Background: Implementation of transmission-based precautions has predominantly been performed in inpatient acute care settings. Limited guidance is available on applying these precautions in ambulatory clinics, especially for patients with suspected or confirmed COVID-19. This timed analysis of empiric isolation precautions for COVID-19 in walk-in clinics (WIC) aimed to identify unintended impacts that are underappreciated with inpatient use. Methods: An observational analysis at four WIC sites in an academic hospital network was conducted in July-October 2024. Patients who screened positive at check-in with cough, sore throat, congestion, or recent COVID-19 positive testing triggered an electronic notification on the need for airborne and contact isolation precautions with eye protection. A timed evaluation of healthcare personnel (HCP) to don and doff personal protective equipment (PPE) upon patient room entry and exit was performed by two observers using a standardized process with a stopwatch. HCP were surveyed regarding attitudes and barriers using a 5-point Likert scale on REDCap. Results: Sixty patient encounters requiring COVID-19 isolation were observed, representing 30.4% of the total WIC patients seen during the observation periods (N=197 over 36.5 hours). Cough and sore throat were the most common symptoms triggering isolation (both 55%). The mean time to don and doff PPE per room entry and exit was 1.58 and 0.57 minutes, respectively (2.16 minutes per don and doff cycle; Table 1). HCP performed donning and doffing an average of 1.8 times (range 1-4) per patient. Extrapolated to a 12-hour shift, this adds 1.3 hours to daily activities and encompasses 35 sets of PPE (e.g. gowns, gloves, eye protection, respirators), contributing to WIC waste volumes (Table 2). HCP survey respondents (N=26/49) indicated a majority strong agreement that PPE increased the time required, burden to HCP, and waste. Conclusions: Multiple workflow, resource, and HCP burdens of using full COVID-19 isolation precautions for WIC patients suggest that refining isolation criteria for ambulatory settings may help preserve clinic efficiency and limit waste. This pilot occurred during a period with low COVID-19 and influenza-like illness incidence, underscoring the challenges of scaling empiric transmission-based precautions to high-volume clinics during surges of respiratory virus season. Further studies are needed to evaluate the impacts of eliminating the gown and gloves components of PPE for COVID-19 in ambulatory settings, which may be unnecessary given the lower likelihood of transmission by non-airborne routes, short duration of outpatient clinic encounters which limits environmental contamination with SARS-CoV-2 virus, and lack of aerosol-generating procedures.

Background: Candida auris is an emerging multidrug-resistant pathogen that presents significant infection control challenges due to its ability to cause invasive infections and outbreaks. Despite its increasing prevalence in healthcare settings, there is limited guidance or data related to perioperative infection prevention in patients colonized with C.auris.(1-4) CDC guidelines do not address perioperative screening or management of C.auris in surgical patients, including solid organ transplant recipients.(5)

This study examines the reported experiences and approaches infectious diseases professionals take in managing C.auris colonization perioperatively. Methods: An online “Quick Query” poll was distributed to members of the Emerging Infections Network (EIN). EIN Quick Queries are a unique tool that utilize focused rapidly-deployable polls to ascertain members’ opinions/approaches to emerging infectious diseases with limited data, allowing for hypothesis generation or identifying areas of need. Our poll included 6 questions assessing perioperative prevention of C.auris infection. Descriptive analysis was used to evaluate responses. Results: Eighty-four EIN members completed the poll, representing 29 U.S. states and three other countries/territories. California accounted for the largest share of responses (17%), followed by Massachusetts (7%), and Florida (6%). Institutional protocols for C.auris prevention/management in surgical patients existed in 17% (14/84) of facilities, with only one facility reporting transplant-specific guidelines (Figure 1). Preoperative screening for C. auris was reported by 8% (7/84) of respondents, predominantly from California (5/7). Among the 44 respondents who encountered colonized surgical patients, only four (9%) used perioperative antifungal prophylaxis, with micafungin as the preferred agent. Notably, none of the seven sites utilizing preoperative screening reported using perioperative anti-fungal prophylaxis for C. auris colonization. Three of the four respondents who used perioperative antifungal prophylaxis also reported encountering postoperative C.auris infections in colonized surgical patients, suggesting evolving practices influenced by clinical outcomes. C.auris colonization in transplant recipients prior to transplantation was reported by 11 respondents (13%), while only two (2%) reported encounters involving transplants from colonized donors. In total,19% of respondents (16/84) reported postoperative invasive C.auris infections in previously colonized patients, including 13 surgical patients and 3 transplant recipients. Three other cases were described among transplant recipients without known donor or recipient colonization pre-transplant. Conclusion: The survey highlights the lack of institutional guidelines for Candida auris prevention in perioperative settings, including among solid-organ transplant patients. Postoperative C.auris infections are being encountered, although uncommon, underscoring the need for further research and standardized guidelines to address perioperative prevention of this emerging pathogen.

