Objective To determine the utility of the Sofia® SARS rapid antigen fluorescent immunoassay (FIA) to guide hospital bed placement of patients being admitted through the emergency department (ED). Design Cross-sectional analysis of a clinical quality improvement study. Setting Two community hospitals in Maryland. From 9/21/2020 to 12/3/2020, 2887 patients simultaneously received the Sofia® SARS rapid antigen FIA and SARS-CoV-2 RT-PCR assays on admission through the ED. Methods Rapid antigen results and symptom assessment guided initial patient placement while confirmatory RT-PCR was pending. The sensitivity, specificity, positive and negative predictive values of the rapid antigen assay were calculated relative to RT-PCR, overall and separately for symptomatic and asymptomatic patients. Assay sensitivity was compared to RT-PCR cycle threshold (Ct) values. Assay turnaround times were compared. Clinical characteristics of RT-PCR positive patients and potential exposures from false-negative antigen assays were evaluated. Results Overall agreement, sensitivity, and specificity for all patients was 97.9%, 76.6% (95% confidence interval (CI): 71%, 82%), and 99.7% (95% CI: 99%, 100%), respectively. No differences in performance were seen between asymptomatic and symptomatic individuals. As RT-PCR Ct increased, sensitivity of the antigen assay decreased. Mean turnaround time for the antigen assay and RT-PCR was 1.2 (95% CI: 1.0, 1.3) and 20.1 (95% CI: 18.9, 40.3) hours, respectively (p<0.001). No transmission from antigen-negative/RT-PCR-positive patients was identified. Conclusions While not a replacement for RT-PCR for detection of all SARS-CoV-2 infections, the Sofia® SARS antigen FIA has clinical utility for potential initial timely patient placement.

Despite increasing awareness of central line-associated bloodstream infections (CLABSIs) in general wards, published strategies come from intensive care units (ICUs) of large tertiary care centers. After implementing a central line insertion checklist, two community hospitals experienced an 86% reduction in CLABSI rates in ICUs and a 57% reduction in non-ICU settings over 36 months.

Aims The importance of early recognition and antimicrobial intervention in paediatric patients developing clinical evidence of sepsis is now well-established. While the concept of a 'golden hour' is a subject of current debate, protocols for patients at risk of sepsis focus upon the administration of antibiotics within 60 min of presentation to an emergency department. The aim of this study was to review the antibiotic administration for children presenting to a specialist paediatric emergency department with one or more age-appropriate observational parameters matching SIRS criteria and an additional risk factor for sepsis, defined as; current oncological chemotherapy, aplastic anaemia, post-stem cell/bone marrow therapy, or home parental nutrition via a central venous catheter.Methods A search of all the patients presenting to a specialist paediatric emergency department over a 1 year period between 2017-2018 with one or more age-appropriate initial observational parameters matching SIRS criteria was performed. The search was performed using PatientFirst software and identified a cohort of 945 patients. This population was searched for criteria identifying them as meeting the high risk criteria above. These identifiers included high risk coding within the software and subsequently coded diagnoses which matched the high risk criteria. This yielded a population of 59 patients (n=59). The scanned and physical hospital records for this population were reviewed with respect to the choice prescription time, and administration time of sepsis-protocolised antibiotics to assess performance according to a 'golden hour' target. Results The notes of 59 patients were reviewed. All 59 patients received an appropriate IV antibiotic as per the hospital protocol (Tazocin or Meropenem). The mean time from prescription of antibiotics to administration was 29.7 min (range À5-80). The mean time from ED booking to antibiotic administration was 59.66 min(range 21-152). 58% of the patients received antibiotics within the golden hour. Conclusion In conclusion, our study demonstrated surprising findings in a population receiving protocolised antibiotic therapy for high risk of sepsis. Clinician perception of this differed significantly and this is worthy of further open discussion. G461(P) ANTIBIOTIC THERAPY IN HIGH RISK OF SEPSIS EMERGENCY DEPARTMENT PATIENTS -THE DEBATE ABOUT WHO SHOULD DELIVER THE CARE 1 NC Richens, 2 C Clay.Aims The importance of early recognition and antimicrobial intervention in paediatric patients developing clinical evidence of sepsis is now well-established. In centres with patients under specialist teams there is a debate about how initial treatment should be delivered and with ever-increasing pressure on emergency services this grows more pertinent. The aim of this study was to review the antibiotic administration for children presenting to a specialist paediatric emergency department with one or more age-appropriate observational parameters matching SIRS criteria and an additional risk factor for sepsis, def...

