Background: Surgical site infection (SSI) following spinal fusion is a major complication that increases mortality and healthcare costs, with Staphylococcus aureus being the most common pathogen. Implementation of an SSI prevention bundle has been reported to significantly reduce SSI rates. This study evaluated changes in SSI rates among orthopedic spinal fusion patients after applying a prevention bundle that included S. aureus decolonization therapy and compared the results with non-intervention neurosurgical spinal fusion patients during the same period. Methods: At a tertiary care hospital in Seoul with 2,432 beds, an enhanced SSI prevention bundle including S. aureus decolonization therapy was implemented for all orthopedic spinal fusion patients beginning in December 2023. Decolonization consisted of a chlorhexidine shower the day before or the day of surgery and intranasal application of povidone-iodine within two hours before surgery. Additional bundle components included the use of colored inner gloves during auto-graft bone preparation to detect glove tearing, and additional sterile drapes when using a C-arm. The intervention was accompanied by staff education, promotion activities, awareness surveys, and ongoing monitoring. SSI rates were compared between the pre-intervention period (January-November 2023) and post-intervention period (December 2023 – October 2024) in orthopedic patients and further compared with neurosurgical surgery to evaluate the intervention’s effectiveness. Pediatric patients who underwent scoliosis surgery and patients with infections present at the time of surgery (PATOS) were excluded from the study. Diagnosis was based on the updated 2023 CDC/NHSN (National Healthcare Safety Network) definitions. Result: In the orthopedic department, the SSI rates significantly decreased from 2.65% (14/529) before the intervention to 0.34% (1/295) after the intervention (p=0.01). In the non-intervention neurosurgery department, there was no significant difference in SSI rates between the two periods (3.05% [12/393] vs. 2.16% [5/231], p=0.62). Although the post-intervention SSI rates in orthopedics were lower than that in neurosurgery (0.34% vs. 2.16%), the difference was not statistically significant (p=0.09). The SSI rates caused by Staphylococcus spp. in orthopedics decreased from 2.27% (12/529) before the intervention to 0% (0/295) after the intervention (p=0.01). In neurosurgery, there was no significant change in the incidence of SSIs caused by Staphylococcus spp. between the two periods (1.53% [6/393] vs. 1.30% [3/231], p<0.99). Conclusion: The enhanced SSI prevention bundle, which included S. aureus decolonization therapy, effectively reduced the SSI rate in orthopedic fusion surgeries. This effect was not observed in the neurosurgery department without the intervention, supporting the effectiveness of the implemented bundle.

Background: A potential cluster of post-craniotomy surgical site infections was noted by the neurosurgery service in December 2024. A case review revealed a total of five organ space surgical site infections (SSI) identified between October 4th-December 4th, three of which had the same organism isolated, Cutibacterium acnes (C. acnes). Methods: Infection Prevention met with Surgical Services, Sterile Processing, Neurosurgery, and Infectious Disease to strategize next steps. After a retrospective review of the five initial SSIs, a case definition was established including patients who underwent a craniotomy procedure and had cultures positive for C. acnes collected upon readmission with signs of infection. An epidemiological curve and line list of cases meeting definition was created. Excluded cases included: C. acnes isolated from the index procedure and unrelated to an infection, isolation of a different organism post craniotomy, and infection post burr hole procedure. Observations of the neurology OR and case setup, pre/intra/post-op workflows and sterile processing practices were completed and staff interviewed. Surgical positioning equipment and instrument instructions for use (IFU) were reviewed. Equipment and implants used in each case were noted and compared to cases without infections to identify similarities. A common DuraGen implant was sent to the Microbiology Laboratory for culturing. The C. acnes isolates were sent to the Molecular Laboratory for genomic typing. Result: Altogether, four patients met the case definition. No deficiencies were identified during the observation of the neurology OR and case setup. Staff interviews revealed patients would arrive from the inpatient units prior to procedure with dirty hair and bed linens. Investigation into intra-op practices revealed that key positioning equipment was not being cleaned or disinfected per manufacturer’s IFU. Additionally, a retrospective chart review of index procedures revealed a common DuraGen 2x2 implant was utilized in each case. Subsequent culturing of the DuraGen implant resulted in growth of a Cutibacterium species. Molecular typing of the patient and DuraGen samples revealed two of the four patient samples to be genetically similar, however none of the patients to be genetically similar to the DuraGen sample. Conclusion: Quick attention to gaps in the OR and engagement of the leadership team led to improved practices and adherence to IFUs. Since the fourth and final case, there have been no additional C. acnes SSI cases. As a result of the investigation, craniotomy cases have been added to Infection Prevention’s daily surveillance with completion of root cause analyses for any infection,regardless

