Background: The COVID-19 pandemic highlighted health inequities with rates of illness and outcomes among various populations. This project evaluates factors involved with health disparities in patients with identified hospital-associated infections (HAIs). Identifying and targeting these inequities as risk factors could reduce HAIs in affected groups. Method: We examined HAIs reported to National Health and Safety Network (NHSN) from a large integrated health network, including 21 acute care hospitals in Northern California. This data set included Methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile infection (CDI), and Vancomycin-resistant enterococci (VRE) infections, catheter-associated urinary tract infections (CAUTI), central line associated bloodstream infections (CLABSI), and surgical site infections (SSI) from 29 procedures. The analysis included 6,813 reported cases of HAI from 2019 to 2023. Data was stratified with equity, inclusion, and diversity risk factors, and employing multivariate regression analysis to calculate odds ratios for infection. Result: Spanish-speaking patients had increased odds ratios for CLABSI (1.8, p=0.003), CAUTI (2.08, p=<0.0001). Conclusions: The study identifies those with Spanish as preferred language, using interpreters, or family or friends as interpreters, as all having a higher risk for acquiring an HAI. These differences remain after accounting for known risk factors of age, gender, body max index (BMI), length of stay, emergency admissions, and comorbidity risk. This suggest that including and analyzing health inequity risk factors may help in early intervention to reduce or prevent HAIs.

Background: Carbapenemase-producing Enterobacterales (CPE) poses a major infection control challenge in healthcare settings. Over the past decade, Klebsiella pneumonia carbapenemase (KPC)-CPE colonization at our hospital declined to under 10% of all CPE rectal screens, while New Delhi metallo-beta lactamase (NDM)-CPE and oxacillinase (OXA)-CPE colonization rates have tripled, Figure 1. Methods: A comparative historical study was conducted on adult patients colonized with OXA-CPE (2017-2023), NDM-CPE (2017-2023), or KPC-CPE (2017-2018). Patients were retrospectively identified through the microbiology laboratory, their files reviewed for demographics, clinical characteristics, and outcomes. Results: The study included all 341 patients who underwent a screening rectal swab for CPE on admission or during contact tracing: 115 tested positive for OXA-CPE, 136 for NDM-CPE, and 92 for KPC-CPE. Patients colonized with OXA-CPE or NDM-CPE were younger (61.7±20 and 60.7±19.56, respectively) compared to those colonized with KPC-CPE (67.2±18.78; P=0.043 and P=0.013). Clinical characteristics and outcomes for the three cohorts are summarized in Table 1. Patients colonized with OXA-CPE or NDM-CPE were more likely to be admitted to surgical wards, have fewer urinary catheters and decubitus ulcers, and were more often discharged home compared to KPC-CPE colonized patients. OXA-CPE and NDM-CPE genes were predominately associated with Escherichia coli, while KPC-CPE gene was mainly found with Klebsiella sp. Conclusions: OXA-CPE and NDM-CPE colonized patients are younger, less debilitated and primarily reside at home. These findings prompted a revised CPE admission strategy, resulting in higher detection of OXA-CPE and NDM-CPE colonization upon admission.

Background: Candida auris, a multi-drug resistant fungal pathogen, was first detected in Tennessee healthcare facilities in 2022. C. auris can colonize a patient’s skin and cause clinical infection. Patients with clinical infections have high mortality, with a wide range of reported rates between 30 – 72%. Here we compare the risk factors associated with 30-day all-cause mortality among colonized and clinical cases in Tennessee. Method: Clinical and colonization C. auris case data was obtained from the Tennessee State Public Health Laboratory. Cases with only a skin specimen were classified as colonization, while patients with any other sterile or non-sterile collection site were classified as clinical. Mortality data was obtained through the Tennessee Office of Vital Records and matched with C. auris case information. Risk factors for multi-drug resistant organism acquisition were collected using a REDCap survey completed by facility staff. Chi-square tests were used to compare mortality and risk factor differences. All analyses were conducted in SAS Enterprise Guide v8.3. Result: Between 2022 and 2023, 130 out of 418 colonized patients (31.1%) and 33 out of 108 clinical cases (30.1%) died with no significant differences in age. Of the patients that died, 20 (60.6%) with clinical infection and 50 (38.5%) with colonization died within 30 days of specimen collection (p<.05). However, eight patients with clinical infection who died within 30 days of specimen collection were previously colonized. Risk factors associated with C. auris acquisition were available for 55 patients with clinical infection and 120 with colonization. Patients with clinical infection who died within 30 days of specimen collection were more likely to have incontinent urine (p<.05), a draining wound (p<.05), and have a gastric tube placed (p<.05) than those who survived. Patients with colonization who died within 30 days of specimen collection were more likely to have a previous stay in an inpatient rehabilitation facility (p<.01), an ambulatory surgery center (p<.01), and less likely to have a tracheostomy tube placed (p<.05) than those who survived. Conclusion: Patients with clinical C. auris infection are more likely to die within 30 days of specimen collection than patients with colonization in Tennessee. However, risk factors associated with C. auris acquisition varied between patients with clinical infection or colonization and are not consistently associated with higher mortality. Clinical teams should emphasize infection prevention and control practices that reduce the risk of invasive infection in colonized patients in all settings, regardless of perceived risk.

