Background: Rates of Candida auris are rising across the US, particularly in New York. Due to C. auris’ affinity for environmental contamination and prolonged skin colonization, rapid implementation of comprehensive infection prevention & control (IP&C) measures is essential. Given the complexity and multidisciplinary involvement required for these efforts, we developed the C.A.R.E (Candida Auris Response & Engagement) framework in response to an inpatient outbreak to guide multidisciplinary efforts and provide a model for other facilities facing similar challenges with C. auris or other pathogens with extensive contact transmission. Methods: A C. auris cluster was identified in an 862-bed New York City academic medical center between July and October 2025. 23 cases were found involving a medical stepdown unit and adjacent intensive care unit. Baseline IP&C C. auris efforts include isolation precautions (gown and gloves), twice-daily room cleaning/disinfection, dedicated equipment, ATP testing of high touch surfaces (HTS) post terminal room cleaning, observations of personal protective equipment (PPE) use and hand hygiene, and screening of exposed roommates. After an August point prevalence surveillance (PPS) identified additional cases, we expanded interventions across various categories. The C.A.R.E. framework (Fig. 1) summarizes baseline and expanded efforts during this cluster. Figure 1. The C.A.R.E. (Candida Auris Response & Engagement) Framework to approaching a rise in C. auris cases. Results: Of 23 cases, 83% (19/23) were detected through surveillance. Clinical cases included bloodstream (3/4) and respiratory (1/4) sources. Shared rooms, either roommates or subsequent room occupants, were associated with 52% (12/23) of cases. Following implementation of the C.A.R.E. framework, further transmission ceased, confirmed by two negative rounds of PPS on each unit (Fig. 2). Figure 2. A timeline of C.auris cases identified on 2 units with corresponding IP&C effort implementation. To address identified gaps, a C. auris task force was created to improve IP&C processes. Key actions included clarifying equipment cleaning responsibility in collaboration with Environmental Services and Nursing, reevaluating the C. auris isolation category, and expanding screening for high-risk patients. Further, we incorporated fluorescent marker audits alongside ATP testing into routine practices to monitor environmental and equipment cleaning. While not all measures in the C.A.R.E. framework may be needed for every outbreak, facilities can adapt and scale interventions based on feasibility and outbreak severity. Conclusions: Effective prevention of C. auris transmission requires coordinated and multidisciplinary efforts. Establishing a structured response after early case detection can help close gaps in infection prevention that contribute to spread.

Background: vSNFs are known reservoirs of MDROs. However, data are lacking on how MDRO carriage may differ between residents in ventilator-capable (vBed) and non-ventilator-capable (non-vBed) areas within vSNFs. Methods: We conducted two point-prevalence MDRO sweeps in two vSNFs (Facility A: 44 vBeds/55 non-vBeds; Facility B: 31 vBeds/167 non-vBeds) from May-June 2025. All occupied beds were sampled except for Facility B’s non-vBeds which randomly sampled 50 beds due to size. Sampling involved hands, axilla/groin and peri-rectal areas cultured for MRSA, ESBL, VRE, C. auris, CRAB, and CRE, plus bilateral nares swabs cultured for MRSA and C. auris. Descriptive statistics summarized overall and MDRO-specific prevalence across body sites, with differences between vBed and non-vBed residents evaluated using t-tests and chi-square tests. Results: Overall MDRO prevalence was higher in vBeds (83.9%, 115/137) than non-vBeds (73.2%, 145/198; p=0.029) although the rank order of carriage was similar: MRSA > ESBL > VRE > C. auris > CRAB > CRE. vBed residents had significantly higher prevalence for all pathogens except MRSA (Figure). Multi-MDRO burden was greater in vBeds (mean 2.3 MDROs/resident) than non-vBeds (1.3; p<0.001); vBeds had a substantially higher likelihood of carrying ≥3 (46.0% vs 13.6%; p<0.001), ≥4 (24.1% vs 4.0%; p<0.001), or ≥5 MDROs (10.9% vs 1.0%; p<0.001). Emerging MDROs (CRE, CRAB, C. auris) were more prevalent in vBeds (43.1% vs. 19.7%; p<0.001), and were highly associated with endemic MDRO co-carriage (98.3% [58/59] vBeds; 97.4% [38/39] non?vBeds). The mean number of positive body sites was higher in vBeds (2.4 vs 2.0; p=0.003), with a higher likelihood of being positive at ≥2 sites (73.0% vs 59.6%; p=0.009), ≥3 sites (51.1% vs 39.4%; p=0.017), or 4 sites (35.0% vs 23.7%; p=0.010). vBed residents were more likely to have axilla/groin carriage (79.6% vs 58.1%; p<0.001) with non-significantly higher carriage at other sites (Figure). Nasal carriage patterns differed by organism: MRSA prevalence was similar between vBed and non?vBed residents (29.2% vs 32.8%; p=0.559), whereas C. auris was markedly higher in vBeds (29.2% vs 4.0%; p<0.001). Conclusion: Carriage of both endemic and emerging MDROs is widespread in vSNFs, affecting ~75% of residents regardless of ventilator status. However, vBed occupants were more likely to harbor an MDRO, and more likely to harbor multiple MDROs at multiple body sites. Emerging pathogens were also more common in vBed occupants, and were almost always associated with co-carriage of endemic MDROs. Guidance is needed for comprehensive MDRO response in vSNFs.

