To assess whether wind-driven natural ventilation in the Infectious Diseases Treatment Module (IDTM) can achieve ventilation performance consistent with airborne precaution requirements [160 liters per second (L/s)] and to estimate associated pathogen-specific infection risks.

An experimental campaign of air velocity measurements and CO2 decays were conducted to validate the developed computational fluid dynamics (CFD) model. The validated CFD model simulated wind-driven natural ventilation (1–4 m/s) for an L-shaped IDTM configuration under four structural scenarios defined by the presence or absence of patient porches and mosquito nets. Airborne infection risk was estimated using a Wells–Riley quanta-based model for seven representative airborne pathogens under short-duration healthcare worker exposure and prolonged patient co-exposure.

Ventilation performance varied widely based on wind speed and structural configuration. Airflow ranged from 7 L/s in the most restricted configuration (porch and mosquito nets present at 1 m/s) to over 3,100 L/s when mosquito nets were removed at 4 m/s.

When mapped to infection-risk estimates, ventilation rates at 160 L/s substantially reduced short-duration healthcare worker infection risk for all pathogens (≤1%), whereas prolonged co-exposure remained associated with high risk for high-emission pathogens despite high ventilation.

Under favorable wind conditions and optimized configurations, the IDTM can achieve ventilation rates consistent with the 160 L/s recommendation for airborne precautions. While this provides substantial protection for healthcare workers, individual-room isolation remains essential for patient management. Operationally, removing window-mounted nets is the most effective way to ensure safety targets are met; hybrid ventilation measures should be considered during low-wind conditions.

Single-use supplies stored in bedside supply carts with paper packaging cannot be wiped with disinfectants. We aimed to determine the prevalence of pathogens on these unused supplies.

Prospective study over 7 weeks in 2025.

Two pediatric ICUs at a university affiliated children’s hospital.

The unit of analysis was the bedside supply cart from each discharged ICU patient.

One swab was used to swab three supply items contained in a single drawer in a room’s bedside cart. Carts had two drawers sampled, each with a swab for bacterial culture and respiratory viral nucleic acid amplification testing (NAAT).

Paper-packaged supply items (n = 840) from 70 consecutive bedside carts were swabbed after patient discharge. All bacterial swabs had no growth of pathogen [0/140 (0%), 95% CI 0%, 2.3%)]. A non-pathogen was cultured from 8/140 (5.7%) swabs [7/70 (10.0%) carts], most with scant growth [7/8 (87.5%) only one colony]. Non-pathogens (common commensal skin and oral flora) included coagulase-negative staphylococci (n = 5), Actinomyces oris (n = 1), aerobic spore-forming Bacillus (n = 1), and viridans group streptococcus [non-anginosus] (n = 1). Of viral swabs, 3/140 (2.1%, 95% CI 0.5%, 6.4%) were NAAT positive (3/70 (4.3%) carts). Room isolation status, length of stay, and ICU were not associated with a positive bacterial or viral swab.

Bacterial pathogen detection on supplies, a necessary step in transmission, was extremely low. Viral NAAT detection on supplies was low and likely exaggerated the risk of fomite transmission, as whether there was viable virus at sufficient concentration to transmit infection is unknown.

Blood culture over-ordering is a recognized diagnostic stewardship challenge, contributing to contamination, inappropriate antimicrobial escalation, and laboratory burden. Validated tools to guide culture ordering at initial patient assessment are lacking.

We aim to derive and externally validate a two-step diagnostic stewardship rule for blood culture ordering in the emergency department (ED) patients with suspected infection.

We derived the Stepwise Culture Assessment with NEWS and NLR in ED (SCANNED) rule using consecutive blood cultures from a Singapore ED (April–July 2025) and validated it in Vancouver, Canada (2016–2019). The rule uses age-stratified National Early Warning Score (NEWS) thresholds (Step 1), followed by neutrophil-lymphocyte ratio (NLR) ≥5 for remaining patients (Step 2). Thresholds were selected via exhaustive grid search, optimizing culture reduction while constraining the false-negative rate to <5%.

We included 1,224 derivation and 808 validation encounters. Blood culture positivity was 9.6% (117/1,224) and 13.8% (112/808), respectively. The optimal rule (NEWS ≥5 if age <75 or NEWS ≥3 if age ≥75; NLR ≥5 for remainder) reduced cultures by 18.8% (95% CI 16.6–20.9%) in derivation and 15.1% (95% CI 12.8–17.6%) in validation, missing <5% of bacteremia cases in both cohorts. Performance was consistent across infection sources, including unclear/occult infections (17.5% reduction, 3.7% false-negative rate).