Background: Previously published studies, including our own, have demonstrated that empiric antibiotic therapies with activity against methicillin-resistant Staphylococcus aureus (MRSA) and resistant gram-negative (RGN) bacteria are often unnecessarily prescribed for patients hospitalized with diabetic foot infections (DFI) and lower extremity osteomyelitis (OM). We implemented a multidisciplinary intervention based on local and national data to optimize antibiotic prescribing for these patients, including development of a “diabetic foot algorithm,” stakeholder education, and creation of an infectious diseases bone and joint consult service. We evaluated changes in antibiotic use and clinical outcomes after implementation of this intervention. Methods: This was a “before and after study” of all patients hospitalized with DFI and/or lower extremity OM in our hospital system in 2021 and 2025. Patients were included if they had an International Classification of Disease, Tenth Revision (ICD-10) diagnosis code of M86, E10.621, E11.621, or E08.621. Patients were excluded if antibiotics were for a different indication or if they were less than 18 years of age. Empiric antibiotic therapy included antibiotics started by the admitting team. Definitive antibiotic therapy included the final antibiotic course either completed during admission or prescribed at the time of discharge. The intervention began in October 2023. The primary outcomes were changes in use of empiric and definitive antibiotic therapies with activity against MRSA and RGN bacteria. The secondary outcomes were changes in amputation rates and hospital length of stay (LOS). Results: There were 259 and 242 unique patients hospitalized with DFI or lower extremity OM who met inclusion criteria in 2021 and 2025, respectively. Comparing 2021 to 2025, the percentage of patients receiving empiric therapies with activity against MRSA decreased from 87% to 70% and against RGN bacteria decreased from 84% to 68% (p<0.001) (Figure 1). There was also a trend in the decreased use of definitive therapies with these spectra of activity, while the prevalence of resistant organisms in cultures remained similar. Inpatient days of antibiotic therapy with activity against MRSA and RGN bacteria also decreased 16% and 11%, respectively. There was no difference in clinical outcomes with 44% of patients in both 2021 and 2025 undergoing inpatient amputation surgeries (p=0.997). There was a significant decrease in hospital LOS (8 vs. 6 days, p=0.002). Conclusions: A multidisciplinary, multifaceted intervention was associated with significant decreases in use of antibiotic therapies with activity against MRSA and RGN bacteria with no noted adverse effects on clinical outcomes.