Background Ethiopia’s Ministry of Health (MoH), in collaboration with ICAP at Columbia University and the U.S. Centers for Disease Control and Prevention, sought to establish five infection prevention and control (IPC) Centers of Excellence (CoEs) with the ultimate goal of promoting effective and sustained implementation of IPC interventions. The CoEs are based on MoH IPC CoE guidance and leverage capacity gained through previous initiatives including implementation of a national IPC Advanced Training Program and a national monitoring and evaluation system. CoEs are encouraged to develop innovative solutions to challenges and serve as a reference for other healthcare facilities. We describe the initial phase of establishing IPC CoEs. Methods In 2023, five hospitals were selected based on the following criteria: experience implementing IPC interventions, hospital size and location, supportive leadership, and willingness to disseminate findings. Selected hospitals used the WHO multimodal improvement strategy to strengthen IPC over nine months, starting with environmental cleaning programs in maternity units. Facility-level baseline assessments and unit-level environmental cleaning needs assessments were created and conducted, followed by the development of operational plans to address identified gaps. The implementation team provided training, mentorship, and resources (e.g., CDC’s Best Practices for Environmental Cleaning in Healthcare Facilities) to each facility. Initial and follow-up audits assessing visual cleanliness and availability of appropriate cleaning materials were conducted after <3 months to assess progress. Results Baseline assessment demonstrated that all hospitals outsourced environmental cleaning services. None of the hospitals provided regular training upon employment or had job-aids for environmental cleaning staff. One hospital had an environmental cleaning policy. The maternity unit needs assessment identified gaps in IPC standard operating procedures (SOPs) at four hospitals. During implementation, all facilities developed operational plans to guide improvements, subsequently creating or updating environmental cleaning policies and SOPs. Hospitals worked with environmental cleaning companies to train cleaning staff and monitor cleaning. Mean audit scores across four hospitals increased from 51% at baseline (range 22-90%) to 83% (range 71-94%); a follow-up audit was not conducted at one hospital. Conclusion Initial efforts to establish IPC CoEs demonstrated that hospitals with existing IPC capacity built from national programs successfully led interventions to address identified gaps in environmental cleaning programs. Further work is needed to determine whether the interventions are sustainable long-term and whether interventions can be applied to other wards and healthcare facilities in the country.

Background: Midlines and peripherally-inserted central catheters (PICC) have increased in use due to their ease of insertion, low insertion risk to patients, and relatively low cost. Three common complications are central line-associated bloodstream infection (CLABSI), upper extremity deep venous thrombosis (DVT), and lumen occlusion. The literature reports PICC-associated CLABSI rates of 0.5-2.1 per 1000 catheter days, DVT rates of 1.4 to 9.5%, and lumen occlusion 5 to 16.1%. Both CLABSI and lumen occlusion are more common in multi-lumen than in single lumen (SL) PICC. Our objective is to evaluate the appropriateness of midline and PICC lumen selection, to assess for rates of complication, and to identify targets for clinical decision support intervention. Methods: Setting. This is a retrospective cohort study of adult patients ≥18 y.o. with a midline or PICC placed by the Vascular Access Team (VAT) between 1/1/24 and 6/30/25 at a 500-bed academic safety net and teaching hospital. Data abstraction. Indication for line placement was determined by VAT consultation order or manual chart review. Upper extremity DVT was screened by ICD10 codes and confirmed through manual chart review. CLABSI was determined through cross-reference to National Healthcare Safety Network data. Alteplase administration was used as a surrogate for lumen occlusion. Appropriateness criteria. Appropriateness of midline and PICC lumen selection was determined by adapting the Michigan Appropriateness Guide for Intravenous Catheters and Michigan Multi-Lumen Appropriateness Criteria (Figure 1). Results: Six hundred twelve midline (n=97, all SL) or PICCs (n=515) were placed into 524 patients in the study period (SL PICC, n=213; double lumen [DL] PICC, n=243; triple lumen [TL] PICC, n=59). The indication for line differed based on the line type (Table 1). The majority of midlines (95.9%) and SL PICCs (99.5%) were deemed appropriate; in contrast, 74.1% of DL PICC and 3.4% of TL PICC were considered appropriate. Complications of midline and PICC were rare (CLABSI: 0.19 per 1000 line days; DVT: 1.1%; lumen occlusion: 11.8%). Any complication occurred in 12.9% of cases and was more common in multi-lumen as compared to SL devices (i.e. midline or SL PICC) (19.9% vs 6.1%, P). Conclusion: Opportunities exist to reduce multi-lumen PICC insertion. This may decrease device-related complications. Optimizing lumen selection through clinical decision support may improve patient safety and vascular access outcomes.