The SCANNED rule represents a practical diagnostic stewardship intervention that can reduce unnecessary blood cultures by 15–19% while maintaining >95% sensitivity for bacteremia. It requires no electronic health record integration and can be applied at triage. Prospective validation is needed before clinical implementation.

The GeneXpert® MTB/RIF nucleic acid amplification test has been proposed as an alternative method to smear microscopy in guiding de-isolation for patients with suspected pulmonary tuberculosis, given its convenience and higher diagnostic accuracy. Currently, there is no comprehensive review summarizing the evidence on the isolation duration using GeneXpert. This systematic review and meta-analysis addressed the length of airborne infection isolation in hospitalized patients initially suspected of having pulmonary tuberculosis where de-isolation decisions were guided by GeneXpert nucleic acid amplification test compared to traditional smear microscopy.

We conducted a comprehensive search in databases (Medline, Embase, and Scopus) from January 1, 2001, to April 1, 2026, and applied median-based quantile estimation methods to determine the pooled difference in median times of isolation. We also assessed diagnostic accuracy as well as hospital length of stay as secondary outcomes.

We screened 746 titles and abstracts, of which 7 were eligible for inclusion. Five studies included in the meta-analysis involved 1,409 patients, all within low-incidence tuberculosis settings. The meta-analysis demonstrated that use of a single unconcentrated GeneXpert versus serial acid-fast bacilli smear microscopy resulted in a pooled reduction in median isolation duration by 38.8 hours (95% confidence interval 20.2–57.3 hours).

Compared to serial microscopy, GeneXpert done on a single unconcentrated respiratory specimen reduces airborne infection isolation duration by over 1.5 days, on average, making it an attractive strategy for optimizing healthcare facility resources while evaluating persons for pulmonary tuberculosis.

Protocol Registration (PROSPERO, CRD42024538644)

Emergency departments in tertiary care are critical areas for decision-making regarding antimicrobial use,however, they are often underrepresented in antimicrobial stewardship (AMS) interventions. This study evaluates the impact of a nurse-driven antimicrobial stewardship intervention in a medical emergency unit of a tertiary care facility.

A quasi experimental pre–post study was conducted in the Emergency Medical Outpatient department in a tertiary care center. Following a baseline assessment of antimicrobial use patterns conducted by a team of trained stewardship nurses, salient intervention targets were identified and implemented. AMS nurses actively reviewed antimicrobial prescriptions, reinforced adherence to institutional guidelines, monitored device- related practices and diagnostic utilization, and participated in audit and feedback with clinical teams. Data on patient characteristics, infection type, culture practices, antibiotic use, and guideline adherence were collected and compared between pre-intervention and intervention phases.

Following the intervention, compliance with hospital antibiotic guidelines improved from 82.4% to 91.0%. The proportion of cultures collected before initiating antibiotics increased from 23% to 40.3%, with a corresponding rise in culture positivity from 8% to 22%. An increase in antibiotic de-escalation practices was also noted.

This nurse-driven antimicrobial stewardship intervention was associated with more rational antimicrobial use, improved diagnostic utilization, and strengthened infection control practices. Integrating stewardship activities into nursing workflows represents a feasible approach to strengthening AMS in high-volume acute care settings.

Benchmarking hospitals on their antibiotic use may be facilitated by metrics that adjust for inter-hospital differences in patient case-mix, such as types of infections, procedures, and comorbidities. Metrics that capture antibiotic spectrum [e.g., days of antibiotic spectrum coverage (DASC)] can be more sensitive to stewardship activities than metrics based on days of therapy (DOT). In this study, we developed risk-standardized metrics for both DOT and DASC.

We performed a mixed-methods study to build risk-standardized metrics for inpatient antibiotic use, using a modified Delphi process integrating expert- and data-driven strategies to identify nonmodifiable risk factors associated with appropriate inpatient antibiotics. These factors were used to create risk-standardized ratios (RSR) for DOT and DASC. A standardized antimicrobial administration ratio (SAAR)-like metric was also constructed.