Background: The National Healthcare Safety Network (NHSN) Standardized Antimicrobial Administration Ratio (SAAR) is a widely used metric for benchmarking antimicrobial use and supporting antimicrobial stewardship efforts. The Centers for Disease Control and Prevention (CDC) Priority Core Elements of Hospital Antibiotic Stewardship Programs offer a complementary, framework-based approach to evaluating stewardship infrastructure and practices. Understanding the relationship between implementation of Priority Core Elements and SAAR performance may help clarify how structural stewardship components translate into measurable antimicrobial use outcomes. Tennessee Department of Health explored the association between NHSN SAARs and Priority Core Elements to better inform stewardship program evaluation and improvement strategies. Methods: Using 2023 NHSN data, TDH evaluated the relationship between all-antibacterial SAARs by overall Priority Core Element and by interventions that comprise each element. Aggregate SAAR data from qualifying adult units was utilized to create a hospital wide SAAR. Specific Priority Core Element components—including leadership, accountability, pharmacy expertise, action and reporting were analyzed. The tracking priority was excluded as participating hospitals had to submit antimicrobial use data to generate a SAAR. Associations between SAAR performance and presence of interventions for each included Priority Core Element were analyzed using t-tests in SAS 9.4. Results: Mean all-antibacterial SAAR declined with greater attainment of priority Core Elements (1.13, 1.07, and 1.01 for 0–2, 3–4, and 5 elements, respectively), though the difference was not statistically significant (p=0.31). Hospital leadership commitment was not associated with SAAR differences. Hospitals meeting the Accountability Core Element demonstrated significantly lower SAARs than those that did not (1.02 vs 1.14; p=0.035). Hospitals with physicians who completed infectious diseases fellowships (0.96 vs 1.10; p=0.004) or pharmacists who completed stewardship certificate programs (1.00 vs 1.11; p=0.027) demonstrated lower SAARs. Action and Reporting Core Elements showed trends toward lower SAARs. Facilities implementing treatment recommendations with both prospective audit and feedback and preauthorization had significantly lower SAARs (1.00 vs 1.13; p=0.014). Conclusion: Implementation of accountability and targeted stewardship training was associated with lower all-antibacterial SAARs, suggesting that specific structural and personnel-focused interventions may improve antibiotic use. Action and Reporting Core Elements demonstrated trends toward lower SAARs, but these were not statistically significant. Findings underscore the potential value of Priority Core Elements in guiding stewardship strategies; however, limited sample size may have reduced the ability to detect additional associations. Larger, multistate studies are needed to confirm these relationships and further elucidate how comprehensive Core Element implementation impacts antimicrobial use outcomes.

Background:? Legionella poses a significant threat to immunocompromised oncology patients. To mitigate nosocomial legionellosis, healthcare systems often implement environmental surveillance. At MD Anderson Cancer Center, we combined a shared analytics platform with long-read whole genome sequencing (WGS) to enable detection of genetically related isolates from facility ice machines.? Methods:? A centralized dashboard (Power BI, Microsoft) was developed to monitor environmental Legionella surveillance across the institution and highlight areas with elevated positivity rates. Targeted environmental sampling was conducted to identify potential reservoirs. Given repeated isolation of L. anisa strains, a subset of isolates underwent WGS using the MinION platform (Oxford Nanopore Technologies). Genetic relatedness was assessed using MINTyper for single-nucleotide polymorphism (SNP) calling and Prokka with Roary for pan-genome analysis.? Results:? Environmental sampling of facility water sources revealed five positive Legionella samples from five separate ice machines, three of which grew L. anisa. No shared feeder lines or water sources tested positive. WGS performed by an infection control practitioner and revealed that two L. anisa isolates shared 99.9% genome similarity, differing by fewer than five SNPs, suggesting a common origin or transmission route (Figure 1). No clinical cases were associated with these findings during the investigation.? Conclusion:? A WGS based investigation powered by infection control practitioners without the use of a core genome sequencing facility uncovered potential transmission between geographically separated reservoirs that would have gone unrecognized through conventional methods. WGS also helped exclude a third ice machine from the suspected cluster. These findings led to the development of an updated institutional standard operating procedure (SOP), integrating data visualization and genomic analysis to enable earlier identification of related environmental sources and guide proactive interventions before clinical cases occur. This provides a framework for real-time implementation of WGS for Infection Control that can be deployed with minimal investment in nearly any clinical setting.

In the aftermath of formal independence, two institutions, the East African Court of Appeal (EACA) and the University of Dar es Salaam School of Law, became important international barometers of the potential of post-colonial legal radicalism. Due to the unique power of federal Pan-Africanism in East Africa, the EACA survived the wave of dissolution that claimed similar colonial courts of law. If the EACA represented the formal apotheosis of one version of supranational law, it was the law school at the University of Dar es Salaam, which produced a deeper and wider development of legal thought about the circumstances of law in East Africa. The scholarship produced in Dar es Salaam not only undergirded the legal academies of multiple East African nations but proved globally influential for several left and left-liberal schools of thought. Despite the loose and imperfect coordination of these parallel bodies, the project of East African law shared by the Court and University provides unique insights into the opening for anticolonial or heterodox visions of the law that existed in the opening of twentieth century decolonization and independence. The legal institutions of federal Pan-Africanism usefully illustrate both the unexpected successes and structural limitations on atypical iterations of internationalist Global South legal radicalism.

