The Perfect Storm: A Hardy and Lethal Pathogen and a Unit Filled with Immunocompromised Patients with Large Open Wounds. Troubles with Candida Auris in a Burn Intensive Care Unit

Background: C auris is an emerging often multidrug resistant pathogen capable of causing severe morbidity and mortality. C auris has been increasingly isolated from patients in skilled nursing facilities and hospitals, and has been associated with facility outbreaks. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and readily colonizes the environment posing an especially great risk to immunocompromised patients with large open wounds and long lengths of stay. Methods: From 7/1/21 - 8/30/21 we noted a cluster of 4 patients with C auris in clinical cultures from the Burn ICU (BICU). A multidisciplinary team involving infection prevention, nursing/medical directors, health and safety, engineering, environmental services, and hospital leadership investigated the cluster as a potential outbreak. Mitigation measures involved a multi-modal response of C auris admission screening, weekly point prevalence testing of all BICU patients, environmental surface cultures, enhanced room cleaning, staff education, hand hygiene and personal protective equipment usage audits. Results: 11 cases of C auris were identified on our BICU from 7/1/21 - 2/28/22. 5 (45.5%) cases from clinical isolates, 1 (9.1%) from a BICU point prevalence screen on 12/15/21, 5 (45.5%) as a part of weekly point prevalence screens started on 1/1/22. 6 (54.5%) patients were admitted for burn related injuries, 2 (18.2%) for Steven Johnson Syndrome, 2 (18.2%) for necrotizing wounds, and 1 (9.1%) for COVID-19 pneumonia. Cases occurred in 6/10 rooms in the Burn ICU. One (9.1%) patient expired during this outbreak (not deemed to be from C auris infection). Conclusion: Resilient infections like C auris pose a risk of nosocomial transmission and potential high morbidity and mortality to burn patients with impaired immune defense and large open wounds. A multidisciplinary team using targeted interventions including screening, education, enhanced cleaning eradicated the outbreak in our BICU. As of 5/1/22, we went 13 + weeks without identifying a new case. The last patient with C auris was discharged 3/16/22. To prevent future outbreaks, we created a standardized response plan and instituted a universal screening protocol for C auris targeting all patient admissions from skilled nursing facilities and admissions to all ICUs. Disclosures: Jorge Paiva Parada, MD MPH, Shionogi: Honoraria.

Pre pre-service teacher training: Professional preparation and work-integrated learning pedagogy

In order to compensate for a demise in New Zealand's pre-service teacher training, particularly in health and physical education (HPE), a work-integrated learning (WIL) course was added to a Bachelor of Sport and Exercise curriculum. This exploratory research provides insights into the outcomes of twenty-nine final year undergraduate PE students' involvement in teaching, coaching and management of school sports events and activities. The impact of initiatives resulted in enhanced participation, opportunities and engagement in physical education and sport activity for a range of children. Themes emerged from content analysis of student perceptions of individual's learning outcomes. WIL opportunities enabled students to build self-efficacy and career capability despite the COVID-19 restrictions and lockdowns. Findings indicated that from the students' perspectives, school-based initiatives enriched career capability, whilst also requiring adaptability, flexibility and resilience. The WIL experience enabled development of transferable skills and attributes in preparation for pre-service teacher training.

A comparison of clinic versus home spirometry in the captain study

Rationale: Many respiratory consultations are currently taking place virtually due to the ongoing SARS-CoV-2 pandemic, while traditional lung function testing in clinic is difficult to perform. Therefore, there is increasing interest in whether home measurements of lung function could be used in place of clinic testing. However, little is known as to whether home spirometry accurately reflects clinic measurements, and whether it provides sufficient precision to inform treatment decisions. Therefore, we evaluated the agreement between home and clinic measurements of trough FEV1 using data from the CAPTAIN study. Methods: This Phase IIIA, double-blind, 24-52- week, parallel-group study randomized adults with uncontrolled asthma despite inhaled corticosteroid/long-acting β2-agonist therapy. Treatment: once-daily FF/VI (100/25, 200/25mcg) or FF/UMEC/VI (100/31.25/25, 100/62.5/25, 200/31.25/25, 200/62.5/25mcg) (ELLIPTA inhaler). Trough FEV1 and other spirometry measurements were taken in clinic at approximately the same time in the morning using a MasterScope device. Patients also measured trough FEV1 each morning at home using a peak flow meter (AM3 device);three measurements were performed at each time point, with the highest measurement recorded. We used the Bland-Altman method to assess agreement between clinic trough FEV1 and the average of the home trough FEV1 measurements collected on the same day and 2 days prior to the clinic measurement, at baseline and at Week 24 (post hoc analyses). Only patients with a value for both clinic and home trough FEV1 were included (baseline: n=2434, Week 24: n=2261). Results: Agreement between clinic and home trough FEV1 measurements was poor (Figure). At baseline, the lower and upper limits of agreement were -812 mL and 943 mL, respectively, while at Week 24 these were -771 mL and 980 mL, respectively. In total, 6% of patients were outside the limits of agreement at baseline (n=151) and Week 24 (n=143) (Figure). Conclusions: This comparison of home and clinic spirometry in the CAPTAIN study suggests that home spirometry performed with the AM3 device cannot be used as an alternative to clinic spirometry, and that caution should be exercised when using home spirometry data in research or clinical care. The reason for the lack of agreement between home and clinic trough FEV1 measurements is not clear. Possible explanations include the different devices and methodologies, and lack of supervision and coaching for home measurements. However, it is possible that home spirometry may provide different and potentially complementary information to clinic measurements. Further investigation is warranted.