Background: Despite the crucial roles Infection Preventionists (IPs) and Hospital Epidemiologists (HEs) have in the implementation of patient safety strategies, there is paucity of data on what constitutes effective IP and HE staffing. Disparities in staffing and resource allocation in IPC and HE departments are currently underexplored. This study aims to evaluate staffing patterns, resource allocation, and collaboration among IPs and HEs comparing multi-facility organizations to free standing hospitals. Methods: All IPC departments in hospitals participating in the National Healthcare Safety Network were invited to participate in an electronic survey between August and December 2023. Data were collected on hospital and IPC department characteristics including organizational structure, IP staffing and resources, as well as HE staffing and time allocation. Descriptive statistics were used to summarize the data; Wilcoxon rank-sum tests and chi-square tests were used to compare variables between single, free-standing and multi-facility hospitals. Results: Responses were received from 901 IPC departments representing 2779 NHSN facilities. The majority of respondents were situated in multi-facility (61%) vs. free-standing hospitals (39%). Over half (57%) of the IPC programs were located under Quality (65% vs. 45% for multi-facility and free-standing hospitals, respectively) and 18% under Nursing (12% vs 27% for multi-facility and free-standing hospitals, respectively). Compared to free-standing hospitals, ICP departments in multi-facility hospitals reported higher median number of IPs (3.0 vs.1.0; p) Conclusion: This study reveals differences in IPC staffing and resources between free-standing and multi-facility hospitals with free-standing hospitals facing notable challenges, including limited access to HEs/ID Physicians. Future research should focus on identifying optimal staffing models and resource allocation to address these staffing and resource disparities and ensure equitable access to expertise. Interventions that leverage the collective expertise between IPC and HE are necessary to advance patient safety.

Background: Approximately half of all fevers in intensive care units (ICUs) are attributed to noninfectious causes. Despite this, most providers routinely culture urine from patients with indwelling urinary catheters who develop a new fever, which can lead to overdiagnosis and unnecessary antibiotic use. This study evaluated the impact of transitioning from a urinalysis (UA) with reflex to culture order to a stand-alone UA with microscopy in the Surgical and Neurosciences Intensive Care Unit (SNICU) on the frequency of urine cultures ordered and Catheter-Associated Urinary Tract Infections (CAUTIs). Methods: This quasi-experimental before-and-after study was conducted at the University of Iowa between July 2022 and August 2024 and included all SNICU patients. In August 2023, SNICU staff were educated to send a UA with microscopy, review results with the care team, and then decide whether a reflex to culture was warranted. This initiative was collaboratively developed by SNICU leadership and the hospital epidemiology team. Data on the frequency of urine cultures and CAUTI rates per 1,000 catheter days were compared before and after implementation using a P chart in QI Macros. Results: During the pre-intervention period, SNICU ordered approximately 66 urine cultures per 1,000 patient days, with a CAUTI rate of 1.55 per 1,000 catheter days (Figure 1a and 1b). While all data points remained within control limits, red data points between November 2022 and January 2023 indicated possible special cause variation; after further investigation, the specific cause was not identified and data points returned to normal cause variation. Following implementation, the frequency of urine cultures decreased to approximately 32 per 1,000 patient days, and the CAUTI rate dropped to 0.47 per 1,000 catheter days. The intervention also resulted in greater process stability, as evidenced by a narrower range between the upper control limit (48.97) and lower control limit (15.36). These improvements demonstrated the effectiveness of transitioning to a deliberate, decision-making process based on UA with microscopy. Conclusion: Transitioning from reflex urine culture orders to a stand-alone UA with microscopy, combined with provider decision-making and leadership engagement, significantly reduced the frequency of urine cultures and CAUTI rates in the SNICU. By requiring a deliberate review of UA results before ordering cultures, this intervention successfully optimized diagnostic stewardship. The pilot program will be integrated into the electronic medical record and expanded to other units.