Introduction: Clinicians often order a variety of tests for hospitalized patients, including urinalysis with urine cultures. However, fever has limited diagnostic value for urinary tract infection (UTI); pooled estimates indicate that fever has likelihood ratios near 1, offering minimal discriminatory value for ruling UTI in or out. We evaluated the diagnostic yield of inpatient urine cultures by fever status in an acute care safety-net hospital in Denver, Colorado. Methods: We analyzed inpatient urine culture events from April 2016 through December 2025 using an automated electronic medical record report. Fever was captured within the National Healthcare Safety Network (NHSN) infection window period (+/- 3 calendar days). Culture positivity was defined per NHSN UTI criteria as ?10 colony forming units of one or two organisms; cultures with no growth or reported as yeast/Candida spp. or mixed flora were classified as negative. Antibiotic exposure was extracted from medications given up to 3 days after culture collection, and urinary infection-related diagnoses from problem/diagnosis entries up to 7 days after culture collection. To scale adjudication, we used deterministic text classification of medication and diagnosis fields. Medication strings were normalized and parsed with regular expressions to extract generic drug names (token preceding dose/formulation), then matched to a curated antibiotic dictionary. Urinary diagnoses were identified by regular-expression matching to UTI-related terms (e.g., UTI/urinary tract infection, cystitis, pyelonephritis, urosepsis). Results: Across 17,629 inpatient urine cultures, fever within the NHSN infection window period was documented in 37.1% of episodes and UTI diagnoses were documented in 29.6%. Overall, 7,983 cultures (42.1%) were positive for a bacterial pathogen, and antibiotics were prescribed in 77.8% of episodes. Culture positivity was similar to, or higher than, that among afebrile vs febrile episodes (44.1% vs 38.8%) and was higher with documented UTI diagnoses (58.5% vs 35.2% without). Culture positivity varied by strata: UTI diagnoses were more common among culture-positive episodes (60.9% with fever; 57.1% without fever), while febrile episodes without UTI diagnoses had the lowest positivity (29.4%) (Figure 1). Antibiotic exposure remained common across the fever–culture result combinations, including 22.5% of all episodes occurring in afebrile, culture-negative patients who nevertheless received antibiotics and 18.9% in febrile, culture-negative patients who received antibiotics (Figure 2). Conclusion: Fever was not reliably associated with urine culture positivity, whereas UTI diagnosis (clinical suspicion) was. Antibiotic use remained common after negative urine cultures, supporting opportunities to refine inpatient urine culture ordering and antimicrobial stewardship.

Background: Sustaining reductions in inappropriate antibiotic prescribing for acute respiratory tract infections (ARTIs) remains challenging, with improvements often diminishing after stewardship interventions end. In a large, rural, non-profit, healthcare system with three high-volume urgent care centers (UCCs), an initial 11-month behavioral intervention reduced inappropriate prescribing for ARTIs; however, rates increased after intervention cessation. We evaluated whether reimplementing the same intervention could sustain reductions in inappropriate antibiotic prescribing in urgent care settings. Methods: We conducted a quasi-experimental interrupted time series (ITS) analysis using monthly data from October 2020 through October 2025. The reimplementation of monthly individualized feedback and quarterly blinded peer comparison emails began in February 2024. Prescribing trends were analyzed across four phases: Pre-Intervention (October 2020 - September 2021), Initial Intervention (October 2021 - August 2022), Post-Intervention (September 2022 - January 2024), and Reimplementation (February 2024 - October 2025). Mean prescribing rates were compared using descriptive statistics and analysis of variance (ANOVA). A Seasonal Autoregressive Integrated Moving Average (SARIMA) model accounted for autocorrelation and seasonality. Analyses were performed using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Results: Among 52,842 ARTI visits, 15,180 antibiotics were prescribed during the study period. Mean inappropriate antibiotic prescribing decreased from 41.7% (SD 9.79%) Pre-Intervention to 32.3% (SD 3.36%) during Initial Intervention, followed by an increase to 32.6% (SD 6.58%) Post-Intervention, and subsequent decline to 24.4% (SD 3.79%) during Reimplementation (Figure 1). ANOVA revealed significant differences across phases (F(3,57)P P PPPPP Conclusion: Reimplementation of a behavioral stewardship intervention was associated with a larger and sustained, though non-significant, reduction in inappropriate antibiotic prescribing for ARTIs. These findings suggest that ongoing or repeated stewardship efforts may be necessary to maintain prescribing improvements in outpatient urgent care settings.

