pilot at a single facility in
June 2018 for all healthcare workers (HCWs) who entered patient rooms. e system
prompted HCWs to perform HH with an audible and visual reminder emitted from a
badge if a HH event had not been registered within specic timeframes of entering or
exiting a patient room. e system captured compliance with preferential handwashing
(soap and water) for at least 15 seconds upon exit of Clostridioides dicile (C.dicile)
designated rooms. All HH data were collected by the HHMS. Hand hygiene compli-
ance and HAI data were compared for the pre-intervention (June 2017-May 2018)and
intervention periods (July 2018-March 2019). No changes were made to environmental
cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices.
Results. HH compliance by direct observation in the pre-intervention period
was 91% (1,612 observations). HH compliance with the HHMS during the interven-
tion period was 97% (2,778,402 observations). e mean monthly HH opportunities
recorded during the pre-intervention period was 134, while the HHMS captured
308,711, a greater than 2,300-fold increase. e incidence of healthcare facility-onset
C.dicile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41
GDH+/Toxin+ laboratory-identied [labID] events/42,726 patient-days). With the
HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID
events/31,169 patient-days). No policy changes in environmental cleaning of high-
touch surfaces were made or observed during thepilot.
Conclusion. e use of an HHMS facilitated more comprehensive HH data and
improved compliance. e preliminary ndings also support an association between
more robust HH compliance data and a signicant decrease in toxin-producingCDI.
Disclosures. Al l authors: No reported disclosures.
1187. Estimation of Individual Healthcare Workers’ Relative Hand Hygiene
Compliance Using an Anonymous Electronic Monitoring System
Maxime-Antoine Trem bl ay, MD; Mona AbouSader, RN; Yves Longtin, MD; Jewish
General Hospital, Montreal, Québec, QC, Canada
Session: 144. HAI: Hand Hygiene and Transmission - Based Precautions
Friday, October 4, 2019: 12:15 PM
Background. e current hand hygiene (HH) auditing and feedback strategy in-
clude anonymized data collection using direct observation and feedback of aggregated
data. We aimed to evaluate whether an anonymous (without wearable device) HH
electronic monitoring system (EMS) could detect patterns associated with individual
healthcare workers (HCWs) and estimate their relative HH performance.
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