Background: The terminal cleaning procedure for disinfection of a hospital room is an essential, yet difficult to monitor, step in infection prevention. Current methods for auditing require intensive human resources investment, depend on self-report, or employ spot checks using ATPase or glo gel audits. Inconsistent feedback and self-report are notoriously poor ways to drive behavior change or evaluate quality. Methods: We assessed a new AI platform developed by Myna Technologies that monitors cleaning and disinfection. The system incorporates thermal and optical cameras to detect percentage of total surface area cleaned including adequate contact time for two high touch surfaces: bedside table and mattress, in our Environmental Services (EVS) training suite. A researcher, trained by our hospital’s EVS team, performed 20 cleaning passes each for the mattress and bedside table. Each pass covered 25%, 50% 75% or 100% of total surface area; we compared the planned cleaning percentage to the device-observed results for both cameras. A Fisher’s exact test analysis was performed for fully clean (100% surface) and not clean Results: See Tables 1 and 2 for cleaning plan and device results. The mattress was 100% cleaned 6 times of 20 passes. The thermal camera correctly identified complete clean 100% of the time Discussion: Initial assessment of this novel AI technology to monitor disinfection in real time shows promise for detecting adequate cleaning. A formal validation trial comparing results of the automated system with direct observation, glo-gel marking and ATPase for all high touch surfaces, utilizing multiple cleaners is underway.

Background: Carbapenem-resistant (CR) organisms (CROs) pose a serious public health threat. We examined the burden of CRO colonization, the proportion of CROs among clinical isolates, and infection prevention and control (IPC) practices in three hospitals in India. Methods: This study was conducted December 2023 to December 2024 in medical intensive care units (ICUs) at three hospitals in western India. CRO colonization was assessed by direct MacConkey method in rectal/stool specimens collected ≤24 hours after admission and weekly until colonization detection or ICU discharge, colonies < 25mm from carbapenem disks were processed for bacterial identification and carbapenem susceptibility. Proportion of CROs in clinical isolates was assessed by screening Gram-negative bacilli (GNB) identified for carbapenem susceptibility. CRO was defined as GNB resistant to any carbapenem. Carbapenemase production among Enterobacterales was detected by modified carbapenem inactivation method (mCIM). Fifty day shift hand hygiene (HH) observations were collected weekly to measure adherence. Fluorescent gel markers (FGM) were placed on high-touch surfaces (HTS) to assess environmental cleaning (EC); effectiveness was assessed by proportion of FGM removed the following day. Nine key EC indicators were observed weekly to monitor cleaning technique. HH and EC data included were from June 2024 to November 2024.

The epidemiological triad model (Population-Environment-Agent) is used to describe results. Results: Population: Over half (476 [55%]) of 869 patients screened at ICU admission were colonized with CROs. An equal proportion of colonization was observed among patients without prior healthcare exposure in last 90 days (55% [217/396]). Of the 660 GNBs isolated from clinical specimens, 60% were CROs. Environment: CRO colonization was acquired by 65% (20/31) of the patients who remained in ICU for ≥ 7 days. Average HH adherence was 50% (30%-69%). HTS cleaning effectiveness averaged 65% (50%-77%). Adherence with correct EC technique was 77% (53%-86%). Agent: Among clinical isolates, 92% Acinetobacter-baumannii-complex, 70% Klebsiella pneumoniae, and 47% Escherichia coli were CRO. K. pneumoniae (35%) was the most frequently isolated CRO followed by A.baumannii-complex (33%) and E.coli (16%). Among colonization screening swabs, E.coli (57%) was the most frequently isolated CRO followed by K. pneumoniae (23%) and A.baumannii-complex (10%). 96% of CR Enterobacterales among clinical isolates and colonization screening were carbapenemase producers. Conclusions: The high prevalence of CRO colonization, acquisition rate, and carbapenem resistance indicate a high level of CRO threat in these Indian ICU settings with suboptimal IPC measures. There is an urgent need to strengthen IPC practices to interrupt transmission in healthcare settings.

