SHEA, in partnership with ASGE, APIC, AAMI, AORN, HSPA, IDSA, SGNA, and The Joint Commission, developed this multisociety infection prevention guidance document for individuals and organizations that engage in sterilization or high-level disinfection (HLD). This document follows the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities. This guidance is based on a synthesis of published scientific evidence, theoretical rationale, current practices, practical considerations, writing group consensus, and consideration of potential harm when applicable. The supplementary material includes a summary of recommendations. The guidance provides an overview of the Spaulding Classification and considerations around manufacturers’ instructions for use (MIFUs). Its recommendations address: point-of-use treatment prior to sterilization or HLD, preparation of reusable medical devices at the location of processing, sterilization, and immediate use steam sterilization (IUSS), HLD of lumened and non-lumened devices, processing of reusable medical devices used with lubricating or defoaming agents, monitoring for effectiveness of processing, handling of devices after HLD, augments and alternatives to HLD, processing of investigational devices, tracking of reusable medical devices, and approaches to implementation.

Constitutional law — Law for establishing any religion — Grant of Financial Assistance to States — Validity of Commonwealth legislation providing financial assistance to non-government schools — Constitution ss. 96, 116

The One Health High-Level Expert Panel’s definition of One Health includes optimizing the health of people, animals (wild and domestic) and ecosystems. For many One Health practitioners, wildlife that can spread zoonoses are the focus, particularly if they can come in contact with people. However, ecosystem health is often best-indicated by less-encountered species, for instance, amphibians and reptiles. This review highlights how these taxa can benefit human health and well-being, including cultural significance, as well as their impact on plant, animal and environmental health. We highlight current challenges to the health of these species and the need to include them in the One Health Joint Action Plan. We conclude with a call to action for inclusion of amphibians and reptiles in a One Health approach.

Background: In September 2022, UNC Hospitals was awarded a Regional Emerging Special Pathogens Treatment Center (RESPTC) grant by the U.S. Department of Health and Human Services Administration for Strategic Preparedness and Response (ASPR) to care for up to two patients with viral hemorrhagic fever, or similar pathogen, and up to ten patients with novel respiratory pathogens. Intensive infection prevention efforts and timely multidisciplinary commitment was required to develop the Space, Strategy, Staff, and Stuff needed to care for patients with a special pathogen. Methods: Multiple space needs assessments were undertaken to acquire spaces for the care of patients, simulation training, and a dedicated laboratory. Strategies for developing the response plan required collaboration with hospital executives, nursing leadership, public health leaders, and regional partners. Staff were recruited across various disciplines to join the response team and were provided hands-on skills training which was assessed by post-training surveys. Specialized ‘stuff’ (i.e., PPE, training equipment, and waste management devices) were researched and procured for use by the team. Results: Patient care and dedicated laboratory space was identified within existing infrastructure, and renovation plans were developed to adapt the space for these specialized activities. A waste management plan that benefits the hospital for routine waste and allows for Category A waste management was approved. Fifty-three staff members were recruited from 3 main disciplines (RNs, MDs, Paramedics), and across numerous settings (Medicine Acute Care & ICU, Pediatric ICU & Stepdown, Air Care/Transport, Burn ICU, Surgery Stepdown, Emergency Medicine, Infection Prevention, Infectious Disease) were trained during five 4-hour training sessions, culminating in an exercise involving transporting a rule–out Ebola patient to the hospital’s special pathogens unit. Post-training evaluations demonstrated a very high level of confidence (‘strongly agree’) in staffs’ knowledge about the RESPTC site (92.3%), special pathogens (80.8%), collaboration needed for managing patient care (80.8%), and in their comfort with special PPE donning and doffing (73.1%). Conclusions: Using a systematic approach to develop Space, Strategy, Staff, and Stuff, a large academic hospital readied itself to become a new RESPTC site. Key lessons learned include the importance of a multidisciplinary response team; local, state, and regional coordination for care planning and delivery; and early community partnership development. Logistical infrastructure and waste management challenges continue to require partnership with hospital leadership to optimize workflows and patient care. Holistic decision-making around infrastructure has led to changes that benefit all hospital patients and offer efficiencies to

