Abstract Background Neonatal intensive care units (NICUs) provide life-sustaining care to premature neonates and infants with complex medical needs. NICU patients are at high risk for healthcare-associated infections (HAIs) and require nuanced infection prevention and control (IPC) strategies due to unique care requirements and medical equipment. Health departments are key in providing IPC technical assistance to NICUs for outbreak response and quality improvement initiatives; however, many health department personnel are unfamiliar with NICU settings. We created and delivered NICU-specific IPC training to help health departments improve their capacity to support NICUs. Methods CDC developed three NICU-specific IPC educational webinars for health department personnel covering NICU settings, care, neonatal physiology, IPC practices and their nuances, and select NICU outbreak case reports. Health department personnel submitted demographic information and registered for the course electronically. Participants voluntarily responded to polls during webinars; questions included level of comfort, job duties, and NICU IPC concerns. Results A total of 562 individuals enrolled in the course with 469 (84%) representing 59/64 (92%) of CDC-funded health department jurisdictions across the U.S.; most enrollees (59%) currently work in a non-IPC role (e.g., epidemiologist, program lead, data analyst). Most had five years or less time in their current role (84%), including 18% with less than a year of experience; 47% reported never providing technical assistance to a NICU in the past. Among poll participants (55%) reported being unaware of how many NICUs are in their jurisdiction. HAI risk associated with medical devices (46%), hand hygiene (20%), and environmental (19%) issues were perceived as the greatest IPC concerns in the NICU. After two of three training sessions, 94% of participants felt more confident providing IPC support to a NICU. Conclusion Educational and training courses like these are an efficient way to improve health department capacity in providing IPC technical assistance to NICUs, and can help to build partnerships with healthcare facilities by strengthening infection prevention and quality improvement initiatives. Disclosures All Authors: No reported disclosures
Abstract Background The US Centers for Disease Control and Prevention (CDC) provides technical assistance (consultations) to health departments responding to single cases and clusters of carbapenemase-producing organisms (CPOs). We aimed to characterize consultations involving pediatric patients.Figure 1.Flow diagram of screening of CDC consultations for pediatric CPO cases requiring public health responses or clusters with suspected or confirmed transmission.Abbreviations: AR, antimicrobial resistance; CPO, carbapenemase-producing organism; HAI, healthcare-associated infection.*Includes one additional recent consultation not yet added to database at time of query.†One consultation involved two unrelated single cases and another consultation included 3 subclusters.‡Applicable public-health response components were contact screening, site visit/infection control assessment, and/or environmental sampling. Methods We searched CDC databases of healthcare-associated infection (HAI) consultations (November 2001 to January 25, 2024) using pediatric key-word patterns. We reviewed this subset for CPO investigation consultations with at least one pediatric case (age < 18 years with a CPO-positive clinical or screening specimen) or involving a pediatric healthcare facility. We classified CPO consultations as either (a) a cluster with likely transmission or (b) a single case with a public-health response (Figure 1). We abstracted and descriptively analyzed consultation characteristics regarding microbiology, healthcare setting, index patient characteristics, public-health response, and likely transmission mechanisms.Figure 2.Number of CDC consultations for CPOs by year among children in U.S. healthcare settings, 2015–2023. Results Among 2338 HAI consultations, 271 (12%) related to pediatric cases or facilities were reviewed (Figure 1). Thirty-three consultations from 2015–2023 across 20 states were included, which comprised 16 single cases and 20 clusters (Figure 2). Eight (40%) clusters only involved pediatric cases and the remainder included both pediatric and adult cases. Most commonly, for 17 (47%) index cases, Enterobacterales was identified in a clinical specimen from an acute-care hospital patient in an intensive care unit (e.g., burn unit; Table 1). The most common carbapenemases were NDM (53%), KPC (28%), and VIM (22%). Among the 16 clusters with available information, the most common transmission mechanisms were gaps in core infection control practices (9, 56%) and premise plumbing (3, 19%). Overall, 9 (56%) single cases and 6 (30%) clusters had history of international healthcare or travel for the index case-patient.Table 1.Microbiologic, healthcare setting, index patient, and public health response characteristics of consultations of CPO among children in U.S. healthcare settings, by consultation type, 2015–2023 Abbreviations: ACH, acute care hospital; CPO, carbapenamase-producing organism; ICU, intensive care unit; IPC, infection prevention and control; LTACH, long-term acute-care hospital; PFGE, pulse field gel electrophoresis; SNF, skilled nursing facility; WGS, whole genome sequencing. a Proportions may not add to 100% as values may not be mutually exclusive per consultation and/or rounding error. b Three clusters of VIM–P. aeruginosa in different facilities were part of multistate outbreak linked to artificial tears. c Denominator for clusters is 16 ACHs. “Other” includes one each of surgery, pediatrics, medicine, and adult ICU units. d Includes three single cases and one cluster where index case was a US-born patient in a neonatal ICU whose mother had history of international healthcare or travel. e Includes hand hygiene, Transmission-Based Precautions, and cleaning and disinfection of high-touch surfaces in patient rooms. Conclusion Review of CDC consultations for CPOs in pediatric patients identified multiple cases and clusters among high-risk inpatient units. Links to healthcare outside the U.S. were common. Admission screening, particularly on high-risk units, and adherence to core infection control practices may prevent future outbreaks. Disclosures All Authors: No reported disclosures
, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of
In July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A). C. auris is a multidrug-resistant yeast that can cause invasive infection. Its ability to colonize patients asymptomatically and persist on surfaces has contributed to previous C. auris outbreaks in health care settings (1-7). Since the first C. auris case was identified in Florida in 2017, aggressive measures have been implemented to limit spread, including contact tracing and screening upon detection of a new case. Before the COVID-19 pandemic, hospital A conducted admission screening for C. auris and admitted colonized patients to a separate dedicated ward.
In 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015.Investigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples.Onsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer's updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera-containing aerosols into the operating room, despite hospital requests to the manufacturer.These findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer's protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.