In 2021, there were 497,061 patient-admissions across 121 Veterans Health Administration (VHA) hospitals. The median hospital RSR was 1.00 (interquartile range (IQR) 0.95–1.05) for DOT and 1.00 (IQR 0.96–1.04) for DASC; the median ratio for the SAAR-like metric was 0.85 (IQR 0.68–1.03). The Kendall’s tau for RSR-DOT and the SAAR-like metric was 0.48; RSR-DASC and the SAAR-like metric was 0.33; and RSR-DOT and RSR-DASC were 0.48. Compared to the SAAR-like metric, 60 (49.6%) and 80 (66.1%) hospitals ranked in a different quartile for RSR-DOT and RSR-DASC, respectively.

Hospital performance on the SAAR-like metric was weakly correlated with the RSR-DASC and moderately correlated with the RSR-DOT. Hospitals’ performance on the SAAR-like metric differed from that of the RSR metrics, suggesting the RSR metrics may have added value over the SAAR.

To evaluate the effect of copper-coated high-touch surfaces on environmental microbial burden and healthcare-associated infection (HAI) rates.

Observational cohort study over 20 months.

Pediatric intensive care and oncology inpatient units in a tertiary care hospital.

All patients admitted to rooms with or without copper-coated surfaces.

Spray-on copper coating applied to high-touch surfaces in patient rooms.

Patients were admitted to rooms according to routine hospital practices. Demographic and clinical data were collected for a subset of patients admitted to rooms with copper-coated surfaces and matching control rooms. Environmental samples were collected from high-touch surfaces to quantify bacterial colony counts. HAIs were identified via a surveillance database and reported per 10,000 patient days. Poisson regression and negative binomial mixed-effects model were used for analysis.

Patients in copper-coated rooms were more likely to have an infection on admission (29.7% vs 2.9%; P = .003). Bacterial colony counts trended lower in copper-coated rooms (rate ratio (RR) 0.74, 95% CI 0.50–1.08; P = .11; absolute rate difference −12.25, 95% CI −26.12–2.10), with variability by surface type. HAI rates trended higher in copper-coated rooms compared to control rooms (48.2 vs 30.5 per 10,000 patient days; RR 1.58, 95% CI 0.78–3.20; P = .20).

Copper-coated surfaces were not associated with statistically significant reductions in microbial burden or HAI rates. Contributing factors may include low baseline microbial load, low baseline HAI rates, variable copper alloy efficacy, short study duration, and differences between patients in intervention and control rooms.

Patients receiving maintenance hemodialysis are frequently exposed to antibiotics, a proportion of which may not be necessary thereby increasing the risk of antibiotic-associated adverse events. Antimicrobial stewardship programs remain underdeveloped in outpatient dialysis facilities. This study aimed to quantify antibiotic prescribing trends across in-center dialysis units and identify patient- and facility-level factors associated with decreased antibiotic use to inform the future stewardship strategies.

Retrospective observational cohort study among 16 in-center hemodialysis units

Antibiotic prescribing patterns and patient- and unit-level characteristics were analyzed among patients receiving maintenance hemodialysis from April 1, 2021, to March 31, 2024. Antibiotic prescribing trends were analyzed using general linear models. Generalized estimating equations were used to identify factors associated with decreased prescribing.

A total of 937 (26.4%) among 3,549 patients received ≥1 antibiotic dose, with an average of 15.36 doses per 100 patient-months, ranging from 4.82 to 30.87 doses/100 patient months. Types and frequency of antibiotics prescribed among units varied considerably. Trends in antibiotic prescribing did not decrease among 10 (62.5%) of the in-center hemodialysis units. Patient-level characteristics in units associated with a decrease in prescribing included Black race, Hispanic ethnicity, age 56–65, and diabetes as the cause of kidney failure.

There is substantial variability in antibiotic prescribing across dialysis units. Decreasing trends in prescribing were observed in a subset of units and were associated with patient-level factors. These findings support the need for developing and implementing antimicrobial stewardship programs targeting the outpatient dialysis setting.

A diagnosis code-based algorithm classifies outpatient antibiotic prescribing as almost always (Tier 1), sometimes (Tier 2), and almost never (Tier 3) appropriate. This algorithm has been leveraged to quantify antibiotic appropriateness and direct stewardship initiatives for adults and children, primarily based on Tier 3 encounters receiving antibiotics, but has not been validated.