Background: SSI results in increased mortality, morbidity, length of stay and healthcare costs. Use of nasal iodine for some surgeries has been proposed as an easy, economic alternative to 5-day preoperative chlorhexidine bath and intranasal mupirocin decolonization in SSI prevention but data on effectiveness is limited. We aim to assess the association between preoperative nasal iodine application and odds of SSI. Methods: We performed a retrospective study of all total hip replacement, total knee replacement, and spinal fusion surgeries performed between January 2023 through June 2024 in 10 facilities in a large healthcare system. Demographics, clinical risk factors, and procedural data were collated from the electronic health record and merged with SSI data obtained through routine surveillance by trained infection preventionists using standard NHSN (National Healthcare and Safety Network) definitions. Patients with SSI present at the time of surgery were excluded. Nasal iodine compliance was defined as documentation of nasal iodine administration in both nostrils on the day of surgery in the preoperative space. Surgeries where nasal iodine was documented as not given or that had absence of documentation were counted as noncompliant. Descriptive statistics were used to compare compliant and noncompliant patients. Multivariate logistic regression was performed to assess the association between nasal iodine compliance and SSI. Results: A total of 14,505 surgeries were included, of which 161 (1.1%) were complicated by SSI. 12,281 (84.6%) of patients were compliant with nasal iodine. Around 55% of the noncompliant surgeries had absent documentation. In the univariate analysis, compliance was associated with several clinical and procedural factors including older median age, female gender, White race, shorter procedure duration, elective procedure, outpatient procedure, and lower ASA score. Unadjusted SSI rate per 100 procedures was lower in those compliant with nasal iodine compared to noncompliant (1% and 1.6% respectively, p=0.01). (Table 1) After adjusting for age, gender, race, procedure type, and procedure duration, there was no significant difference in odds of SSI associated with nasal iodine compliance. (Odds ratio 0.78, p=0.23) (Table 2) Conclusion: Use of nasal iodine on day of surgery did not impact odds of SSI after adjusting for other clinical factors. This study is limited by inclusion of cases with absent documentation of nasal iodine and differences in clinical and procedural characteristics between compliant and noncompliant patients. Further studies are needed to assess effect of nasal iodine on SSI.

What is lost if we don’t have a diagnosis? This article examines the aims of clinical medicine and the role of understanding in these aims. Starting from a case prompt with a patient suffering from persistent physical symptoms, I argue that understanding is at the clinical core and that the target of such understanding is the patient’s body with symptoms. Synthesizing accounts of medical understanding and phenomenology of illness, I suggest that the understanding sought in the clinic extends beyond mechanistic explanation to include a sense of bodily intelligibility and that diagnoses are useful but not necessary tools to this end.