Background: The National Healthcare Safety Network Antimicrobial Resistance Option (NHSN AR) is the nation’s primary tracking system for antimicrobial resistance. As of December 2025, 89% of Washington (WA) acute care hospitals are reporting antimicrobial susceptibility data to the AR option. The AR option provides a feature to generate antibiograms, a clinical tool to guide empiric antibiotic selection. However, the NHSN generated antibiograms do not adhere to the Clinical and Laboratory Standards Institute’s widely used M39 (CLSI M39) guidelines, which are best practices for antibiogram creation. Due to concerns of limited clinical applicability, we sought to create a CLSIM39 compliant antibiogram dashboard using NHSN AR data to support hospitals to make informed clinical decisions and track local resistance data. Methods: We downloaded the line list for All Antimicrobial Resistance Events from NHSN, transformed the data in R, and imported it into PowerBI to generate interactive antibiogram reports. The initial dashboard focused on the most commonly reported Gram-negative pathogens in WA: Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. We included isolates from blood, cerebrospinal fluid, lower respiratory tract, skin and soft tissue, wound, musculoskeletal, and urine specimens. Following CLSI M39 guidelines, we retained only the first isolate per organism per patient per calendar year. For specimen-specific reporting, we applied specimen filters by source prior to isolate selection. We selected antimicrobials and final susceptibility interpretations to calculate percent susceptible based on CLSIM39 and M100 guidelines. We suppressed organism-agent combinations with fewer than 30 isolates tested or lack of clinical relevance. To improve interpretability, we included the median and range of isolates tested for each organism. Three antibiograms were available: all-specimen sources, blood only, and urine only. To ensure data security, we assigned hospital alias codes and hosted the dashboard on a secure PowerBI platform. Results: WA DOH launched the NHSN AR Antibiogram Dashboard in December 2025. The dashboard displays susceptibility data based on analysis of 209,836 isolates collected between 1/1/2020 and 11/30/2025. We generated 74 all-specimen, 43 blood, and 74 urine-specific facility antibiograms. Currently, 93 antimicrobial stewards representing 80 hospitals have dashboard access, enabling them to track antimicrobial resistance trends year-to-year and compare resistance patterns by specimen source. Conclusion: The dashboard equips antimicrobial stewards with actionable data to monitor local resistance trends and inform facility-specific antimicrobial use guidelines. We plan to expand the dashboard to include additional organisms and specimen-specific reports.

Background: Cook Children's has two hospitals in North Texas and a network of clinics extending to the West, where a measles outbreak totalling 762 cases began on January 20, 2025. Measles symptoms include fever, cough, coryza, and conjunctivitis before the onset of the morbilliform rash. Timely isolation is recommended for measles. Isolation should continue from four days before to four days after the onset of rash. We hypothesized that contact, travel, and symptom-based screening could prevent amplification of measles in our healthcare settings and avoid positive screens in most neonates with febrile URI. Administratively, screening is unpopular because screening leads to longer registration times, more manpower requirements, and lower patient satisfaction scores. Methods: We selected five measles screening questions employing an adjustable scoring system in which a total score of 5 triggered a positive registration screen, rapid isolation, and further clinician assessment to determine actual testing needs. We scored practice patients by trial and error to settle upon a scheme, then deployed screening at all registration points. We adjusted questions based on evolving local measles epidemiology and redeployed the questions. We monitored throughput. Results: Screening for the first iteration started network-wide on March 31, 2025 (Table 1). Scoring included: 1 point for travel to/living in a measles area; 2 points for case exposure; 1 point for no measles vaccination; 2 points for fever; 1 point for ALL 3 C's – cough, congestion, and red eyes. Not anticipating that parents would answer "UNKNOWN" to some questions, a point counted for those instances. Initially, screen positivity was 0.32% (256 of 80,071), while there were 0 PCR-positive cases. The second iteration (55,603 screens) mended the oversight, reducing positive screens to 0.01%. During a third iteration (70,018 screens) following a visitation to a resort by an outbreak-linked case, "ANY," rather than "ALL of the 3 Cs," and/or rash was counted, increasing screen positivity to 0.03%. After a worrisome non-network case presented without travel or known exposure, a fourth iteration (215,957 screens) increased the maximum to 2 points for each 3C or rash (1/2 point for each), so children without travel or known exposure could have a positive screen. Positivity was 0.01%. For iterations 2-4 (341,578 screens), using measles PCR (n=27) positive as the gold standard, sensitivity was 100%, specificity 96%, PPV 50%, & NPV 100% (Table 2). Using "clinician felt PCR was needed" as a gold standard, clinicians ordered PCR in only 5.7% of positive screens and 0.01% of negative screens, including 3 children with fever and vaccine-associated rash only (Table 4). Registration throughput climbed by 117% but returned to baseline by 2 months (Graph). However, managers were pressed into service directing traffic until screening ended July 27, 2025. Conclusion: Exposure and symptom-based measles screening can avoid positive screens among low-risk febrile neonates with URI. This model should be employed in other areas to prevent measles transmission before the onset of rash.

