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Abstract Introduction Toxic tobacco smoke residue, also known as thirdhand smoke (THS), can persist in indoor environments long after tobacco has been smoked. This study examined the effects of different cleaning methods on nicotine in dust and on surfaces. Aims and Methods Participants had strict indoor home smoking bans and were randomly assigned to: dry/damp cleaning followed by wet cleaning 1 month later (N = 10), wet cleaning followed by dry/damp cleaning (N = 10) 1 month later, and dry/damp and wet cleaning applied the same day (N = 28). Nicotine on surfaces and in dust served as markers of THS and were measured before, immediately after, and 3 months after the cleaning, using liquid chromatography with triple quadrupole mass spectrometry (LC–MS/MS). Results Over a 4-month period prior to cleaning, surface nicotine levels remained unchanged (GeoMean change: −11% to +8%; repeated measures r = .94; p < .001). Used separately, dry/damp and wet cleaning methods showed limited benefits. When applied in combination, however, we observed significantly reduced nicotine on surfaces and in dust. Compared with baseline, GeoMean surface nicotine was 43% lower immediately after (z = −3.73, p < .001) and 53% lower 3 months later (z = −3.96, p < .001). GeoMean dust nicotine loading declined by 60% immediately after (z = −3.55, p < .001) and then increased 3 months later to precleaning levels (z = −1.18, p = .237). Conclusions Cleaning interventions reduced but did not permanently remove nicotine in dust and on surfaces. Cleaning efforts for THS need to address persistent pollutant reservoirs and replenishment of reservoirs from new tobacco smoke intrusion. THS contamination in low-income homes may contribute to health disparities, particularly in children. Implications Administered sequentially or simultaneously, the tested cleaning protocols reduced nicotine on surfaces by ~50% immediately after and 3 months after the cleaning. Nicotine dust loading was reduced by ~60% immediately after cleaning, but it then rebounded to precleaning levels 3 months later. Cleaning protocols were unable to completely remove THS, and pollutants in dust were replenished from remaining pollutant reservoirs or new secondhand smoke intrusion. To achieve better outcomes, cleaning protocols should be systematically repeated to remove newly accumulated pollutants. New secondhand smoke intrusions need to be prevented, and remaining THS reservoirs should be identified, cleaned, or removed to prevent pollutants from these reservoirs to accumulate in dust and on surfaces.

Background MRSA and C. diff are important causes of hospital-onset (HO) or healthcare-associated infections (HAI). Molecular sequencing of bacterial pathogens is often used retrospectively during outbreak investigations to determine phylogenetic linkage. We evaluated the utility of on-demand multilocus sequence typing (MLST) in characterizing hospital transmission events. Methods Using VA or NHSN criteria, inpatients with MRSA-HAI or HO-C. difficile infection (HO-CDI) were identified by infection preventionists (IPs) for MLST (by time and location) during active hospital surveillance starting October 2016 or September 2017 (for C. difficile and MRSA, respectively) through March 2019. Vitek 2 identified MRSA from blood or other sources, and stool samples positive for C. difficile by Cepheid Xpert® C. difficile or FilmArray® Gastrointestinal (GI) Panel were collected and C. diff isolated on CCFA plates. Sequence types (STs) were generated by Sanger sequencing and MLST using standard protocols (pubmlst.org). C. difficile genes included adk, atpA, dxr, glyA, recA, sodA, tpi. MRSA genes included arc, aro, glp, gmk, pta, tpi, yqil. Staphylococcal protein A gene (spa) type was determined by spa gene sequencing. Results MLST assay (C. diff 33, MRSA 26) intervals ranged from 1–4 weeks based on IP request. 109 C. diff isolates from 105 patients representing 44 STs (10 unique) were found. ST1 and ST2 (27, 20) were most common. 5 patients had 2–3 identical ST isolates over 21–180 days. Of 72 HO-CDI identified, 9 possible person-to-person transmissions events (33 cases) were ruled out; 3 events (9 cases) were ruled in; 14 events (21 cases) were not resolved due to missing samples or no growth. 100 MRSA isolates from 96 patients representing 26 STs (9 unique) were found. ST8/spa t008 (USA300) and ST5/spa t002 (USA100) (44, 29) were most common. 11 patients had 2–3 identical ST isolates over 2–367 days. Of 16 MRSA-HAI identified, 1 transmission event (4 cases) was ruled out, 1 event (2 cases) lacked one strain and was unresolvable. Conclusion Common MRSA and C. diff STs predominated among hospital isolates, yet significant heterogeneity was seen over a 2-year period and few true transmission events were documented. On-demand MLST-augmented IP surveillance was useful to rule-out hospital transmission. Disclosures All authors: No reported disclosures.

