COVID-19 vaccine uptake in healthcare personnel (HCP) is poor. A cross-sectional survey study of behavioral health HCP was performed. Commonly identified reasons for vaccination were protecting others and oneself. Reasons against were a lack of perceived protection, dosing intervals, and side effects. Assessing vaccination attitudes can assist in uptake strategy.

Background: Recent evidence has shown that the updated COVID-19 bivalent booster is effective in preventing COVID-19 compared with no previous vaccination and prior monovalent vaccination. Despite its effectiveness, uptake has been poor, and a minority of eligible recipients have received the booster. Understanding healthcare worker (HCW) attitudes for and against voluntary uptake of the bivalent booster dose against COVID-19 can help guide communication strategy to maximize uptake. In this survey study, we investigated attitudes toward updated and/or bivalent booster uptake in a behavioral health hospital shortly after a COVID-19 outbreak. Methods: A survey tool was developed and sent to all HCWs at the Yale New Haven Psychiatric Hospital in December 2022. The survey queried demographic data, job category, history of COVID-19, prior COVID-19 vaccinations, perception of COVID-19 exposure, and updated and/or bivalent booster doses. The survey was administered several weeks after a COVID-19 outbreak on multiple inpatient behavioral health units. Receipt of the COVID-19 primary vaccination series and the first booster dose were mandated for HCWs; however, receipt of the bivalent booster was voluntary. Results: The survey was sent to 664 HCWs with primary assignments in behavioral health settings. In total, 182 (27.4%) provided complete responses to the survey and are included in these data. Moreover, 91 HCWs (50.0%) reported previously having COVID-19 at least once. Overall, 100 HCWs (55.0%) received the bivalent booster. The most identified reasons for receiving the bivalent booster were wanting to protect family and friends (n = 113), importance of staying healthy (n = 112), and protecting colleagues and patients (n = 103). The most identified reasons for not wanting to receive the bivalent booster dose were not thinking it provides additional protection (n = 33), “too many” shots already received (n = 31), and concern about side effects (n = 30). Discussion: Bivalent booster dose uptake in HCWs on behavioral health units shortly after a COVID-19 outbreak was greater than the general population. HCWs reported varying reasons for and against receipt of the bivalent booster dose, with the most common being protection of family and friends and perceptions of no additional protection, respectively. A limitation of this study was voluntary response bias, in which results are biased toward individuals more likely to receive a bivalent booster vaccine. It is unclear whether reasons for declining the vaccine are representative of HCWs who did not complete the survey. Assessing attitudes for the bivalent booster dose can assist in guiding communication and outreach strategies to increase vaccine uptake by HCWs.

Disclosures: None

Emergency departments are high-risk settings for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) surface contamination. Environmental surface samples were obtained in rooms with patients suspected of having COVID-19 who did or did not undergo aerosol-generating procedures (AGPs). SARS-CoV-2 RNA surface contamination was most frequent in rooms occupied by coronavirus disease 2019 (COVID-19) patients who received no AGPs.

Hospitals are increasingly consolidating into health systems. Some systems have appointed healthcare epidemiologists to lead system-level infection prevention programs. Ideal program infrastructure and support resources have not been described. We informally surveyed 7 healthcare epidemiologists with recent experience building and leading system-level infection prevention programs. Key facilitators and barriers for program structure and implementation are described.

Background: Patients requiring vascular catheters are at risk for bloodstream infections (BSIs), particularly those with central venous access devices (CVADs). Central-line–associated bloodstream infections (CLABSIs) may occur as a result of the introduction of pathogenic microbes during CVAD access procedures, including through the needleless connector. The use of an antiseptic scrub is recommended to disinfect the needleless connector before device access, and this procedure has been shown to reduce the risk for CLABSI. We identified perceived barriers and facilitators and assessed compliance with instructions for use of chlorhexidine or alcohol antisepsis products (CHG or IPA; 5-second scrub time plus 5-second dry time) and alcohol antisepsis products (IPA; facility protocol 15-second scrub time plus let dry) for needleless connector disinfection. Methods: We performed a multiple-methods study involving focus groups composed of a convenience sample of nurses and clinical observations of CVAD needleless-connector access procedures in 3 medical ICUs and 1 surgical ICU at 2 academic medical centers. We used open-ended questions to guide the focus-group discussions. We directly observed nursing staff performing needleless-connector disinfection following a time–motion paradigm using an electronic tool to document the observed needleless-connector access events and to measure needleless-connector antiseptic scrub times and dry times. Results: In total, 8 focus groups involving 28 nurses revealed access to the antiseptic product and lesser workload as best-practice facilitators of needleless-connector disinfection. Identified barriers were often the opposite of the facilitators, particularly the time required per needleless connector access using IPA and knowledge deficits regarding the need for disinfection between multiple needleless-connector accesses. From 36 observations, including a total of 48 access events, we determined that the mean scrub times were below the recommended times, especially for IPA (Table 1). Drying time after use of either antisepsis product was negligible. Conclusions: A lack of access to the disinfection product, emergency situations, and increased workload were perceived barriers to needleless-connector disinfection. Observed scrub times and drying times were shorter than recommended, much more so for IPA. These deficits in the performance of needleless-connector disinfection may increase the risk of CLABSI. Ongoing education and periodic competency evaluation of needleless-connector disinfection are needed to imbed and sustain best practices.

