A 41-year-old white male with past medical history significant for renal transplantation in 2007, was admitted with malaise, fever and worsening jaundice. Four days before admission he underwent an uneventful laparoscopic cholecystectomy with liver biopsy. Liver biopsy revealed moderate to severe mixed portal tract infiltration with unknown etiology.Physical examination was benign except the cervical lymphadenopathy. His laboratory tests showed anemia, leukopenia, and thrombocytopenia. Liver function tests were altered: aspartate aminotransferase 70 (3-50) IU/L, alanine aminotransferase 68 (3-60) IU/L, alkaline phosphatase 1351 (20-125) IU/L, total bilirubin 10.2 (0.2-1.3) mg/dL. Tests for viral hepatitis, autoimmune markers, serum rapid plasma reagin (RPR), QuantiFERON-TB Gold, Ebstein-Barr virus (EBV), and cytomegalic virus (CMV) were all negative. Blood and urine cultures were negative. He was tested positive for human immunodeficiency virus (HIV). Computed tomography (CT) of the abdomen showed heterogeneous lesions in the right hepatic lobe suspicious for infection with mesenteric and retroperitoneal lymphadenopathy (Fig.

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Background: Catheter-associated urinary tract infections (CAUTIs) have gained popularity in recent years for increasing morbidity and mortality in multiple healthcare settings. In fact, they are the most common type of healthcare-associated infection (HAI) in US hospitals, and they account for ~35% of HAIs. Objectives: At our institution, CAUTI rates were higher than the national average; therefore, various preventative protocols were implemented. Southeast Health’s Medical ICU (MICU) has taken many measures to decrease the CAUTI incidence. Methods: We conducted an observational study with a retrospective analysis of the data beginning in 2014 after a poor performance at prevention of CAUTIs as noted in the Leapfrog Hospital Survey. As part of improving prevention measures in MICU, we started a lean project in 2015 that primarily focused on systems-based practices and improvements in the existing nurse protocols. Results: We were successful in this endeavor and in August 2018 the Alabama Department of Public Health (ADPH) reported that we still lower than the national average in prevention of CAUTIs. This finding led us to tighten the protocols and to appoint 2 infection preventionists in the MICU. With the assistance of the infection preventionists, we were able to actively decrease indwelling catheter and device days with daily multidisciplinary rounds to access the necessity for catheter use. We also set monthly attainable targets and reinforced nurse driven protocols with educational in-service programs. One of the most significant additions was the introduction of female external catheters (Purewick) in December 2019 and male external catheters (Liberty) in May, 2019. Our results showed a significant reduction in the number of CAUTIs divided by number of Foley catheter days in the MICU from 32 of 7,435 in 2014 to 1 of 5,934 in 2019. We are excited to see reduction in the CAUTIs with our above measures. We will continue our measures to reach our target of 0 CAUTIs, and we plan to remain above the national average.Funding: NoneDisclosures: None

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