Background: Healthcare-associated central line associated bloodstream infection (HA-CLABSI) surveillance is important for monitoring healthcare-associated infections (HAIs) and evaluating effectiveness of infection prevention (IP) measures. However, implementing it is a laborious and time-consuming approach. Exclusive focus on central lines neglects HAI risk due to peripheral vascular catheters. This study aimed to assess whether HA-CLABSI incidence could be inferred from HA-bloodstream infection (BSI) trends and explore shift to HA-BSI surveillance. Methods: The study was performed in a Singaporean tertiary care hospital. Electronic medical records review was performed to determine whether positive blood cultures met Centers for Disease Control/National Health Safety Network (CDC/NHSN) definitions for HA-CLABSI and HA-BSI. Incident episodes of HA-BSI were included (excluding positive cultures repeated within 14 days). Incident organisms were explored to identify common causative pathogens (excluding same organisms isolated from cultures repeated within 14 days). CLABSI and BSI occurring ≥72hrs after admission were considered healthcare-associated. Patients under oncology or hematology service were considered immunocompromised. Incidence rates (IR) per 10,000 patient-days, patient characteristics and causative pathogens were compared between both indicators. Results: From January 2022 to October 2023, mean IR for HA-CLABSI was 0.63 (n=68) and for HA-BSI was 10.06 (n=1094). Median age of patients with HA-CLABSI was 66 years and HA-BSI was 68 years. HA-CLABSI and HA-BSI were more common in males (60.86% & 58.68%). Median duration between admission to HA-CLABSI was 20 days and to HA-BSI was 12 days. Median duration between central line insertion to HA-CLABSI was 16 days. Of 1094, 631 (57.7%) patients had vascular catheter(s) (i.e., IV cannula, port-a-cath, peripherally-inserted central catheter or central line) inserted at time of HA-BSI diagnosis, of whom 46 (7.3%) patients had CLABSI ±2days from positive blood culture. There was no significant correlation between monthly aggregate data from these indicators (Spearman’s correlation coefficient= 0.36, p-value=0.1). Predominant organisms causing HA-CLABSI and HA-BSI were gram negative bacteria (GNB, 40% & 57.21%), gram positive bacteria (24.71% & 22.23%), and fungi. Common GNB in CLABSI patients were Pseudomonas spp. and Stenotrophomonas maltophilia (8.24%), followed by Serratia marcescens and Klebsiella pneumoniae (5.88%). The frequent GNB in HA-BSI patients were Escherichia coli (15.4%), Klebsiella pneumonia (12.68%), and Pseudomonas spp. (6.69%). Common multi-drug resistant organisms were vancomycin-resistant Enterococcus faecium (10.59% & 3.69%) and methicillin-resistant Staphylococcus aureus (10.59% & 3.07%). Conclusion: HA-BSI did not correlate with HA-CLABSI. HA-BSI reflects heterogenous population outcomes. For utilization as surveillance indicator, further assessment on exclusion criteria is required to improve specificity.

Objectives: Improper reprocessing of endoscopes may result in healthcare-associated infections. Regular microbiological surveillance is an important means of evaluating the quality of endoscope reprocessing. We evaluated the effectiveness of reprocessing endoscopes (including the protocols on steps to be taken in the event of any positive microbiological results) in a sterile supply unit (SSU) and an endoscopy unit in a Singapore tertiary-care academic hospital. Methods: Singapore General Hospital (SGH) is a 1,750-bed, tertiary-care, academic medical center in Singapore with 2 main SSUs: 1 inpatient endoscopy unit and 1 outpatient endoscopy unit. We reviewed microbiological surveillance results from endoscopes following reprocessing from January 2018 to December 2021. In total, 160 endoscopes (27 bronchoscopes, 58 gastroscopes, 52 colonoscopes, 6 duodenoscopes, 5 echoscopes, 5 cystoscopes, 5 rhinolaryngoscopes, and 5 enteroscopes) and 15 automated endoscope reprocessors (AERs) were evaluated for the presence of microorganisms. Samples were obtained by swabbing the tip of the scope and the biopsy channel. Fluid was flushed from the biopsy channel after reprocessing, and this water from the AERs was sampled after waterline disinfection. Results: Of the 15,783 samples collected, 15,667 (99.3%) yielded no growth; 36 (0.2%) were positive for gut and environmental flora; and 80 (0.5%) were positive for low-concern organisms such as skin flora. Conclusions: Microbiological surveillance yielded a high percentage of negative results confirming the effectiveness of endoscope reprocessing. This quality-assurance process is necessary and beneficial in achieving patient safety.

