To evaluate the implementation and effectiveness of a novel home infusion central line-associated bloodstream infection (CLABSI) and home infusion-onset bloodstream infection (HiOB) dashboard and prevention toolkit.

Mixed methods study.

Five home infusion agencies participating in the first CLABSI prevention collaborative.

Agencies uploaded CLABSI and HiOB data to a comparative dashboard. The dashboard started in December 2022 and accepted retrospective data from June 2021. A CLABSI prevention toolkit was made available in June 2024. Using an interrupted time series, we present CLABSI and HiOB rates before and after dashboard and toolkit implementation. We surveyed and interviewed participants about the tools and toolkit, using directed content analysis to analyze the interviews.

After dashboard implementation, there was a decrease in CLABSI (−0.23/10,000 home-CVC days, 95% CI −0.28 to −0.18) and HiOB (−0.25/10,000 home-CVC days, 95% CI: −0.31 to −0.18) over time. With toolkit implementation, there was a further decrease in CLABSI (−0.17/10,000 home-CVC days, 95% CI: −0.30 to −0.044) and HiOB (−0.23/10,000 home-CVC days, 95% CI: −0.37 to −0.089) over time. Themes were associated with use of the tools (accessible, adaptable, patient-centered tools; user-friendly education to enhance understanding; barriers identified; tool mismatches; and strategies for tool delivery) and toolkit implementation (structural barriers, user-centered design, collaborative engagement and communication, toolkit used to enhance workforce competency, and concerns related to consistency).

Implementation of a dashboard and a CLABSI prevention toolkit were each associated with both CLABSI and HiOB reduction in a collaborative of home infusion agencies.

nvHAP (nonventilator hospital-acquired pneumonia) can affect all non-intubated patients, and semi-automated systems enable incidence surveillance. This feasibility study evaluated the performance and implementation of a semi-automated nvHAP surveillance in Swiss acute care hospitals.

Multicenter feasibility study

Seven Swiss acute care pilot hospitals representing different sizes and language regions

Inpatients of the participating hospitals.

Hospitals implemented an adaptable nvHAP selection algorithm including one to five indicators (radiology procedure, radiology report, leukocytes, body temperature, intubation). Five hospitals performed manual review on the preselected patients following standardized definitions. Performance characteristics of the algorithms (i.e., sensitivity and percentage records to manually review) and time investment to implement the semi-automated surveillance were evaluated. Barriers and facilitators for implementation were identified through interviews.

Hospitals implemented algorithms including one, two, four and five indicators. Sensitivity ranged from 98% to 100% in larger hospitals. Percentage of records to manually review ranged from 1% to 6% in hospitals that surveyed the total patient population and was 13% in one hospital that focused on two high-risk departments. Time for technical implementation varied from 55 to 437 hours. Mean time for manual review per preselected patient was 14 minutes and decreased with experience. Implementation facilitators included preprocessed data, team experience in similar projects, and external support.

Semi-automated nvHAP surveillance was feasible and sufficiently sensitive regardless of the algorithm. It required effort for setup and manual review. Algorithm adaptability enabled the implementation in hospitals with limited electronically available data or IT resources.

There is increasing evidence on the effectiveness of prevention bundles against non-ventilator hospital-acquired pneumonia (nvHAP), but detailed reports on their implementation are lacking. This study aims to describe and structure the implementation activities undertaken in a single-center multimodal intervention that achieved a 31% reduction in nvHAP incidence.

Longitudinal descriptive qualitative study.

Nine medical and surgical departments of a Swiss university hospital.

Healthcare professionals and implementation teams in study departments.

We collected longitudinal data on implementation activities using (1) implementation activity logs, (2) drop-in interviews and observations, (3) “action plan meetings,” (4) focus groups, and (5) unstructured recall sessions among the project team. Data were deductively coded using the “Expert Recommendations for Implementing Change” taxonomy, specified using Proctor et al.’s “Recommendations for specifying and reporting implementation strategies” and mapped to the “Exploration, Preparation, Implementation, Sustainment” framework phases.

