{'fraction_non_alphanumeric': 0.03384480491012714, 'fraction_numerical': 0.02647961420429636, 'mean_word_length': 5.119098712446352, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
1155. CAUTI Path to Zero: A Triple-Pronged Approach to Minding Our Pees and Cues

Abstract Background Catheter-associated urinary tract infections (CAUTIs) account for nearly 30% of all hospital-acquired infections. From 2009 to 2013, the frequency of CAUTIs increased by 6% with associated increases in length of stay, antibiotic usage and mortality (2.3%); they are also a risk factor for secondary bloodstream infections. In 2017, the CAUTI SIR for the UTSW University hospitals was 0.990 for Clements University Hospital (CUH) and 1.224 for Zale-Lipshy (ZL), placing UTSW above the 50th percentile compared with similar academic medical centers. By the end of 2018, the aim of the quality improvement project was to reduce CAUTIs by 25% or improve the SIR to 0.78, which is at or below the 50th percentile. Methods Baseline data included identifying indications and duration of catheter placement as well as performing debriefings on all CAUTIs along with analysis of adherence to the CAUTI bundle. Using evidence-based guidelines, the three primary interventions were (1) streamlining indications for insertion, (2) ensuring prompt removal and (3) providing alternative care pathways after removal. We observed insertion technique and catheter care; nursing services were engaged to understand barriers to catheter removal and subsequently informed of other options such as in-and-out protocols, bladder scanners and female external catheters. Nursing leadership also performed daily necessity audits of all patients with indwelling catheters. Results Urine output monitoring in acute/critical illness and urinary obstruction/retention were the top two indications for use. Catheter utilization rates have decreased since 2016. The average dwell time at CUH was 51 hours (excl. urology) and 40 hours at ZL. There was actually a 34% decrease in the total number of CAUTIs from 38 in 2017 to 25 in 2018, exceeding the goal of 25% reduction; the 2018 SIR for CUH was 0.818 and 0.496 for ZL. The prevention of 13 CAUTI events from 2017 to 2018 resulted in ~$180,000 savings. Conclusion Successful reduction of CAUTI is an interdisciplinary effort requiring consistent attention and support from infection prevention, nursing, education, quality improvement, IT and hospital administration. Empowering nursing staff, providing clear protocols post-removal and options for alternative external urinary devices is key. Disclosures All authors: No reported disclosures.

Background. High regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days.
Methods. At the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as "preventable" infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre-and post-intervention data.
Results. Prior to intervention (July 2017-March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018-March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre-and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1).
Conclusion. At our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies.

Disclosures. All authors:
No reported disclosures. Background. Catheter-associated urinary tract infections (CAUTIs) account for nearly 30% of all hospital-acquired infections. From 2009 to 2013, the frequency of CAUTIs increased by 6% with associated increases in length of stay, antibiotic usage and mortality (2.3%); they are also a risk factor for secondary bloodstream infections. In 2017, the CAUTI SIR for the UTSW University hospitals was 0.990 for Clements University Hospital (CUH) and 1.224 for Zale-Lipshy (ZL), placing UTSW above the 50 th percentile compared with similar academic medical centers. By the end of 2018, the aim of the quality improvement project was to reduce CAUTIs by 25% or improve the SIR to 0.78, which is at or below the 50th percentile.

CAUTI Path to Zero: A Triple-Pronged Approach to Minding Our Pees and Cues
Methods. Baseline data included identifying indications and duration of catheter placement as well as performing debriefings on all CAUTIs along with analysis of adherence to the CAUTI bundle. Using evidence-based guidelines, the three primary interventions were (1) streamlining indications for insertion, (2) ensuring prompt removal and (3) providing alternative care pathways after removal. We observed insertion technique and catheter care; nursing services were engaged to understand barriers to catheter removal and subsequently informed of other options such as in-and-out protocols, bladder scanners and female external catheters. Nursing leadership also performed daily necessity audits of all patients with indwelling catheters.
Results. Urine output monitoring in acute/critical illness and urinary obstruction/ retention were the top two indications for use. Catheter utilization rates have decreased since 2016. The average dwell time at CUH was 51 hours (excl. urology) and 40 hours at ZL. There was actually a 34% decrease in the total number of CAUTIs from 38 in 2017 to 25 in 2018, exceeding the goal of 25% reduction; the 2018 SIR for CUH was 0.818 and 0.496 for ZL. The prevention of 13 CAUTI events from 2017 to 2018 resulted in ~$180,000 savings.
Conclusion. Successful reduction of CAUTI is an interdisciplinary effort requiring consistent attention and support from infection prevention, nursing, education, quality improvement, IT and hospital administration. Empowering nursing staff, providing clear protocols post-removal and options for alternative external urinary devices is key.