Disclosure: William Fischer: Consultant - Roche, Merck, Inhalon Biopharma; Speaker for ACGME - IMG. David J Weber: Consultant on vaccines: Pfizer; DSMB chair: GSK; Consultant on disinfection: BD, GAMA, PDI, Germitec

Limited analyses based on national samples have assessed whether early attention-deficit/hyperactivity disorder (ADHD) symptoms predict later internalizing and externalizing symptoms in youth and the influence of sex and pubertal timing on subsequent psychiatric symptoms. This study analyzed data (n = 2818) from the Environmental influences on Child Health Outcomes Program national cohort. Analyses used data from early childhood (mean age = 5.3 years) utilizing parent-reported ADHD symptoms to predict rates of internalizing and externalizing symptoms from late childhood/adolescence (mean age = 11.9 years). Within a subsample age at peak height velocity (APHV) acted as a proxy to assess pubertal timing from early childhood (mean age = 5.4 years) to adolescence (mean age = 12.3 years). Early-childhood ADHD symptoms predicted later psychiatric symptoms, including anxiety, depression, aggressive behavior, conduct problems, oppositional defiant disorder, and rule-breaking behavior. Earlier APHV was associated with increased Conduct Disorder symptoms from late childhood to adolescence for females only. A stronger relation between ADHD symptoms and later aggression was observed in females with earlier APHV, whereas this same pattern with aggression, conduct problems and depression was observed in males with later APHV. Clinicians should consider that both young girls and boys with elevated ADHD symptoms, particularly with off-set pubertal timing, may be at risk for later psychiatric symptoms.

We performed a literature review to describe the risk of surgical-site infection (SSI) in minimally invasive surgery (MIS) compared to standard open surgery. Most studies reported decreased SSI rates among patients undergoing MIS compared to open procedures. However, many were observational studies and may have been affected by selection bias. MIS is associated with reduced risk of surgical-site infection compared to standard open surgery and should be considered when feasible.

Intravesical Bacillus Calmette-Guérin (BCG) is a standard therapy for non–muscle-invasive bladder cancer used in urology clinics and inpatient settings. We present a review of infection risks to patients receiving intravesical BCG, healthcare personnel who prepare and administer BCG, and other patients treated in facilities where BCG is prepared and administered. Knowledge of these risks and relevant regulations informs appropriate infection prevention measures.

Background: Clostridioides difficile infection (CDI) is a serious healthcare-associated infection responsible for >12,000 US deaths annually. Overtesting can lead to antibiotic overuse and potential patient harm when patients are colonized with C. difficile, but not infected, yet treated. National guidelines recommend when testing is appropriate; occasionally, guideline-noncompliant testing (GNCT) may be warranted. A multidisciplinary group at UNC Medical Center (UNCMC) including the antimicrobial stewardship program (ASP) used a best-practice alert in 2020 to improve diagnostic stewardship, to no effect. Evidence supports use of hard stops for this purpose, though less is known about provider acceptance. Methods: Beginning in May 2022, UNCMC implemented a hard stop in its electronic medical record system (EMR) for C. difficile GNCT orders, with exceptions to be approved by an ASP attending physician. Requests were retrospectively reviewed May–November 2022 to monitor for adverse patient outcomes and provider hard-stop compliance. The team exported data from the EMR (Epic Systems) and generated descriptive statistics in Microsoft Excel. Results: There were 85 GNCT orders during the study period. Most tests (62%) were reviewed by the ASP, and 38% sought non-ASP or no approval. Of the tests reviewed by the ASP, 33 (62%) were approved and 20 (38%) were not. Among tests not approved by the ASP, no patients subsequently received CDI-directed antibiotics, and 1 patient (5%) warranted same-admission CDI testing (negative). Of tests that circumvented ASP review, 18 (56%) ordering providers received a follow-up email from an associate chief medical officer to determine the rationale. No single response type dominated: 3 (17%) were unaware of the ASP review requirement, 2 (11%) indicated their patient’s uncharted refusal of laxatives, 2 (11%) indicated another patient-specific reason. Provider avoidance of the ASP approval mechanism decreased 38%, from 53% of noncompliant tests in month 1 to 33% of tests in month 6. Total tests orders dropped 15.5% from 1,129 during the same period in 2021 to 954 during the study period (95% CI, 13.4%–17.7%). Compliance with the guideline component requiring at least a 48-hour laxative-free interval prior to CDI testing increased from 85% (95% CI, 83%–87%) to 95% (95% CI, 93%–96%). CDI incidence rates decreased from 0.52 per 1,000 patient days (95% CI, 0.41–0.65) to 0.41 (95% CI, 0.32–0.53), though the change was neither significant at P = .05 nor attributable to any 1 intervention. Conclusions: Over time and with feedback to providers circumventing the exception process, providers accepted and used the hard stop, improving diagnostic stewardship and avoiding unneeded treatment.