Background: Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). Outbreaks of HBV infection in healthcare settings have been linked to lapses in infection control, including unsafe injection practices, such as reuse of needles, fingerstick devices, and syringes. In December 2024, an acute case of hepatitis B in a patient without traditional risk factors was reported to the Connecticut Department of Public Health (CTDPH). We investigated a potential healthcare exposure as part of a multidisciplinary investigation. Methods: Acute hepatitis B is reportable to CTDPH. Immunization Program staff interviewed the patient with hepatitis B to determine risk factors for infection. Immunization and Healthcare-Associated Infections and Antimicrobial Resistance (HAI-AR) team members assessed potential healthcare exposures via medical chart review. Upon identification of a potential healthcare exposure, HAI-AR staff conducted an on-site Infection Control Assessment and Response (ICAR). Results: Patient interview and medical chart review identified potential high-risk procedures at an outpatient clinic that performs aesthetic procedures. Among 15 procedures performed during the six months prior to HBV infection, the highest risk procedures were injection of platelet rich plasma and invasive hormone replacement therapy. ICAR identified the following breaches in infection prevention and control (IPC) practices: poor hand hygiene, failure to label and improper handling of blood products, and improper operation of a sterilizer. Environmental cleaning/disinfection practices were inconsistent, and disinfectants were improperly labeled and stored. HAI-AR staff recommended training on and auditing of hand hygiene, training on proper cleaning/disinfection practices for office staff and environmental services (EVS), and discontinuation of sterilizer use until such time that biologic monitoring could be performed and staff could be properly trained on use. The clinic stopped all operations until IPC oversight was in place, changed all equipment to single-use, and trained staff on disinfection. Providers received bloodborne pathogen training. In response to IPC breaches, the clinic also notified 118 patients who had received high-risk procedures in the prior year to recommend bloodborne pathogen testing. Conclusion: Outpatient healthcare environments where aesthetic procedures are performed may have limited regulatory oversight and no requirement for an individual responsible for IPC. In these settings, healthcare providers might perform a large number and variety of invasive procedures, which may require education and training on specialized equipment, such as sterilizers. Improved oversight of these settings with a focus on education and training of outpatient providers on IPC could improve infection prevention and patient safety.

Background: Staphylococcus aureus (SA) is a leading cause of infection-related mortality worldwide and remains one of the most common pathogens in healthcare settings, particularly methicillin-resistant SA (MRSA). Approximately 30% of patients are colonized with SA in the nares, and these asymptomatic carriers serve as a reservoir for invasive infections, including bloodstream infections, pneumonia, and surgical site infections. Targeted strategies, such as nasal decolonization, are essential to reduce colonization and prevent subsequent infection. We evaluated the impact of SA nasal decolonization on overall SA infection rates and healthcare facility-onset (HO) MRSA bacteremia, a laboratory-identified (LabID) event. Methods: In this pre–post quasi-experimental retrospective study, we compared overall SA, MRSA, and methicillin-susceptible SA (MSSA) infection rates per 1,000 patient days and the HO-MRSA bacteremia Standardized Infection Ratio (SIR) between the preintervention period (January 2020–June 2021) and the intervention period (October 2023–September 2025) at a 5-hospital healthcare system in Michigan. HO-MRSA bacteremia was determined using National Healthcare Safety Network (NHSN) criteria. SA infections included positive clinical cultures in hospitalized patients. Previously, our protocol consisted of daily chlorhexidine (CHG) bathing only, and HO-MRSA bacteremia SIR remained above goal. In a two-phased approach, we implemented nasal decolonization with an alcohol-based nasal antiseptic twice daily in addition to CHG for all ICU patients in August 2021, followed by all general practice unit patients with central lines in August 2023. Results: Following implementation, the cumulative HO-MRSA bacteremia SIR decreased 50% from 1.148 to 0.571 (95% CI, 0.336–0.73; p. Conclusion: Adding nasal decolonization to daily CHG bathing significantly reduced SA infection rates and HO-MRSA bacteremia. These findings confirm the effectiveness of a bundled decolonization strategy in mitigating both MRSA and MSSA infections. Broader adoption of nasal antiseptic protocols, alongside CHG bathing, should be considered a critical component of infection prevention strategy for high-risk hospital populations.

