Objectives The Filtered Far UVC handheld disinfection device is a small portable device that emits far UVC at 222nm. The objective of this study was to evaluate the devices ability to kill microbial bioburden on hospital surfaces and compare it to manual cleaning using germicidal sodium hypochlorite wipes. Methods A total of 344 surfaces (86 observations per group) were sampled with 2 pairs of samples per surface a pre and a post sodium hypochlorite sample, and a pre and a post FFUV sample. The results were analyzed via a Bayesian multi level model that account for the correlation between sample pairs and within surfaces. Additionally, the bacterial flora recovered was identified. Results The estimated mean colony counts for the sodium hypochlorite control and treatment groups were 20.5 (11.7 to 36.0) and 0.1 (0.0 to 0.2) colony forming units (CFUs) respectively. The FFUV control and treatment groups had mean colony counts of 22.2 (12.5 to 40.1) and 4.1 (2.3 to 7.2) CFUs. The sodium hypochlorite samples had an estimated 99.4% (99.0% to 99.7%) reduction in colony counts, while those from the FFUV group an estimated 81.4% (76.2% to 85.7%) reduction. Conclusions The findings from this study suggest the FFUV handheld device effectively reduced microbial bioburden on real world hospital surfaces; however, a manual clean using sodium hypochlorite was more effective in reducing bioburden. Several healthcare associated infections causing pathogens (gram positive and negative bacteria) were retrieved from the surfaces indicating a potential for onward transmission.

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Background Enterococcus faecium (E. faecium) is a common hospital-associated infection (HAI) that can lead to increased costs, morbidity, and mortality. Pulsed Xenon Ultraviolet light (PX-UV) has been shown to reduce bacterial bioburden levels on surfaces. This study aims to assess the effect of the addition of PX-UV to terminal cleaning on the clonal recovery of E. faecium sequence types (STs) using Whole Genome Sequencing (WGS) on patient isolates. Methods During 2017 to 2020 a prospective, randomized, double-blinded, sham-controlled, interventional, crossover trial in 2 separate Detroit hospitals (H1 and H2) compared HAI counts after the addition of either PX-UV or a non-UV sham device to terminal cleaning methods. The trial consisted of a total of 16 units randomized to have either the treatment of PX-UV (Group Q) or the sham control device with no UV (Group W) for 12 months. A washout period (Group R) of 6 months followed and the trial concluded with a 12-month crossover of treatments. A total of 60 E. faecium samples were collected, then WGS was performed by the Illumina Nextseq 550 instrument. de novo assembly was preformed using the SPAdes program. Whole Genome Multilocus Sequence Type (wgMLST) analysis was performed by BioNumerics (v7.6) to construct minimum spanning tree (MST). Results A total of 7 STs were obtained across the 2 hospitals (H1 and H2). ST117, ST17, and ST80 all had more than 10 total recovered isolates, ST117 being the most frequent with 24 isolates. Less than 3 isolates were recovered for all other STs. For all STs, Group Q (PX-UV) had 14, Group R (washout period) had 22, and Group W (non-UV sham) had 24. ST18 was only found in Group Q. ST412, ST584, and ST736 were not found in Group W. The data shows that the intervention PX-UV group had a reduction of clonal recovery by 10 STs as compared to the sham UV group. Table 1:Total number of each sequence type (ST) in H1 and H2 Conclusion The overall reductions in the number of isolates in the real UV units was driven by reductions in the ST117 a predominant strain in a hospital environment reported previously in Detroit and ST80. There were negligible differences in recovery of other ST between the groups. The reduction in clonal recovery of E. faecium isolates in Group Q as compared to Group R might be related to use of PX-UV following terminal room cleaning. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|GlaxoSmithKline plc.: Receiving symposia honoraria|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502|Merck: Advisor/Consultant|qpex: Advisor/Consultant|Shionogi: Grant/Research Support|Spero: Advisor/Consultant Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