Funding: Professional Disposables, Inc.

Disclosures: None

Background: Although substantial efforts have been made to improve hand hygiene (HH) compliance among healthcare personnel (HCP), much less attention has been devoted to improving HH technique. To date, no standard method for assessing HH technique has been widely adopted by hospitals. Because applying an alcohol-based hand sanitizer (ABHS) transiently reduces adjacent skin temperature, we explored the feasibility of using thermal imaging to determine whether ABHS has been applied to fingertips and thumbs, areas often missed by HCP. Methods: A convenience sample of 12 Quality and Safety staff volunteered for the study. A FLIR One Pro thermal camera attached to an iPhone was used to obtain thermal images of the palmar aspect of each volunteer’s dominant hand before applying ~1.8 mL ABHS gel, immediately after hands felt dry, and at 1 minute and 2 minutes later. Spot temperature readings of the mid-palm area and middle finger were recorded at each time point. The sex and estimated hand surface area (HSA in cm2) of each volunteer were recorded. Results: In 11 of 12 volunteers, thermal imaging showed a significant decrease in mid-palm and middle finger skin temperatures after performing HH (paired t test P < .01 for both), especially for the fingers and thumb, indicating that ABHS was applied to these areas (Fig. 1). When HH was performed with ABHS and the thumb was purposefully excluded, the lack of colorimetric change in the thumb was visible (Fig. 2). The palmar area showed the least drop in temperature and reverted to normal temperature more quickly. Immediate post-HH mid-palm temperature change ranged from +0.5 to −2.7°C, with a significantly greater mean temperature drop with small or medium hands than with large hands (Mann-Whitney U test P = .048). With some volunteers, the color changes lasted 1 minute or longer. However, for persons with “cold” fingers at baseline, it was more difficult to draw conclusions from the gross assessment for colorimetric change. Conclusions: Thermal imaging of HH performance shows promise as an HH assessment technique and may be useful to determine whether HCP have applied ABHS to their fingertips and thumbs. Additional studies involving a much larger number of HCP under varying conditions are needed to determine whether thermal imaging can be a practical modality for teaching HH technique, for routinely monitoring HH technique, or as a research tool for studying the dynamics of HH using ABHS.

Funding: None

Disclosures: None

Background: Aerosol-generating procedures (AGPs) performed on COVID-19–positive patients raise concerns about the dissemination of SARS-CoV-2 via aerosols and droplets. Infectious aerosols and droplets generated by SARS-CoV-2–positive patient AGPs or through direct COVID-19 patient coughing or exhalation could potentially contaminate surfaces, leading to the indirect spread of SARS-CoV-2 via fomites within the emergency department (ED). We sampled surfaces of ED patient rooms occupied by known SARS-CoV-2–positive patients or patients under investigation for COVID-19 and undergoing an AGP to determine the frequency of room contamination with SARS-CoV-2 RNA. Methods: Swabs were collected from 5 room surfaces in the ED following AGPs performed on patients under investigation for COVID-19 or positive for SARS-CoV-2. High- and low-touch surfaces 6 feet (2 m) from the patient (door handle and return vent, respectively) and reusable medical equipment were swabbed. Swabs were tested for SARS-CoV-2 RNA by RT-qPCR; positive samples were cultured in Vero E6 cells. Patient COVID-19 results were confirmed through the electronic medical record. Results: In total, 203 rooms were sampled: 43 SARS-CoV-2–positive patients with an AGP, 44 SARS-CoV-2–positive patients who did not have an AGP, and 116 SARS-CoV-2–negative patients with an AGP, for a total of 1,015 swabs. Overall, SARS-CoV-2 RNA was detected on 36 (3.5%) surfaces from 29 rooms (14.3%) (Table 1). RNA contamination was detected more frequently in rooms occupied by SARS-CoV-2–positive patients who did not have an AGP than rooms occupied by COVID-19 patients (30% vs 14%). SARS-CoV-2 RNA was also detected in rooms occupied by SARS-CoV-2–negative patients undergoing an AGP (9%). SARS-CoV-2 RNA was most frequently detected on air vents (n = 15), bedrails (n = 10), equipment and vital signs monitors (n = 4 each), and door handles (n = 3). One bedrail was positive by culture and confirmed by an RT-qPCR cycle threshold reduction from >40 to 13. Conclusions: We detected SARS-CoV-2 RNA contamination on room surfaces in the ED, regardless of patient AGP or COVID-19 status; however, RNA contamination of room surfaces was most common in rooms occupied by SARS-CoV-2–positive patients who did not have an AGP, which may be attributable to stage of disease and viral shedding. SARS-CoV-2 RNA contamination was also present in rooms where APGs were performed on SARS-CoV-2–negative patients, suggesting carryover from previous patients. SARS-CoV-2 RNA was found most often on room air-return vents, further emphasizing the importance of aerosols in the spread of SARS-CoV-2.