Background Implementation of diagnostic stewardship is a key strategy in antimicrobial stewardship to improve use of antimicrobials and human resources to promote value-based care. Pediatric urinary tract infections represent the most common pediatric infection with increasing antibiotic resistance and high utilization of diagnostic testing. The purpose of this study is to examine the impact of implementing a reflex urine culture (UCx) algorithm to reduce unnecessary UCxs in a pediatric emergency department. Methods: This is a pre/post study from April 1st, 2022 through March 31st, 2025, with the UCx algorithm intervention implemented in July 2023. A urinalysis (UA) and UCx report was generated from EPIC, placed in Excel, and analyzed descriptively and statistically via Wizard 2.0, Version 2.0.14. Data included age, gender, weight, race, ethnicity, payor status, language, zip code, and UA and UCx results. Children 2-18 years of age were included. Patients <2 years of age and any patient with only a point of care test (POCT) UA, UCx, or urine microscopic test, or duplicate test within 24 hrs were excluded. The reflex criteria was defined as a UA with ≥5 WBC/hpf and excluded children <2 years of age or who are immunocompromised. Results A total of 17,502 unique patients with a UA were evaluated. Both pre (n=6,956) and post (n=10,597) were similar for demographics including gender (female 69.7% vs 69.4%) and average age (9.93 years vs 9.97 years). Percent of UA’s with ≥5 WBC/hpf in the pre (n=1,567) vs post (2,361) were also similar at 22.5% vs 22.3% (p=0.7). 3,453 total UCxs were completed in the pre compared to 3,170 post. The UCx to UA ratio was 49.6% pre compared to 29.9% post (p<0.001). An improvement in UCx positivity rate from 11% pre to 20.3% post (p<0.001) was also shown. Cost savings further justifies the intervention as a projected $300,960 was saved by preventin 2,090 unnecessary UCx ($144 /culture). No differences were found by demographics except for race. While all races (black, white, other) saw a significant improvement in urine culture obtainment (p<0.001), white patients had a larger decrease from 48% to 27.2% compared to black from 49.9% to 33.4%. Conclusions A reflex UCx algorithm can be a successful implementation tool in diagnostic stewardship. Next steps will include exploring more stringent reflex criteria, lowering the age to 1 year, assessing the impact on health equity, and evaluating the impact in other health care locations to promote further value-based care.