Disclosures. All authors:
No reported disclosures. Background. Patient transportation for off unit procedures is associated with transfers from bed to chair to examination tables, frequent elevation of the urine collection bag (UCB) above the bladder and urinary reflux (UR) of bacteria-laden urine into the bladder, significantly increasing risks of catheter-associated urinary tract infection (CAUTIs). If UCBs were systematically emptied prior to transportation the likelihood of UR would be greatly diminished, potentially reducing CAUTIs.

Running on Empty: Enlisting Transportation Services in Quality Improvement Initiatives as a Safeguard Against Catheter-Associated Urinary Tract Infections
Methods. During a 5-week period transportation services (TS) collected baseline data on UCB status of all ICU patients, classifying them as empty/good to go vs. full/ not good to go (Phase 1). Then, TS were educated on the importance of reducing UR as part of CAUTI reduction and were empowered to request UCBs be emptied. In parallel, unit-based staff were instructed to drain CBs prior to patient transport off unit and to expect the TS would refuse transport if CB was not emptied (Figure 1). Wireless voice-activated communications devices were used to improve coordination between TS and unit staff. During a 3 month (Phase 2) period, TS again collected data on the UCB status of ICU patients while reinforcing the need to empty UCBs.
Results. At baseline it was a coin toss as to whether a patient's UCB would be empty or full at the time of transportation, while over 90% of UCB were emptied in Phase 2 (47.1% and 52.9%, vs. 90.6% and 9.4%, empty and unemptied in Phase 1 and Phase 2, respectfully, P < 0.001) (Figure 2). Figure 3 shows the detailed UCB status (empty at TS arrival, emptied upon TS request, transported full, transport refused) during Phase 2, with significant month upon month improvements (P = 0.014).
Conclusion. Despite longstanding existing hospital policies promoting best practices, including the need to empty UCBs prior to transport, we found this was commonly ignored in usual practice. Recruiting the TS to enforce UCBs are empty at the time of transportation proved a very effective way to markedly improve best practices. If representative of general practices elsewhere, this suggests leveraging TS can help ensure UCBs are emptied prior to patient transport and reduce CAUTI risk. It also exemplifies how ancillary services can be recruited to play an active role in quality improvement/patient safety projects.

Disclosures. All authors:
No reported disclosures. Background. Urinary tract infections (UTIs) account for 34% of all healthcare-associated infections (HAI). Urinary catheters (UC) are placed in 15-25% of hospitalized patients and >75% of HAI UTIs are UC-related. Bacteria introduced via UC can colonize the bladder within 3 days. So, the greatest risk factor for acquiring a catheter-associated urinary tract infection (CAUTI) is prolonged use of indwelling UC. Nursing (RN) staff noted inconsistency with appropriate use of UC and commonly UC remained in place well after their original indication had expired.

GET IT OUT! Nurses and Clinical Quality Improvement Specialists Drive Initiative to Reduce Standardized Utilization Ratios for Indwelling Urinary Catheters in Hospitalized Patients
Methods. As part of a multi-faceted approach for quality improvement and patient safety, we rolled out an Agency for Healthcare Research and Quality (AHRQ)based initiative to reduce UC days/Standardized Utilization Ratio (SUR). Daily critical reviews of the indication for UC were conducted by two groups. First, frontline night shift RN staff identified patients who no longer had a valid justification for continued UC. They handed-off the information to day-shift RNs, who recommend removal of UC during daily rounds with the physician teams. A second review was performed by Clinical Quality Improvement Specialists (CQIS) based on defined criteria from our nursing decatheterization protocol. Their discontinue UC recommendations were also sent to the care teams. The critical reviews of UC for CAUTI reduction started with 4 ICUs in August 2018, with additional ICUs added in December, January and March. Monthly UC SURs were tracked