Background: Catheter-related or central line-associated bloodstream infection (CRBSI/CLABSI) is a common and serious complication in patients undergoing hemodialysis (HD), often resulting in significant morbidity and mortality. Managing CRBSI/CLABSI often requires removing the central venous catheter (CVC) and placing a new one at a different vascular site. However, this approach is not always feasible for these patients that often have limited vascular access. No adjunct antimicrobial lock therapy has been FDA-approved for managing such infections and is urgently needed to salvage HD vascular access. Our study evaluated a novel triple combination antimicrobial catheter lock solution containing minocycline, EDTA, and ethanol (Mino Lok (MLT)). MLT has shown broad-spectrum in-vitro activity and positive results in a Phase 2 trial. Herein, we report the results of MLT CVC-salvage therapy in the subgroup of HD subjects from a phase 3 trial. Methods: This international, multicenter, superiority trial was conducted at 34 sites. HD, cancer, or other patients requiring a long-term CVC (LTCVC), aged ≥ 12 years, with CLABSI/CRBSI, were enrolled and randomized (1:1 ratio) to receive MLT or site-specific standard of care (SOC) antimicrobial lock therapy for 2 hours/day for 7 days. The primary endpoint was median time to catheter failure (i.e., mortality, catheter removal due to inability to administer lock or infectious-related reasons, worsening signs/symptoms, persistent or recurrent bloodstream infection, or deep-seated infection). Results: From February 2018 to February 2024, 54 HD patients were enrolled and randomized: 26 to MLT and 28 to SOC. Gram-negative bacteria accounted for 50% of CLABSI/CRBSIs, gram-positive bacteria 43%, and Candida species 7%. Highly virulent organisms (non-commensals) caused 69% of all cases. Patients in SOC had a significantly shorter time to catheter failure compared to MLT (p=0.03) with 25% of CVCs failing by day 6 and 50% by day 22 in SOC compared to 25% failing by day 37 in MLT (Figure 1). Similarly, 16 subjects (57%) in SOC had a CVC failure event compared to only 8 (31%) in MLT. Adverse events (AEs) and serious AEs (SAEs) were comparable between the two groups. There were no drug-related SAEs. Conclusion: This phase 3 pivotal study demonstrated MLT to be highly effective and superior to SOC antimicrobial lock therapy in salvaging LTCVCs associated with CRBSI/CLABSI in HD patients. MLT has broad-spectrum activity, was well-tolerated, and was not associated with drug-related SAEs. MLT may satisfy an urgent unmet need in salvaging HD catheters in patients with CRBSIs/CLABSIs.

Background: Urinalysis with reflex culture order sets (reflex order set) require urinalyses to meet specific criteria before triggering a culture to reduce unnecessary urine cultures and inappropriate treatment of asymptomatic bacteriuria (ASB). A reflex order set was designed and implemented at a large academic medical center in 2016 and updated in June 2022 to require clinicians to select which pre-specified exemption the patient met to bypass the reflex order set and order a urine culture. We aimed to assess the association between reflex order set bypass and antibiotic prescribing for urinary tract infections (UTIs) in outpatient encounters. Methods: Patient demographics, co-morbidities, encounter diagnoses, and treatment data, including required antibiotic indications, were extracted from all outpatient healthcare system adult and pediatric patient encounters utilizing the reflex order set. Using multivariable logistic aggression, we assessed associated odds with 95% confidence intervals (95% CI) of bypassing the reflex order set and antibiotic prescribing for UTI. Results: From June 2022 to June 2024, 192,310 encounters met inclusion criteria. After adjusting for patient factors, bypassing the reflex order set was associated with higher odds (2.87 95% CI: 2.81 to 2.94) of antibiotic prescribing for UTI. Increasing age, female gender, indwelling catheter, history of urological surgery, UTI, and neurogenic bladder were associated with increased prescribing. Being on immunosuppression, pregnancy, pending urological surgery, renal transplant status and chronic kidney disease were associated with reduced odds of antibiotic prescribing (Table 1). Discussion: Urinalysis reflex order set implementation in a large ambulatory clinic system was associated with lower likelihood of antibiotic prescribing for UTI. Further analysis will evaluate accuracy of selected bypass indications and appropriateness of antibiotic prescriptions to identify opportunities for optimizing this intervention.

Background: Bacteremia is associated with significant morbidity and mortality. At least 14 days of antibiotic treatment has traditionally been the standard of care. However, shortening the duration of antibiotic therapy is a key strategy for improving antimicrobial stewardship. This meta-analysis of randomized controlled trials (RCTs), including the recently published BALANCE trial, seeks to identify the duration of antibiotics needed to optimize this mortality benefit by comparing seven versus 14 days of antibiotic duration. Hypothesis: The mortality risk ratio (RR) in the 7-day group is similar to 14-day group. Methods: Multiple electronic databases and trial registries were searched on December 29, 2024, for RCTs reporting mortality outcomes in patients with bacteremia treated for seven versus 14 days of antibiotics. We estimated the effect of these two-treatment durations using random-effects meta-analyses with the generic inverse variance method. Subgroup analyses were conducted to assess the impact of the source of bacteremia on mortality. Results: Four eligible RCTs consisting of 4,794 patients with bacteremia, were included. Median age was 71 years (interquartile range (IQR): 69-73), and 47% (IQR: 45%-49%) were male. Of the patients with bacteremia, 87% had gram-negative bacteria and 13% gram-positive bacteria. Patients with Staphylococcus aureus bacteremia, severe immune compromise, prosthetic heart valves, syndromes with well-defined requirement for prolonged treatment such as infective endocarditis or osteomyelitis, single positive blood culture with common contaminant, Candida or other fungi were excluded. Overall mortality rate was 8%. The RR for 90-day and 30-day mortality between 7 versus 14 days was 0.92 (95% CI: 0.79 – 1.06) and 0.92 (95% CI: 0.96-1.12), respectively. Median antibiotic-free days were higher in the 7-day group than 14- day group (19 days vs 14 days, p=0.03). The rates of Clostridioides difficile infection were similar in two groups (1.6% vs 1.5%, p=0.97). Subgroup analysis indicated no effect modification by the source of bacteremia. The risk of bias was assessed as low. Conclusions: This systematic review and meta-analysis of RCTs found no difference in mortality between 7- and 14-day treatment durations in low-risk patients with non-Staphylococcus aureus bacteremia. Reducing antibiotic treatment for uncomplicated gram-negative and gram-positive bacteremia to 7 days is a critical antibiotic stewardship intervention.