This article introduces CriTaRep v1, a geo-coded event dataset documenting state repression against Crimean Tatars (2000–2024). Drawing on locally sourced materials in Crimean Tatar, Ukrainian, and Russian languages, CriTaRep records n = 709 repression events affecting more than 2,200 individual victims. We inductively identify 22 repression types across three categories: deprivation of liberty, legal and administrative repression, and physical repression. Russia’s 2014 annexation of Crimea marked the onset of a large-scale and systematic repression campaign against the Crimean Tatar population. We document a concentration of arbitrary searches on Thursdays, physical repression targeting elites, and intensified repression during periods of dissent. Empirical analyses show that repression spikes in response to protest activity. Russian authorities respond rapidly and increasingly harshly to dissent, pursuing a dual strategy of protest suppression and long-term deterrence. CriTaRep fills critical gaps in existing datasets and provides new opportunities to study patterns and mechanisms of demographically targeted repression in Russian-occupied territories and beyond.

Background: Prospective audit and feedback (PAF), a cornerstone of antimicrobial stewardship programs (ASP), relies on infectious disease (ID) clinicians’ direct review of electronic health records (EHR). We assessed the consistency of ID clinicians’ EHR-based assessments on real-world patient data. Methods: Antibiotic orders were randomly selected from a list of hospitalized adults at UCSF medical center. ID specialists (physicians and pharmacists) independently reviewed orders in real time using data from the EHR. Reviewers assessed the stated need for antibiotics, their agreement with necessity and choice, and overall appropriateness as defined by the National Antimicrobial Prescribing Survey (NAPS) tool. We measured agreement with either Cohen’s kappa or weighted Cohen’s kappa for ordinal observations. Results: Conclusion: We observed only modest agreement between independent ID clinicians’ reviews of antibiotic orders in a real-world assessment of inter-rater agreement. Discrepancies in assessments likely reflect a mixture of practice pattern variation, the intrinsic difficulty of assessing antibiotic choice without directly evaluating the patient, and variation due to the instruments used to collect information. Reference: Khanina A, Douglas AP, Yeoh DK, et al. Validation of the Antifungal National Antimicrobial Prescribing Survey (AF-NAPS) quality assessment tool. J Antimicrob Chemother. 2023;78(6):1367-1377. doi:10.1093/jac/dkad085

Background: The rapid clinical translation of human gene therapy products, particularly those utilizing replication-deficient viral vectors such as adenovirus and adeno-associated virus, has introduced novel biosafety considerations regarding "shedding"—the dissemination of the vector through patient urine, saliva or stool. While therapeutic protocols focus on patient outcomes, unintentional exposure of healthcare workers, caregivers, or other close contacts to these viral vectors represents a critical, yet under-analyzed, epidemiological event. Objective: To critically evaluate the hazards posed by accidental exposure to recombinant viral vectors from an epidemiological perspective, focusing on risks of horizontal transmission and immunological interference. Discussion: Although modern viral vectors are engineered for safety, unintentional exposure via mucosal contact or accidental inoculation poses multiple risks that warrant critical evaluation. First, immunological priming or seroconversion in an exposed individual can induce development of neutralizing antibodies against the specific vector capsid. Such "silent" immunization may preclude an individual from receiving future gene therapies, creating a long-term public health barrier. Second, while rare, the risk of in vivo recombination with wild-type viruses (e.g., a natural adenovirus infection) could theoretically result in the rescue of replication-competent viral variants. Third, the biodistribution and persistence of a transgene in non-target populations remains poorly characterized. Identifying and tracking these events is essential for refining risk to public health, the environment and development of adequate containment guidelines for human gene therapy treatments utilizing viral vectors. Conclusion: Unintentional exposure to recombinant viral vectors represents a significant, under-recognized epidemiological hazard. To ensure the safe expansion of genetic medicine, it is imperative to move beyond patient-centric monitoring and treat unintentional exposures as epidemiological data points. Systematic surveillance of these events is vital for establishing a real-world safety profile of genetic medicines, refining biosafety protocols and safeguarding public health.