Disclosures: None

Background: Central-line–associated bloodstream infections (CLABSIs) are linked to increased morbidity and mortality, longer hospital stays, and significantly higher healthcare costs. Infection prevention guidelines recommend line placement in specific insertion locations over others because of the relative risk of infection. The purpose of this study was to assess CLABSI rates by line type to determine whether some central lines had a lower risk of infection and should be recommended over others given similar clinical indications. Methods: At UNC Hospitals, data were obtained on central lines across a 3-year period (FY20–FY22) from the EMR (Epic Systems). Central lines were categorized as apheresis catheters, CVC lines (single, double, or triple lumen), hemodialysis catheters, introducer lines, pulmonary artery (PA) catheters, PICC lines (single, double, or triple lumen), port-a-catheters, trialysis catheters, or umbilical lines. The line type(s) associated with each CLABSI during the same period were recorded, and CLABSI rates by line type per 1,000 central-line days were calculated using SAS software. If an infection had >1 central-line device type associated, the infection was counted twice when calculating the CLABSI rate by line type. We calculated 95% CIs for each point estimate to assess for statistically significant differences in rates by line type. Results: During FY20–FY22, there were 264,425 central-line days and 458 CLABSIs, for an overall CLABSI rate of 1.73 CLABSIs per 1,000 central-line days. Also, 16% of patients with a CLABSI had >1 type of central line in place. Stratified data on CLABSI rates by each central-line type is presented in the Figure. CLABSI rates were highest in patients with apheresis lines (6.22; 95% CI, 3.96–9.35) and PA catheters (6.22; 95% CI, 3.54–10.20), and the lowest CLABSI rates occurred in patients with PICC lines (1.44; 95% CI, 1.19–1.73) and port-a-catheters (1.14; 95% CI, 0.89, 1.45). For both CVC and PICC lines, as the number of lumens increased from single to triple, CLABSI rates increased, from 0.91 to 2.63 and from 0.57 to 1.20, respectively. Conclusions: At our hospital, different types of central lines were associated with statistically higher CLABSI rates. Additionally, a higher number of lumens (triple vs single) in CVC and PICC lines were also associated with statistically higher CLABSI rates. These findings reinforce the importance of considering central-line type and number of lumens to minimize risk of CLABSI while ensuring that patients have the best line type based on their clinical needs.

Disclosures: None

Digital Livestock Technologies (DLTs) can assist farmer decision-making and promise benefits to animal health and welfare. However, the extent to which they can help improve animal welfare is unclear. This study explores how DLTs may impact farm management and animal welfare by promoting learning, using the concept of boundary objects. Boundary objects may be interpreted differently by different social worlds but are robust enough to share a common identity across them. They facilitate communication around a common issue, allowing stakeholders to collaborate and co-learn. The type of learning generated may impact management and welfare differently. For example, it may help improve existing strategies (single-loop learning), or initiate reflection on how these strategies were framed initially (double-loop learning). This study focuses on two case studies, during which two DLTs were developed and tested on farms. In-depth, semi-structured interviews were conducted with stakeholders involved in the case studies (n = 31), and the results of a separate survey were used to complement our findings. Findings support the important potential of DLTs to help enhance animal welfare, although the impacts vary between technologies. In both case studies, DLTs facilitated discussions between stakeholders, and whilst both promoted improved management strategies, one also promoted deeper reflection on the importance of animal emotional well-being and on providing opportunities for positive animal welfare. If DLTs are to make significant improvements to animal welfare, greater priority should be given to DLTs that promote a greater understanding of the dimensions of animal welfare and a reframing of values and beliefs with respect to the importance of animals’ well-being.