Background: The Texas Epidemic Public Health Institute (TEPHI) aims to safeguard public health and bolster the economy by preparing for infectious disease outbreaks. The Infection Prevention and Control Webinar (IPC) 200 series of the Small Rural Healthcare Preparedness offers free educational resources and continuing education for public health and healthcare personnel responsible for infection prevention programs across ten lectures from requested topics from TEPHIs IPC 100 series. Methods: Data from the second year of the Infection Prevention and Control lecture series were collected using attendee registration and attendance data, knowledge assessments, and post-lecture evaluation surveys via WebEx®, QuestionPro®, and Microsoft Teams®. The modules were developed using resources from the Association for Professionals in Infection Control and Epidemiology (APIC), the Occupational Safety and Health Administration (OSHA), the Centers for Disease Control and Prevention (CDC), The Joint Commission (TJC), and Centers for Medicare and Medicaid Services. Results: The series had 1,088 attendees to the live lectures and generated 3,103 YouTube views. Lectures were accredited for 1.0 hours of public health education and a-IPC certification, with 8 of 10 sessions offering 1.0 continuing education hours for CIC certifications for infection preventionists. Of the 286 participants completing knowledge assessments, the average score was 91% (range: 81% in Module 201 to 96% in Module 206). Post-evaluations (n=280) rated the content highly (mean: 4.83/5) for beneficial, easy to understand, and clear/concise. Additionally, 90.4% of respondents indicated plans to implement the knowledge gained, and 98.9% expressed interest in attending future sessions. Conclusion: The Infection Control lecture series improved participants’ knowledge of infection prevention and control best practices. By disseminating evidence-based education and providing no-cost continuing education, the series equips healthcare personnel with the tools to foster safer environments for patients and staff in healthcare settings.

Background: Uganda has a high prevalence of healthcare associated infections (HCAIs) with 28% often linked to inadequate hand hygiene practices among health workers. Hand hygiene is one of the most important measures in reducing the transmission of nosocomial infections. Implementing a world health organization (WHO) multimodal hand hygiene improvement strategy has shown influence on health workers’ behaviors, knowledge and practices. We aimed at evaluating hand hygiene compliance among health workers before and after implementation of the WHO multimodal improvement strategy at select health facilities(HF) in Uganda. Method: 27 health facilities were randomly selected from two regions in Uganda to implement the WHO multimodal hand hygiene improvement strategy over a period of 4 weeks. Before the interventions, healthcare worker’ (HCW) compliance with hand hygiene during routine patient care was directly observed using the WHO hand hygiene observation tool. Interventions included; weekly onsite mentorships focusing on Training and education, provision of locally produced alcohol-based hand rubs (ABHR), soap, and placement of reminders such as posters at point of care areas to emphasize the importance of hand hygiene. HCWs from different facility departments were designated to champion hand hygiene. We recorded and distributed hand hygiene promotional videos to the health facilities to reinforce key messages consistently. After the interventions, follow up observations were conducted and data was analyzed using SPSS 20. Results: A total of 156 health workers were observed at baseline and 151 at follow on. 1,205 hand hygiene opportunities were recorded at baseline and 1,369 at follow on. 454 actions were observed at baseline and 845 after. Healthcare worker hand hygiene compliance improved from 32.6% (SD=23) to 60.7% (SD=23; p=0.0083) after the intervention. The increase in compliance to hand hygiene was different across all professional categories with significant improvement among Lab technicians (72% Versus 35%). Compliance among students remained low at 36% versus 38% post intervention. 76% of the observed health workers preferred use of locally produced ABHR while 22% used water and soap. Conclusion: The improvement in hand hygiene compliance among health workers following short term interventions using the WHO multimodal improvement strategy shows potential effectiveness. This underscores the importance of prolonged commitment from hospitals in adopting and reinforcing this strategy for long-term improvements in hand hygiene practices among health workers.