Objectives: Following a cluster of COVID-19 cases in a Singapore public hospital in April 2021, the local health authority mandated the use of N95 respirators in all inpatient wards. This increased the demand for N95 mask fit-testing to ensure that healthcare workers were donning respirators that fit their facial characteristics and hence provided protection through a good facial seal. The demand for fit-testing during the pandemic highlighted the scarcity of manpower and ergonomics concern, such as carpel tunnel syndrome experienced in long hours of qualitative fit-testing sessions. We evaluated the operational efficiency, cost-effectiveness, and difference in passing rate after the introduction of the quantitative method. Methods: Conventional qualitative fit-testing was conducted using manual pumping of a challenge agent, enabling the user to determine the fit of the respirator. The quantitative fit-testing protocol used a condensation particle counter (CPC) to measure the concentration of particles inside the mask and the atmosphere to determine the fit of respirator. The Occupational Safety and Health Administration (OSHA)–approved minimum fit factor of 100 was used as the criterion for a successful N95 respirator fit. Tubes used during quantitative fit-testing were reprocessed using thermal disinfection. Results: Quantitative mask fit-testing provided an objective numerical measure to assess adequate fit of N95 respirator, which provided users with confidence in the respirator fit. It addressed a manpower limitation issue because it did not require qualified trainers to conduct the test, and automation also prevented any potential occupational hazard from repeated actions required in qualitative fit-testing. An increase in the passing rate for N95 fit-testing from 94.5% to 95.5% was observed. However, the high cost of equipment, annual recalibration, and consumables must be considered. Conclusions: Quantitative N95 fit-testing, when adopted with careful consideration of its cost, is an approach to consider for hospital-wide fit-testing.

Objectives: Streptococcus mitis is a gram-positive coccus and is a common commensal found in the throat, nasopharynx, and mouth. In an immunocompromised host, S. mitis opportunistically multiplies and can translocate to other sites. At baseline, the prevalence of S. mitis remained stable among hematological patients, averaging ~1 case monthly. However, in August–September 2020, 5 S. mitis cases were documented in a hematology ward and included overlapping inpatient stays. In this descriptive cluster report, we sought to identify the reasons for the increased prevalence of S. mitis in our institution. Methods: A literature review was undertaken to gain a better understanding of the bacteriology of S. mitis. Subsequently, geographical mapping was performed to identify epidemiological links. Further culture and sensitivity testing was requested. Hand hygiene compliance, environmental audit, and handling of central lines within the ward were examined for any lapses in practice. Results: Based on geographical mapping, no epidemiological linkages were established between patients; they were admitted to different rooms and did not share any equipment. Moreover, based on the antibiogram, different bacteria sensitivities were recorded across the isolates from these patients. A hand hygiene and environmental audit result showed 100% compliance. Nurses performed care of central lines in accordance with guidelines. However, an investigation of changes in practice revealed that the use of a toothbrush had only recently been permitted as part of streamlining oral care for hematology patients. Because toothbrushes were not provided by the hospital, patients were utilizing their personal toothbrushes with no direct supervision of their oral care regimen. Conclusions: The prevalence of S. mitis in hematological patients was likely due to the neutropenic condition of patients. This report provides valuable information supporting the optimization of oral hygiene in immunocompromised patients while minimizing the risk of opportunistic infections.

Background: Singapore General Hospital (SGH) is the largest acute tertiary-care hospital in Singapore. Healthcare workers (HCWs) are at risk of acquiring COVID-19 in both the community and workplaces. SGH has a robust exposure management process including prompt contact tracing, immediate ring fencing, lock down of affected cubicles or single room isolation for patient contacts, and home isolation orders for staff contacts of COVID-19 cases during the containment phase of the pandemic. Contacts were also placed on enhanced surveillance with PCR testing on days 1 and 4 as well as daily antigen rapid tests (ARTs) for 10 days after exposure. Here, we describe the characteristic of HCWs with COVID-19 during the third wave of the COVID-19 pandemic. Methods: This retrospective observational study included all SGH HCWs who acquired COVID-19 during the third wave (ie, the 18-week period from September 1 to December 31, 2021) of the COVID-19 pandemic. Univariate analysis was used to compare characteristics of work-associated infection (WAI) and community-acquired infection (CAI) among HCWs. Results: Among a workforce of >10,000 at SGH, 335 HCWs acquired COVID-19 during study period. CAI (exposure to known clusters or household contact) accounted for 111 HCW infections (33.1%). Also, 48 HCWs (14.3%) had a WAI (ie, acquired at their work places where there was no patient contact). Among WAsI, only 5 HCWs had hospital-acquired infection (confirmed by phylogenetic analysis). The sources of exposure for the remaining 176 HCWs were unknown. Weekly incidence of COVID-19 among HCWs was comparable to the epidemiology curve of all cases in Singapore (Fig. 1 and 2). The mean age of HCWs with COVID-19 was 39.6 years, and most were women. At the time of positive SARS-CoV-2 PCR test, 223 HCWs were symptomatic, and 67 (20.0%) of them had comorbidities. Only 16 HCWs (4.8%) required hospitalization, and all recovered fully with no mortality (Table 1). Being female was associated with community COVID-19 acquisition (OR, 4.6, P Conclusions: During the thrid wave of the COVID-19 pandemic, a higher percentage of HCWs at SGH acquired the infection from the community than from the workplace. Safe management measures, such as universal masking, social distancing, and robust exposure management processes including prompt contact tracing and environmental disinfection, can reduce the risk of COVID-19 in the hospital work environment.

