To evaluate the incidence of hospital-onset bacteremia and fungemia (HOB) among solid organ malignancy (SOM), hematologic malignancy (HM), and hematopoietic cell transplant (HCT) therapy patients at a large cancer care center.

A single-center, observational, retrospective analysis was conducted for hospitalizations between January 1, 2018, and September 30, 2024, to identify patients with a first positive blood culture on or after day four of hospitalization. Hospitalizations were grouped into three categories: SOM, HM with HCT, and HM without HCT. The primary objective was to study the incidence of HOB. Secondary objectives: identification of risk factors for HOB events and pathogens associated with HOB events.

In 45,896 admissions, 1,470 HOB events were identified (incidence: 3.2%). The incidence of HOB was highest in the HM/HCT cohort (3.8%), followed by HM without HCT (2.3%) and SOM (0.9%). Risk factors of HOB identified included HM (OR 1.49), hospitalization within the past 90 days (OR 1.50), length of stay greater than or equal to 30 days (OR 6.74), intensive care unit (ICU) admission (OR 4.06), development of a CAUTI during admission (OR 23.23), or presence of a central line (OR 51.61). The most common pathogens were Escherichia coli (20.1%), coagulase-negative Staphylococci (19.0%), and Viridians streptococci (11.3%).

This study highlights the high incidence of HOB among cancer and HCT patients. The risk factors and differential rates of HOB in subpopulations of this demographic may help to inform targeted infection prevention efforts in cancer centers.

Cardiovascular surgeries can be lifesaving, but mediastinitis following these procedures results in increased morbidity and mortality. We sought to increase the number of days between cases of mediastinitis at our institution from an average of 58 to greater than 223 days, the upper control limit of our baseline data.

Quality improvement initiative.

Freestanding pediatric hospital.

We convened a multidisciplinary team to identify potential interventions. As many infections were not captured by the Solutions for Patient Safety definition, we monitored mediastinitis cases using the Society of Thoracic Surgeons definition. Our outcome measure was cases of mediastinitis. Plan-Do-Study-Act cycles were completed within our operating rooms (ORs) and cardiac care unit (CCU). We tracked measures on statistical process control charts and with descriptive statistics.

From a baseline of 58 days, our hospital has gone over 450 days without a case of mediastinitis. No special causes were noted in our balancing measures. All process measures showed improvement.

A series of OR- and CCU-based interventions significantly increased the amount of time between our cases of mediastinitis. This work highlights the importance of engaging both OR and postoperative stakeholders in proactive mediastinitis prevention work.

In the neonatal intensive care unit (NICU), outbreaks caused by methicillin-susceptible Staphylococcus aureus (MSSA) are less commonly described than outbreaks caused by methicillin-resistant Staphylococcus aureus (MRSA) despite the increased burden of MSSA infections.

To investigate a NICU MSSA outbreak utilizing whole-genome sequencing (WGS) and multi-locus sequencing typing (MLST) to identify transmission events.

An investigation was initiated in a level IV NICU after four patients developed MSSA skin and soft tissue infections (SSTI) within three weeks. MLST and WGS were performed on MSSA isolates obtained from clinical and surveillance specimens.

During the outbreak, 16 infants developed MSSA infections including SSTIs (n = 15) and bacteremia (n = 1). Thirteen SSTIs presented on neonates’ faces, all of whom were on non-invasive respiratory support. During 7 rounds of surveillance, an additional 31 patients were found to be colonized with MSSA. MLST identified a predominant cluster (ST-121). WGS found that all ST-121 isolates were closely related (≤10 genetic variants between isolates) suggesting likely transmission events, harbored the mupA gene, exhibited mupirocin MIC values ≥1,024 µg/mL, and were associated with infection. Multiple infection control measures were implemented including the “bare below the elbows” practice. No further mupirocin-resistant isolates were recovered or ST-121 SSTIs identified after Week 26.

WGS analysis furthered the MLST analysis and identified a single MLST as the outbreak-related strain. Successful control of this outbreak was achieved with a multitude of infection prevention and control methods.

To deconstruct the multiple levels of risk factors for Clostridioides difficile infection, using multilevel models (MLMs) accounting for patient movement.

Case-control study of patients hospitalized in three acute care Delaware hospitals, December 2019–December 2023.

Cases were patients aged ≥18 years who tested positive for hospital-onset C. difficile infection. Controls were patients aged ≥18 years hospitalized more than 72 hours, who did not test positive for C. difficile infection.

Hierarchical and cross-classified MLMs were used to calculate odds of C. difficile infection based on patient-level risk factors and to evaluate the variation in odds of infection attributable to environmental risk factors using the hospital unit(s) a patient was assigned to during hospitalization.