Background: Ventilator-associated pneumonia (VAP) primarily occurs due to the aspiration of secretions containing microorganisms from the oropharynx or stomach into the lungs. Preventing aspiration is a critical strategy for reducing VAP incidence. This study analyzed the impact of aspiration prevention measures—head-of-bed elevation (HOBE) and enhanced oral care—on VAP rates in adult intensive care units (ICUs). Method: This interventional study was conducted in the adult ICU of a 2,734-bed tertiary care hospital. A total of 8 ICUs (medical, surgical, cardiology, cardiovascular, neurology and neurosurgery) with 112 beds observed an increase in VAP incidence from January to April 2023, prompting enhanced measures in May 2023. The first intervention involved revising and reinforcing indications for head-of-bed elevation (HOBE) while strengthening monitoring and on-site feedback. During clinical procedures such as positional changes requiring a supine position, oropharyngeal suctioning was performed before lowering the head of the bed, and staff were trained to ensure prompt restoration of the HOBE to the appropriate position afterward. The second intervention improved oral care by replacing chlorhexidine and gauze with tooth brushing. A protocol was developed requiring 2 minutes of brushing teeth, artificial airways, tongue, and palate using a silicone toothbrush moistened with saline or sterile water, excluding patients with contraindications such as bleeding risks. Monitoring revealed missed areas during brushing, necessitating additional simulation training using dental models and colored toothpaste to confirm plaque removal. The pre-intervention period was conducted over 9 months (August 2022 to April 2023), while the intervention period lasted 17 months (July 2023 to November 2024). VAP incidence rates were compared before and after the intervention. Additionally, the incidence of VAP associated with pathogens such as Klebsiella pneumoniae, Acinetobacter baumannii, or Pseudomonas aeruginosa, often isolated from dental plaques of ICU patients, were analyzed. Results: The incidence rate of VAP per 1,000 ventilator days among adult ICU patients decreased from 3.9 (66/16,849) before the intervention to 2.4 (78/32,185) after the intervention (IRR, 0.62, 95% CI, 0.45-0.86; P = 0.007). Similarly, the incidence rate of VAP associated with pathogens K. pneumoniae, A. baumannii, or P. aeruginosa were 1.6 (27/16,849) before the intervention, and 1.0 (31/32,185) after the intervention (IRR, 0.60, 95% CI, 0.36-1.01; P = 0.07). Conclusion: As a result of implementing enhanced head-of-bed elevation and oral care protocols for ventilated patients in the adult ICU, the incidence of VAP significantly decreased. Further multicenter studies are needed to validate our findings.

Introduction: Within our healthcare system, hospitalists receive feedback on antibiotic prescribing via an observed-to-expected ratio (OER) calculated by days of therapy (DOT) for CDC defined broad-spectrum, hospital-onset (BSHO) antibiotics and adjusted for patient characteristics and billing. In this sub-analysis, we quantify the impact of infectious disease (ID) consultations on OER. Methods: For each two-month period in five hospitals, encounters were assigned to each hospitalist if they billed for ≥1 day of care. The encounter was considered to involve an ID consult if an ID provider billed during the encounter. Percent of encounters with ID consultation (density) was calculated and stratum defined by gross ratios (e.g., 1 in 3 or 1 in 4 patients). We assessed whether consult density varied overtime, by facility, or by DOT. We assessed the effect of consult density on antibiotic DOT using established linear mixed effects model with random intercepts for both provider and facility (nested) and adjusted for patient characteristics and billing. Distribution of OERs were compared among strata to evaluate how ID consult changes OERs. Results: Between January and June 2023, 154 unique providers collectively received 458 bi-monthly OERs reflecting their care for 53,815 unique patients. Overall, 21% of hospital medicine patients were evaluated by an ID consultant during inpatient stay; median consultation density varied among providers by facility (19%-26%, Figure 1). Multivariate models (accounting for sepsis, UTI, renal disease) estimated significantly increased DOT for hospitalists having ~1:3 (+3.4 DOT, 95% CI 0.9 – 5.9) or 1:4 (+2.7 DOT, 95% CI 0.4-5.0) patients with ID consults compared to hospitalists with fewer than ~1:7 with an ID consult; however the effect was not significant in other strata and not linear (Table 1). Calculating the distribution of OERs both before and after adjusting for consult density resulted in small changes in OERs (Figure 1b). Discussion: The frequency of ID consults affected hospitalists’ BSHO-DOT in a non-linear fashion. Impact of ID consultation on prescribing metrics should be considered in building credibility of stewardship prescribing performance metrics.

