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.
BackgroundWe aimed to use weekly PI calls in conjunction with 24/7 hand hygiene monitoring technology (HHMT) to engage front-line Intensive Care Unit (ICUs) clinicians in improving Hand Hygiene (HH) complianceMethodsHHMT is used to monitor aggregate, unit-based HH compliance in real time and displayed on monitors at the nursing stations at our academic medical center. After installation and validation were completed, unit-based teams of nursing and physician leadership joined weekly 15-minute HH PI calls to discuss their previous week’s compliance rate, next steps in their own PI plan, and share successes and failures. Calls were suspended for 6 months and restarted in early 2017.ResultsGraph representation of weekly HH compliance rates for the ICUs are shown in figure 1. Units AandB underwent physical moves during the break, Unit C had no change, and Unit D moved and consolidated with other ICUs constituting a major change in personnel and patient population. Each ICU participated in 84 calls and recorded approx. 50,000–100,000 HH opportunities during each month resulting in over 8 million opportunities for HH compliance recorded during the call-in periods. Unit A had an average compliance of 39% for the first 4 weeks of calls and 64% during the same 4 week period one year later (P < 0.0001). After 6 months without the calls, HH compliance was 48% (P < 0.0001 compared with baseline compliance) and unit A implemented 20 separate PI interventions over the course of the calls. Compliance was also significantly improved (P < 0.0001 for all comparison to baseline) for units B, C, and D (Unit B: 42% baseline, 71% at 1 year, 67% after the break, 23 interventions; Unit C: 54% baseline, 58% at 1 year, 59% after the break, 19 interventions; Unit D: 41% at baseline, 56% after 1 year, 49% after the break, 19 interventions). Attendance was >90% for nursing leadership and <25% for physician leadership.ConclusionWeekly 15-minute calls were successful in engaging local nursing leadership to undertake performance improvement interventions and significantly improved HH compliance that was sustained over 18 months of calls and did not drop back to baseline even after a 6 month break.Disclosures
E. Landon, GOJO: Speaker, travel expenses for speaking; J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; A. H. Bartlett, CVS Caremark: Consultant, Consulting fee
Background Outbreaks of invasive mold infection associated with active construction sites are well documented in the literature. We routinely perform air sampling for mold prior to opening all new inpatient and high-risk outpatient units. Historically this practice led to early identification of an outbreak linked to a contaminated ventilation system. Based on our experience, we clean areas 3 times, wait at least 8h then sample. We describe the results of air sampling during the commissioning of our new Labor and Delivery unit and the identification of the source of fungal contamination.Methods Fungal cultures were obtained throughout the unit using a two stage viable Andersen Cascade Impactor loaded with Sabouraud dextrose with chloramphenicol and gentamicin agar (BBL, BD, Sparks MD). Additional surface cultures were obtained using a 3M Sponge stick with neutralizing buffer (3M Healthcare, St Paul MN) and inoculated onto the same media. Plates were incubated for 10 days and mold colonies were counted and identified by standard methods.ResultsInitial samples in several rooms were positive for mold, suggesting more detailed cleaning was needed. Continued positives, including in previously negative rooms, prompted further investigation. No leaks or moisture were found. Construction dust was found in the supply plenum and ducts. We discovered that during construction the ventilation system was on allowing air from the unit to recirculate. The contractor assumed the filters would remove any dust, but the filters were not gasketed and a failed duct seam was found above the rooms with highest contamination. After replacement of filters and cleaning of all ductwork, one OR remained positive. Swabs of the laminar flow diffuser grew mold. After cleaning, final samples were all negative for mold.Conclusion A complete understanding of air flow and filtration capability during construction is critical to maintaining a healthy environment. Routine air sampling before opening new units identifies mold contamination and allows for remediation prior to occupancy by patients.Disclosures
All authors: No reported disclosures.
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%.
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