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An outbreak of SARS-CoV-2 in a skilled nursing facility (SNF) can be devastating for residents and staff. Difficulty identifying asymptomatic and pre-symptomatic cases and lack of vaccination or treatment options make management challenging. We created, implemented and now present a guide to rapidly deploy point prevalence testing and three-tiered cohorting in a SNF to mitigate an outbreak. We outline key challenges to SNF cohorting.

Objective: To determine clinical characteristics associated with false negative SARS-CoV-2 testing to help inform COVID-19 testing practices in the inpatient setting. Design: A retrospective observational cohort study. Setting: Tertiary care facility. Patients: All patients two years of age and older tested for SARS-CoV-2 between March 14, 2020 and April 30, 2020 who had at least two SARS-CoV-2 reverse-transcriptase polymerase chain reaction tests within seven days. Methods: The primary outcome measure was a false negative testing episode, which we defined as an initial negative test followed by a positive test within the subsequent seven days. Data collected included symptoms, demographics, comorbidities, vital signs, labs, and imaging studies. Logistic regression was used to model associations between clinical variables and false negative SARS-CoV-2 test results. Results: The 1,009 SARS-CoV-2 test results included in the analysis, 4.0% were false negative results. In multivariable regression analysis, compared to true negative test results, false negative test results were associated with anosmia/ageusia (aOR 8.4, 95% CI 1.4-50.5, p = 0.02), having a COVID-19 positive contact (aOR 10.5, 95% CI 4.3-25.4, p < 0.0001), and having an elevated lactate dehydrogenase level (aOR 3.3, 95% CI 1.2-9.3, p = 0.03). Demographics, symptom duration, other laboratory values, and abnormal chest imaging were not significantly associated with false negative test results in multivariable analysis. Conclusions: Clinical features can help predict which patients are more likely to have false negative SARS-CoV-2 tests.

skills course. Our colleague Samantha Morris also designed a framework for taking an inclusive sexual history, which was subsequently adopted for our standardized patient encounter. Going forward, we are continuing to work with administrators to formalize longitudinal clinical experiences with LGBTQ+ populations.Providing an inclusive environment for LGBTQ+ patients requires that institutions move from theoretical policies to concrete actions. Trainees can play a crucial role in this process, leveraging both their own experiences and the expertise of national networks (e.g., the Medical Student Pride Alliance). We encourage all trainees, whether they identify as LGBTQ+ or as allies, to use their voices to improve the health and well-being of all LGBTQ+ individuals.Acknowledgments: The authors would like to thank Samantha Morris and Liam Spurr for their co-leadership on these efforts.

We implemented universal inpatient Clostridioides difficile screening at an 800-bed hospital. Over 3 years, 2,010 of 47,048 screening tests (4.2%) were positive, with significantly higher rates of C. difficile colonization on transplant units than medical-surgical units: 5.4% (152 of 2,801) versus 4.3% (880 of 20,564), respectively (P = .005). Compliance with screening ranged from 79% to 96%.

Background: At our institution, the concern for false-negative nasopharyngeal testing for SARS-CoV-2 at the onset of illness led to a general policy of retesting inpatients at 48 hours. For such patients, 2 negative SARS-CoV-2 PCR test results were required prior to discontinuation of COVID-19 control precautions. To assess the utility of routine repeat testing We analyzed patients presenting to our hospital who initially tested negative for SARS-CoV-2 but were found to be positive on repeated testing. Methods: All inpatients with symptoms concerning for COVID-19 were tested via nasopharyngeal sample for SARS-CoV-2 by PCR on admission. Patients with continued symptoms and no alternative diagnosis were retested 48 hours later. Testing was performed using either the Roche cobas SARS-CoV-2 RT-PCR assay or the Cepheid Xpert Xpress SARS-CoV-2 test. Between March 17, 2020, and May 10, 2020, we retrospectively analyzed data from patients with false-negative SARS-CoV-2 PCR test results who were subsequently confirmed positive 48 hours later. We evaluated demographic information, days since symptom onset, symptomatology, chest imaging, vital sign trends, and the overall clinical course of each patient. Results: During the study period, 14,683 tests were performed, almost half (n = 7,124) were performed through the ED and in the inpatient setting. Of 2,283 patients who tested positive for SARS-CoV-2, only 19 (0.01%) initially tested negative. Patients with initial false-negative test results presented with symptoms that ranged from fever and dyspnea to fatigue and vomiting. Notably, few patients presented “early” in their disease (median, 6 days; range, 0–10 days). However, patients with initial false-negative PCR test results did seem to have consistent imaging findings, specifically bilateral bibasilar ground glass opacities on chest radiograph or computed tomography scan. Conclusions: Among inpatients with COVID-19, we found a very low rate of initial false-negative SARS-CoV-2 PCR test results, which were not consistently related to premature testing. We also identified common radiographic findings among patients with initially false-negative test results, which could be useful in triaging patients who may merit retesting. Based on these data, we revised our existing clearance criteria to allow for single-test removal of COVID-19 precautions. Evaluating subsequent reduction in unnecessary testing is difficult given changing community prevalence, increased census, and increased opening to elective procedures. However, given the significant percentage of ED and inpatient testing, removal of repeated testing has likely resulted in a reduction of several thousand unnecessary COVID-19 tests monthly.Funding: NoDisclosures: None

BackgroundRespiratory pathogens are an important cause of morbidity and mortality in hospitalized patients and nosocomial spread of such pathogens is known to occur. However, little is known about the epidemiology of respiratory viruses in healthcare workers (HCW).MethodsBetween December 28, 2018 and April 26, 2019 enrolled HCW completed a weekly symptom diary, including presence or absence of respiratory symptoms, flu exposure history and whether they received medical attention. Vaccination and flu infection history were collected on enrollment. Participants self-collected flocked nasopharyngeal (NP) swabs every other week and if they reported any symptom on the weekly diary. These were tested using a multiplex PCR platform (Biofire, Salt Lake City, UT) with targets for 14 respiratory viruses. Symptomatic HCW with influenza or respiratory syncytial virus (RSV) were notified and followed policy regarding work restriction.Results66 HCWs provided baseline data and 57 continued data submission (9 withdrew). The active participants included 13 nurses (22.8%), 7 advanced practice providers (12.3%), 18 physicians (31.6%), and 19 other (33.3%). Participants received quadrivalent inactivated flu vaccine this season (2 self-reported/unknown type). Compliance was 89.8% (749 of 834) with weekly diary completion and 83.3% (378/454) for biweekly NP swabs. Thirty-nine unique participants reported symptoms on weekly diaries 100 times and submitted 88 total “symptomatic” NP swabs (88% compliance). Of these, 16 swabs revealed any pathogen (18.2%) and 3 had influenza H3N2 (18.8%) (only one reported fever). Other pathogens identified are detailed in Figure 1. 12 of the 366 asymptomatic swabs were positive for respiratory viruses (23.3%, see Figure 1). No participant had asymptomatic influenza.ConclusionPauci-symptomatic influenza has been previously described by our group and others and is noted even in this small cohort. While asymptomatic flu was not found, there were several cases of other asymptomatic respiratory viruses in HCW. Analysis of the impact on patients is still underway from this cohort but the initial data suggest that patients are at risk of contracting healthcare-acquired respiratory infection even from health care providers. Disclosures All authors: No reported disclosures,

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