Background: Portable medical equipment is a potential source for transmission of healthcare-associated pathogens. However, cleaning and disinfection of equipment is suboptimal in most healthcare facilities. Methods: On a long-term care facility (LTCF) ward, we examined the impact of an intervention in which a far ultraviolet-C wand was used to provide low-level disinfection of portable equipment and high-touch items in common areas. The surrogate markers bacteriophage MS2 and cauliflower mosaic virus DNA were inoculated onto 5 portable medical devices in the morning on day 1; in the afternoon on days 1, 3, and 7 swabs for recovery of the markers and culture for pathogens were obtained from 50 surfaces including portable equipment, common areas, and resident rooms. The percentages of sites with contamination were compared for the week of the intervention versus for a control week without far UV-C exposure. Results: In the control period, the DNA marker and bacteriophage MS2 disseminated widely and were detected on non-inoculated equipment, the nursing station, and in resident rooms. In comparison to the control period, there was a significant reduction in contamination with the DNA marker during the far UV-C intervention period (P<0.01), and a trend toward reduced contamination with bacteriophage MS2 (P=0.20) and pathogens (P=0.11) (Figure). Conclusions: Surrogate markers inoculated onto portable medical equipment disseminated widely throughout a LTCF ward. Daily low-level disinfection using a far UV-C wand reduced dissemination of the surrogate markers and there was a non-significant reduction in pathogen contamination.

Background: Urine testing is common among hospitalized patients with indwelling urinary catheters, yet variation in collection practices may compromise diagnostic accuracy and contribute to unnecessary downstream interventions. Guidelines recommend avoiding sampling from indwelling catheters when feasible to reduce contamination and detection of asymptomatic colonization. However, real-world compliance and its relationship to diagnostic urine test results, subsequent UTI diagnosis, and antimicrobial prescribing remain incompletely characterized. Methods: We conducted a retrospective medical record review of adult patients who underwent urine testing between March and November 2024 and had an indwelling urinary catheter or catheter removal within the prior 24 hours. Urine samples were classified as compliant if obtained after catheter removal and noncompliant if collected with a catheter in place. Analyses included all urine samples, with urinalysis-specific analyses limited to samples with available results. Urine collection practices, urinalysis parameters, urine culture outcomes, provider-documented UTI diagnoses, concordance with symptom-based criteria and IDSA/NHSN definitions, and antimicrobial prescribing following urine testing (receipt, timing, route, and duration) were summarized descriptively and stratified by compliance status. Results: A total of 921 urine samples were included; 663 had an initial urinalysis with reflex urine culture, while the remainder underwent urine culture alone. Samples compliant with recommended collection practices accounted for 59% of cases. Among samples with urinalysis, overall positivity was similar in compliant and noncompliant samples (57% vs 55%), with comparable urinalysis component positivity across compliance groups. Urine culture positivity was also similar across compliance groups in both reflex-culture and culture-only samples (29% vs 27% and 27% vs 29%). Gram-negative organisms predominated (13-15%), followed by fungi (7-12%) and Gram-positive organisms (2-4%), with fungal isolates more common among noncompliant samples. Antimicrobial therapy was prescribed in 19% of compliant samples compared with 15% of noncompliant samples and was frequently initiated before culture results in both groups. Median treatment duration was similar (7 vs 6 days). Provider-documented UTI diagnoses were common (80% vs 84%); however, only a portion met standardized UTI definitions (IDSA criteria: 41% compliant vs 32% noncompliant), with greater concordance observed among compliant samples. Conclusion: Recommended urine collection practices were followed in just over half of samples, with similar urine test positivity across compliance groups. Differences in organism distribution, antimicrobial prescribing, and concordance between provider-documented and standardized UTI diagnoses suggest that urine collection practices may influence diagnostic classification and antimicrobial decision-making in hospitalized adults.