Introduction: The healthcare sector contributes significantly to global greenhouse gas (GHG) emissions, accounting for 8.5% of the total emissions in the United States alone. Infection control practices designed to prevent disease transmission contribute to this substantial carbon footprint. These practices, which include enhanced ventilation requirements, extensive sterilization processes, and laundry services, inherently increase energy consumption and GHG emissions. The approach to making healthcare more sustainable has been multipronged, including initiatives to reduce waste and energy use. We explored environmental cleaning practices and the energy use associated with ultraviolent (UV) light disinfection. Methods: A retrospective analysis was conducted on the energy consumption of three different UV light disinfection machines used at Stanford Health Care from September 2023 to August 2024. Annual run time data was obtained from vendor-provided logs, and energy use was calculated using the equipment wattage specifications provided with each machine. Results: We found that UV light disinfection utilized approximately 7,300 kWh constituting less than 1% of Stanford Health Care total energy use for the period. This energy consumption equates to the charge required for 3.5 round trips from San Francisco to New York City in an electric vehicle. Discussion: UV light has been widely used in healthcare over the last decade. Recent data suggests that there may be no additional benefit to UV light disinfection when other enhanced cleaning methods, such as sporicidal cleaners, are utilized. Therefore, using UV light in addition to sporicidal cleaners may be redundant. Infection prevention practices often incorporate redundancies given the dependence on human behavior and the high consequences of practice failures. As the healthcare industry continues to work towards reducing greenhouse gas emissions it will be important to consider all energy reductions and any redundancies in practices. In the future, a life cycle analysis could be conducted to compare UV light disinfection and sporicidal cleaning methods to evaluate each practice’s impact on sustainability efforts. Our evaluation showed that UV light disinfection results in modest energy usage reductions. However, as the healthcare industry continues to work towards reducing greenhouse gas emissions it will be important to consider all energy reductions and any redundancies in practices.

Background: Conferences play a crucial role in the early dissemination of significant research to peers and experts within the same field. They provide a platform for receiving feedback, fostering collaborations, and refining groundbreaking findings, which can eventually be developed into full articles for publication in peer-reviewed journals. The transition of presented abstracts to full research journal publications is a key metric for evaluating research productivity, quality, and dissemination. Despite this, there is limited data on the proportion of abstracts that are ultimately published as full articles in peer-reviewed journals. Method: All abstracts (351) presented at the SHEA Spring Conference in 2018 and 2021 were indexed and cataloged from the 2018 online archive and the 2021 Antimicrobial Stewardship & Healthcare Epidemiology journal supplement. We then manually searched the top 20 results of both Google Scholar and PubMed to determine the publication status of each abstract as of Jan 10, 2025. Publication status criteria included: matching at least three keywords between the abstract and any resulting manuscript, having at least one common author, and publication occurring after and inclusive of the year of abstract acceptance. Data was compiled into an Excel spreadsheet, categorizing abstracts as ‘yes’ or ‘no’ for publication. Publication rates were then calculated using Excel formulas based on these categorizations. Factors associated with publication were evaluated, and publication metrics were described. Result: All 351 abstracts were analyzed. Among these, 175 (49.9%) were published as full articles in peer-reviewed journals indexed in Google Scholar or PubMed. Abstracts presented in 2021 and those presented orally had higher publication rates, though the association was statistically nonsignificant (p = 0.06 and p = 0.66, respectively). Abstracts with authors from different institutions and those with more than six authors showed a statistically significant association with higher publication rates (p = 0.002 and p = 0.003, respectively). Infection Control & Hospital Epidemiology was the most common journal in which abstracts were ultimately published, accounting for 51 (29.1%) of the publications. The publication rates surpass those reported in most similar studies of other internal medicine and subspecialty conferences, including IDWeek. Conclusion: Approximately half of the abstracts presented were subsequently published as full articles. Collaborative research, involving more authors and authors from different institutions, was associated with a higher publication rate. These findings highlight the strong academic impact of SHEA-presented research. Further research into the barriers to publication is warranted to improve the dissemination of conference abstracts.