Background: Central Line-Associated Bloodstream Infections (CLABSI) are multifactorial, making trends difficult to identify. CLABSI can occur from the time of insertion to delayed removals beyond the time central access was indicated. The objective of creating a CLABSI Preventability Index tool was to enable strategic quality improvement work. Methods: A preventability index tool was created with stakeholder input and was categorized into four categories (see Table 1): Indication for Line, Care and Maintenance and Line Access, Diagnostic Stewardship, and Specimen Collection. Each category had one or more questions prompting users to assign points for each preventable action. Scores range from 0 through 15, with the higher score indicating more prevention opportunities. (See table 2). Results: During the 2024 calendar year, there were 25 Adult CMS CLABSIs. The preventability index was applied to each case. There was 1 ‘extremely preventable’ case, 2 ‘very preventable’ cases, 6 ‘preventable’ cases and 16 ‘not preventable’ cases. In the 3 cases scoring very preventable or extremely preventable, the category “indication for line” was consistently scored high. Two of the 3 cases had preventable actions from a care and maintenance standpoint, 2 cases scored for diagnostic stewardship category and all 3 cases scored in the specimen collection category. In the 22 cases scoring 6 or lower, 0 scored in the indication for line category, 16 scored in the care and maintenance category, 11 scored in diagnostic stewardship and 4 scored in specimen collection. Conclusion: The preventability index objectively identifies the highly preventable CLABSIs in order to target high-priority actions to prevent future cases. Based on this tool, the use of central lines when not indicated causes the highest preventability scores, but care and maintenance activities score the most frequently.

Purpose: This study aimed to verify the effectiveness of a virtual reality (VR)-based multidrug-resistant organisms (MDROs) infection control education program for nursing students. Methods: This study is quasi-experimental with a nonequivalent control group pretest-posttest design. The subjects were 56 nursing students (28 in the experimental and 28 in the control group). A VR education program on infection control for MDROs was applied to the experimental group. The effectiveness of the education was assessed using a questionnaire. Results: The experimental and control groups had no statistically significant difference in the knowledge of MDROs infection control, performance confidence, and self-efficacy before and after the VR-based education. The difference in the knowledge of MDROs infection control between the experimental group before and after the VR education was 9.08±7.50, and the control group was 6.12±16.69. The difference value between the two groups was statistically significant (p = .036). The difference in performance confidence was 0.32±0.38 points in the experimental group and 0.27±0.52 points in the control group, and there was no statistically significant difference between the two groups (p = .073). The difference value of self-efficacy was 0.43±0.39 points in the experimental group and -0.23±0.71 points in the control group, and there was a statistically significant difference between the two groups Conclusion: This study found that This study found that VR-based infection control education can help acquire knowledge and self-efficacy in MDROs infection control.

Background: Turnover within the field of Infection Prevention is high, and this can cause significant organizational disruption and associated costs. Career growth and professional development are important retention factors in the field of infection prevention, however many infection preventionists (IP) tend to find their roles become stagnant resulting in attrition. The objective of this study was to determine organizational and leadership factors that contribute to IPs staying with an organization while still growing their career and profession. Methods: A mixed-methods approach with focus groups and survey methodology was used to assess organizational and leadership factors. Focus group and survey participants were stratified by (1) IPs who had been with the same organization for >5 years (long-term IPs), (2) IPs who have changed from one IP role to another IP role within the last 3 years (short-term IPs) and (3) IP leaders. Survey responses were analyzed using a Cochran Mantel-Haenszel test for associations. Qualitative responses were analyzed using a thematic analysis to identify themes and subthemes. Results: There were 82 participants in the focus groups and 632 survey respondents. 37.5% (n=117) of long-term IPs responded that their organizations were effective at providing career advancement opportunities in infection prevention compared to only 16.1% (n=20) of short-term IPs (p) Conclusion: The findings suggest that healthcare organizations could reduce turnover amongst IPs by providing career advancement opportunities and supporting professional growth. Future studies should focus on identifying the most effective professional advancement pathways specific to the field of infection prevention and control.

This paper presents the design, simulation, and real-world validation of a compact, dual-band, right-hand circularly polarized antenna for Global Navigation Satellite System (GNSS) applications. The antenna operates in the L1 (1575 MHz) and L5 (1176 MHz) bands, utilizing a stacked patch structure on low-cost FR4 substrates to achieve compactness and circular polarization. The design ensures axial ratio values below 3 dB, with peak gains of 2.59 dBi (L1) and -0.89 dBi (L5), while maintaining wide radiation coverage. Unlike many recent proposals based on Rogers substrates or complex geometries, our design focuses on cost-effectiveness and manufacturing simplicity. The prototype was validated using a Quectel LC29HAAMD GNSS receiver during the 2024 French National Microwaves Days (JNM), successfully acquiring over 40 satellites within 60 seconds in a real-world suburban environment. These results demonstrate the antenna’s suitability for space-constrained and low-cost GNSS platforms in the “New Space” era.