Background Carbapenem-resistant Acinetobacter baumannii (CRAb) is increasing due to widespread use of antibiotics. Multidrug resistant (MDR) CRAb is a major threat to public health as treatment options are limited. The objective of this study is to elucidate the molecular epidemiology of circulating antibiotic resistance genes causing MDR CRAb infections by using a combination of whole-genome Multi-Locus Sequence Typing (wgMLST) and antibiotic susceptibility phenotyping. Table 1.Molecular characterization of MDR CRAb isolates*The numbers indicate % of sequence identity match for each Beta-lactamase gene. Methods Bacterial isolates were derived from cultures taken from subjects 48 hours following admission as part of routine clinical care for patients between 2017-2020. Isolates were obtained from 16 hospital units (both ICU and non-ICU) across two hospitals in the Detroit area. Whole Genome Sequencing (WGS) was performed using Illumina MiniSeq or Nextseq. WgMLST analysis was performed using BioNumerics software v7.6. ResFinder software was used for analysis of antibiotic resistance genes. Isolates underwent antibiotic susceptibility testing using a broth microdilution method (VITEK2) and Clinical & Laboratory Standards Institute (CLSI) minimum inhibitory concentration (MIC) cut offs. Results Out of the 95 total isolates, 51(54%) were CRAb isolates and of the CRAb isolates, 21(41%) were MDR CRAb. WgMLST identified that majority of the circulating MDR CRAb isolates belonged to ST2Pas (ST195Ox and ST208Ox) based on CDC definitions (Table 1). MDR CRAb isolates were resistant to 3 different classes of antibiotics including aminoglycosides, fluroquinolones and β-lactams. β-lactamase genes present include (blaADC-25, blaOXA-23, blaOXA-66 and blaTEM1D) for both ST195Ox and ST208Ox and (blaADC-25, blaOXA-23 and blaOXA-223) for ST406Pas (ST310Ox). Among the patients with MDR CRAb infections, most were males with respiratory infections in a non-ICU setting. Conclusion The study demonstrated a high proportion of isolates belonged to ST2 Pas carrying multiple beta-lactamase genes including blaOXA-23 gene. ST406Pas might be an emerging lineage carrying the blaOXA-23 gene. In addition to stringent infection control measures, continuous surveillance is recommended in limiting the spread of MDR CRAb isolates in the healthcare settings. Disclosures Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|GlaxoSmithKline plc.: Receiving symposia honoraria|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502|Merck: Advisor/Consultant|qpex: Advisor/Consultant|Shionogi: Grant/Research Support|Spero: Advisor/Consultant Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System.

Background Many studies reporting the excess cost of healthcare-associated infections (HAIs) have used data from positive cultures found in electronic medical records. These data are often limited in a number of ways including whether the positive culture truly represents an actual infection and not just colonization, when the onset of the infection occurred, and whether the infection was device related. Our objective was to generate estimates of the excess cost of HAIs in one facility, the Central Texas Veterans Health Care System (CTVHCS), using highly reliable information extracted from chart review regarding the infection. Methods Our study included data from all inpatient admissions between 1/1/2014 and 12/31/2019 at CTVHCS. HAIs were identified via chart review and were classified based on the infecting organism, specimen location, and whether the infection was device related using 2017 National Health and Safety Network definitions. To minimize time-dependent bias in our estimates of the excess cost of HAIs, we matched each patient with an HAI on day t of their inpatient stay to up to 4 patients who had not had an HAI up until day t of their inpatient stay. We used multivariable generalized estimating equations models to compare the inpatient costs prior to discharge between patients with and without HAIs. Finally, we used multivariable 2-part models to estimate the impact of HAIs on post-discharge readmission costs. Results Our analysis cohort consisted of 425 patients with HAIs who were matched to 1,645 patients without HAIs. HAIs were associated with $29,412 (95% CI:$18,064-$40,759) excess pre-discharge costs, 46.3% increase in the odds of a post-discharge readmission, and $16,049 excess post-discharge costs (see Table 1). The excess pre-discharge costs for central line, catheter-associated urinary tract, and surgical site infections (SSIs) were $96,655 (95% CI:$61,557-$131,754), $34,026 (95% CI:$9,562-$58,491), and $20,014 (95% CI:$5,324-$34,703), respectively. As seen in Table 2, the excess readmission cost for SSIs was $28,222 (95% CI:$9,523-$46,920). Table 1Multivariable regression model results - excess pre-discharge costs associated with healthcare-associated infectionsTable 2Multivariable regression model results - excess post-discharge costs associated with healthcare-associated infections Conclusion We found that HAIs significantly increased both pre- and post-discharge inpatient costs. These costs could potentially be saved if interventions to prevent HAIs could be successfully implemented. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.