Background: Pyogenic arthritis is a commonly encountered condition by Infectious Diseases clinicians and can occur in native joints as well as prosthetic joints. Synovial fluid culture is key in identifying the pathogen but there is a high incidence of culture-negative infections – up to 40% in native pyogenic arthritis and up to 15% in prosthetic joint infections. Multiplex polymerase chain reaction (PCR) testing offers the potential for rapid organism identification but real-world data on utilization of the test is lacking. Methods: A health system in the Chicagoland area recently began use of the BIOFIRE® Joint Infection Panel, which tests for 39 common bacterial and fungal causes of joint infection, as well as several markers of antimicrobial resistance. If the PCR is ordered, a synovial fluid culture must also be ordered. Of note, coagulase-negative staphylococci and Cutibacterium acnes are not targets on the PCR panel. A retrospective review was conducted of synovial fluid PCR testing among 5 hospitals from 1/1/25 – 12/6/25. Result: A total of 168 synovial fluid PCR tests were sent and 48 (28.4%) were positive. Age, gender, and race/ethnicity were similar between the PCR-positive and PCR-negative groups. In the PCR-positive and PCR-negative groups, 54.2% and 57.5% of patients had a prosthetic joint, respectively. All patients also had a synovial fluid culture obtained. Among patients with a positive PCR test, PCR and culture results were concordant for 31 (64.6%) patients. Of the 17 patients with a positive PCR but a discordant culture result, 14 had a negative synovial fluid culture and 3 had a culture identifying the organism found on PCR but also a second bacteria (Staphylococcus epidermidis, C. acnes, Finegoldia magna). Additionally, 90.8% of negative PCR tests had a corresponding negative culture result. Among the 12 patients with a negative PCR and a positive culture, six (50%) had growth of organisms included on the PCR panel (Staphylococcus aureus [n=2], Pseudomonas aeruginosa [n=2], Escherichia coli [n=1], Streptococcus infantarius [n=1]). The remaining isolates (Pasteurella multocida, Corynebacterium striatum, S. epidermidis [n=2], Dermabacter hominis, and Haemophilus parainfluenzae) were off-panel organisms. Conclusion: Synovial fluid PCR paired with culture can decrease the incidence of pyogenic arthritis without an identifiable pathogen among patients with native and prosthetic joint infections. Further research should examine the impact of the PCR test on antibiotic use, including time to targeted therapy, which may inform diagnostic stewardship recommendations regarding the test.

In a world of increasing human movement and displacement, language learning is an educational concern with significant implications for social inclusion in contexts of migration. This review of recent research analyses 40 empirical studies which explore various aspects of language education with adult migrants, investigating what they reveal regarding pedagogical approaches and the impact of policy on language learning, teaching, and assessment. It identifies issues in relation to diversity among adult migrant learners, the value of multilingual practices and the recognition of multiliteracies, as well as the potential of digital learning and affective approaches to language teaching. In addition, this review shows how migration and integration policies can influence language instruction, considering programme design, testing requirements, the learning of minoritised languages, and the role of educators in this field. It outlines directions for further research in areas including critical multilingual approaches to language teaching, equitable forms of assessment, trauma-informed pedagogy, the development of inclusive policies, and teacher education. This paper can thus inform educators, researchers, and policymakers by providing insights which may guide language-related educational support for adult migrants.

Background: Central line-associated bloodstream infection (CLABSI) is one of the four most common healthcare-associated infections worldwide and often results in serious consequences, including prolonged treatment duration, increased antibiotic usage costs, and higher mortality risk. In Vietnam, the CLABSI rate in intensive care units (ICUs) remains high, ranging from 5 to 10 episodes per 1,000 central venous catheter (CVC)-days. Therefore, implementing a CLABSI prevention bundle in ICUs is urgently necessary to ensure patient safety. Methods: A CLABSI prevention bundle was developed, consisting of an insertion bundle and a maintenance care bundle. Training and implementation were conducted in three ICU units: Neurosurgical ICU Dept. (NsICU), Internal Cardiology Dept. (IC), and Cardiac surgery resuscitation Dept. (CSR) from February to September 2025. External audits were conducted on all CVC insertion cases and 5% of CVC maintenance care opportunities in the three departments. Results: The total number of insertion bundle observation opportunities in NsICU, IC, and CSR were 67, 35, and 43 respectively, with average compliance rates increasing over time as follows: 96.76% (range 91.67–100%), 89.46% (range 79.63–95.83%), and 97.18% (range 85–100%). The total number of maintenance care observation opportunities in NsICU, IC, and CSR were 86, 63, and 53 respectively, with average compliance rates over time increasing as follows: 78.07% (range 70–87.5%), 87.75% (range 75–100%), and 82.41% (range 72.73–100%). Despite this, there were certain periods with low compliance rates for both the insertion and maintenance care bundles, particularly in areas such as proper hand hygiene procedures, insufficient antiseptic contact time, and non-compliance with drying time requirements. The average CLABSI rates post-intervention compared to pre-intervention in NsICU, IC, and CSR decreased from 2.38 to 1.6 (P=0.54), from 3.15 to 2.57 (P=0.68), and from 2.4 to 2.02 (P=0.75), respectively. Conclusion: The initial implementation of the CLABSI prevention bundle in three clinical departments led to progressively improved compliance with both CVC insertion and maintenance care practices, contributing to a reduction in CLABSI rates compared to the pre-intervention period.