Sanseitō is a fringe Japanese political party founded during the coronavirus disease 2019 (COVID-19) pandemic that has won several seats in the National Diet since 2022. Initially coming to prominence as a promoter of anti-vaccine narratives, the party has since promoted a conspiracist worldview that connects to more conventional right-wing nationalism and addresses a much broader range of issues and beliefs. In this article we outline the core tenets of this worldview and examine how attention to its construction as a participative political ideology sheds light on the party’s political actions and motivations.

We construct a mod $\ell $ congruence between a Klingen Eisenstein series (associated with a classical newform $\phi $ of weight k) and a Siegel cusp form f with irreducible Galois representation. We use this congruence to show non-vanishing of the Bloch–Kato Selmer group $H^1_f(\mathbf {Q}, \operatorname {\mathrm {ad}}^0\rho _{\phi }(2-k)\otimes \mathbf {Q}_{\ell }/\mathbf {Z}_{\ell })$ under certain assumptions and provide an example. We then prove an $R=dvr$ theorem for the Fontaine–Laffaille universal deformation ring of ${\overline {\rho }}_f$ under some assumptions, in particular, that the residual Selmer group $H^1_f(\mathbf {Q}, \operatorname {\mathrm {ad}}^0{\overline {\rho }}_{\phi }(k-2))$ is cyclic. For this, we prove a result about extensions of Fontaine–Laffaille modules. We end by formulating conditions for when $H^1_f(\mathbf {Q}, \operatorname {\mathrm {ad}}^0{\overline {\rho }}_{\phi }(k-2))$ is non-cyclic and the Eisenstein ideal is non-principal.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction(PCR) is a rapid screening test (turnaround time ~1-2 hours) used to evaluate nasal colonization with MRSA. For respiratory and bloodstream infections, MRSA nasal swab has a high negative predictive value >95% which could help de-escalation of MRSA directed therapy in the appropriate clinical setting. Tufts Medical Center recently implemented this test and requires an indication for ordering: pneumonia, sepsis or septic shock, bacteremia, or other (with free-text reason). Intervention/Aim: Evaluate clinician adherence to the recommended indications through reviewing of ordering indication and assess utilization of MRSA PCR as a tool for de-escalating MRSA directed antibiotics. Methods: Retrospective review of MRSA PCR orders between September 28, 2023, and March 28, 2024. Ordering data including indication selected and test result was extracted from the electronic medical records. Other variables were collected by chart review by two study members. Free-text reasons documented when selecting “other” were categorized by system (e.g genitouniary or skin and soft tissue). Free text reasons were evaluated based upon published negative predictive value (NPV). Indications with NPV lower than 95% were considered inappropriate. MRSA antibiotics were considered vancomycin, daptomycin, linezolid, or ceftaroline. Changes in MRSA antibiotics were determined by chart review of the antibiotics administered at least 24 hours prior to MRSA PCR administration and 24 hours after administration. Results: 113 of 1339 tests were ordered with “other” indication. Only 17 (15%) of these orders were considered appropriate. Among the appropriate tests were infections involving the head, eyes, ears, nose, and throat (HEENT). Of 441 tests reviewed, 411 were negative (93.2%). Of those with negative tests 324 (78.8%) were given MRSA antibiotics prior to the test. and only 92 (28.4%) remained on MRSA therapy after a negative test Conclusion: Reviewing “others” helped identify gaps in knowledge to target educational interventions and identify additional appropriate indications to include in the computerized order entryMRSA Nares is an effective tool to de-escalate MRSA antibiotics, but other interventions are needed to increase appropriate antibiotic de-escalation with a negative test.

Background: Several studies have shown an association between deprivation and excessive antibiotic use in the US. However, these studies were limited by their geographic design, making them unable to assess a causative relationship. This study analyzed the impact of socioeconomic deprivation on antibiotic days supplied among older Medicare Part D beneficiaries in the US using an instrument variable (IV) approach. Method: This study utilized the Medicare Part D and the Social Deprivation Index (SDI) repositories. The maximum Earned Income Tax Credit was chosen as an IV to consider the reverse causality of the SDI values. Spatial dependence between predicted SDI and study outcome (log antibiotic days supplied per 100 beneficiaries) was evaluated by global Moran’s I analysis and cluster mapping. Linear regression models were performed to assess the impact of predicted SDI or its components (poverty, single parent, low education, no car, renter-occupied, crowding, and non-employment) on the study outcome. The study adjusted for the following confounders: prescriber gender, specialty, graduate school rank, teaching location, metropolitan area, US state, and beneficiary characteristics (demographics, risk scores, and dual public insurance). Results: A total of 438,431 providers were included. There was no spatial dependence between the predicted SDI and study outcome (I = 0.007, P = 0.0656, Figure). Higher predicted SDI values resulted in higher antibiotic days supplied (log) per 100 beneficiaries (estimate 0.58, SE 0.16, P) Conclusion: This study showed a causative relationship between SDI and antibiotic days supplied. It highlights opportunities for public health in the US to explore gaps in antimicrobial stewardship. More studies are needed to investigate the knowledge and attitudes of patients and providers and potential barriers to access that might impact antibiotic prescription in older patients.