Background: Urinalysis (UA) with reflex to urine culture (UARC) protocols aim to optimize diagnostic testing and reduce unnecessary antibiotic use in hospitalized patients. By limiting urine cultures to cases where initial urinalysis results meet predefined criteria, UARC protocols can minimize false-positive results and reduce overtreatment. This study examines the impact of a UARC protocol implemented across a hospital system on urine culture volume and antibiotic utilization. Methods: A UARC protocol was implemented at our institution, performing urine cultures for UA specimens with ≥5 WBC/HPF. This study was an interrupted time-series analysis that compared the pre-implementation period (October 2022–June 2023) and the post-implementation period (January 2024–September 2024), with data elements abstracted from the electronic medical record. Antibiotic exposure within 48 hours before and 168 hours after urine specimen collection was evaluated. Comparisons were made using chi-square and Wilcoxon rank-sum tests, with p-values A total of 107,646 urine specimens were analyzed with 49,504 in the pre-implementation period and 58,142 post-implementation. Following UARC introduction, only 51.3% of reflex orders continued on to urine culture (29,836/58,142). Overall urine specimen orders resulting in antibiotic utilization decreased from 39.2% to 33.5% (p Implementing a UARC protocol significantly reduced urine culture volumes and antibiotic utilization, demonstrating its effectiveness in diagnostic and antimicrobial stewardship. While overall antibiotic use decreased, the unchanged treatment duration among recipients suggests complete courses were maintained with the reduction in culture orders serving as the mechanism driving this change. These findings support UARC protocols as valuable tools for reducing antibiotic use and optimizing healthcare resources. Further research should refine reflex criteria and assess long-term clinical outcomes.

Background: Hospitals experienced increased demand for acute care and specialty services during recovery following COVID-19 epidemics. Internal analysis identified potential inaccuracies in NHSN location unit designations across a large healthcare system with 2,249 mapped NHSN locations. Findings revealed inconsistencies in how location change decisions were determined mainly from the type of data applied. Facilities utilized finance data to determine NHSN location mapping creating limitations. NHSN locations defined by patient populations, associated with baseline risk adjustments to provide comparison performance and impacts CMS metrics. Methods: Decision Support Tool (DST) based on NHSN to evaluate patient populations for acuity, service line data indicating specialty services, financial billing codes, DRG and surgical or non-surgical populations. The DST outlines data elements for review when validating mapped locations. Each tab represents a unique data element to analyze as part of the NHSN decision algorithm (Figure 1). Unit level data aggregates in DST tabs (Figure 2). Implementation consisted of a pilot followed by a regionally phased implementation via coaching calls and follow-up touchpoints. Although all units were reviewed, specific activities focused on non-CMS reportable units such as telemetry, step-down, mixed acuity. As a part of the defined change control process facilities followed an internal standardized workflow to document changes, dates and reasons for change for historical reference (Figure 3). NHSN facility population changes were applied to vendor surveillance software utilized for CDA direct reporting to NHSN. System and facility internal record keeping promotes a standardized process for data validity, associated software maintenance and CMS reporting compliance. Results: The majority of changes were made to units mapped as telemetry with a 62% reduction overall. Figure 4 illustrates the non-CMS reporting locations with notable location mapping changes. Patients in an ‘observation’ status were found to be housed within any inpatient unit and required another data tool for analysis. Overall, the number of mapped 24-hour observation units is low (1.7%) across the healthcare system. Conclusions: The initiative standardized objective data and competency which elevated the trained infection preventionists on this topic. Admission orders offer telemetry for evaluation and treatment requiring continuous cardiac monitoring. NHSN definition is specific requiring 80% of unit patients to have a cardiac centered DRG/care and cardiac specialty treatment to meet telemetry definition. NHSN recommends at minimum annual mapping evaluation. As a large healthcare system, the DST analysis is managed continuously due to growing service lines, acquisitions and construction projects.

Te Papa Tongarewa, the Museum of New Zealand, is a cultural institution located in Aotearoa New Zealand. The museum’s foundational principle of biculturalism appears increasingly inadequate for addressing the fundamental injustices associated with settler/invader colonialism and can be seen as a barrier to achieving a “collective future.” This article argues that Te Papa must discard biculturalism insofar as it does not provide for tino rangatiratanga (self-determination) or mana motuhake (Indigenous sovereignty). Currently, Te Papa promotes Indigenous cultural inclusion and the celebration of Te Ao Māori (The Māori World) within a settler/invader-defined national identity and cultural memory. In the future, a decolonial and tikanga-based (Māori legal and customary practices and system) approach should be implemented at Te Papa.

Background: There is a high prevalence of catheter associated urinary tract infections (CAUTIs) on a hospital cardiology unit, with a rate of 2.48 CAUTIs per 1,000 catheter days over the past two years compared to the national average of 0.96 CAUTIs for similar units. CAUTIs lead to increased lengths of stay, mortality, and hospital expenditures. Per NHSN, the presence of an indwelling urinary catheter (IUC) increases the risk for developing a CAUTI by 3-7% each day an IUC is in place. Method: A process improvement approach was utilized to study the problem of increased CAUTIs and implement a PDSA intervention.

A process map was created to identify opportunities for error that could increase risk for CAUTIs (Figure 1). Contributing factors were explored through developing a driver diagram (Figure 2).

