OBJECTIVETo evaluate ultraviolet C (UV-C) irradiance, UV-C dosage, and antimicrobial effect achieved by a mobile continuous UV-C device.DESIGNProspective observational study.METHODSWe used 6 UV light sensors to determine UV-C irradiance (W/cm2) and UV-C dosage (µWsec/cm2) at various distances from and orientations relative to the UV-C device during 5-minute and 15-minute cycles in an ICU room and a surgical ward room. In both rooms, stainless-steel disks inoculated with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile spores were placed next to sensors, and UV-C dosages and log10 reductions of target organisms achieved during 5-minute and 15-minute cycles were determined. Mean irradiance and dosage readings were compared using ANOVA.RESULTSMean UV-C irradiance was nearly 1.0E-03 W/cm2 in direct sight at a distance of 1.3 m (4 ft) from the device but was 1.12E-05 W/cm2 on a horizontal surface in a shaded area 3.3 m (10 ft) from the device (P<.001). Mean UV-C dosages received by UV-C sensors located at different distances and orientation relative to the device varied significantly during 5-minute cycles and during 15-minute cycles (P<.001). Log10 reductions ranged from >4 to 1–3 for MRSA, >4 to 1–2 for VRE and >4 to 0 log10 for C. difficile spores, depending on the distance from, and orientation relative to, the device with 5-minute and 15-minute cycles.CONCLUSIONUV-C irradiance, dosage, and antimicrobial effect received from a mobile UV-C device varied substantially based on location in a room relative to the UV-C device.Infect Control Hosp Epidemiol 2016;37:667–672

Objective: Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population. Methods: We performed a retrospective review of all neonates admitted to the 54-bed, level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013, and December 31, 2018. Clinical definitions per NICU team and NHSN site-specific definitions used for source identification were compared using the McNemar χ2 test. Results: We identified 86 HABSIs with an incidence rate of 0.80 per 1,000 patient days. Only 13% of these were CLABSIs. Both CLABSIs and non–catheter-related bloodstream infections occurred primarily in preterm neonates, but the latter were associated with a significantly higher incidence of comorbidities and the need for respiratory support. The NHSN definitions were less likely to identify a source compared to the clinical definitions agreed upon by our NICU treating team (P < .001). Furthermore, 50% of patients without an identified source of infection by NHSN definitions were bacteremic with a mucosal barrier injury organism, likely from gut translocation. Conclusions: HABSIs occur primarily in premature infants with comorbidities, and CLABSIs account for a small proportion of these infections. With the increasing focus on HABSI prevention, there is a need for better NHSN site-specific definitions for the NICU population to prevent misclassification and direct prevention efforts.

Outbreaks and pseudo-outbreaks of infection related to bronchoscopy typically involve Gram-negative bacteria, Mycobacterium species or Legionella species. We report an unusual bronchoscopy-related pseudo-outbreak due to Actinomyces graevenitzii. Extensive epidemiological and microbiological investigation failed to identify a common source. Strain typing revealed that the cluster was comprised of heterogeneous strains of A. graevenitzii. A change in laboratory procedures for Actinomyces cultures was coincident with the emergence of the pseudo-outbreak, and we determined that A. graevenitzii isolates more readily adopted a white, dry, molar tooth appearance on anaerobic colistin nalidixic acid (CNA) agar which likely facilitated its detection and identification in bronchoscopic specimens. This unusual pseudo-outbreak was related to frequent requests of bronchoscopists for Actinomyces cultures combined with a change in microbiology laboratory practices. Actinomyces graevenitzii is infrequently identified in clinical specimens, and its pathogenicity is not well defined. A. graevenitzii is a component of the oropharyngeal microbiota and has been reported to cause pneumonia, lung abscesses, osteitis of the jaw, and bacteremia (1-8). In early December 2013, an increase in the recovery of A. graevenitzii from specimens from patients who underwent bronchoscopy was noted by microbiology and infection control staff. Our investigation revealed that the cluster of A. graevenitzii isolates represented a pseudo-outbreak associated with a change in laboratory practices. MATERIALS AND METHODS Setting.A 1,500-bed tertiary care university-affiliated teaching hospital was the setting for this study.Epidemiological investigation. The microbiology laboratory's computerized database was queried to obtain the number of bronchoscopy cultures performed, the number of Actinomyces cultures ordered on bronchoscopy specimens, and the number of those cultures ordered that were positive for Actinomyces from January 2011 through December 2013. Medical records of patients whose bronchoscopy specimens yielded Actinomyces were reviewed, and the following variables were recorded: date of bronchoscopy, results of bronchoscopic specimen cultures for routine respiratory pathogens and for Actinomyces, bronchoscope used, bronchoscopist, endoscopy personnel involved in the procedure, procedure room number, and medications administered during bronchoscopy procedures. Only three bronchoscopes were routinely used, and almost all bronchoscopies were performed in procedure room 3. Therefore, we focused our investigation on room 3, the three bronchoscopes, and the "wash room" in which all bronchoscopes and endoscopes undergo highlevel disinfection using one of three automated endoscope reprocessors (AERs) (DSDs Medivators, Minneapolis, MN). Findings of cytologic examination and bronchial biopsy specimens were also recorded.Environmental sources of samples collected for culture in the endoscopy suite included unopened bottles of lidocaine, atomizer, cotton ball...

Background Candidemia is the fourth most common nosocomial blood stream infection with significant morbidity and mortality. Central lines have been considered a risk factor for invasive fungal infection. We evaluated the epidemiology, management, and outcomes of Candida CLABSI in an academic medical center.Methods We conducted a retrospective cohort study in a single academic center from January 1, 2011 to December 31, 2016 of patients who had positive blood cultures for Candida sp. and met CDC criteria for CLABSI. Outcomes measured were 30-day mortality and relapse or recurrence. Descriptive statistics were used to compare the outcomes of patients who had infectious diseases consult and managed per standard of care (SOC) as defined by IDSA guidelines and those without.ResultsOf 722 CLABSI cases, 82 (11%) were due to Candida sp. Candida species isolated were as follows: C. glabrata (40%), C. albicans (32%), C. parapsilosis (9%), and others (19%). Median age of pediatric patients was 2.25 years (range 0.5–6) and median age of adults was 59 years (19–92). Most common comorbidities were malignancy (35%) and end-stage renal disease (21%). Non-tunneled catheters were present in 58% of cases. Median time from line placement to candidemia was 15 days (IQR 8–29). Sepsis was present in 34 (42%) cases. Seventy-four (90%) cases were initiated on antifungal therapy (AFT) when culture turned positive. After Candida speciation, AFT was adjusted appropriately for 82 (100%) cases. IDC was present in 56 (68%), of which 41 (73%) followed SOC, whereas 15 (27%) did not. Two of 26 patients (8%) without IDC received SOC. Complications occurred in 11/82 (13%) (three endocarditis, two osteomyelitis, three endophthalmitis, and four septic thrombophlebitis). Cure was achieved in 26/82 (32%). Relapse or recurrence occurred in 15/82 (18%). The 30-day mortality for the cohort was 50%. Patients with IDC who received SOC had lower mortality compared with those who did not (35% vs. 67%, respectively; P = 0.03).Conclusion Candida CLABSI was infrequent but had significant mortality in our cohort. Our results suggest that adherence to SOC per IDSA guidelines and involvement of IDC may improve survival of patients with Candida CLABSI. Future studies are needed to validate these findings.Disclosures All authors: No reported disclosures.

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