A total of 174 activities were undertaken. Activities varied by implementation phase, most frequently involving “evaluative and iterative strategies,” “develop stakeholder interrelationship strategies” and “training and education of stakeholders” during Exploration, Preparation, and Implementation, respectively. During Implementation, 54% of activities were initiated by department nurses, and 27% were initiated by the institutional implementation team. Activities included interdisciplinary kick-off events, education in various formats, posters, informational stickers for patients, provision of new equipment (e.g., toothbrushes), and electronic medical records order sets.

This report offers valuable insights for future implementation efforts by providing a structured overview of the concrete implementation activities performed in a successful one-hospital multimodal nvHAP prevention project.

Clostridioides difficile infection (CDI) requiring colectomy carries substantial mortality risk, with optimal timing of surgery remaining poorly defined. We examined temporal trends in colectomy among inpatients with CDI, identified predictors of surgical intervention and postoperative mortality, and evaluated the association between surgical timing and patient outcomes.

A retrospective cohort study was conducted using the National Inpatient Sample database from 2018 to 2022. We compared patients undergoing colectomy with those managed medically. To minimize confounding by hospital-onset cases, the analysis of surgical timing and mortality was restricted to patients undergoing colectomy within 8 days of admission. Predictors were identified using survey-weighted logistic regression and LASSO regression models.

Among 240,564 CDI hospitalizations (representing 1,207,995 weighted nationally), 717 patients underwent colectomy (3,585 weighted). CDI prevalence declined from 0.99% (2018) to 0.76% (2022), while colectomy rates increased from 0.28% to 0.34%. Peritonitis (OR 5.42; 95% CI, 4.46–6.59), coagulopathy (OR 4.96; 95% CI, 3.76–6.55), and sepsis/septic shock (OR 3.89; 95% CI, 3.39–4.47) were the strongest predictors of colectomy. Among patients undergoing colectomy within 8 days (2,830 weighted), in-hospital mortality was 26.5% overall, increasing from 21.0% (2018) to 30.7% (2022). Sepsis/septic shock (OR 8.20; 95% CI 2.92–23.07) and coagulopathy (OR 7.27; 95% CI 3.31–15.97) predicted mortality. Each additional day from admission to colectomy was associated with a 16% (OR 1.16; 95% CI 1.04–1.28) increased mortality risk.

In this nationally representative cohort, surgical timing was an independent and modifiable determinant of survival in patients with CDI requiring colectomy. Our findings underscore the importance of early surgical consultation for CDI patients with peritonitis, sepsis, and coagulopathy.

To understand how the workflows and infection prevention and control (IPC) practices of certified nursing assistants (CNAs) during high-contact resident care activities contribute to multidrug-resistant organism (MDRO) transmission in nursing homes.

We conducted 10 high-fidelity simulations of two high-contact resident care activities, bed bathing and incontinence care, with CNAs from long-term or mixed-care units. Four genetic variants of λ phage were applied to select surfaces prior to simulations and subsequently sampled from the environment, residents, supplies, and CNAs. Simulations were video recorded and analyzed for patterns of hand-to-surface contact and performance of IPC practices, including hand hygiene, personal protective equipment use, and environmental surface cleaning or disinfection.

A median of 11.5 transmission events occurred per simulation. Most events (60%) occurred within residents’ immediate environments, reflecting how CNAs frequently transitioned between a resident, their surroundings, and care supplies, combined with infrequent hand hygiene and surface disinfection. Contamination of CNA scrubs and hands accounted for 24% of events, primarily from bed bathing, which involved frequent contact without a gown. Transmission to shared objects (e.g., linen bin, trash can, wheelchair) accounted for 16% of events and created additional opportunities for transmission between residents. Transmission between residents or their immediate environments was rare but typically associated with workflow disruptions from limited-supply availability.

In high-fidelity simulations of high-contact resident care activities, transmission of surrogate markers for MDROs closely followed the workflows of CNAs. This method identifies potential transmission pathways and interventions for mitigating MDRO spread in nursing homes.

Multidrug-resistant organisms (MDROs) such as carbapenem-resistant Enterobacterales (CRE) are a significant public health threat. Patients colonized with MDROs are at higher risk of severe outcomes and can serve as a source of spread to others. The public health impact of a hypothetical agent that reduces MDRO load (i.e., pathogen reduction), including in the gastrointestinal tract, has not been described.

Compartmental models of CRE transmission in healthcare facilities were used to estimate the impact of a hypothetical pathogen reduction agent on CRE bloodstream infections (BSIs) and deaths.