Background: Central line-associated bloodstream infection (CLABSI) represents the most common and costly device-associated hospital-acquired infection in children. While prevention bundles are effective when reliably implemented, pediatric-specific risks often require strategies beyond standard bundles. Existing CLABSI risk models are insufficient for pediatric patients, remaining static during their hospital stay despite changing clinical conditions. Moreover, previously reported dashboards and predictive models generally do not incorporate data science principles to provide a daily prediction score, and they often exclude demographic factors beyond age and sex. The purpose of developing the CLABSI risk model was to leverage technology-driven strategies for identifying, intervening, and escalating care for high-risk pediatric patients in real time, thereby decreasing infection risk. Methods: Quality Improvement, Data Intelligence, and the interdisciplinary clinical team partnered to develop an evidence-based predictive model tailored to institutional risk factors. Using evidence and clinical expertise, an affinity diagram was created. Data from 61,068 inpatient central line days (January 2022- July 2024), sourced from electronic health records (EHR) and clinical surveillance software, formed the dataset. CLABSI was identified using NHSN surveillance definition. Patient risk factors from the infection date plus two days prior were evaluated. Exploratory data analysis was completed using RStudio integrated development environment to inform model development. Separate models were created for nontunneled lines and tunneled lines. Prediction models were developed using Python coding language and Databricks data intelligence platform. Under-sampling was used to account for uneven distribution between CLABSI and non-CLABSI cases. Logistic regression, random forest, and XGBoost models were created. Candidate models were compared using area under the curve (AUC), sensitivity, and specificity. Result: Using the XGBoost model for nontunneled line, the test AUC was 0.831, demonstrating strong discriminative power. This model achieved a sensitivity of 0.828, indicating its ability to correctly identify a high proportion of actual CLABSI cases, and a specificity of 0.751, reflecting its capacity to correctly identify non-CLABSI cases. Similarly, the tunneled line XGBoost model yielded an AUC of 0.845, showcasing excellent predictive performance. Its sensitivity was 0.833 and specificity was 0.668. In both models, the number of modifiable risks was the most significant factor (Tables 1-3). Conclusion: The CLABSI prediction model enables real-time identification and intervention to support proactive prevention, leveraging these performance characteristics to improve patient care. While predictive modeling has limitations due to EHR documentation, clinician expertise and frontline team engagement remain essential for deploying resources to highest risk patients.

Background: Sharps injuries remain a major occupational and infection prevention concern in healthcare settings, yet underreporting and inconsistent use of protective equipment persist despite mandatory regulations. Evidence on institutional and behavioral factors associated with reporting and preventive practices is limited. This study examined institutional, educational and behavioral correlates of sharps injury reporting among nursing professionals in the Republic of Croatia. Methods: We conducted a national-level cross-sectional survey in May 2024 using an anonymous online questionnaire. Eligible participants were nursing professionals who experienced at least one sharps injury in the previous five years. Data included sociodemographic characteristics, sharps injury reporting behavior, as well as the use of protective equipment and safety devices. Descriptive statistics were used for sample characterization. Group differences were tested using Mann-Whitney U and chi-square tests. Associations between organizational climate and reporting behavior were assessed using point-biserial correlation. Statistical significance was set at p < 0.05 (two-tailed). Result: A total of 215 participants met inclusion criteria; 88.4% were female, with a mean age of 36.4 years and a mean of 15.4 years of professional experience. Sharps injury reporting differed significantly by healthcare level: nurses working in tertiary healthcare institutions reported injuries more frequently than those in secondary care, where partial or non-reporting was more common (p = 0.048). Moreover, the use of protective equipment differed significantly by educational level, with more regular use reported by nurses with undergraduate or graduate education compared with those with secondary-level education (p = 0.028). A strong association was observed between regular use of protective equipment and sharps injury reporting: irregular or non-use of protective equipment was markedly more common among nurses who partially reported or did not report injuries, whereas regular use predominated among those who reported injuries (p < 0.001). The most frequently cited reason for non-reporting was low perceived infection risk associated with the injury. Conclusion: Sharps injury reporting is closely linked to both institutional context and preventive behavior. Higher reporting in tertiary care settings and the strong association between protective equipment use and reporting underscore the importance of organizational and safety culture factors. Infection prevention strategies should integrate reporting systems with interventions that promote consistent use of protective equipment, most notably in secondary-level healthcare settings, to strengthen surveillance and reduce preventable occupational exposures.