Background: Antimicrobial resistance (AMR) is a pressing global public health issue, and the limited development of new antibiotics necessitates robust Antimicrobial Stewardship Programs (ASP). As a global healthcare leader, IHH Healthcare successfully implemented ASP across 80 hospitals in seven countries (Singapore, Malaysia, India, Brunei, Hong Kong, China, and Turkey), aligned with the Centre for Disease Control and Prevention (CDC) Hospital ASP Core Elements, World Health Organization, and national guidelines. Method: A three-phase ASP strategy was developed following a crosswalk analysis of ASP practices across the seven countries (See Table 1): Phase 1 (2023): ASP committee establishment, terms of reference, and adoption of evidence-based guidelines. Phase 2 (2024): Guideline compliance audits, antibiogram development, resistance pattern monitoring, post-prescription audits, therapy optimization, and education. Phase 3 (2025): Antimicrobial preauthorization, infection-based interventions, and antimicrobial timeouts within 48–72 hours of initiation. Quarterly ASP meetings facilitated progress tracking and shared learning. Key metrics included guideline adherence, resistance trends, and antimicrobial utilization. Results: By 2023, all countries have established ASP committees and adopted guidelines for infections and surgical prophylaxis (see Table 2). In 2024, Phase 2 implementation (see Table 3) showed that: Guideline compliance: Regular audits monitored antimicrobial use for appropriateness, quantity, duration, and type, achieving full compliance across facilities. Education: Comprehensive initiatives included patient education on completing antibiotic regimens and continuous education for healthcare professionals. Post-prescription audits: Standardized protocols ensured systematic audits, with findings and targeted interventions shared with stakeholders. Antibiogram and resistance monitoring: Standardized antibiogram protocols monitored resistance patterns, guiding treatment decisions and policy updates. A framework for tracking key resistance organisms and hospital-acquired infections was also established. Therapy optimization: Policies required prescribers to document antibiotic doses and indications, while IV-to-oral conversion protocols reduced costs and improved outcomes. Metrics like Days of Therapy and Defined Daily Doses measured impact, with dose optimization improving treatment for resistant organisms. Conclusion: IHH Healthcare is the first large international group to adopt and implement the U.S. CDC ASP elements across its network of foreign hospitals. By utilizing a phased approach, we have ensured consistent and effective implementation across diverse healthcare settings. To date, all 80 hospitals have successfully completed Phase 2 of the program and are on track to achieve Phase 3 milestones by 2025 (see Table 4). Early outcomes from this initiative underscore the significant value of standardized ASPs in enhancing patient safety, reducing AMR and fostering sustainable quality improvement.

Background: During the COVID-19 pandemic, the rate of central line-associated bloodstream infections (CLABSI) decreased at the Veteran Affairs North Texas Health Care System. From fiscal year (FY) 2022 Quarter (Q)4 to FY2023 Q2, the CLABSI rate increased from 0 to 0.79 per 1,000 device days. Breaches in evidence-based practices for the maintenance of vascular access devices (VAD) were hypothesized to have contributed to the increase in CLABSI rate. Methods: In March 2023, a multidisciplinary workgroup was created with the primary goal of improving compliance with VAD standards of care to ≥ 95% by FY2023 Q4 and a secondary goal of decreasing CLABSI rates. A baseline assessment of 12 VAD insertion and maintenance process measures was developed using an assessment tool to record nurses’ observations and review documentation in the computerized patient record system. In addition, the facility VAD policy was updated, and nurses received competency training on VAD management. Baseline compliance data for the 12 VAD process measures was compared to data during the intervention period for acute and critical care areas. CLABSI rates (classified using the National Healthcare Safety Network surveillance criteria) were compared to the period before the creation of the workgroup, policy updates, and training. Results: Nurse observations in acute and critical care units during FY2023 were 19 (Q2), 1,284 (Q3), and 718 (Q4). From FY2023 Q2 to Q4, three of the 12 process measures met the ≥ 95% compliance goal by FY2023 Q4. The process measures that met the goal from Q2 to Q4 were clean peripheral IV catheter hub: 100% to 95.0%, unused tubing Y-sites capped with swap cap: 0% to 96.0%, and documentation of the last dressing change in CPRS: 0% to 99.0%. Notable increases were also seen for three other measures: appropriately dating of peripheral IV tubing: 78.9% to 88.0%, presence of Coban or kerlix occluding site: 0% to 46.0%, and documentation of device insertion: 0% to 89.0%. Persistent deficits were noted in the documentation of peripheral intravenous dressing dates and initials (compliance Conclusions: Enlisting a multidisciplinary team approach, including training, and updating VAD policy/procedures, led to a moderate improvement in VAD management compliance and a decline in CLABSI rates.

