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Background: Blood Culture Contamination (BCC) is a significant safety and quality indicator for intensive care units (ICU) at the Veteran Affairs North Texas Healthcare System. In February 2023, the combined ICU BCC rate was 4.7%. The American Society for Microbiology and the Clinical Laboratory Standards Institute recommends a BCC rate not exceed 3%. Methods: In March 2023, a multidisciplinary workgroup was created to reduce the combined ICU BCC rate to a target goal of evidence-based standardized process was implemented using a blood culture kit and guide, hand hygiene, site prep, and aseptic technique. Nurses were also educated to avoid drawing from existing lines. In phase two, a second verifier was added to observe blood culture draws, and documentation fields were modified to record the verifier’s name and location. Training reinforced hand hygiene, use of clean gloves, site prep, and cleaning bottle tops with alcohol. In addition, the Microbiology supervisor disseminated monthly BCC reports to key stakeholders. BCC Champions used reports to monitor compliance with processes, and if deficits were detected, feedback was provided to nurses for immediate corrective action. Results: In the 6-month pre-intervention period (12/1/22 – 3/31/23), 16 BCC events occurred from 570 blood cultures, 2.7% BCC rate. In the 6-month intervention period (4/1/23 – 9/30/23), 16 BCC events occurred from 548 blood cultures collected, 3.1% BCC rate (Phase 1: 2.2% BCC rate, Phase 2, 3.5% BCC rate). The BCC rate reduced by 60% from a peak of 4.7% in the pre-intervention period (2/23) to 1.9% (9/23). In May 2024, a new blood culture kit was piloted and adopted for use in the ICU. Quarterly workgroup meetings were implemented to monitor the quality initiative. In the 12-months post-intervention (10/23 – 9/24), the ICU BCC rate was 1.9%. Conclusion: We reduced the ICU BCC rate to Reducing BCC may lower healthcare costs and reduce unnecessary antibiotic use.

Background: During the COVID-19 pandemic, the rate of central line-associated bloodstream infections (CLABSI) decreased at the Veteran Affairs North Texas Health Care System. From fiscal year (FY) 2022 Quarter (Q)4 to FY2023 Q2, the CLABSI rate increased from 0 to 0.79 per 1,000 device days. Breaches in evidence-based practices for the maintenance of vascular access devices (VAD) were hypothesized to have contributed to the increase in CLABSI rate. Methods: In March 2023, a multidisciplinary workgroup was created with the primary goal of improving compliance with VAD standards of care to ≥ 95% by FY2023 Q4 and a secondary goal of decreasing CLABSI rates. A baseline assessment of 12 VAD insertion and maintenance process measures was developed using an assessment tool to record nurses’ observations and review documentation in the computerized patient record system. In addition, the facility VAD policy was updated, and nurses received competency training on VAD management. Baseline compliance data for the 12 VAD process measures was compared to data during the intervention period for acute and critical care areas. CLABSI rates (classified using the National Healthcare Safety Network surveillance criteria) were compared to the period before the creation of the workgroup, policy updates, and training. Results: Nurse observations in acute and critical care units during FY2023 were 19 (Q2), 1,284 (Q3), and 718 (Q4). From FY2023 Q2 to Q4, three of the 12 process measures met the ≥ 95% compliance goal by FY2023 Q4. The process measures that met the goal from Q2 to Q4 were clean peripheral IV catheter hub: 100% to 95.0%, unused tubing Y-sites capped with swap cap: 0% to 96.0%, and documentation of the last dressing change in CPRS: 0% to 99.0%. Notable increases were also seen for three other measures: appropriately dating of peripheral IV tubing: 78.9% to 88.0%, presence of Coban or kerlix occluding site: 0% to 46.0%, and documentation of device insertion: 0% to 89.0%. Persistent deficits were noted in the documentation of peripheral intravenous dressing dates and initials (compliance Conclusions: Enlisting a multidisciplinary team approach, including training, and updating VAD policy/procedures, led to a moderate improvement in VAD management compliance and a decline in CLABSI rates.

We describe an epidemiologic investigation and successful control measures for the first reported outbreak of bla NDM-1 -carrying Pseudomonas aeruginosa in Texas occurring in a veteran with transmission of the same organism and a bla NDM-5 -carrying Escherichia coli , respectively, to two roommates and bla NDM -carrying organism/s to a patient cared for by common staff.

Background: New Delhi metallo-β-lactamases impart resistance to carbapenems. Enterobacteriaceae carrying New Delhi metallo-β-lactamases have been reported before. However, only 7 cases of bla NDM-carrying Pseudomonas aeruginosa has been reported from 4 states in the United States as of January 1, 2018, according to the CDC. We describe an epidemiologic investigation of the first reported case of bla NDM-carrying Pseudomonas aeruginosa in Texas and the measures that controlled the spread of the organisms carrying this gene at a 30-bed spinal cord injury unit (SCI) and the acute-care hospital within the Veterans’ Affairs North Texas Health Care System. Methods: After identification of bla NDM-1–carrying P. aeruginosa from a urine culture in an SCI patient who received medical treatment in Thailand prior to transfer, we performed a rectal screen for the presence of bla NDM in the index patient’s hospital roommates. Based on the results, we expanded the investigation to other patient care units that had provided care to the patient. We initiated universal contact isolation precautions, 1:1 nursing care, restricted movement, phased point-prevalence testing, and intense environmental cleaning until the threat of bla NDM was mitigated. Whole-genome sequencing (WGS) was performed on clinical isolates from the index patient and the roommates by the CDC. Results: Of the 2 roommates of the index, 1 patient had a urine culture positive for bla NDM-5-carrying Escherichia coli . The second roommate has subsequently grown bla NDM-1-carrying P. aeruginosa from a clinical culture. A third patient who was in the same unit as the index patient but not in the same room in an acute-care unit tested positive for bla NDM in a rectal screen. Of the 54 patients who were hospitalized in the same unit as the index patient, 26 refused to get the test and 28 tested negative. In addition, point-prevalence rectal screening was conducted in the SCI in 3 phases that were 3 to 4 weeks apart. All of these screening tests were negative. WGS revealed that the index patient and roommate 2 had bla NDM-1–carrying P. aeruginosa , whereas the roommate 1 had bla NDM-5–carrying E. coli . No further spread occurred. Conclusions: Our aggressive efforts quickly mitigated further spread of bla NDM. Our epidemiologic investigation indicates that an intergenus transfer of bla NDM from P. aeruginosa to E. coli likely took place. In addition, it appears there was an evolution of NDM-1 to NDM-5, which differs from the former by 2 amino acid substitutions at positions 88 (Val→Leu) and 154 (Met→Leu). This type of evolution has been shown by prior studies to confer increased antibiotic resistance in certain resource limited settings. Funding: None Disclosures: None