Objectives: The highly transmissible SARS-CoV-2 has swept across the globe, causing large swaths of COVID-19, displacing medical resources and attention from patients with other life-threatening illnesses, and overwhelming healthcare institutions. Shifting toward endemicity, the Singapore Ministry of Health ceased issuing quarantine orders to close contacts of infected cases on October 11, 2021. However, contact tracing and exposure management within SGH continued with the same risk criteria. We have examined COVID-19 exposures in different hospital locations to determine the effectiveness of surveillance in breaking the chain of transmission. Methods: Contact tracing of COVID-19 exposures among Singapore General Hospital (SGH) staff and patients has been conducted since the first COVID-19 diagnosis in January 2020. The information collected is used to identify those at higher risk of infection for enhanced surveillance or isolation. The data analyzed in this study were collected during later periods of the SARS-CoV-2 δ (delta) pandemic wave between August 1, 2021, and December 31, 2021. Results: During the 4-month study period, there were 1,686 SARS-CoV-2 exposures in SGH. Among these 1,686 exposures, 1,157 (69%) were contacts with an infected patient. Among these infected source patients, 915 were emergency department patients, 210 were ward inpatients, and 32 were clinic outpatients. The remaining 524 exposure events (31%) were contacts with infected staff, of whom 441 were SGH employees and 83 were employees from other SingHealth institutions. The remaining 5 index cases were visitors to SGH. Of the 1,686 exposure events, 330 had associated at-risk contacts requiring exposure management. Among 330 patient index cases, 213 (64.5%) resulted in 699 exposed contacts (patients vs staff), whereas 117 staff index cases resulted in 435 exposed contacts (patients vs staff). For 434 exposed contacts who were staff, 204 (47%) of their exposures occurred in inpatient ward settings, followed by 153 (35.3%) that occurred in outpatient clinics, 36 (8%) that occurred common lounging areas, 16 (3.6%) that occurred in office sites, 15 (3.4%) that occurred in the community, 8 (1.8%) that occurred in occupation therapy, and 2 (0.5%) that occurred in the emergency department. For 688 exposed contacts who were patients, 579 (84.1%) exposures occurred in inpatient wards, 70 (10.2%) occurred in DEM, 19 (2.7%) occurred in other SingHealth institutions, 16 (2.3%) were exposures to roving porters, and 3 (0.4%) occurred in the community. During the study period, 3 hospital clusters were identified and investigated, one of which included secondary cases. Conclusions: Most SARS-CoV-2 exposures in SGH occurred in inpatient settings where patients were index cases. Despite intensive contact tracing and stringent surveillance and isolation measures, inpatient clusters could not be prevented.

Background: Hand hygiene (HH) remains arguably the most effective way to prevent healthcare-associated infections (HAIs) and ultimately improve the prospect of patient safety. Studies have shown that as many as 50%–70% of infections are transmitted through hands due to poor HH practices. HH with use of alcohol-based hand rub (ABHR) is preferred over handwashing with soap and water because of its wide microbial efficacy, time efficiency, and improved skin tolerance. It is also well known that ABHR can be used as an effective prevention measure during disease outbreaks. Before and during the COVID-19 pandemic, health facilities in Sierra Leone have been challenged with HH infrastructural problems such as lack of sinks with constant running water. Before Sierra Leone recorded its first case of COVID-19 in March 2020, the consumption of ABHR in the health facilities was estimated to be 24,000 L per year, which doubled during the COVID-19 pandemic. The demand for commercially available ABHR increased, leading to acute shortages. The estimated cost of the locally produced ABHR ~$2–3 per 500 mL, although it may cost up to $10 for 500 mL when buying imported ABHR products from the local market. Methods: All ingredients were procured locally, and ABHR production was based on WHO formula 1. The production was set for 12 months to cover the estimated annual consumption of ABHR, with periodic monitoring to ensure effective distribution and availability at the point of care. Analysis of assessment results in 12 hospitals from the pre-COVID-19 era (2019) to the COVID-19 era (2021) was performed based on the WHO IPC Assessment Framework (IPCAF) indicator. Results: With an average monthly production of 3,482 L, a total of 41,780 L ABHR was produced and packaged in branded 500-mL containers for distribution to healthcare facilities. This quantity exceeded the estimated demand for ABHR during the COVID-19 pandemic. The data show a considerable increase (from 25% to 44%) in the number of available and functioning HH stations with mainly locally produced ABHR. Results from the monitoring of 575 peripheral health units (PHUs) in 2021 also showed that >67% of PHUs had HH facilities in all clinical areas and that the locally produced ABHR was used in 79% of these HH stations. Conclusions: Locally produced ABHR has shown to be a cost-effective and evidence-based intervention to optimize HH at the point of care. Therefore, localities are encouraged to undertake this realistic and sustainable approach to address issues of acute shortage of ABHR, especially during a global pandemic.