Introduction: Patients with mechanical circulatory support (MCS) devices, such as ventricular assist devices (VAD) and extracorporeal membrane oxygenation (ECMO), are excluded from the National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) criteria, whereas patients with intra-aortic balloon pumps (IABP) and Impella devices remain included. Since both MCS and Impella/IABP devices are associated with bloodstream infection risks, this study compares bacteremia rates among patients with VAD/ECMO, IABP/Impella, and central venous catheters (CVCs) to inform more accurate infection reporting. Methods: Using a surveillance database, we retrospectively reviewed bloodstream infections among patients with a CVC, ECMO/VAD, or IABP/Impella admitted to Duke University Hospital Cardiology units from January 2019 to July 2024. Bacteremia episodes were calculated per 1000 device days, with de-identified data pooled for final analysis. Results: A total of 849 bacteremia episodes were observed in patients with only a CVC (0.14 episodes/1000 device days), 98 in patients with ECMO/VAD (0.19/1000 device days), and 64 in patients with IABP/Impella (0.16/1000 device days). (Figure 1) Bacteremia incidence rate ratio (IRR) in patients with ECMO/VAD compared to patients with only a CVC was 1.30 (95% CI 1.05, 1.60, p-value 0.01). Bacteremia IRR in patients with Impella/IABP compared to patients with only a CVC was 1.12 (95% CI 0.87, 1.45, p-value 0.37). However, when we combined both ECMO/VAD and IABP/Impella bacteremia episodes and compared the bacteremia rate to patients with only a CVC, the incidence rate ratio was 1.22 (95% CI 1.03, 1.44, p-value 0.02). Discussion: The significantly different combined bacteremia rates among ECMO/VAD and IABP/Impella suggest that both device categories have significantly higher rates of bacteremia compared to CVC-only patients. Thus, NHSN should reconsider NHSN exclusion criteria for Impella/IABP patients similar to that for ECMO/VAD patients. Further collaboration with institutions, could strengthen findings and refine infection control protocols in high-risk, device-dependent patients.

Background: Candida auris is an emerging fungal pathogen with potential to cause outbreaks. To mitigate transmission, the California Department of Public Health (CDPH) recommends considering implementation of an active case detection process in acute care hospitals to identify high-risk patients who may be colonized on admission. Methods: From 1/5/2024 to 9/20/2024, Stanford Health Care piloted an active surveillance program to identify high-risk patients for C. auris – defined as patients coming from (1) long term acute care hospitals (LTACHs), (2) ventilator skilled nursing facilities (vSNFs), (3) outside institutions with known C. auris outbreaks, (4) hospitals in Nevada, (5) recent international hospitalizations, and (6) patients with carbapenemase-producing organism (CPO) colonization.

Patients were identified for screening via daily review of custom-designed lists from the electronic medical record (EMR). A list of patients admitted from skilled nursing facilities (SNFs) and a list of patients transferred to Stanford from an outside facility were cross-referenced with a published list of high-risk facilities provided by CDPH. A list of inpatients flagged for CPOs was reviewed daily. Infection prevention was also notified by the transfer center or the care team if a patient had a recent international hospitalization. Screening was via superficial skin specimens from the axilla and groin. Culture-based testing was performed with identification of any fungal growth via MALDI-TOF. Results: During the pilot period, 1159 patients were evaluated for high-risk criteria; 58 (5%) met criteria for C. auris testing. One of 58 patients (colonization (Figure 1). There were 5 clinical cases during the pilot period, including the patient identified via screening. Active surveillance required 5-7 hours per week of infection preventionist effort, plus an hour to educate nursing staff when screening tests were performed. Conclusions: Our experience with performing active surveillance for C. auris resulted in one positive case, suggesting that this approach may have a lower yield in regions with low prevalence. Since surveillance can often be a time-intensive task for infection preventionists and nursing staff, it is important we continue to improve our knowledge about when and what surveillance is the most effective.