Funding: None

Disclosures: None

We surveyed trainees about their urine culture practices and assessed the impact of an educational intervention delivered electronically and in person. Trainee scores improved across all levels of training and across all questions on the postintervention survey, but there was no difference in scores by mode of education (P = .91).

In this cross-sectional survey, we assessed knowledge, attitudes and behaviors regarding operating room air-change rates, climate change, and coronavirus disease 2019 (COVID-19) pandemic implications. Climate change and healthcare pollution were considered problematic. Respondents checked air exchange rates for COVID-19 and ∼25% increased them. Respondents had difficulty completing questions concerning hospital heating, ventilation and air conditioning (HVAC) systems.

Mass asymptomatic SARS-CoV-2 nucleic acid amplified testing of healthcare personnel (HCP) was performed at a large tertiary health system. A low period-prevalence of positive HCP was observed. Of those who tested positive, half had mild symptoms in retrospect. HCP with even mild symptoms should be isolated and tested.

Background: Outbreaks of infections in healthcare negatively impact patient outcomes and experience. Transparency is critical to engendering trust and optimizing health. Consistent guidance is not available regarding when to report a possible outbreak of healthcare-associated infections (HAIs) to public health and when to notify a limited population or to publicly disclose the occurrence of HAI. Recent analyses of state public health policies revealed that most states address reporting of outbreaks using terms such as clusters, unusual occurrences, or incidences over baseline. Specific wording about healthcare outbreaks or guidance for notifying patients or public is often absent. Thus, HAI outbreak notification and disclosure guidance and practices vary significantly around the country. A best-practice guidance document will provide clarity for when such reporting should occur. Methods: The Council for Outbreak Response: HAI and Antimicrobial-Resistant Pathogens (CORHA) has undertaken the task of developing this guidance by forming a multidiscipline policy work group with representation from its partner organizations. This work group has been tasked with creating a general framework that will guide notification and disclosure in the context of a possible HAI outbreak. The draft guidance document has been developed over several months of telephone and in-person conferences among work group members. Results: The standardized actions stemming from the guiding principles and recommended practices for conducting step 1 (immediate notification, initial and critical communications that occur when an outbreak is first suspected), were arranged in a table format with rows representing stakeholders and constituents to be notified and columns demonstrating the actions to be taken (Fig. 1). As an investigation progresses, notification should be revisited, especially if an investigation’s scope expands. The principles and practices for step 2 (expanded notification) have also been drafted in a table format. Next, the draft guidance addresses step 3 (public disclosure), outlining indications, practical guidance, and considerations in an outline and/or summary format. Real-world examples demonstrating application of the framework are being developed as supplementary resources to the framework. Current work group activities include engaging bioethicists, media reporters and patient advocates to review and comment on the guidance to ensure that it is clear, consistent and practical. Discussion: The draft guidance provides a framework for standardized actions for HAI outbreak notification and disclosure in a stepwise fashion, modeling public health practices and grounded in bioethical principles. The final product will provide valuable, practical advice for effectively sharing information with affected or potentially affected individuals and their caregivers in a timely manner.

Funding: None

Disclosures: Dawn Terashita reports that her spouse has received honoraria rom the speaker’s bureaus of Novo Nordisk and Abbott.