Funding: None

Disclosures: None

Background: In the last 2 years of the COVID-19 pandemic, Singapore has been forced to explore alternative sites to quarantine persons or manage infected cases during surge periods in a national effort not to overwhelm the public healthcare facilities. External quarantine facilities were created at the EXPO and further extended to D’Resort and other hotels in May 2020. Infection prevention (IP) practices were implemented at these external facilities, where training non–healthcare staff to quickly learn and understand these required practices has been challenging. A team of staff from different clinical disciplines was formed to manage the COVID-19 patients at these facilities. The Infection Prevention and Epidemiology (IPE) department was invited to train all staff, including the clinical team, management agency, and security staff, regarding IP measures. We have described the system and approach used in the rapid training of all staff in IP measures where the goal is zero transmission while providing care to COVID-19 patients. Methods: Training materials were developed to facilitate rapid learning by all staff; medical jargon was avoided. Curriculum included precautions to be taken while performing terminal cleaning of patient rooms, serving meals, disinfecting phones and thermometers, as well as donning and doffing personal protective equipment (PPE). “Green” and “red” zones were created to assist staff in remembering appropriate PPE to be used. PPE training was provided using slides and video. Posters were created as a guide for staff at donning and doffing stations. Additionally, the IPE training team utilized an online data collection tool to capture staff completion on IP training and PPE competency for record keeping. We used a ‘soft’ approach because staff members were fearful of the unknown when caring for COVID-19 patients. Daily audits were conducted with immediate concurrent feedback to engage the relevant stakeholders. Infection prevention liaison officers (IPLOs) were appointed to assist in the daily audits. An electronic audit tool was used to facilitate audit and quick analysis. Conclusions: The experience gained in the last 2 years has been useful and may provide a template if new external sites are needed in the future because of the potential surge associated with the ο (omicron) variant.

Funding: None

Disclosures: None

Sporadic clusters of healthcare-associated coronavirus disease 2019 (COVID-19) occurred despite intense rostered routine surveillance and a highly vaccinated healthcare worker (HCW) population, during a community surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) B.1.617.2 δ (delta) variant. Genomic analysis facilitated timely cluster detection and uncovered additional linkages via HCWs moving between clinical areas and among HCWs sharing a common lunch area, enabling early intervention.

Background: The ongoing COVID-19 pandemic tests the healthcare system in many ways. The scarcity of resources poses challenges to infection prevention (IP) practices. We describe our experience in managing such scarcity in our care of COVID-19 patients in the hospital as well as community settings. Methods: The hospital pandemic plan traditionally included only plans for healthcare delivery management within the hospital. However, on March 25, 2020, a decision was made by the Ministry of Health to set up swab isolation (SIFs) and community care facilities (CCFs) to meet the growing demand for isolation beds for migrant workers infected by COVID-19. The CCFs were located in convention halls and resort centers and the SIFs were located in facilities previously functioning as hotels. Mobile medical teams were activated to run clinics at the dormitories housing 200,000 migrant workers. The IP team of an acute- and tertiary-care hospital in Singapore was activated to oversee IP measures at facilities managed by medical teams from the hospital, with the goal of zero healthcare-associated COVID-19 cases among staff. Two IP leaders were set up to oversee the IP program at 8 dormitories, 4 SIFs, and 2 CCFs. In total, 12 IP staff and 15 infection prevention liaison officers (IPLOs) were deployed from 2 acute-care hospitals and 3 specialty centers to conduct training in hand hygiene and the use of personal protective equipment, and to conduct daily audits of compliance to practice guidelines. Education on personal hygiene was also given to patients in these facilities in at least 7 languages. In the SIFs and dormitories, IPLOs were recruited to perform daily audits and feedback to the IP team on issues related to IP at the sites. Results: Since our first COVID-19 patient on January 23, 2020, there has been no report of healthcare-associated COVID-19 within the hospital nor among the medical, administrative, and support service staff working in the external operation facilities. Daily audits showed an average of 99.4% compliance to IP guidelines. Conclusions: IPLOs or IP champions play a significant role in ensuring compliance to IP guidelines. This compliance allows the IP professional to focus on the evaluation of the IP program, managing IP consultations, and planning and implementation of the IP program in nontraditional healthcare settings. The key success factors of the program included the ability to contextualize the planning and implementation of IP programs in various settings, strong leadership support, cohesive teamwork, and effective communication at various levels.

Funding: No

Disclosures: None

With the advent of printed electronics and flexible devices, flexible energy storage has received so much attention in the past few years. In this work, a scalable process for manufacturing of a flexible supercapacitor device based on nanostructured PANI and MnO2 was demonstrated. In this process, nanostructured materials are transformed into form of a printable ink which is applied on a current collector using a simple screen printing method, which can be used in a roll to roll scheme. The flexible device was assembled using a solid polymer electrolyte and the electrochemical performance of the devices was evaluated. A specific capacitance of 120 F/g and 89 F/g for two symmetrical devices based on PANI and MnO2 were obtained respectively. The devices are showing relatively good cyclability and columbic efficiency.

Background: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.

Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001–2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.

Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.

Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia.