Background: Parvovirus B19 causes a spectrum of illness in children, from asymptomatic infection to severe organ-invasive disease, particularly in immunocompromised hosts. Current infection prevention guidelines recommend prolonged isolation for patients with chronic infection, yet no validated quantitative PCR threshold exists to guide discontinuation of precautions. This uncertainty may lead to extended isolation and resource utilization. Objective: To evaluate the association between quantitative parvovirus B19 PCR levels and clinical manifestations in pediatric patients and explore implications for infection control practices. Methods: We conducted a retrospective observational study of patients aged 0–18 years who underwent quantitative parvovirus B19 PCR testing in a quaternary care hospital system from January–December 2024. Demographics, clinical features, and treatment were abstracted from the electronic medical record. Encounter-level and patient-level characteristics were summarized using Fisher’s exact and Kruskal-Wallis tests. Multivariable generalized estimating equation (GEE) models assessed factors associated with symptomatic infection. Optimal viral load cut-off associated with symptomatology was determined using Youden’s index. A patient with symptomatic infection was defined as having one or more signs/symptoms associated with clinical parvovirus B19 infection (fever, rash, arthropathy, cytopenias, carditis, hepatitis, etc.) that was not explained by a pre-existing underlying condition. Results: Among 103 patients (median age 7 years [IQR 4–11]), 224 encounters were analyzed; 57% were symptomatic (Table 1). Median viral load was 647,500 IU/mL (IQR 6,800–15,500,000) in symptomatic encounters versus 2,000 IU/mL (IQR 900–8,400) in asymptomatic (p<0.001). An optimal threshold of ?25,000 IU/mL (log10 ?4.4) was strongly associated with symptoms (adjusted OR [aOR] 6.54, 95% CI 1.98–21.64; p=0.002). Additional predictors associated with symptoms included hemoglobinopathy (aOR <700; p<0.001) and diagnostic testing indication (aOR 155.01, p<0.001). Viral load was not associated with organ-invasive disease or treatment response. Conclusions: Higher parvovirus B19 viral loads are associated with symptomatic infection, but not with organ invasion or treatment initiation. A threshold of ?25,000 IU/mL may inform future infection prevention guidance, potentially helping to modify isolation practices and improving resource utilization.

Background: Admission to a room previously occupied by a patient with Clostridioides difficile infection (CDI) has been identified as a risk for CDI. However, previous studies have not included molecular typing to definitively link healthcare-associated CDI (HA-CDI) cases to prior room occupants or to residual spore contamination on surfaces. Methods: In an acute care hospital, we conducted a 1-year cohort study to determine the proportion of HA-CDI cases linked to prior room occupants with CDI or to room surfaces remaining contaminated after post-discharge cleaning and disinfection. Cultures were collected from post-discharge CDI and non-CDI rooms. Whole genome sequencing was used to determine relatedness of isolates. We calculated the percentage of HA-CDI cases infected with isolates genomically related to prior room or ward-level exposures. Results: Of 5,746 patients admitted, 22 had community-associated CDI and 55 were diagnosed with HA-CDI. C. difficile was recovered from 79 of 327 (21%) post-discharge rooms, including 14 of 36 (39%) CDI rooms and 83 of 287 (29%) non-CDI rooms. Of 1,773 patients with room-level exposure to prior CDI patients or contaminated surfaces, 21 (1%) developed HA-CDI, but none were infected with genomically-related isolates (Figure 1.A). Of 49 patients developing HA-CDI after ward-level exposures, 3 were infected with isolates genomically related to prior CDI patients or contaminated surfaces on the ward (1.B). Conclusion: Despite frequent exposure to rooms previously occupied by patients with CDI or contaminated with C. difficile, no HA-CDI cases were linked to prior room exposures based on whole genome sequencing.

