Background Environmental contamination contributes to hospital associated infections, particularly those caused by multi-drug resistant organisms (MDRO). This study investigated bioburden presence on surfaces in a critical care center’s patient rooms following typical environmental services (EVS) practices and following intervention with hybrid hydrogen peroxide™ (HHP™) fogging. Methods Upon patient discharge, following standard cleaning or cleaning with ultraviolet (UV) light use, patient rooms were sampled by swabbing for adenosine triphosphate (ATP) and aerobic colony counts (ACC) from five preset locations. Rooms were then fogged via HHP technology using chemical indicators and Geobacillus stearothermophilus biological indicators for sporicidal validation monitoring. Following fogging, rooms were sampled again, and results were compared. Results A 98% reduction in ACC was observed after fogging as compared to post EVS practices both with and without UV light use. No statistical difference was seen when comparing cleaning to cleaning with UV light use. Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa were identified following EVS practices and not detected following HHP fogging. ATP samples were reduced 88% by fogging application. Chemical and biological indicators confirmed correct application of HHP fogging, as seen through its achievement of a 6-log reduction of bacterial spores. Conclusion HHP fogging is a thorough and efficacious technology which, when applied to critical care patient rooms, significantly reduces bioburden on surfaces, indicating potential benefits for implementation as part of infection prevention measures.

The objective of this pilot study was to describe effectiveness of an evidence-based guideline designed to prevent catheter-associated urinary tract infection (CA-UTI) in reducing CA-UTI in the burn-injured patient population. The study used a pre- and post-bundle implementation comparison design. Inclusion criteria included burn-injured patients of all ages with an indwelling urinary catheter. Patient demographic data were collected by medical record review when informed of a CA-UTI. The Rosswurm-Larrabee Model six-step process model guided implementation of practice change. The sample included eight burn-injured patients (7-88 years). Catheter day range was 1 to 27 days. Each patient had a clear indication for an indwelling urinary catheter; the need for accurate urinary output measurement in a critically injured patient. Four patients had a catheter placed twice during the stay. Nurses reported using a bladder scanner to assess bladder volume for post-operative patients with urinary retention avoiding use of an indwelling urinary catheter in some cases. Integration of evidence-based guidelines in practice resulted in a reduced CA-UTI rate, reduced catheter days, increased days between CA-UTI, and outperformance of the national benchmark statistic. In 2013, the burn unit reduced catheter days by about 75% and reduced infection incidence by >90% in three quarters after implementation of the practice changes. The unit was able to sustain a CA-UTI rate of zero for 248 days.

INTRODUCTION:Environmental surfaces impact pathogen transmission and thus hospital acquired infections. This underscores the need for high-level disinfection, especially considering the vulnerability of critical care patients and the risks posed by multi-drug resistant organisms (MDRO). Enhanced cleaning practices employed by hospitals for environmental disinfection are not all equal. For this investigation, a hydrogen peroxide disinfection system was chosen due to its EPA approval against SARS-CoV-2 and its sporicidal efficacy. This study sought to evaluate the efficacy/ feasibility of a hybrid form of hydrogen peroxide (HHP fogging) compared to current disinfection practices (standard cleaning and enhanced UV-light cleaning) in a critical care setting. METHODS:From Dec '20-Jun '21 data were collected in 17 critical care patient rooms post-discharge. Samples were collected to evaluate HHP fogging versus standard and enhanced cleaning. Sampling followed each intervention: post-EVS standard cleaning, post-enhanced cleaning with UV-light, and post HHP fogging following standard/enhanced practices. Five preset high touch patient room locations were swabbed for aerobic colony counts (ACC) and enumerated for MDRO presence: toilet, phone, bed rail, touchscreen, sink countertop. Measurements included quantitative and qualitative counts (ACC, adenosine triphosphate (ATP) swabs -measured in relative light units,RLU), hydrogen peroxide chemical indicators, and bacterial spore biological indicators(BIs, Geobacillus stearothermophilus). RESULTS:No difference was seen between standard cleaning and enhanced cleaning with UV light (mean ACC 7. 16 and 6.35, respectively;p=0.186). HHP fogging reduced present ACC levels by 98% beyond current EVS post-discharge cleaning practices (mean ACC 0.137, p< 0.0001). MRSA instances were observed after standard and enhanced cleaning with UV light (mean ACC 0.178), no MRSA was detected after HHP fogging. ATP results showed an average 88% reduction post HHP fogging (mean RLU: post cleaning=9012, post HHP fogging=1109;p=0.014) and BIs confirmed a 6-log bacterial spore efficacy.CONCLUSION: HHP fogging resulted in successful elimination of MDROs and reduction in aerobic colony counts versus standard and UV-light cleaning. Deployment of HHP fogging is feasible and safe in a critical care setting.

BackgroundEarly recognition of tuberculosis (TB) cases is critical to prevent spread. Infants are at high risk for TB acquisition after exposure. A TB case went unrecognized despite seeking medical attention in December 2016 for a cough and suspicious radiographic and laboratory testing. During a two week period in November and December 2016 the case visited an infant in a Neonatal Intensive Care Unit (NICU) almost daily for extended periods of time. The NICU was housed in a local community hospital, but staffed by personnel from a separate local children’s hospital. On January 3, 2017, Summit County Public Health was notified of the case and after ascertaining the potential NICU TB exposure began a collaborative contact investigation with the community hospital and the children’s hospital staff, newborns and visitors to the NICU.MethodsThis observational study describes a TB contact investigation of potentially exposed persons in a NICU. The three institutions jointly developed a plan whereby the children’s hospital notified families of the potentially exposed babies, provided prophylactic anti-tubercular medication and follow-up screening. The hospitals’ Infection Preventionists notified and tested the potentially exposed staff. The health department screened the case’s family, personal contacts, and any identified or concerned NICU visitors. At the onset of the investigation the three institutions held a joint press conference. The investigation began in early January 2017 and ended late April 2017.Results TotalInfants potentially exposed68Families contacted68Infants evaluated62Infants put on INH prophylaxis31Infants tested at 10–12 weeks47Infants tested positive0Employees tested183Employees tested positive0 ConclusionAn after-action review revealed strengths, weaknesses and lessons learned. One successful decision was the planned press conference that provided media and public with transparent, consistent messages. A weakness was the inability to identify visitors since there was no NICU visitor log. Therefore visitors other than parents could not be individually contacted about exposure and screening. This investigation successfully involved three different community institutions and was conducted with minimal disruption and public concern.Disclosures All authors: No reported disclosures.