Background: Nasal colonization with Staphylococcus aureus is a well-established risk factor for central line–associated bloodstream infections (CLABSIs). Many institutions have adopted screening and targeted decolonization strategies using intranasal mupirocin; however, real-world implementation remain incompletely characterized. Methods: We conducted a retrospective cohort study at University Hospitals Cleveland Medical Center to evaluate implementation of S. aureus screening and decolonization protocol among hospitalized adults undergoing central venous catheter (CVC) or peripherally inserted central catheter (PICC) placement. All patients aged ≥18 years admitted between October 1, 2023, and May 5, 2025, who had a catheter placed were included. Patients with documented bloodstream infection at the time of catheter placement were excluded. Primary implementation outcomes were: (1) proportion of patients screened for S. aureus colonization, and (2) proportion of colonized patients who received prophylactic intranasal mupirocin. Secondary outcomes included overall mupirocin use, bloodstream infection (BSI), and CLABSI rates. Mixed effects logistic regression was performed to identify factors associated with screening uptake. Results: Among 11,107 central lines placed, 63.4% underwent S. aureus screening. Of those screened, 22.6% tested positive for Staph aureus. Only 21.2% of colonized patients received intranasal mupirocin, corresponding to an overall mupirocin use rate of 5.3%. Across all central lines placed during the study period, the overall BSI and CLABSI rates were 0.91% and 0.67%, respectively. In adjusted analyses, screening was more likely among patients with arm insertion sites (OR 1.68, 95% CI 1.34–2.12), left-sided catheter (OR 1.18, 95% CI 1.07–1.29), increasing catheter lumens (three lumens: OR 1.27, 95% CI 1.11–1.47; four lumens: OR 2.22, 95% CI 1.58–3.12), ICU location (OR 1.66, 95% CI 1.49–1.84), and hematology–oncology services (OR 1.51, 95% CI 1.12–2.03). Although catheter type itself was not independently associated with screening, patients receiving PICCs demonstrated a positive, though non-significant, trend toward higher screening uptake compared with CVCs (OR 1.15, 95% CI 0.91–1.47). Tunneled catheters (OR 0.87, 95% CI 0.79–0.97) and a higher number of prior inpatient admissions were associated with lower odds of screening, while demographic characteristics and most comorbidities were not. Conclusions: S. aureus screening uptake among patients with central lines was low, and gaps at subsequent steps in the process resulted in fewer than one quarter of colonized patients receiving mupirocin. This stepwise breakdown in implementation highlights opportunities to improve protocol reliability by reducing decision points through more standardized approaches.

Background: High-level disinfection (HLD) of ultrasound probes is a required patient safety and regulatory practice. Automated vaporized hydrogen peroxide (VHP) systems, widely implemented for HLD since 2011, involve sizable capital costs, substantial maintenance requirements, and lengthy probe turnaround times. Chlorine dioxide foam has been used for ultrasound probe HLD in Europe since the late 1990s and received U.S. Food and Drug Administration clearance in 2023, consistent with the ANSI/AAMI ST58 standard. Evidence describing operational impact and feasibility in U.S. outpatient practice remains limited. Objective: To compare workflow and probe turnaround times between two ultrasound probe HLD methods and to evaluate the feasibility of chlorine dioxide foam implementation, including staff training requirements and adherence to reprocessing protocols. Methods: From October 2025 to January 2026, we conducted a quality improvement study examining the transition from automated VHP to manual chlorine dioxide foam for transducer HLD in an outpatient urology practice. A total of six registered nurses and four medical assistants participated in the study. Training provided to staff included manufacturer-provided online training, 1:1 in-person instruction, and direct observation to confirm competence with the new reprocessing protocol. Workflow steps for both HLD methods were mapped and compared. Outcomes measured included probe turnaround time (defined as the interval from immediate post-use handling to readiness for subsequent clinical use); number of workflow steps; feasibility of protocol-specific staff training; and adherence to the reprocessing protocol. Results: Each of the methods had a comparable number of workflow steps. Average probe turnaround time for chlorine dioxide was four minutes, while the automated VHP system required 14–15 minutes. Most participants completed manufacturer-provided online training. All participants received 15 minutes of 1:1 in-person instruction and direct observation. Overall, direct observation demonstrated high adherence to the reprocessing protocol. The manual foam process was integrated into routine clinical workflows without disruption to patient care. Conclusion: In a single outpatient urology practice, manual chlorine dioxide foam disinfection was feasible to implement and integrated into existing workflows with considerably shorter probe turnaround time while maintaining staff adherence. Results informed our policy on workflow steps, training, and documentation. Observations were conducted over a limited period, and findings may not be generalizable to other clinical settings.