The agent was assumed to reduce the time to pathogen clearance with effectiveness varying from 25–100% across simulations. Interventions were modeled in acute care hospitals (ACHs), critical access hospitals, long-term acute care hospitals (LTACHs), skilled nursing facilities, and ventilator-capable skilled nursing facilities (vSNFs). Direct effects (among patients who received the agent) and indirect effects (among patients who did not receive the agent) were estimated at the national healthcare network level.

At baseline without intervention, an estimated 2,086 CRE BSIs and 622 associated deaths occurred annually nationwide. Use of a pathogen reduction agent in LTACHs and vSNFs averted 69–75% of CRE BSIs nationally, with greater reductions when expanded to all facility types. Approximately 90% of averted CRE BSIs would have occurred in patients who were not administered the agent.

An effective pathogen reduction agent might substantially reduce MDRO infections and deaths among patients in U.S. healthcare facilities. New and expanded efforts are needed to accelerate the development of such products.

Describe the first healthcare-associated outbreak of Candida auris in Maricopa County, Arizona. Also, outline the Maricopa County Department of Public Health (MCDPH) response activities to halt transmission and identify affected healthcare facilities (HCFs) and contacts colonized with C. auris.

At HCFs with confirmed C. auris cases (i.e., exposed HCFs), MCDPH provided virtual infection control assessment and response activities, including contact investigations among hospitalized patients and point prevalence surveys (PPSs) to identify ongoing transmission. Confirmed C. auris cases included C. auris detected by cultures or polymerase chain reaction (PCR) in a hospitalized patient. Clinical cases had C. auris from cultures obtained during routine care in a hospitalized patient. Colonized cases included C. auris detected by PCR obtained from hospitalized patients for screening purposes.

On April 21, 2022, the first clinical case was identified, resulting in an outbreak with C. auris screening at 28 exposed HCFs. In total, 39 clinical C. auris cases were reported. Among 1,994 contacts identified, 899 (45.0%) were screened, 8 (0.4%) declined screening, and 1,087 (54.5%) were ineligible for screening (i.e., no longer hospitalized in Maricopa County). Among screened patients, 158 (17.6%) were colonized with C. auris; 15 (9.5%) colonized contacts later acquired clinical infections. This outbreak concluded on February 23, 2023, after 2 consecutive PPSs yielded no C. auris detection at exposed HCFs.

The first C. auris outbreak in Maricopa County highlights the coordinated efforts between HCFs, laboratories, and public health to identify exposed HCFs, screen contacts, and halt C. auris transmission.

Determine site attributes affecting uptake of a national, multi-site antimicrobial stewardship project focused on reducing unnecessary urine culture orders and antibiotic prescriptions for asymptomatic bacteriuria (ASB).

Forty-one United States Veterans Affairs Medical Centers (VAMCs) were randomized into two arms: “Technical Assistance” (TA) or the “Virtual Learning Collaborative” (VLC). TA sites could request one-on-one guidance from the coordinating center, and VLC sites participated in semimonthly informational webinars. Otherwise, we provided TA and VLC sites with the same resources to educate healthcare professionals on proper ASB management. At the intervention’s conclusion, we conducted 45–60-minute semi-structured interviews with local site leads and focus groups with their teams. TA and VLC sites were sampled based on time spent on intervention implementation, resulting in 19 participants across varying roles (e.g., pharmacists, physicians). We iteratively coded transcripts using thematic analysis.

We propose five considerations for how site attributes informed uptake of our stewardship initiative: (1) existing connections with leadership and important contacts; (2) workplace structure and culture; (3) previous and concurrent antimicrobial stewardship initiatives; (4) availability of existing resources (e.g., time); and (5) personnel turnover (e.g., daily provider transition, job turnover).

We recommend conducting pre-intervention interviews to identify site-specific obstacles and then tailoring the intervention to site-specific needs. Additionally, we stress the importance of sites’ prior experiences with antibiotic stewardship and the availability of personnel to work on stewardship initiatives. Ultimately, a better understanding of sites’ unique environments is an essential step for improving uptake of antimicrobial stewardship projects.