Our study included 1,223 patients (249 cases, 974 controls). In both models, greater odds of infection were associated with antibiotic exposure [adjusted odds ratio (aOR) = 11.20, 95% confidence interval (CI) = 7.19, 17.40; aOR = 12.80, 95% CI = 8.46, 19.40 for hierarchical and cross-classified models respectively] and health insurance (aOR = 1.74, 95% CI = 1.12, 2.68; aOR = 1.62, 95% CI = 1.03, 2.53; public vs. private). Median odds ratios (MOR) for both models indicated greater relevance of between-unit heterogeneity in the outcome than health insurance but less than antibiotic exposure (MOR = 1.83, 95% CI = 1.56, 2.30 and 2.71 95% CI = 2.10, 4.06).

Using multilevel methods accounting for patient movement, we found that while antibiotic use is the most important risk factor in patients that developed C. difficile infection, environmental risk factors are additionally important and should be considered in research involving hospitalized patients and healthcare-associated infections.

Assess knowledge, attitudes, and practices for control of Candidozyma auris among healthcare providers in long-term acute care hospitals (LTACHs).

Mixed methods; quantitative survey, followed by qualitative focus groups.

Two LTACHs with endemic spread of C. auris in the Chicago, Illinois region.

Convenience sample of frontline healthcare providers.

Fifty-three quantitative surveys were completed, and 21 individuals participated in qualitative focus groups. Survey participants were 92% female, 43% nurses, and 60% had >10 years of experience in their current role. They reported awareness of high-priority healthcare-associated multidrug-resistant pathogens, including C. auris (86%). Most participants agreed that C. auris is a national problem (74%), but only 56% agreed it was a problem in their own hospital. Barriers to C. auris prevention identified in the survey included understaffing (63%), lack of training (52%), lack of coworker accountability (48%), and lack of adequate time for task completion (49% for self, 48% for coworkers). Focus groups included 10 nurses, 5 patient care technicians, 3 secretaries, and 3 therapists. Focus groups highlighted the importance of enforcement and monitoring of prevention measures and the need for additional education. When asked how to improve infection prevention at their hospital, participants identified themes of education, improvements in enforcement and monitoring of prevention measures, staff support, and improvements in visual communication and healthcare design.

In this cohort of frontline LTACH healthcare providers, we identified multiple barriers to C. auris containment and elicited potential solutions. These insights suggest targets for future interventions to improve C. auris control.

Investigate the increased incidence of Mycobacterium chelonae positive respiratory cultures in hospitalized patients.

Apply the Healthcare-Associated Links in Transmission of Nontuberculous Mycobacteria (HALT NTM) toolkit to an outbreak investigation of M. chelonae.

Quaternary-care pediatric hospital and medical center in the United States with a recently opened LEED-certified critical care tower.

Adult and pediatric patients with M. chelonae positive respiratory cultures between June 2022 and January 2024.

An epidemiological investigation involving clinical and laboratory practices, water management, building construction and renovation projects. Environmental sampling of air vents, water sources and endoscope reprocessing equipment was performed. M. chelonae isolates recovered from patients and the environment were analyzed using whole genome sequencing and compared for relatedness.

Three clusters of matching environmental and patient isolates were identified. The most common environmental source of M. chelonae was ice/water dispensers with 40% positivity of sampled units. The critical care tower’s water system performance and metrics were suboptimal, leading to four physical remediation activities along with a hyperchlorination treatment.

Recent and ongoing construction along with the implementation of a LEED-certified, low-flow water system in a new critical care tower provided enhanced opportunities for M. chelonae exposure at point of use locations such as ice/water dispensers. More national infection prevention and control guidance is needed to address the infection risks from water sustainability efforts and construction activities in healthcare facilities.

Outbreak investigation and control are critical for preventing the spread of infectious diseases in healthcare settings. Traditional methods rely on manual processes, which are time-consuming and limited in scope. Whole genome sequencing (WGS) surveillance improves outbreak detection but still requires extensive manual chart reviews to identify transmission routes. Integrating artificial intelligence (AI) may enhance the efficiency and accuracy of these investigations.

We evaluated an AI tool developed to streamline healthcare outbreak investigations detected by the Enhanced Detection System for Healthcare-associated Transmission (EDS-HAT). For outbreaks detected between November 2021 and November 2023, multiple data elements were extracted from electronic health records (EHR) for all patients. The AI algorithm was applied to identify transmission routes, and its performance was assessed against expert manual reviews. Key measures included additional transmission routes identified and sensitivity.

Data from 172 outbreaks involving 476 case patients were analyzed. The AI tool identified 37 transmission routes that were missed by manual review, including procedures and provider routes. The algorithm achieved a sensitivity of 76.0% (95% confidence interval [CI] 71.1%–81.1%) compared to manual review, increasing to 91.7% (95% CI 87.7%–94.7%) after accounting for transmission at other facilities and downstream exposures.