Background: Device stewardship is an important infection prevention opportunity for catheter-associated urinary tract infection reduction. This starts with the avoidance of initial catheter placement without definitive clinical need, especially with the option of alternative of non-invasive foley devices for both male and female anatomy. Urinary catheter placement in the Emergency Department (ED) is an area of opportunity where catheter placement could be avoided in favor of non-invasive management. This study assessed potential unnecessary catheter placement in a community hospital-based ED with a focus on ED-placed urinary catheters removed within 24 hours of admission. Methods: All patient encounters with an indwelling urinary catheter placed in 3 community hospital EDs from May 20, 2024 through September 29, 2025 were included. Encounters for patients who required chronic urinary catheterization (defined as the presence of a urinary catheter for ≥ 45 days) who had catheter replacement in the ED were excluded. The frequency of possible unnecessary catheter placement was defined as the number of catheters removed within 24 hours out of the total encounters. A subset of charts for encounters with a possible unnecessary catheter placed were reviewed to assess for commonalities to guide quality improvement. Results: During the study period, across all 3 facilities, 27.7% (385/1391) of urinary catheters placed in the ED were removed within 24 hours with a similar frequency at each individual facility (Hospital 1 = 24.6% (82/334), Hospital 2 = 24.9% (121/486), Hospital 3 = 31.9% (182/571)). The monthly frequency of possible unnecessary catheter placement ranged between 12.5% to 48.4% (Figure 1). Based on chart review, several common themes were noted, including placement in patients with altered mental status without hemodynamic instability and in patients with brief transient hemodynamic instability weaned from low dose inotropic medications and ventilation within 24 hours of admission. A clinical decision-making tool was created targeting recurrent scenarios that might warrant catheter avoidance (Figure 2). Discussion: ED placement of urinary catheters that were quickly removed by clinical teams upon admission was common across 3 community-based hospitals, highlighting possible unnecessary placement upon evaluation by the inpatient teams. A proposed clinical decision tool was created to help guide physicians in the reasoning behind the perceived need for catheter placement in the ED versus waiting to evaluate clinical need upon admission based upon patient course and failure of alternative methods for urine output management.

Background: Due to concern for ongoing colonization and substantial risks posed by horizontal transmission of RGN in acute care settings, it is common practice in many institutions to employ indefinite CP once a patient tests positive for resistant bacteria. However, it is important to recognize the adverse environmental and patient care costs of CP which has led institutions to consider structured CP discontinuation policies. Emerging evidence supports implementation of practices to safely discontinue CP in select patients following a defined period without subsequent positive cultures. Despite this, standardized methods to identify eligible patients remain unexplored. Objective: As a part of a larger study to evaluate our institution’s adopted policy of contact precaution (CP) discontinuation for resistant gram negative organisms (RGNs) after one year of no subsequent positive cultures, we aimed to assess the utility of a retrospective audit of medical records as a strategy to identify patients eligible for CP discontinuation. Methods: A retrospective chart review of patients with identified RGNs in the Children’s Hospital of Philadelphia (CHOP) electronic medical record (EMR) system from May 2021 to November. In concordance with the internal policy established November 202 recommending removal of contact precautions after one year without subsequent RGN culture positivity, each chart was assessed for the date and organism of the initial infection as well as last positive culture to determine eligibility for CP removal. Patients with carbapenem resistant organisms or those with cystic fibrosis were excluded from the review. Results: Of the/of the identified patients were determined to be eligible for de-labeling. The time required to determine eligibility status in the EMR was approximately 1 minute per patient totaling around 2.5 hours of review. Conclusion: This review identified a significant proportion of RGN-positive patients for whom standing CP were not removed in real time, allowing for an efficient update of CP status to align with hospital policy. Removal of CP not only alleviates a significant environmental and financial burden but also could contribute to a more positive patient/family experience during the hospital stay. The results of this study suggest that employing prospective plans for chart audits as CP discontinuation policies are modified would improve resource utilization.