Data was collected to study root causes of CAUTI development and identify opportunities for improvement. 7 nurses were observed placing IUCs in mannequins to assess insertion practices. 19 maintenance audits of IUCs among patients were conducted. Electronic medical record (EMR) data was compiled to assess hospital location of catheter insertion, catheter utilization ratio, indication for insertion, and duration of catheterization. Based on data, team decided to focus PDSA intervention on reducing IUC duration, a process measure for the desired outcome of reducing CAUTIs. Results: EMR baseline data during the period 11/6/2024- 12/29/2024 revealed an average IUC duration of 7.92 days. A SMART(IE) goal was established to reduce the average duration of IUCs on this unit by 15% from 7.92 days to 6.73 days within 4 weeks.

An intervention was developed to incorporate discussion of IUC indication, duration, and eligibility for removal for patients with IUCs during daily multidisciplinary rounds. Unit charge nurses received training on CAUTI prevention, facilitating rounds discussions, and data collection. Intervention is being implemented over the period 12/30/2024- 1/25/2025.

During the pre-intervention period 11/6/2024- 12/29/2024, 70 IUCs were reviewed. In preliminary analysis of the post-intervention period of 12/30/24- 1/15/25, 15 IUCs were reviewed. Preliminary analysis shows the average duration of IUCs per patient decreased by 31%, to an average of 5.47 days (Figure 3). There were 4 IUCs that were removed after discussions at multidisciplinary rounds. Conclusion: Process improvement tools can be utilized to study contributors to CAUTIs and develop unit-level solutions. Preliminary data demonstrates that incorporating review of IUCs during multidisciplinary rounds may reduce average duration of IUC use.

Background: Up to 10% of children have penicillin allergy labels, although, when tested, >95% tolerate penicillin. These labels expose children to increased risks of harm through adulthood. Professional allergy societies recommend the proactive removal of low-risk penicillin allergy labels among children by history alone or following direct oral drug challenges. However, access to subspecialty allergy testing is limited and recent studies have demonstrated that direct oral amoxicillin challenges in low-risk populations can be safely performed in pediatric primary care settings. We aimed to identify prescribers’ attitudes towards penicillin allergy delabeling and barriers and enablers to penicillin allergy delabeling in pediatric primary offices. Method: We conducted a multisite qualitative study consisting of interviews and/or focus groups with 29 primary care prescribers at 10 primary care practices of two health systems in the northeast U.S. We analyzed data using conventional content analysis and grouped barriers and enablers to penicillin allergy delabeling according to the Capability, Opportunity, and Motivation domains of the COM-B Behavior Change Wheel. Results: Prescribers agreed that unnecessary penicillin allergy labels in children should be avoided and shared their experiences delabeling penicillin allergies from history alone and collaborating with parents to trial amoxicillin in children with low-risk penicillin allergies. Predominant barriers among prescribers to penicillin allergy delabeling included insufficient capability (suboptimal knowledge and skills in penicillin allergy delabeling), poor social and environmental opportunity (parent unwillingness to trial penicillin, lack of time, inadequate office space and resources), and poor motivation (tendency to accept reported penicillin allergies due to perception that consequences of penicillin allergy are rare and distant, inherent logistical difficulties to delabel, and lack of reasons to delabel). To facilitate penicillin allergy delabeling, participants recommended the implementation of a protocol and training in penicillin allergy delabeling, interventions to engage parents in delabeling, innovative approaches to address insufficient resources and infrastructures, and amplification of reasons for primary care prescribers to delabel. We provide representative quotes of the barriers and corresponding enablers to penicillin allergy delabeling in pediatric primary care in Table. Conclusion: There is precedent for penicillin allergy delabeling in pediatric primary care. Findings indicate that prescribers are inclined to delabel low-risk penicillin allergies if given the necessary education/training, parent support, resources, and infrastructure.

In the context of self-defence, successive governments have taken an inconsistent approach to using public opinion as a basis for reforming criminal law. In the case of householders acting in self-defence, reform was based on limited public opinion whereas in the case of the domestic abuse victim who uses force against their abuser reform proposals were rejected without considering public opinion. There is a limited evidence base of actual public perceptions in either situation and yet their value is substantial when considering the role of lay decision-makers in the criminal trial and the need to maintain public trust in the system. This paper explores theoretical justifications for the inclusion of public perceptions in the development of criminal defences. Using a social constructivist approach, the authors consider public perceptions, as found in a small-scale empirical study, towards self-defence claims in both a householder and domestic abuse context, concluding that the public can in some circumstances find that the latter is more deserving of a claim than the former.