Ibuprofen is a commonly used medication in the United States and is used both by prescription and over the counter, while hypokalemia is a life-threatening condition caused by various etiologies, one of which is the side effect of medications. Ibuprofen is well-known for its various nephrotoxic side effects, including hyperkalemia as a common electrolyte abnormality, however, renal tubular acidosis leading to hypokalemia with the use of ibuprofen has been reported rarely. We present here two cases of life-threatening hypokalemia due to over-thecounter use of large doses of ibuprofen and describe its management.

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BackgroundThe Center for Disease Control and Prevention recommends strict contact isolation precautions (CP) that include hand hygiene (HH) and barrier (gloves and gown) precautions upon entering and leaving the rooms of patients diagnosed with multidrug-resistant organism or Clostridium difficile infections. Although this policy has been in place for several years, compliance rate among HCW is rarely studied. The aim of our study was to covertly monitor, analyze, and compare the overall bundle compliance (OBC) and individual (HH, glove and gown) component compliance (ICC) among HCWs during routine patient care.MethodsA prospective observational study was done in six Detroit Medical Centers (July 2017 to February 2018). Trained observers audited both inpatient and intensive care units on random days and time. Components audited (1) HH before donning and after doffing (2) gowning and gloving techniques before entering and after existing the patient room. A mobile application (speedy audit) was used to record all data. A pilot targeted education program (TEP) was also conducted in one of the hospitals where education was focused only on strict HH practice before donning.ResultsA total of 6,274 observations were collected. The OBC was 38%. Common HCWs observed included nurses (registered nurse and nursing student) 47%; physicians (attending’s, residents, fellows) 28%; service workers including Environmental Service, Food service, Patient transporter, Social worker, Pastoral care- 14%; Allied Health Professions including Dietician, Blood Collection, Physiotherapist, Radiology Tech, Respiratory Therapist 4%; The OBC among all HCW were below 50%. For the ICC, HH (49%) was way below the gloving (80%,) and gowning (62%) compliance. HH compliance before donning was strikingly lower (40%) than the compliance after doffing (62%). This trend was similar in all HCW. Within a month of TEP, a drastic increase in both HH [↑ to 75% from 26% (P < 0.001)] and OBC [↑ to 68% from 16% (P < 0.001)] was seen.ConclusionCommon misconception that gloves are substitute to HH could explain the low HH rates before donning. Recognition of this gap and focused education on HH before donning has led to improved compliance in all HCW.Disclosures All authors: No reported disclosures.

BackgroundResidents of long-term care facilities (LTCF) have high risk of Clostridium difficile infection (CDI) and its associated adverse outcomes. We describe the clinical characteristics and outcomes of CDI in LTCF patients admitted to an acute care (AC) hospital.MethodsThis is a descriptive retrospective study of CDI patients admitted to Detroit Medical Center (DMC) from LTCF from January 2009 to December 2017. Patients identified through chart review as having CDI on admission or within 48 hours of admission and without recent AC hospitalization in the prior 4 weeks were included. CDI and CDI severity were defined based on 2017 clinical consensus guidelines. Definitions: CDI-Either presence of diarrhea or evidence of ileus or megacolon and either presence of C. difficile toxin in stool or evidence of pseudomembranous colitis. Severe CDI-Presence of white blood counts ≥15,000 and serum creatinine >1.5 mg/dL. Complicated CDI-Presence of either toxic megacolon, sepsis, systemic inflammatory response syndrome, colonic perforation, or requiring ICU admission. Demographics, medical conditions, laboratory results, prior 60-day antibiotic use, CDI treatment, and outcomes were collected. Patients’ follow-up extended 90 days; however, data were limited to hospital charts from index admission or readmission to the same hospital.ResultsAmong the 85 patients who met the inclusion criteria, 45 (53%) were female, the mean age was 76 (SD: 16), and the median Charlson index score was 6 (range: 4–8). The common source of prior 60-day antimicrobial exposure was β-lactam/β-lactamase inhibitors (39%), Flagyl (15%), vancomycin (18%). The majority of patients were treated with flagyl (71%), 41% with vancomycin and 17% with concurrent or sequential flagyl and vancomycin. Majority of CDI patients (56%) experienced severe CDI with 25% experiencing complicated CDI. During the 90-day follow-up period, 32% of patients required readmission (within 30 days of discharge) for recurrent CDI and 15% of patients died in the hospital.ConclusionCDI patients admitted to DMC from LTCF experience considerable clinical burden. Further research is warranted toward understanding the burden of CDI among LTCF patients admitted to AC facilities.Disclosures S. Chandramohan, Pfizer Inc.: Collaborator, Research grant. P. Zhang, Pfizer Inc.: Employee, Salary. K. Heinrich, Pfizer Inc.: Employee, Salary. E. Gonzalez, Pfizer Inc.: Employee, Salary. T. Chopra, Pfizer Inc.: Collaborator, Research grant.