Background: Timely conversion of intravenous (IV) antibiotics to oral (PO) therapy remains a core principle of antimicrobial stewardship. Appropriate transition from IV to PO medications reduces the potential for adverse events such as line infections and thrombophlebitis but may also reduce healthcare costs by potentially facilitating a timelier discharge. In addition, IV to PO supports sustainability initiatives by reducing the environmental impact of single-use IV bags and tubing, and PO antibiotics are prepared more quickly by pharmacy and administered easier by nursing, lessening staffing requirements. Methods: Emory Healthcare developed a fully automated dashboard to monitor IV to PO transitions and assess adherence to institutional protocols. The dashboard details antibiotic utilization and documented indication for select IV and PO agents among inpatients at Emory Healthcare from January 2024 to the current year-to-date. Selected antibiotics were chosen based on their inclusion in the Emory Healthcare IV to PO Medication Conversion by Pharmacist Protocol. The dashboard integrates data from the electronic health record including antibiotic selection, infection type, and days of therapy. The data is organized into sections and graphs for streamlined viewing and clear interpretation. Results: A dashboard was successfully created to monitor IV to PO therapy conversions. The first section (Figure A) shows days of therapy (DOT), which can be filtered by operating unit and indication. The second section (Figure B) displays DOT filtered by route and indication for the specific antibiotics included in the Emory Healthcare IV to PO conversion protocol. The third section (Figure C) displays DOT filtered by route and antibiotic for all indications. The antibiotic and indication charts can additionally be filtered to include any combination of antibiotics, indications, facility, unit type, and units. The dashboard also includes tables with antibiotic route of administration data stratified by facility, unit type (ie. oncology, emergency, operating room, acute care), and individual unit. Conclusion: The dashboard provides a novel tool for ASPs to continuously assess utilization and adherence to the Emory Healthcare IV to PO conversion protocol. The dashboard is interactive, customizable, and data is readily available, making it a key tool for optimizing stewardship practices. The data can also be used to identify stewardship opportunities, set quality improvement targets, and quickly display information to key stakeholders.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an opportunistic organism that can cause serious infections that are difficult to treat. CRAB often possesses concerning resistance mechanisms, including carbapenemase enzymes, which can spread resistance through mobile genetic elements. Prevention-driven point prevalence surveys (PPSs), a strategy outlined in the Centers for Disease Control and Prevention’s multidrug-resistant (MDRO) prevention guidance, can enable early identification of colonized patients and inform targeted infection control measures to mitigate transmission. From 2024-2025, the Louisiana Office of Public Health partnered with a long-term acute care hospital (LTACH) to implement prevention-driven PPSs for CRAB. Methods: LTACHs were targeted due to the increased risk of MDRO colonization among high-acuity patients admitted for prolonged periods. A webinar was held for LTACH facilities in a region of the state with a high CRAB burden, and one facility agreed to participate. The PPSs were conducted quarterly for one year. Testing was performed by the Southeast Antimicrobial Resistance Laboratory Network (ARLN) and included organism confirmation, real-time polymerase chain reaction to detect carbapenemase genes, antimicrobial susceptibility testing, and whole genome sequencing (WGS). Methods are described on ARLN's website. Genetic relatedness and pairwise single nucleotide polymorphism (SNP) differences among isolates were analyzed using the National Center for Biotechnology Information Pathogen Detection Isolate Browser. Result: From February 2024 to January 2025, 121 specimens were collected from 87 patients. Screening sites included axilla-groin (71%), wounds (20%), and rectum (9%). Five percent (4/87) of the patients were found to be colonized with CRAB. These isolates were resistant to all carbapenems tested (meropenem, doripenem, and imipenem), produced OXA-23 or OXA-24/40 carbapenemases, and two of the isolates were pan-resistant. Three CRAB patients were identified within the same SNP cluster and were closely related, averaging 12 SNP differences. One CRAB patient was also colonized with Stenotrophomonas maltophilia. Additionally, 4 different patients (5%) tested positive for Pseudomonas aeruginosa; 3 were carbapenem-resistant, and of these, 1 was pan-resistant. Colonized patients exhibited typical risk factors for MDRO colonization, including underlying conditions, wounds, recent antimicrobial exposure, and indwelling device use. Conclusion: Screenings enabled routine assessment of CRAB colonization burden. PPSs identified colonized patients who may have otherwise gone unrecognized, allowing for timely implementation of infection control actions. WGS detected a previously-unknown cluster, indicating transmission within healthcare facilities. These findings align with and support current MDRO containment guidance and underscore the importance of conducting screenings in high-risk healthcare settings to reduce MDRO exposure among vulnerable patients.

