To the Editor-Healthcare workers (HCWs) are at high risk of COVID-19 because of prolonged close contact with SARS-CoV-2-infected patients. Personal protective equipment (PPE), particularly respirators for care of patients undergoing aerosolgenerating procedures (AGPs), is fundamental in protecting HCWs. However, global PPE shortages have occurred during this crisis, forcing healthcare institutions to consider alternative PPE management approaches with regard to appropriate utilization and conservation. At our institution, we limited PPE distribution from central supply to avoid misuse and to maintain visibility on usage and needs. This approach led to delays in obtaining PPE by bedside teams. Furthermore, frequent changes in public health guidance and hospital PPE approaches resulted in HCW confusion and apprehension. To address these issues, we implemented several strategies to optimize PPE utilization and education. The most valuable was a PPE stewardship initiative, which allowed us to simultaneously reserve PPE, assure HCW safety, provide real-time education and guidance regarding optimal infection control practices and PPE use, and ensure timely PPE availability. Here we present our successful PPE stewardship initiative at the Ann & Robert H. Lurie Children's Hospital of Chicago. Early in the pandemic, PPE stewardship was the responsibility of the infection prevention and control (IP&C) team, who instated daily bedside COVID-19 rounds on all suspected and confirmed COVID-19 inpatients. IP&C provided patient-specific recommendations regarding isolation status and PPE utilization, the recommendations for which frequently changed based on new science and evolving public health guidance. Rounds were conducted as a multidisciplinary team that included IP&C, respiratory therapists, bedside and quality nurses, physicians, and unit leadership. These rounds allowed for discussion and dissemination of current PPE guidance and fostered discussions regarding risk mitigation practices. The benefits were reciprocal-clinicians provided patient-related information to clarify the level of PPE required, and in return, IP&C provided PPE feedback and education regarding PPE needed, how to don and doff, handling N95s for reuse/

between groups (Table 1). In the standard group, 5/15 patients correctly answered the comprehension question before and after counseling. In the iPad group, 0/10 patients answered the question correctly before, but 6/10 answered correctly after. A positive trend between iPad counseling and improved comprehension was seen (RR ¼ 1.8, 95% CI ¼ 0.7-4.3). Using logistic regression models, there was no correlation between responses to other questions, age or education and whether comprehension improved. Overall, 22/25 (88%) patients were satisfied or strongly satisfied with their counseling experience, irrespective of counseling type they received (RR ¼ 1.0, 95% CI ¼ 0.7-1.3). CONCLUSION: A trend towards improved comprehension was seen when Boston Scientific's, Pelvic Floor Institute POP-Q, 3D iPad app was used compared to our standard model. Current literature implores improvement in POP counseling, given that rates of surgical dissatisfaction are associated with feeling "unprepared." This "unpreparedness" is tied to ineffective counseling and a lack of patient comprehension. While statistical significance was not met due to a small sample size, our pilot study provides preliminary evidence that dynamic models may improve patient comprehension and perhaps, surgical preparedness. At minimum, using visual models provide high patient satisfaction with counseling. Future studies should evaluate interactive models in pre-operative counseling and how it affects patient preparedness and satisfaction with surgery.

Background C. difficile is one of the most common healthcare-associated infections in the United States. Studies of patients with asymptomatic carriage of toxigenic C. difficile have reported conflicting results on the risk of subsequent C. difficile infection (CDI). Older studies suggest that the risk was low and colonization may be protective. Subsequent studies indicate that asymptomatic carriers have a 6-fold greater risk of developing CDI. The aims of our study were to assess the burden of asymptomatic C. difficile carriage and risk of subsequent CDI.MethodsAdult inpatients at NorthShore University HealthSystem, Illinois hospitals between August 1, 2017 and February 28, 2018 were eligible for the study. Focused admission screening of patients at high risk of C. difficile carriage was performed: (1) history of CDI or colonization, (2) prior hospitalization past 2 months, or (3) admission from a long-term care facility. A rectal swab was collected and tested using the cobas® Cdif Test (Roche) real-time PCR. The development of hospital onset CDI (HO-CDI) in colonized patients was monitored prospectively for at least 2 months. HO-CDI testing of colonized patients was performed using the Cepheid GeneXpert RT-PCR. HO-CDI was defined as patients hospitalized for at least 72 hours with 3 or more episodes of diarrhea/24 hours, in the absence of other potential causes of diarrhea. Patient demographics were collected using a standardized form and data analyzed using VassarStats.ResultsThere were 6,104 patients enrolled in the study and 528 (8.7%) were positive on admission for toxigenic C. difficile carriage. The mean age of colonized patients was 75.5 years (range 24–103) and 56.4% (298 patients) were females. Of 528 colonized patients, 21 (4%) had a positive CDI test. A total of 7 patients (1.3%) developed HO-CDI. Mean time to positive HO-CDI was 46.1 days (range 5–120 days). Of 5,576 patients that were negative for C difficile carriage on admission, 14 (0.3%) patients developed HO-CDI. The relative risk of HO-CDI was 5.28 (95% CI: 2.14–13.03, P = 0.05).ConclusionWe found that 8.7% of at-risk admissions were asymptomatic toxigenic C. difficile carriers. While only 1.3% developed HO-CDI, asymptomatic carriers had a 5 times higher risk of subsequent CDI compared with non-carriers.Disclosures All authors: No reported disclosures.