The EDS-HAT AI tool significantly improved outbreak investigations by automating the identification of transmission routes, both with concordant findings of manual review as well as finding additional routes of transmission missed by traditional chart review. AI with genomic surveillance has the potential to optimize outbreak detection and investigation to streamline interventions in healthcare settings.

Therapies provided in nontraditional settings or by individuals without knowledge of core principles of infection prevention and control (IPC) may place consumers at risk of adverse events. We summarize findings from our recent consultation experiences in the Division of Healthcare Quality Promotion (DHQP) at the Centers for Disease Control and Prevention (CDC) to help identify targets for prevention efforts and enhanced consumer protections.

We reviewed records of DHQP consultations with state, local, or territorial health officials conducted from 2016 to 2023 to identify investigations involving nontraditional therapies or settings in the United States. Information collected included type of procedure or therapy, type of setting, pathogens involved, number of affected individuals, and types of IPC issues identified.

Of 1500 consultations, we identified 30 (2%) involving nontraditional therapies or settings. Therapies were performed for esthetic reasons, general wellness, or as treatment for pain. Infectious pathogens were identified in the blood, joint fluid, and skin and soft tissue, and included viruses, bacteria, and fungi. Investigations revealed breaches in injection safety, medical device reprocessing, medication preparation and handling, and environmental disinfection. Over 7000 consumers received notification regarding potential exposure to an infectious pathogen.

This summary highlights the potential infectious risks to consumers posed by nontraditional therapies, which may have unproven benefits and poorly defined risks. With continued expansion of nontraditional therapies and settings, consumers will benefit from education, training, and oversight of those who provide therapies in these settings.

Shorter antibiotic courses and transition to oral therapy for uncomplicated gram-negative bloodstream infections (GN-BSI) are evidence-supported yet remain challenging to implement. Here we report our experience with a GN-BSI antimicrobial stewardship (AS) quality improvement initiative in a large health system.

We implemented two sequential AS interventions in adult patients hospitalized with uncomplicated GN-BSI: (1) mandatory AS review of patients discharging on intravenous (IV) antibiotics (“OPAT review”) and (2) a clinical guideline informing oral antibiotic transition and duration, in our 22-hospital system. We evaluated the initiative from January 2018 to September 2024. Pre- and postimplementation rates of (1) IV antibiotics at discharge and (2) total length of antibiotic therapy were calculated across the following periods: preintervention, after OPAT review, and after guideline implementation. Secondary outcomes included duration <10 days, oral antibiotic prescribing, and guideline-recommended dosing.

3,231 patients (preintervention: 666, postOPAT review: 1,357, postguideline: 1,208) were included. We observed decreases in IV antibiotics at discharge (22.7% preintervention, 10.7% postOPAT review, and 9.2% postguideline, p < 0.001) and median length of treatment (13.5 days preintervention to 10.7 days postguideline, p < 0.001). We also observed improvement in durations <10 days (19.1% vs 45%, p < 0.001), oral antibiotic prescriptions, and appropriate dosing (2.8% vs 33.5%, p < 0.001), but no difference in rates of BSI recurrence, mortality, or C. difficile infection.

After implementing GN-BSI-focused AS initiatives in our large health system, we observed a shift toward more frequent oral rather than IV antibiotics at discharge, and shorter overall antibiotic durations, without obvious changes in adverse outcomes.

To explore the impact of an immersive virtual reality (VR) training module on infection prevention and control (IPC) knowledge and attitudes of healthcare personnel (HCP) and to demonstrate the use of VR for performance assessment in cleaning and disinfection of portable medical equipment (PME).

Quasi-experimental study.

Two academic medical centers and three long-term care facilities.

HCP in clinical roles were recruited.

Pilot sites trained participants on an immersive VR training module on PME cleaning and disinfection. Participants completed the VR module and pre- and post-knowledge and attitude assessment surveys, including a post-survey on the user experience of the VR module. Performance data were collected from the head-mounted displays (HMD) on the duration of the VR session, and participant performance including in-module task completion, hand hygiene compliance, PME disinfection percentage, and in-module quiz performance. Statistical significance and effect size were calculated using paired sample t-tests and Cohen’s D for pre- and post-survey results. HMD data were analyzed using descriptive statistics.

A total of 60 participants were recruited; 54 were included for analysis, with improvements in knowledge and attitudes post-training. Participant user experience was rated 50.19/55. HMD data demonstrated: 22-minute mean module duration, mean of 2.15/28 tasks not completed, mean of 2.56 missed hand hygiene opportunities, and 54% PME mean disinfection percentage, and varied performance on in-module quizzes.

Immersive VR training may be effective in improving HCP knowledge and attitudes in IPC concepts. Performance data collected through VR training can evaluate learner performance and be used to target training for improvement.