This study assessed the predatory activity (PA) of Dactylellina candida (Dc) and Arthrobotrys musiformis (Am) against Haemonchus contortus infective larvae (HcIL). It also examined the effect of crude extracts from HcIL, Panagrellus redivivus (Pr), and Turbatryx aceti (Ta) on liquid cultures of these fungi as potential enhancers of their nematocidal activity against HcIL. The fungi were cultured in sweet potato dextrose broth (SPDB), and the corresponding nematode crude extract (NCE) was added to flasks containing the fungus. Control groups included fungi without extracts and media alone. Liquid culture filtrates were assessed at three concentrations (100, 50, and 25 mg/mL) against HcIL during 72 hours at 18–25°C. The highest mortality (86.61%) was observed with Dc stimulated by HcIL crude extract (HcCE) at 100 mg/mL (p < 0.05). Arthrobotrys musiformis showed 47.49% mortality when stimulated with HcCE. Both fungi increased their nematocidal activity when exposed to HcCE, demonstrating their potential nematocidal activity against H. contortus.

Background: Blood culture contamination (BCC) is a persistent problem in the hospital, contributing to unnecessary antibiotic exposure, excessive diagnostic testing, increased length of stay, and higher costs. For patients with suspected or confirmed sepsis, BCC has particularly serious implications, as early identification of the causative pathogen and prompt initiation of appropriate antimicrobial therapy are critical. National benchmarks define <3% contamination as acceptable, yet emerging evidence supports a more ambitious goal of ?1%, particularly in high-risk populations such as patients with sepsis. Methods Using a sequential practice change across three time periods: (1) no blood culture diversion device (2019–2020), (2) implementation of manual blood diversion device (BDD) #1 (2021–2022), and (3) automatic BDD#2 (2023–present), we have achieved a 74% reduction in BCC (Figure 1). In this project, we further evaluated the impact of this overall reduction on patients admitted with suspected or confirmed sepsis. Results Data were extracted for adult patients admitted to the hospital who had a final discharge diagnosis of sepsis, regardless of their initial admission diagnosis. A total of 154 blood cultures were analyzed across the three time periods. During period 1 (2019 & 2020), 6/62 cultures were contaminated (9.7%). After implementation of manual BDD#1 (11/17/2021-2022), BCC decreased to 2/30 cultures (6.7%). After transition to automatic BDD#2 (1/20/2023-present), BCC further declined to 3/62 cultures (4.8%). One-way analysis of variance (ANOVA) demonstrated a statistically significant difference in BCC rates across the time periods, with post hoc comparisons showing a significantly lower contamination rate when using BDD#2 as compared with both no BDD and manual BDD#1. Additionally, manual BDD#1 was used in 48% (30/62) of the blood culture collections versus to 78% for automatic BDD#2, with staff feedback indicating greater ease of use with the automatic BDD#2 system. Conclusion Adoption of BDD was associated with a 50% (9.7-4.8%) reduction in BCC, with the lowest rates following implementation of automatic BDD#2. Compliance with BDD use was also highest with automatic BDD#2, and staff reported greater ease of use. These findings underscore the importance of optimizing BCC practices as a key component of sepsis management, antimicrobial stewardship, and patient safety efforts. Additional research is needed to identify strategies to further reduce BCC in sepsis patients, with particular attention to BDD usability, workflow integration, and process adherence during real-world use.