BackgroundBehavioral health units (BHU) have been implicated in influenza outbreaks due to group activities, low availability of alcohol-based hand gels and unique host factors. We describe the management of an unusual influenza outbreak, which started in the BHU and then spilled over to the acute care hospital (ACH).MethodsUniversity of Maryland Harford Memorial Hospital is a 95-bed ACH with a 14-bed closed-door adult BHU located on the fifth floor. Two cases each of hospital-acquired influenza were identified in our BHU during 2016 and 2017. In January 2018, however, hospital-acquired influenza cases in the BHU spilled over to the adjacent ACH to cause an outbreak. A case was defined as a patient with fever of >100.4°F, presence of influenza-like illness, and a positive influenza test >72 hours after admission. Outbreak control measures included twice daily fever screening, enhanced droplet precautions, visitor restrictions, discontinuing community activities, enforcing hand hygiene at all hospital entrances, and hospital-wide chemoprophylaxis with oseltamivir.ResultsOn January 15, 2018, the index patient developed influenza in the BHU followed by a second case in BHU 4-days later. Over the next 10 days, five more patients on the third and fourth floors of ACH tested positive. Attack rate was 3% and average length of stay was 8.9 days. Chemoprophylaxis with oseltamivir 75 mg orally once a day was given to 71% of all eligible hospitalized patients for a week (at a cost of $17,000). All seven patients yielded influenza A, subtype H3N2 and were successfully treated with oseltamivir 75 mg orally twice a day for 7 days. The outbreak lasted 11 days. Figure 1 shows the epidemiologic curve.ConclusionSpecial attention should be paid to influenza prevention in the BHUs due to the risk of spillover effect to sicker patients in the adjacent ACH. A short, 7-day course of hospital-wide oseltamivir chemoprophylaxis, in addition to promptly implementing the infection prevention measures was effective in controlling the outbreak. Disclosures All authors: No reported disclosures.

BackgroundThe clinical impact of antibiotic stewardship programs (ASP) in non-teaching community hospitals (NTCH) is largely unknown. We report our experience in two NTCH with limited resources where ASP was established.MethodsIn 2008, ASP was established at two NTCH: University of Maryland-Upper Chesapeake Medical Center (UM-UCMC) and University of Maryland-Harford Memorial Hospital (UM-HMH) each with 195 and 128 beds, respectively.Empiric use of Level 1 antibiotics (piperacillin/tazobactam and vancomycin) was restricted to 72 hours, after which a positive culture or an ID consult was required to continue the antibiotics further. Empiric use of Level 2 antibiotics (carbapenems, echinocandins, tigecycline, daptomycin, linezolid, ganciclovir, voriconazole, lipid amphotericin and other non-formulary antibiotics) required an ID consult within 24 hours. Pharmacists reviewed restricted antibiotics and culture results, managed drug levels of vancomycin and aminoglycosides, and facilitated IV to PO conversions. Annual antibiograms were generated. Antibiotic utilization, cost, resistance patterns and rates of healthcare-associated (HA) C. difficile infections were tracked.ResultsRates of HA C. difficile infections decreased by 73%. Pseudomonas resistance to carbapenems, gentamicin, and piperacillin/tazobactam decreased by 62%, 56%, and 33% respectively. Enterococcus resistance to vancomycin, and the rates of extended spectrum β lactamase (ESBL) producing organisms remained stable. Total antibiotic purchase decreased by 30%; antibiotic cost per-patient-day decreased by an average of 41%. Physician compliance with our ASP was >90%.ConclusionImplementing an ASP at two non-teaching community hospitals not just reduced the overall utilization and cost of antibiotics, but also resulted in a significant reduction of healthcare-associated C. difficile infections and pseudomonas resistance to carbapenems and aminoglycosides.Figure 1Figure 2Figure 3Disclosures All authors: No reported disclosures.