To assess the performance of the algorithm for assessing antibiotic appropriateness in pediatric outpatients.

Using a pediatric care network of primary care, urgent care, and emergency departments from January 1–December 31, 2024, encounters were classified into tiers using the ICD10 algorithm. Manual chart review was performed on a stratified random sample of 300 (100 per setting) Tier 3 encounters with antibiotics using a structured protocol derived from local and national guidelines to determine antibiotic appropriateness overall and by location. Survey weights were applied to obtain estimates for all Tier 3 encounters with antibiotic prescriptions. The positive predictive value (PPV) for Tier 3 in identifying inappropriate antibiotic prescribing was calculated.

Of 272,698 encounters, 115,508 (42%) had an antibiotic prescription. The algorithm classified 10,370 (9%) as Tier 3. In the stratified manual validation sample, 170/300 were classified as appropriate, corresponding to a survey-weighted estimate of 58% appropriate (95% CI, 52%–64%) and a PPV of 42% for Tier 3 as a marker of inappropriate antibiotic use.

The established algorithm did not reliably predict antibiotic appropriateness in this pediatric outpatient population, demonstrating a need for pediatric-focused algorithms for measuring outpatient antibiotic stewardship.

Timely detection of pathogen-related outbreaks in hospitals is important for preventing onward transmission and can be supported by automated outbreak detection systems (AODS). Many methods overlook in-hospital patient transfers and focus only on patient locations at the time of sampling. This study compares three approaches for incorporating patient transfers into AODS.

Two existing AODS frameworks, a local percentile-based system and a statistical modeling-based system were extended to include patient transfers: 1) grouping wards into communities based on frequent patient exchange, 2) including prior ward visits in the past 14 days, and 3) including both prior ward visits and time spent on wards. Alerts generated were reviewed for clinical relevance.

Data from January 2014 to December 2021 from a University Medical Center in the Netherlands.

Using the percentile-based approach, the baseline scenario detected 99 possible outbreaks. Extension with ward community groupings, prior ward visits, and prior ward visits accounting for time spent in each ward increased this number with 16 (+15%), 42 (+42%), and 106 (+110%) possible outbreaks, respectively. Of the alerts generated by including individual patient transfer history, 35% were judged as requiring investigation. The trade-off between increased detection and relevance was less favorable for the other approaches. Similar findings were found for statistical modeling-based methods.

Inclusion of patient transfer data in AODS improved sensitivity, at the cost of increasing the alert burden. Therefore, ongoing refinement should further optimize the balance between accurate outbreak detection and a manageable alert burden.

Prospective audit and feedback (PAF) is a core antimicrobial stewardship strategy. Discontinuing PAF in favor of alternative interventions has not been previously evaluated.

This descriptive study assessed changes in antimicrobial days of therapy per 1,000 patient days (DOTs/1,000 PD) following PAF removal at two urban hospitals. Preintervention PAF included daily review of broad-spectrum antibiotics and oral therapy transitions. Postintervention efforts emphasized system standardization, education, guideline optimization, and electronic medical record enhancements. Secondary outcomes included trends in antibiotics previously reviewed under PAF: antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa, carbapenems, and oral antibiotics.

Hospital A demonstrated a change in the trend of DOTs/1,000 PD with a significant downward slope after PAF removal (−5.994; 95% CI −8.072 to −3.929; P < .001). Hospital B continued to down-trend postintervention. At hospital A, carbapenem use decreased significantly postintervention (slope change −0.117; 95% CI −0.198 to −0.036; P = .007), with no changes in anti-MRSA or anti-pseudomonal agents. Hospital B demonstrated increasing use of anti-MRSA (slope change + 0.394; 95% CI 0.198 to 0.589; P < .001), anti-pseudomonal (slope change + 0.378; 95% CI 0.075 to 0.681; P = .016), and carbapenem agents (slope change + 0.124; 95% CI 0.020 to 0.228; P = .021). No changes were observed in oral antibiotic use or C. difficile rates.

Shifting stewardship resources away from PAF did not increase total antibiotic use trends. Broad-spectrum antibiotics increased modestly with unclear clinical significance (≤1.3 DOT/1,000 PD). Antimicrobial stewardship strategies, beyond PAF, should continue to be assessed to maximize effectiveness relative to effort.