We give a new definition of matrix Schwarzian derivative, which is simpler than the Lagrange Schwarzian derivative and also provides an alternative to other definitions which appear in the literature. Some basic properties are discussed, in particular, analogs of Möbius invariance and the result of a change of independent variable, these being the two properties of the scalar Schwarzian derivative often considered to account for its universality. We then use our new definition of matrix Schwarzian derivative to construct new Schwarzian matrix ordinary and partial differential equation hierarchies: a Schwarzian matrix second Painlevé hierarchy and a Schwarzian matrix Korteweg–de Vries hierarchy, respectively. In addition, we define a new matrix second Painlevé hierarchy.

Background: Carbapenemase-producing Enterobacterales (CPE) spread silently and offer limited treatment options, making contact screening essential. We evaluated the real-world implementation of contact screening, focusing on screening timing (at exposure vs. at readmission) and positivity rates by room type and carbapenemase enzyme. Methods: This retrospective observational study was conducted at a 2,700-bed tertiary care hospital and included patients identified as contacts of CPE index cases with exposure between 1 January and 31 May 2024. Contacts were defined as patients who shared a room or occupied open beds in the same intensive care unit (ICU) with an index case during the period from 4 days before the index patient’s positive specimen collection until the reporting of results. Screening was performed with stool or rectal swabs either at the time of exposure or upon readmission within 6 months. CPE acquisition was defined as detection of isolates harbouring the same carbapenemase enzyme as the corresponding index case. Acquisition rates were compared by screening timing, room type, and carbapenemase enzyme. Samples were processed using culture or the Xpert Carba-R assay. Result: Among 2,003 contacts linked to 336 index patients, 1,401 (70%) underwent screening, of whom 37 (2.6%) tested positive. Immediate screening identified 30/1,184 (2.5%) positives, while readmission screening detected 7/217 (3.2%); two additional acquisitions were identified from clinical specimens among unscreened readmitted contacts. Acquisition was more frequent after exposure to KPC-producing organisms than NDM-producing organisms (3.7% [26/706] vs. 1.5% [8/520]; p=0.02) and higher in multi-patient rooms than in two-bed or open-bed ICU settings combined (3.4% [34/1004] vs 0.8% [3/397]; p=0.006). Conclusion: CPE acquisition was more likely following exposure to KPC-producing organisms and in multi-patient rooms. Systematic readmission screening identified additional carriers who would otherwise have been missed. These findings support tailored infection-prevention strategies that consider carbapenemase enzyme and the physical care environment, particularly in healthcare systems where multi-patient rooms are common.

Background: In 2026, demonstrating the value of healthcare epidemiology and infection prevention is critical amid vaccine and science denialism and federal funding cuts. As hospitals face increasing financial pressures, executives may question sustained investment in healthcare epidemiologists and infection preventionists. Clinicians and nurses may also disengage from pay-for-performance or value-based initiatives. This project aimed to present a practical method for quantifying program outcomes for senior leadership, expressed as lives saved and costs avoided. Methods: Twelve types of healthcare-associated infections (HAI), including device-associated, laboratory, and surgical site infections—were identified across an eight-hospital health system in upstate New York using standardized CDC National Healthcare Safety Network definitions. Attributable mortality estimates were derived from published evidence. In the absence of improvement, infection rates were assumed stable year to year. Rates (R) from 2024 were multiplied by corresponding 2025 denominators (device days, patient days, or surgeries) (PD2025) to calculate expected infections (EI). Infections prevented (IP) were calculated as IP2025 = EI2025 – OI2025, where OI represents observed infections. To estimate total lives saved (TS) in 2025 compared with 2024, infections prevented (IP2025) were multiplied by the attributable mortality (AM) of each infection type to obtain lives saved (LS), then summed: IP20251 ՠAM1 = LS1; TS = ?LS. One-way sensitivity analyses across reported mortality ranges were performed using R. Cost avoidance was determined using facility-specific HAI costs and nationally reported cost ranges. Results: In 2025, 67 HAIs were prevented, corresponding to about five additional lives saved compared with the previous year (Table). The method also allowed estimation of costs and bed days saved. In our health system, each central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) adds $97,588 and $61,939 in excess costs and 16.9 and 8.8 additional bed days, respectively. Using these and other adjusted HAI cost estimates for 2025, prevention of 67 infections yielded approximately $3.1 million in cost avoidance and 842 fewer inpatient bed days. Conclusion: Expressing outcomes as lives saved resonates more with executives and clinicians than abstract performance metrics. Because overuse of preventive measures (including unnecessary isolation) can cause collateral harm, prioritizing mortality outcomes is more relevant than pursuing reductions in rates or standardized infection ratios of all HAI types at any cost. This practical, generalizable method enables facilities, including those with limited research infrastructure, to quantify the impact of infection prevention and control and highlights the substantial effect of carbapenem-resistant Enterobacterales on overall mortality.

