BackgroundTechnology can extend Infection Disease Consultants (IDCs) into resource limited small community US hospitals. We compared in-person infectious disease (ID) consults with Tele-ID consults to determine whether length of stay, antibiotic usage, drug cost, or readmission rates will remain the same between both groups over a 3-month period.MethodsUniversity of Maryland Harford Memorial Hospital (UM-HMH) is a 95-bed hospital including a 6-bed ICU. From May to August 2017 (study period) there was no IDC at UM-HMH. During study period, IDCs from a regional UM hospital provided formal Tele-ID consults through an HIPAA compliant secured Skype Business account. Patient history and wound examination were done by the IDC via video monitor while a bedside nurse assisted in performing the physical examination. Laboratory and radiological data were reviewed in real time as both hospitals shared the same electronic medical record and IT infrastructure (Meditech 6.15). A formal consultation was dictated and computer orders were entered by the IDC within 24 hours of the consult request. Daily Tele-ID follow-up rounds were conducted. IDCs had the authority to transfer a patient to the regional hospital for in-person care if deemed necessary. Study period was compared with a baseline period (May–August 2016) when IDCs were providing in-person consults at UM-HMH.ResultsBaseline period had 148 inpatient stays and study period had 148 inpatient stays. Despite similar case mix index in both groups, there was no statistical difference between the clinical outcomes. Results are shown in Table 1.Baseline PeriodStudy Period P valuePatients (n)148148–Average length of stay6.77.10.54Case mix index1.161.230.46Average days on antibiotics5.96.20.47Average drug cost$484$4960.85Readmission %22.217.80.38Deaths331ConclusionTele-ID at our hospitals was noninferior to in-person ID consults. An integrated computer system, nursing support, and daily follow-up are key components of a successful Tele-ID program.Disclosures All authors: No reported disclosures.

BackgroundMany US hospitals have implemented CAUTI prevention bundles (CPB) but few have achieved the goal of zero CAUTIs for 12 consecutive months. We report our journey to zero harm at two community hospitals that have each successfully eliminated CAUTIs from all their units, including the intensive care unit (ICU), for over 12 consecutive months.MethodsFrom April 2015 to March 17 (Period A), CPB was implemented at 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. UM-UCMC has a 15-bed ICU while UM-HMH has a 5-bed ICU. The CPB included placement of urinary catheters only for approved indications, use of two persons (buddy system) for catheter insertion, Nurse Driven Protocol for catheter removal, and silver-impregnated cloths for perineal care. A massive frontline engagement campaign “You can’t have a CAUTI if you don’t have a foley” was launched from April 2017 to March 2019 (Period B). The focus was intensified on reducing catheter utilization rates. Real-time feedback on new CAUTIs cases was provided to leadership at the daily safety briefs and to nurses and physicians at the unit-based huddles. The number of CAUTIs and “days without a CAUTI” was shared with team members via small posters and whiteboards.ResultsA statistically significant decrease in utilization of urinary catheters was observed (Table 1). Both hospitals and their respective ICUs remained CAUTI free for >12-consecutive months (Figure 1).ConclusionEliminating CAUTIs for 12 consecutive months in acute care community hospitals is possible and serves as a step toward the journey to zero harm. Reducing catheter utilization is a key strategy. Humanizing each infection and providing real-time feedback to the frontline staff and leadership in whole numbers (instead of the old paradigm of reporting CAUTI rates) may have resulted in greater engagement. Disclosures All Authors: No reported Disclosures.

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.