This study investigates the presence of thirdhand smoke pollution in low-income, multi-unit buildings in San Diego County. Thirdhand smoke (THS) is the lingering, toxic residue left behind from second-hand smoke that can mix with other indoor contaminants to create additional carcinogenic chemicals. Multi-unit housing increases the likelihood of shared airspace, which can contribute to THS contamination in the homes of nonsmokers; additionally, rental turnover rates of low income buildings may contribute to THS in nonsmoking homes. Twelve low income buildings were identified in San Diego County and 6% of each building’s apartments were recruited for the study, resulting in 109 visits. Surface wipes were collected in each home, while participants were asked to complete a survey, regarding smoking habits and policies. Building managers were also interviewed. Surface wipe samples were analyzed for nicotine levels through isotope dilution LC-MS/MS. Homes where residents reported smoking indoors had a geometric mean (95% confidence interval) nicotine level of 144.4 µg/m2 (41.3–498.6 µg/m2), smoking outdoors 7.6 µg/m2 (3.8–14.4 µg/m 2), and non-smoking 3.1 µg/m2 (2.0–4.5 µg/m2). Of the non-smokers (never smokers) homes, 28.4 percent were higher than 3.1 µg/m2 (the lower bound of smokers’ homes in a previous study by the SDSU group) and almost 80% were higher than our previous 0.14 µg/m2 cut-off for non-smoking homes. Extraordinarily high values (2586.2 & 3926.2 µg/m 2) were reported in homes with former smoking occupants, including one that had not been smoked in for nine years. These participants reported heavy indoor smoking for seven and twelve years respectively, but discontinued tobacco use due to serious smoking-related health complications. These results demonstrate THS, as measured by nicotine contamination, is persistent in the indoor environment, and can remain at extraordinarily high levels numerous years after residents have discontinued smoking indoors or altogether. Based on these results, occupants of low-income housing have higher levels of THS contamination than reported in previous studies. The most vulnerable occupants are infants and children, due to hand to mouth behaviors and developing organs. This study is part of a larger study investigating remediation procedures to potentially reduce THS exposure.

This study examined the effectiveness of an evidence-based, community-delivered adaptation of couple relationship education (CRE) program (specifically, The Prevention and Relationship Enhancement Program [PREP]) delivered at two Army installations. The study is a randomized controlled trial with 2 years of follow-up examining marital quality and stability. Sample composition was 662 married couples with a spouse in the U.S. Army. Analyses yielded no evidence of overall enduring intervention effects on relationship quality, but couples assigned to intervention at the higher risk site were significantly less likely than controls to be divorced at the 2-year follow-up (8.1% vs. 14.9%, p<. 01). This effect was moderated by ethnic minority status. Specifically, the impact of the intervention on divorce was strongest for minority couples. The findings add to the literature on who may benefit most from CRE.

Objectives: Opioid overdoses have become a significant problem across the United States resulting in respiratory depression and risk of death. Basic Life Support (BLS) first responders have had the option to treat respiratory depression using a bag-valve-mask device, however naloxone, an opioid antagonist, has been shown to quickly restore normal respiration. Since the introduction of naloxone and recent mandates across many states for BLS personnel to carry and administer naloxone, investigation into the adherence of naloxone use standing protocols is warranted.Methods: This preliminary study examined 100 initial cases of BLS first responder administration of naloxone for appropriate indications and protocol adherence.Results: This study found that n=22/100 naloxone administrations were inappropriate, often given to patients who were not suffering from respiratory depression (n=11/22). Positive pressure ventilation (PPV) was not administered prior to naloxone in n=56/100 cases, of which n=42/100 had an inadequate respiratory effort documented. For patients with a known history of substance use disorder, there was a significant increase in administration of naloxone prior to PPV (60%; n=33/55) compared to patients without a known history (30%; n=9/30).Conclusion: Overall these preliminary data suggest that during BLS naloxone administration, the majority of cases did not follow at least one component of the standard protocol for patients with respiratory depression. This study suggests that further education and more research are needed to better understand the decision-making processes of prehospital providers to ensure adherence to standard protocols.

BACKGROUNDGonorrhea screening is recommended for women at risk and men who have sex with men; expanded screening is encouraged based on local epidemiology. In response to a substantial increase in gonorrhea cases at an urban medical center serving American Indians, gonorrhea screening of all sexually active patients aged 14 to 45 years was initiated in March 2013. We describe gonorrhea screening coverage and case finding before and after implementation of expanded screening. METHODSIn March 2013, provider training, electronic health record prompts, and bundled laboratory orders were implemented to facilitate gonorrhea screening of all sexually active patients aged 14 to 45 years. We assessed the proportions of patients screened and testing positive for gonorrhea in the 2 years before (March 2011–February 2012 [indicated as 2011], March 2012–February 2013 [2012]) and 1 year after (March 2013–February 2014 [2013]) expanded screening measures. RESULTSGonorrhea screening coverage increased from 22% (2012) to 38% (2013); coverage increased 50% among females and 202% among males. Screening coverage increased in nearly all clinics. Gonorrhea case finding increased 68% among females in 2013 (n = 104) compared with 2012 (n = 62), primarily among women aged 25 to 29 years. No corresponding increase in gonorrhea case finding occurred among males. Most increased case finding occurred in the emergency department. CONCLUSIONSAfter introduction of expanded gonorrhea screening, there was a significant increase in gonorrhea screening coverage and a subsequent increase in gonorrhea case finding among females. Despite increased screening in all clinics, increased case finding only occurred in the emergency department.