Organic vegetable production relies on ecologically based practices; however, insect pest management remains a major constraint, particularly in Brassica crops. Organic insecticides often provide inconsistent control, are expensive, and require repeated applications. Mesotunnels, medium-sized tunnels (0.9–1.0 m tall) covered with insect netting, have emerged as a pest management tool for organic vegetable growers. They function as physical barriers that exclude pests while maintaining near-ambient microclimatic conditions. This two-year field study was conducted during the fall growing seasons of 2024 and 2025 on certified organic land at Iowa State University Horticulture Research Station in Ames, Iowa, to evaluate the effectiveness of mesotunnels for pest management and season extension in organic napa cabbage (Brassica rapa var. pekinensis cv. ‘Minuet’). Treatments were arranged in a randomized complete block design with four replications: (i) Mesotunnel, (ii) Mesotunnel + OMRI-listed insecticide, (iii) OMRI-listed insecticide (pyrethrins, Bacillus thuringiensis, and potassium salts of fatty acids), (iv) Low tunnel, and (v) an untreated control. Weekly pest scouting quantified the abundance of key Brassicaceae pests, including caterpillars, flea beetles, harlequin bugs, and aphids. Microclimate variables, including temperature and relative humidity, were continuously monitored at canopy height within each treatment. Marketable and nonmarketable yield were assessed at harvest using USDA commercial grading standards. Across both years, mesotunnel-based treatments consistently reduced insect abundance and produced the greatest number and weight of marketable napa cabbage heads relative to the control. Mesotunnels also advanced crop maturity, resulting in a higher proportion of marketable heads at the first harvest compared with open-field conditions. This is likely associated with modified microclimatic conditions that supported vegetative growth and reduced pest pressure. These findings demonstrate that mesotunnels provide an effective, non-chemical pest management strategy that enhances yield and reduces reliance on organic insecticides in organic napa cabbage production systems.

Bernard Williams contends that philosophy is part of a broader humanistic enterprise of ‘making sense of’ ourselves and our activities, including the activity of science. Whereas the scientific enterprise purports to offer an absolute conception of the world as it is (independently of any local perspective on it), the humanistic enterprise cannot disengage itself from the contingent history of our ideas upon which it operates. While I agree with Williams that philosophy should be more attentive to history, his account of philosophy, from which he derives this conclusion, is fatally flawed, being unable to meet three perennial challenges to any principled defense of philosophy as a discipline: i.e., the questions of authority, incubativity and peculiarity. Those challenges can be met only if we understand philosophy not as a humanistic discipline that is part of the broader humanistic enterprise, but as a distinctively normative discipline that tasks itself with finding answers to explicitly or implicitly normative questions, in contrast to various scientific and humanistic disciplines of descriptive inquiry. In this paper, I argue for the equivalence of philosophicality with normativity, explicate the theoretical and practical implications of the normative account of philosophy, and defend it against potential objections.