Penicillin allergy reporting is common in U.S. healthcare systems, but true allergies and clinically significant reactions are inaccurately reported. Validated tools like PEN-FAST score allow for structured risk assessment; however, many clinicians remain unfamiliar with how to utilize the score to inform decision-making and prescribing. Integrating the PEN-FAST tool into the electronic health record (EHR) admission workflow may promote awareness and improve clinical utility.

We integrated the PEN-FAST tool into the admission navigator of our hospitals’ electronic health record to be completed by nursing staff. Over a seven-month period, completed PEN-FAST scores across our health system were analyzed to evaluate the overall opportunity for allergy assessment and delabeling. The study population consisted of patients with a documented penicillin class allergy and a completed PEN-FAST score. Patients with incomplete scores or responses marked as unknown for every item were excluded.

A total of 13,121 patients were included in the final evaluation. There were 10,309 (78.6%) patients with low-risk scores (PEN-FAST score of 0–2), indicating they were potential candidates for direct antibiotic challenges. The remaining 2,812 (21.4%) patients were categorized as high-risk (PEN-FAST score of 3+), who were likely not eligible for a challenge without prior skin testing.

A substantial opportunity remains to improve the assessment and documentation of penicillin allergies throughout the healthcare system. Utilizing the electronic health record to prompt frontline staff to use validated risk assessment tools may improve documentation of allergies and support better management of patients with penicillin allergy labels.

The COVID-19 pandemic caused unprecedented operational stress on hospital-based antimicrobial stewardship programs (ASP). We utilized a systems engineering framework to characterize multi-level systems challenges to and strategies for resilient, hospital-based antimicrobial stewardship (AMS) during the COVID-19 pandemic.

Using a national data set, we identified hospitals that had significant COVID-19 burden. We conducted semi-structured interviews with pharmacists, physicians and quality leaders involved in ASPs during the pandemic at those hospitals. Interview guides were developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Transcribed interviews were analyzed using deductive content analysis.

We interviewed 37 participants from 22 different healthcare systems across the country. Challenges to resilient ASP included physician employment model; limited AMS resources; staff shortages due to illness; shift in priorities; increased workload; remote work; and therapeutic momentum. Preexisting strategies to promote resilient AMS included system-wide AMS; decentralized AMS; excellent interprofessional relationships; strong culture of AMS and embracing incremental change. Real-time response strategies included ability to prioritize well; consistency with AMS work; being flexible and adopting change; intensifying infectious disease engagement; dedication to the profession; and reliance on automated tools and technology.

Using a systems engineering informed qualitative approach, participants identified many modifiable challenges to AMS resiliency. Given the unfortunate reality that infectious disease pandemics and periods of operational stress are likely to occur in the future, we recommend that healthcare system leadership utilize the preexisting and real-time response strategies identified in this manuscript as a roadmap to ASP preparedness and a more proactive future response.

The spread of Candida auris (C. auris), methicillin-resistant Staphylococcus aureus (MRSA) and various viruses in healthcare settings is of global concern. Far-UV-C222 reduces the concentration of microorganisms in laboratory settings and can be used directly in patient care rooms at doses safe for human eyes and skin. The effectiveness of UV-C222 inactivation of C. auris, MRSA and T1 bacteriophage (a viral surrogate) in a hospital setting was studied.

A partially blinded, cross-over study was conducted of two conditions: intervention, active UV and control, no UV. C. auris, MRSA and T1 bacteriophage were inoculated and dried onto stainless steel disc carriers at two soil levels, (0.03% BSA and 5.0% CBS), and placed at 24 locations in two unoccupied, two-bed patient rooms. UV-C222 luminaires were placed behind the head of each bed and one in the bathroom for both study rooms. Simultaneous 24-h exposures for both rooms were in random order. Pathogens were processed for cultures.

UV-C222 doses exposing the discs ranged from a low of 5 mJ/cm2 to high 637 mJ/cm2. Under treatment conditions, MRSA showed a 1.0 log reduction in 0.03% soil, C. auris showed a 2.6 log reduction in 0.03% soil and a 1.0 log reduction in 5.0% soil and T1 bacteriophage showed a 0.6 log reduction in 0.03% soil.

In patient rooms, continuous UV-C222 exposure showed decreased concentrations of C. auris (low and high soil), MRSA (low soil), and T1 (low soil). Studies are needed to determine benefits in occupied settings.