Funding: None

Disclosures: None

Objectives: Sharp injuries are frequent occurrences in healthcare settings. According to the World Health Organization, >2 million occupational exposures to sharp injuries occur among 35 million healthcare workers (HCWs) annually. We report the 5-year incidence and trends of sharp injuries in an acute-care hospital. We compared the rates of injury, the distribution of injuries, and the type of exposure of HCWs during the prepandemic and pandemic eras. Methods: We conducted a retrospective analysis of a 5-year surveillance on self-reported sharp injuries in Changi General Hospital, a 1,000-bed acute-care hospital. The occupational groups, the type of sharps, and the incident activity involved were reviewed. The bloodborne pathogen statuses of the identified source patients were studied. Results: In total, 441 sharp injuries were reported from 2017 to 2021. Among the occupational groups, doctors reported the highest number of sharp injuries (N = 272, 61.7%), followed by nurses (N = 129, 29.3%) and other allied health professionals (N = 29, 6.4%). An increasing proportion of doctors reported sharp injuries from 2017 to 2019 (prepandemic era) and the proportion declined from 2020 to 2021 (pandemic era); 52 doctors (58.4%) reported sharp injuries in 2017, 61 (61.1%) in 2018, 72 (67.9%) in 2019, 47 (61%) in 2020, and 40 (57.1%) in 2021. Most sharp injuries were caused by solid sharps (212 of 441, 48.1%) and hollow-bore needles (205 of 441, 46.5%). Source patients were identified in 407 sharp injuries. From the known sources, 51 were seropositive: 20 for hepatitis B (HBV), 27 for hepatitis C (HCV), and 4 for human immunodeficiency virus (HIV). No seroconversion occurred. Overall, 198 sharp injuries (44.9%) were sustained during surgical procedures, 83 (18.8%) occurred during blood taking, and 44 (9.9%) occurred during injection administration. Also, 37.5% of sharp injuries among doctors occurred during surgical procedures, and 69.6% of sharp injuries in OT occurred among junior surgical doctors. Conclusions: The overall incidence of sharp injuries has decreased during the pandemic. Fewer elective surgical procedures were performed during the pandemic period. OT suturing training workshops and awareness programs on strategies for preventing sharps injuries in the operating theatre, targeted at surgical residents during the past 2 years, could have contributed to the decrease in the incidence of sharp injuries in our hospital. Sharp injuries pose a significant exposure to blood and body fluids and should be subject to continued epidemiological surveillance.

The burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) is disproportionately high in low and middle-income countries. Barriers to implementing effective antimicrobial stewardship and infection prevention programs include the lack of a structural framework, consensus guidelines, educational opportunities, trained personnel, funding, and access to resources such as manpower, information technology, and diagnostics. Socioeconomic instability with supply chain interruptions, poor skilled staff retention, absence of mandates, and inadequate support to enforce existing policies further aggravates the situation. Failure to implement measures to tackle AMR and HAIs effectively will result in repercussions globally.

Background: The epidemiology of Clostridioides difficile infection (CDI) is complex, and the COVID-19 pandemic has had extreme impacts on known risk factors such as comorbidity burden and antibiotic prescribing. However, whether these changes have affected the incidence of hospital-associated CDI (HA-CDI) remains unknown. We compared incidence and trends of HA-CDI before and after the pandemic onset, and we assessed the impact of changes in key CDI-related risk factors. Methods: We conducted an interrupted time-series study (March 2018–March 2021) of adult inpatients hospitalized 4 or more days with no known CDI on admission at a 576-bed academic medical center. Our primary outcome was monthly HA-CDI per 10,000 patient days. We performed segmented linear regression to compare the preinterruption trend in HA-CDI rate to the postinterruption slope and level change. We established a series of 30-day intervals before and after the interruption timepoint of March 23, 2020, which corresponds with the Oregon stay-at-home executive order. The data included 24 preinterruption time points and 12 postinterruption time points. We also assessed changes in slope and trend for known HA-CDI risk factors. Results: We included 34,592 inpatient encounters in our prepandemic period and 10,932 encounters in our postinterruption period. The mean prepandemic HA-CDI rate was 4.07 cases per 10,000 patient days. After the pandemic onset, the rate was 3.6 per 10,000 patient days. However, the observed differences in rate (both in terms of slope and level) were not statistically significant (P = .90 for level; P = .60 for slope change). We observed a significant decrease in admissions per 30 days (1,441 vs 911; level-change P < .0001) and a slight increase in the mean number of Elixhauser comorbidities (1.96 vs 2.07; level-change P = .05). We also observed significant increases in both frequency and intensity of antibiotic use, with an increase average days of therapy per encounter (5.8 vs 7.2; level-change P = .01; slope-change P < .0001) and in antibiotic spectrum index (ASI) points per antibiotic day (4.4 vs 4.9; P < .0001). We observed a consistent downward trend for case days of CDI colonization pressure per hospital day (preinterruption slope P < .0001), which remained consistent after the pandemic onset (P = 0.5 for postinterruption slope change) (Fig. 1). Conclusions: Despite significant increases in high-intensity antibiotic use and comorbidity burden, we did not observe significant differences in HA-CDI after the pandemic onset. This may be due to the significant decrease in colonization pressure in the postpandemic period. Further research is required to fully understand the impact of the pandemic-related changes on

Disclosures: None

We describe the implementation of an electronic medical record “hard stop” to decrease inappropriate Clostridioides difficile testing across a 5-hospital health system, effectively reducing the rates of healthcare-facility–onset C. difficile infection. This novel approach included expert consultation with medical director of infection prevention and control for test-order override.

We assessed breakpoint changes of 13,101 Enterobacterales and Pseudomonas aeruginosa isolates from the past decade. All β-lactams and fluoroquinolones demonstrated decreased susceptibilities following breakpoint changes. Enterobacter cloacae experienced the largest average decrease in susceptibility amongst the Enterobacterales at 5.3% and P. aeruginosa experienced an average decrease in susceptibility of 9.3%.