Fungal contamination of healthcare environments is increasingly recognized as a potential contributor to healthcare-associated infections, yet standardized environmental surveillance strategies remain poorly defined. Culture-based methods are widely used but have limitations including low sensitivity and prolonged turnaround time. Molecular approaches such as quantitative PCR (qPCR) may improve detection but have not been extensively evaluated in real-world hospital environments.

We conducted a longitudinal observational study across three inpatient units at a tertiary academic medical center from September 2023 through June 2024. Environmental samples were collected monthly from patient rooms and shared unit areas, including air, bathroom floors, HVAC components, patient bedrails, and linen storage areas. Samples were analyzed using direct-from-sample 18S qPCR and culture-based detection followed by 18S or ITS sequencing.

Among 742 samples collected, 474 (64%) were positive for fungi by qPCR compared with 213 (29%) by culture (P < .01). qPCR showed higher detection rates across most sample types, including air (35% vs 3%), bathroom floors (86% vs 42%), HVAC exhaust vents (72% vs 41%), and patient bedrails (78% vs 10%). Culture methods identified a broader diversity of fungi, including Talaromyces, Candida, and Penicillium, while qPCR detections were dominated by Malassezia.

Molecular and culture-based methods provide complementary insights into hospital fungal contamination. qPCR demonstrated greater sensitivity, while culture identified a broader range of viable fungi. Future surveillance strategies may benefit from leveraging qPCR sensitivity using targeted primers for clinically important fungi, reducing the need for broad sequencing and bioinformatic analysis.

To evaluate the pathogen-specific diagnostic yield of rectal and groin screening sites in a hospital-based multidrug-resistant organism (MDRO) surveillance program.

Prospective observational surveillance study.

Tertiary academic hospital in Northern Greece.

Hospitalized patients undergoing active MDRO screening based on predefined infection prevention and control criteria.

A pathogen-focused analysis was conducted using data from a prospective MDRO surveillance program between October 2024 and January 2025. Screening swabs were obtained from the rectum and groin. Target organisms included multidrug-resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa, vancomycin-resistant enterococci (VRE), Candida auris, and Acinetobacter spp. Pathogen-specific detection yields were calculated for each anatomical site.

Among 1,206 screening swabs, 308 (25.5%) were positive for at least one MDRO. Rectal swabs detected 95.8% of Klebsiella pneumoniae (K. pneumoniae) (92/96), 100% of VRE (59/59), and 66.7% of Pseudomonas aeruginosa (46/69). In contrast, 88.9% of Candida auris cases (24/27) were identified exclusively from groin swabs. Reliance on rectal screening alone would have missed nearly 90% of Candida auris carriers, whereas groin-only screening would have failed to detect most K. pneumoniae and all VRE carriers.

Anatomical site selection critically influences MDRO surveillance sensitivity. Rectal screening is optimal for MDROs colonizing the gastrointestinal tract, whereas groin sampling is essential for detecting Candida auris. Pathogen-targeted, site-specific surveillance strategies may substantially improve detection efficiency and optimize infection prevention efforts in high-prevalence hospital settings.

Use the electronic health record (EHR) to prospectively validate a risk prediction tool identifying patients at high-risk for carbapenem-resistant Enterobacterales (CRE).

Prospective, cross-sectional analysis.

Adults admitted to two hospitals in Atlanta, Georgia.

An EHR report calculated a CRE risk score on all admissions from 6/2024–3/2025. The risk score was determined from a prior model incorporating data from current and prior hospitalizations. Stool or perianal samples were cultured from a convenience sample of patients with the highest risk scores. A receiver operating curve analysis calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of various risk scores that could be used as a “threshold” for CRE admission testing. Using the threshold with the greatest Youden’s index, we estimated the cost of implementing a CRE screening program.

Of the 853 patients approached, 342 (40%) consented. Eleven (3.2%) tested positive for CRE. Patients with CRE had a higher median CRE risk score (0.19% vs 0.04%) than those who tested negative. The AUC of the model was 0.66. Using a testing threshold of 0.16% yielded a 55% sensitivity, 84% specificity, 10% PPV, and 98% NPV. The number needed to screen to diagnose 1 patient with CRE was 12 patients, and the screening program approximately costs $8,015/month.

An EHR-based risk prediction tool can detect patients likely to be colonized with CRE. In facilities with a low CRE prevalence, identifying a high-risk subset of patients to test could be a cost-effective infection prevention initiative.