Background: Historically, diagnosis of urinary tract infections (UTIs) has been divided into 3 categories based on symptoms and urine culture results: not UTI, asymptomatic bacteriuria (ASB), or UTI. However, some populations (eg, older adults, catheterized patients) may not present with signs or symptoms referrable to the urinary tract or have chronic lower urinary tract symptoms (LUTS), making the diagnosis of UTI challenging. We sought to understand the clinical presentation of patients who receive urine tests in a cohort of diverse hospitals. Methods: This retrospective descriptive cohort study included all adult noncatheterized inpatient and ED encounters with paired urinalysis and urine cultures (24 hours apart) from 5 community and academic hospitals in 3 states (NC, VA, GA) between January 1, 2017, and December 31, 2019. Trained abstractors collected clinical and demographic data using a 60-question REDCap survey. The study group met with multidisciplinary experts (ID, geriatrics, urology) to define the “continuum of UTI” (Table 1), which includes 2 new categories: (1) LUTS to capture patients with chronic lower urinary tract symptoms and (2) bacteriuria of unclear significance (BUS) to capture patients who do not clinically meet criteria for ASB or UTI (eg, older adults who present with delirium and bacteriuria). The newly defined categories were compared to current guideline-based categories. We further compared ASB, BUS, and UTI categories using a lower bacterial threshold of 1,000 colony-forming units. Results: In total, 220,531 encounters met study criteria. After using a random number generator and removing duplicates, 3,392 encounters were included. Based on current IDSA guidelines, the prevalence of ASB was 32.1% (n = 975), and prevalence of patients with “not UTI” was 1,614 (53%). Applying the expert panel’s new “continuum of UTI” definitions, the prevalence of “not UTI” patients decreased to 1,147 (37.7%), due to reassignment of 467 patients (15.3%)to LUTS. The prevalence of ASB decreased by 24% due to reassignment to BUS. Lowering the bacterial threshold had a slight impact on the number of definitive UTIs (14.9 vs 15.9%) (Table 1). Conclusions: Our rigorous review of laboratory and symptom data from a diverse population dataset revealed that diagnostic uncertainty exists when assessing patients with suspicion for UTI. We propose moving away from dichotomous approach of ASB versus UTI and using the “continuum of UTI” for stewardship conversations. This approach will allow us to develop nuanced deprescribing interventions for patients with LUTS or BUS (eg, watchful waiting, shorter course therapy) that account for the unique characteristics of these populations.

Disclosures: None

Background: Infection prevention and control (IPC) competency is critical for healthcare personnel (HCP) and patient safety. In collaboration with the CDC new national IPC training collaborative called Project Firstline, the Oregon Health Authority’s (OHA) Healthcare Associated Infection (HAI) Program established a state-level program in 2021. The goal of Oregon Project Firstline is to provide relevant, accessible, and engaging IPC training materials for our state’s HCP. We assessed the IPC learning needs of Oregon’s healthcare workforce, and to understand the preferred methods and formats of training across the various HCP roles. Methods: OHA’s HAI program recruited HCP by distributing electronic surveys through multiple healthcare, regulatory, and public health partners’ email listservs and HCP-targeted newsletters. Survey responses were recorded from September 23 to December 10, 2021. The HAI program assessed respondents’ IPC knowledge, online and in-person job training preferences, frequently used training devices, and trusted sources for IPC information. An individual’s understanding of an IPC topic was categorized based on their self-assessed confidence in their knowledge and ability to teach the topic to others. In total, 6,382 surveyed responses were analyzed. Results: The average understanding among HCP was lowest in IPC topics relating to triage and isolation of contagious patients and fit testing of respiratory protection devices. For these topics, 3,208 HCP (66.21%) and 3,657 HCP (75.48%) HCP, respectively, did not understand the topic well enough to teach others (Fig. 1). The highest number of HCP (n = 2,512, 39.36%) requested additional training in methods on how to educate others about IPC topics (ie, “train the trainer”). Surveyed respondents most frequently used personal computers for job trainings in both work and at-home settings (n = 4,603, 72.12%) and 3,437 HCP (53.85%) were open to either in-person or remote formats for job education. The CDC and OHA were the most frequented and trusted IPC sources among surveyed HCP: 4,124 HCP (64.62%) and 3,584 HCP (56.16%), respectively. Conclusions: IPC is a critical topic in HCP training across all healthcare facility types and employee roles. Effective educational planning includes understanding the learners’ knowledge needs and preferred methods of learning. Our learning needs assessment identified important IPC knowledge gaps and will help ensure that our training courses will be offered in effective educational formats for Oregon’s diverse HCP. Future training will include appropriate triage of potentially infectious patients, respiratory fit testing, and general IPC “train the trainer” sessions. Additionally, we will offer both in-person and remote options.

Disclosures: None

Scabies is a parasitic infestation with high global burden. Mass drug administrations (MDAs) are recommended for communities with a scabies prevalence of >10%. Quantitative analyses are needed to demonstrate the likely effectiveness of MDA recommendations. In this study, we developed an agent-based model of scabies transmission calibrated to demographic and epidemiological data from Monrovia. We used this model to compare the effectiveness of MDA scenarios for achieving scabies elimination and reducing scabies burden, as measured by time until recrudescence following delivery of an MDA and disability-adjusted-life-years (DALYs) averted. Our model showed that three rounds of MDA delivered at six-month intervals and reaching 80% of the population could reduce prevalence below 2% for three years following the final round, before recrudescence. When MDAs were followed by increased treatment uptake, prevalence was maintained below 2% indefinitely. Increasing the number of and coverage of MDA rounds increased the probability of achieving elimination and the number of DALYs averted. Our results suggest that acute reduction of scabies prevalence by MDA can support a transition to improved treatment access. This study demonstrates how modelling can be used to estimate the expected impact of MDAs by projecting future epidemiological dynamics and health gains under alternative scenarios.

Over the past 20 years, collaboration has become an essential aspect of archaeological practice in North America. In paying increased attention to the voices of descendant and local communities, archaeologists have become aware of the persistent injustices these often marginalized groups face. Building on growing calls for a responsive and engaged cultural heritage praxis, this forum article brings together a group of Native and non-Native scholars working at the nexus of history, ethnography, archaeology, and law in order to grapple with the role of archaeology in advancing social justice. Contributors to this article touch on a diverse range of critical issues facing Indigenous communities in the United States, including heritage law, decolonization, foodways, community-based participatory research, and pedagogy. Uniting these commentaries is a shared emphasis on research practices that promote Indigenous sovereignty and self-determination. In drawing these case studies together, we articulate a sovereignty-based model of social justice that facilitates Indigenous control over cultural heritage in ways that address their contemporary needs and goals.