Background: There is an increased recognition of importance of quality of environmental cleaning services and its impact on hospital associated infections rates in healthcare facilities. In the era of growing prevalence of multidrug resistance organisms, a strong focus on high environmental services becomes even more important. From January 2024 to December 2024, our 400-bed acute care hospital with single patient room design located in capital of Slovakia has implemented a digital assessment tool of quality environmental cleaning services and measured its impact on hospital associated infections (HAI) rates. Methods: During a calendar year of 2024, two-hundred inpatient rooms were marked with fluorescent marker, fifty per quarter. These rooms were in adult intensive care unit and neonatal intensive care unit, general inpatient units, labor and delivery and mother and baby units. There were pre-defined 8 high touched surfaces marked in general inpatient rooms with 6 additional high touched surfaces in adjunct bathrooms and 10 high touched surfaces marked in intensive care unit’s patient rooms. The presence of fluorescent markings was evaluated using torch 24 hours after cleaning was performed and reported in digital tool downloaded on a mobile phone that provided almost real time data analysis of quality of cleaning based on the percentage of cleaned surfaces, by hospital, by units as well as by type of high touched surfaces. At the end of each quarter, results were discussed with units’ leadership and environment of care manager with quality improvement plan creation and implementation. Due to resource constraints, HAI surveillance relied on point prevalence surveys conducted in December 2023 and December 2024 rather than continuous incidence-based surveillance. Results: Our goal was to achieve 80% of effectively cleaned high touched surfaces, showing no residuals of fluorescent marking. The environmental cleaning quality improved substantially, with adequately cleaned surfaces increasing from 40% in first quarter to 82% in fourth quarter. HAI prevalence decreased from 6.30% (13/202 patients) in 2023 to 5.43% (11/206 patients) in 2024, representing a 0.87 percentage-point absolute reduction (13.8% relative decrease). This difference was not statistically significant (Fisher’s exact test, p ≈ 0.66). Conclusions: The limited sample size inherent to point prevalence methodology likely reduced statistical power and although the reduction in HAI prevalence did not reach statistical significance, we believe that the direction and magnitude of change, together with a marked improvement in environmental cleaning performance, proves a clinically meaningful reduction in HAI burden and increasement in patient safety.

background: the covid-19 pandemic placed infection prevention and control (ipc) units at the center of hospital crisis response. beyond operational overload, ipc managers were required to make rapid decisions, adapt standards in real time, and lead teams under sustained uncertainty. these conditions highlighted the importance of managerial autonomy, self-efficacy, and leadership, and provided a unique opportunity to examine how extreme crisis reshapes managerial capacity in practice. objectives: to examine how the covid-19 pandemic influenced managerial self-efficacy, autonomy, and leadership among ipc physician managers and ipc nurse managers, and to explore associations between these managerial traits and ipc implementation-related activities during the pandemic. Methods: a mixed-methods study was conducted across israeli public hospitals. the quantitative component included 50 senior ipc unit managers(19 physician managers and 31 nurse managers) from 29 of 31 israeli public hospitals, reflecting broad national representation(table 1). the qualitative component included semi-structured interviews with 10 ipc managers(5 physicians and 5 nurses) from 9 hospitals. study instruments included the managerial self-efficacy questionnaire (α=0.91–0.97), managerial autonomy questionnaire (α=0.68–0.89), leadership evaluation questionnaire (α=0.65–0.97), organizational change implementation questionnaire (α=0.78–0.92), and the covid-19 managerial impact questionnaire (α=0.86–0.94). all instruments underwent pilot testing and expert review to ensure content validity and reliability. quantitative data were analyzed using analysis of variance and pearson correlation coefficients, while qualitative data were analyzed thematically to capture experiential and contextual insights. Result: mean managerial scores during the pandemic were high and comparable between physician and nurse managers across autonomy, conflict management, leadership during crisis, and overall managerial performance, with no statistically significant differences between groups (figure 1). perceived covid-19 impact demonstrated significant positive correlations with multiple managerial traits, including autonomy (r=0.473), self-efficacy (r=0.388), strategy and vision (r=0.458), process management and intervention boundaries (r=0.463), and transformative leadership (r=0.320) (p<0.05)(figure 3). correlations were also observed between covid-19 impact and core ipc activity domains, particularly research, consultation, training, and infection monitoring, while weaker or negative associations were noted for investigative and event-driven activities(figure 2). qualitative findings reinforced these patterns, revealing accelerated decision-making capacity, increased managerial autonomy, and strengthened leadership identity. physician managers emphasized maintaining operational continuity, whereas nurse managers highlighted increased assertiveness alongside substantial personal and emotional burden. Conclusion: the covid-19 pandemic functioned as a catalyst that reshaped managerial skills in ipc units, strengthening autonomy, self-efficacy, and leadership under crisis conditions. while managerial growth was evident, the findings also underscore the personal cost borne by ipc leaders, particularly nurses. investment in leadership development and organizational support systems