Background: A measles outbreak associated with a migrant shelter occurred in Chicago in early 2024. Given the high transmissibility of measles in combination with the congregate nature of the shelter, health care facilities were tasked with hospitalizing patients with confirmed measles throughout the duration of their contagious period. Comer Children’s Hospital at the University of Chicago was able to hospitalize many of these patients, but numerous challenges were encountered in the initial response. Method: Communications were sent out to all providers to educate and increase awareness of measles presentations. Our infection prevention team helped coordinate timely collection of appropriate measles testing with the clinical team and helped facilitate timely processing with our microbiology lab for the test to be run by our state reference lab. Constant communication between the area hospitals and the city were instrumental in weathering the challenges our center faced in responding to the local outbreak. Result: Collaboration with the public health department allowed for optimizing turnaround times for diagnostic results, forecasting future patient volume, increasing advanced notice for patient arrival to the ED from the local shelter. Our hospital was faced with an inability to safely accommodate the influx of patients with airborne infection isolation rooms (AIIRs), and discussions with our facilities group led to the construction of multiple makeshift anterooms both in the ED and on the pediatric floors with the necessary amount of air exchanges to safely isolate these patients. A total of 18 patients were tested for measles at Comer Children’s Hospital in March 2024, including those from the community who did not reside in a shelter. Ten patients tested positive for measles, all of whom lived in the nearby shelter. Ages ranged from 2 months old to 9 years old. Patients returned back to the shelter after their infectious window was over. One patient suffered a complication of bacterial empyema requiring readmission. No exposures to patients or staff members occurred. Conclusion: Strong, efficient communication amongst hospital leaders allowed us to safely accommodate all the patients who presented with suspicion of measles. Working closely with the local public health department ensured optimal turnaround times of diagnostic results and increased our hospital’s level of preparedness.

Objectives: Multiple barriers exist for COVID-19 vaccination in high-risk individuals especially adults over the age of 65. Each healthcare visit represents a critical opportunity for vaccination, yet many patients who do seek vaccination receive their vaccines in locations other than their routine health care providers and healthcare sites often lack the capacity for vaccine administration. Here-in we conducted a needs assessment to identify hospital system specific barriers and facilitators to COVID-19 vaccine access in individuals 65 and older in 2024. Methods: We conducted six semi-structured interviews (June-July 2024) with seven healthcare leaders in Yale New Haven Enterprise. We transcribed and analyzed interviews to develop a larger-scale survey targeting healthcare professionals including vaccine leadership of individual clinics across the healthcare systems. The survey was distributed to 42 healthcare leaders (physicians, administrators, and practice supervisors) across 52 ambulatory locations. Results: The survey received twenty responses (47% response rate). Four primary challenges to COVID-19 vaccination among older adults were identified: (1) Patient Hesitancy, driven by misinformation about vaccine contents, concerns about side effects, polarized attitudes, and waning interest in booster doses; (2) Challenges Related to Staff, including distrust in vaccine motives, mandates, and efficacy, as well as a shortage of personnel available to administer vaccinations; (3) Operational and Logistical Barriers, including complex vaccine schedules, vaccine storage, and reliance on retail pharmacies, which led to lower vaccination rates at primary care sites; and (4) Policy and Financial Constraints, such as insufficient financial incentives for on-site vaccinations, Medicare coverage limitations, and high administrative costs. The main proposed actions to address vaccination hesitancy and challenges include enhancing education sessions for patients and staffs, modifying streamlining administration by simplifying the workflows including on-site vaccination process for employees, and centralizing vaccine delivery in primary care or hubs, improving accessibility via routine (home) visits and flexible hours, and partnering with pharmacy department to ensure greater access to vaccination. Conclusion: Through semi-structured interviews and surveys, we identified targets for future quality improvement efforts. Multiple overlapping barriers to COVID-19 vaccination in older adults exist within one U.S. based health care system. Some of these barriers, such as improving vaccine administration workflows or enhancing patient education, can be more readily addressed, while others involve larger structural issues that would require larger societal change. We are seeking a subspecialty clinic partnership to pilot an implementation project, using high-impact intervention tailored to clinic needs and iterative Plan-Do-Study-Act (PDSA) cycles to refine and optimize outcomes.