Background: Patients with NAAT positive/toxin EIA-negative C. difficile infections (TNCDI) represent a spectrum from fulminant infection to asymptomatic colonization. We assessed differences in patient and provider factors associated with TNCDI treatment. Methods: A retrospective review was performed of all hospitalized patients ≥ 18 years with TNCDI from Jan 1st 2018 to Dec 31st 2024. Patients who received anti-CDI treatment were compared to those who did not using chi squared and Mann-Whitney U test. Variables with P≤0.2 were considered for inclusion in the final multivariable model. Results: We identified 550 patients with TNCDI; 488 (88.7%) received treatment while 62 (11.3%) did not (Table). The annual number of cases of untreated TNCDI significantly increased from 2018 to 2024 (p=0.026) (Figure). There were no significant differences in age, race, BMI, or provider services between the two groups. A higher proportion of untreated TNCDI occurred among women and in community-acquired cases. In multivariate analysis, community-acquired diagnosis of infection (within 72 hours of admission) was the only significant predictor of treatment (OR for treatment 0.50, p=0.03) (Table). In unadjusted analysis, treated TNCDI patients had higher LOS after diagnosis and mortality compared to untreated patients. Conclusion: The vast majority of TNCDI received anti-CDI treatment, though the proportion of untreated TNCDI cases increased significantly over time, likely reflecting antibiotic stewardship-based improvements. Patient and provider factors were similar between treated and untreated TNCDI groups, although small sample size of untreated TNCDI patients limited power. Treated TNCDI was associated with significantly longer LOS and mortality compared to untreated TNCDI.

Background Decolonization decreases risk of healthcare-associated and post-discharge infections. Most decolonization data are derived from methicillin-resistant Staphylococcus aureus (MRSA) studies, although results have been extended to other multidrug-resistant organisms (MDRO). Understanding MDRO target outcomes and preferred product characteristics may inform new decolonization protocols, products, and strategic integration into infection prevention practices. Methods We surveyed 134 Society for Healthcare Epidemiology of America (SHEA) Research Network-affiliated US healthcare facilities on MDRO surveillance, isolation, and deisolation practices. The survey asked about decolonization practices, needs, and gaps. The survey was administered via REDCap from 1/7/25-2/25/25, and responses were de-identified. Frequencies and proportions were analyzed in REDCap and Excel. This survey was considered nonhuman subjects research by the Mass General Brigham Institutional Review Board. Results Of 134 facilities surveyed, 52 (39%) completed the decolonization section of the survey. 38/52 (73%) facilities reported performing some form of decolonization. Of these, 87% said the most important decolonization outcome is reduced risk of progression to infection. Lab-based clearance (8%) and reduced risk of transmission (5%) were considered less important. Using carbapenem-resistant Enterobacterales (CRE) as an example of an MDRO without established decolonization products or protocols, respondents’ interest in decolonization increased with patient vulnerability to invasive disease (Figure 1). Preferred decolonization agent characteristics varied by patient population, e.g. a majority selected transmission interruption in the non-intensive care unit compared to patient-specific efficacy in the transplant population (Figure 2). Half of the surveyed facilities reported having unmet decolonization needs. Across all patient types, the most commonly reported reasons not to decolonize were “efficacy not worth the effort”, “wouldn’t protect the patient” and “effect won’t last” (Figure 3). Approximately one quarter of respondents said they would not want to decolonize for “other” reasons including, “no established protocol” and “unclear evidence”. Conclusions Facilities reported valuing decolonization as a means to prevent progression to infection, but transmission prevention was rarely selected as an important outcome of decolonization. Due to reported preferences of agent characteristics by patient population, there may be opportunities for development of population-specific products. Product design should prioritize decolonization agents that are easy to administer, highly effective, and provide long-lasting impact. Evidence-based, standardized decolonization protocols, particularly for gram negative MDRO, are needed to address barriers and support decolonization in prevention of transmission as well as infection.