Background: Empiric extended-spectrum antibiotics are routinely given to patients with cancer despite low risk of infection with multidrug-resistant organisms (MDROs). This secondary analysis of the four INSPIRE (INtelligent Stewardship Prompts to Improve Real-time Empiric Antibiotic Selection) trials evaluated how computerized physician order entry (CPOE) prompts providing patient- and pathogen-specific MDRO risk estimates affected empiric extended-spectrum antibiotic use in patients with cancer. Methods: We identified non-critically ill hospitalized adults (> Results: Including all trials, 36,861 (18,272 baseline; 18,589 intervention) patients had cancer. Mean age was 69.0 (13.6); 48.0% (17,675) were male. Extended-spectrum antibiotic days-of-therapy decreased by 27% (95% CI:20-34%, PPPP Conclusions and Relevance: An antibiotic stewardship bundle that included CPOE prompts recommending standard-spectrum antibiotics for patients at low risk for antimicrobial-resistant infections reduced extended-spectrum antibiotic use in non-critically ill patients with cancer who were hospitalized with community-acquired pneumonia, UTI, abdominal infection, or SST, without observed differences in safety outcomes.

Background: Antimicrobial stewardship programs use the NHSN standardized antimicrobial administration ratio (SAAR) to monitor antimicrobial use (AU) and direct activities, but only certain locations generate SAAR values. We explored the correlation between hospital SAAR coverage using days present (DP) and facility-wide AU measured in days of therapy per 1,000 days present (DOT/1,000DP). Methods: We included Nebraska hospitals reporting at least one adult location and at least six months of AU data that generated a SAAR during 7/2024-6/2025. We classified hospitals by bed size [large: <150, medium: 26–150, and critical access hospitals: ≤25]. Days present from SAAR eligible locations were divided by total facility DP to calculate the SAAR coverage proportion. We categorized hospitals in the upper third as having high SAAR coverage and those in the lower two-thirds as low SAAR coverage. We calculated Spearman correlation coefficients to evaluate the strength of the association between SAAR and AU rates in the high and low SAAR coverage groups. Results: Overall, 45 hospitals were included (median 25 beds, range 7-641) with large variability among total days present (473-228,051). Regarding SAAR coverage, 14 hospitals were classified as low coverage and 31 had high coverage (representing 47% and 83% of total DP, respectively), with an overall median SAAR coverage of 91% (Figure 1). When comparing the all-antimicrobial SAAR with the total AU rate of the top 14 antimicrobials, hospitals with low SAAR coverage showed weak correlation (? 0.163, p-value=0.57) compared to those with high coverage (? 0.901, p-value=<0.001) (Figure 2). Performance varied for other NHSN SAAR categories and AU rates in the low coverage group, with higher correlation between the GRAMPOS SAAR category and vancomycin DOT/1,000DP, and lower correlation between the BSHO SAAR category and the total AU rate of cefepime/piperacillin-tazobactam/meropenem use (Figure 3). Conclusion: In hospitals with low SAAR coverage, SAAR values may not accurately reflect overall facility-wide AU. This discrepancy is especially evident when evaluating overall antimicrobial use. We hypothesize that the weak correlation is likely a result of substantial AU in locations that do not generate a SAAR. We noted variation in AU rates in hospitals with similar SAAR values which may stem from the CDC’s predictive model although incomplete capture of antimicrobial use may be playing some role as well. These findings support CDC efforts to expand the SAAR to include new locations.