Background: The clinical indication for vascular access devices (VAD), including central venous catheters (CVC) and peripheral intravenous catheters (PVC), should be assessed daily. If VADs are no longer indicated, they should be removed to reduce the risk of catheter-associated bloodstream infections (CABSI). In 2030, the CDC’s National Healthcare Safety Network (NHSN) will adopt a new metric for BSI surveillance called Hospital Onset Bacteremia (HOB) which is device agnostic. In this framework, all VADs, not just CVCs, will be considered potential causes of BSIs. We determined that unnecessary VAD use was increasing the hospital’s CLABSI rate, particularly in non-ICU units. We partnered with the Patient Safety Committee and the Mission Control (MC) center to develop an intervention, called MC-CABSI, to encourage prompt removal of unnecessary VADs. Methods: We developed five messages to communicate with patient care teams via our EHR’s secure chat, using data sourced from nursing flowsheets. The first, “Central Line Not Infusing,” tracks CVCs without documentation of infusion in the last 48 hours. The second and third are “Central Line and Two or More PVCs” and “Three or More PVCs,” respectively. These messages indicate high Vascular Access Device Density (VADD), defined as a unit’s median VAD days, including both CVCs and PVCs. The VADD accounts for multiple devices in a given patient, unlike the Standardized Utilization Ratio currently used for CLABSI reporting. The fourth message is “Central Line Not Meeting Necessity,” indicating a CVC documented as no longer indicated, but has not been removed. The fifth category is for any “Field-Inserted PVC,” present <24 hours after admission. Our policy requires such PVCs be removed due to the likelihood they were placed in sub-optimal conditions. Messages are sent by two infection preventionists daily and include one nurse and Attending. Result: We have sent 253 messages since the intervention began July 2025, and care teams responded by removing ≥1 CVC or PVC from 145 patients (57% response rate). Hospital-wide VADD has decreased from 1.40 to 1.33 over this time compared to the previous six months. Conclusion: Dialogue with care teams has been collaborative, with many expressing gratitude for this effort. As the intervention matures, we intend to track results, dialogue with providers, and hone messaging to improve outcomes. We see potential to expand the real-time feedback to cover other devices like indwelling urinary catheters. We also see opportunity for automation to improve scalability in preparation for the shift to HOB surveillance.

Background: Post-acute and long-term care (PALTC) residents are disproportionately affected by viral infections such as influenza, COVID-19, and respiratory syncytial virus (RSV). While chemoprophylaxis is the standard of care for mitigating the spread of influenza in PALTC settings, there are no agents available for chemoprophylaxis against outbreaks of COVID-19 or RSV at present. However, as we advance in our knowledge of antivirals, agents for chemoprophylaxis against outbreaks of COVID-19 and RSV may be available in the future. Little is known about the perspectives of PALTC residents and their care partners regarding the use of chemoprophylaxis against respiratory viruses. Methods: From November 2024 to July 2025, we surveyed residents at a 152-bed community living center (CLC). Inclusion criteria were CLC residents age > Results: Out of 81 eligible residents and LARs, 40% (N=32; 6 residents and 26 LARs) completed the survey. Respondents indicated 9 (28%) and 27 (84%) of residents had an influenza or COVID-19 infection, respectively, during their PALTC stay (Table 1). None recalled an RSV infection though 29 (91%) respondents had previously heard of RSV. Most respondents reported that residents had been vaccinated against influenza (n=31, 97%) and COVID-19 (n=29, 91%), while only 10 (31%) reported that residents had been vaccinated against RSV. Most residents or LARs, on behalf of their resident, indicated they would accept chemoprophylaxis during an outbreak of influenza (n=23, 72%), COVID-19 (n=24, 75%), or RSV (n=25, 78%). Only one resident indicated he would decline chemoprophylaxis for all three viruses. Conclusions: The majority of Veterans, or their representatives, in the PALTC setting would consent to chemoprophylaxis for influenza, COVID-19, and RSV if it were available and recommended by a healthcare provider. Gaining a better understanding of how PALTC residents and their care partners perceive the use of chemoprophylaxis against respiratory viruses can support the effective implementation of these programs.

Background: The Society for Healthcare Epidemiology of America (SHEA) International Ambassadors Program (IAP) aims to strengthen global infection prevention and healthcare epidemiology through engagement of emerging international leaders. Although program reach and activities have been described, factors associated with sustained engagement and post-program impact have not been quantitatively assessed. We conducted the first survey of current and former IAP participants to evaluate motivations, activities, barriers and factors associated with continued involvement. Methods: We administered an anonymous, cross-sectional online survey during 2023 to all identifiable current and former IAP members. The survey included 35 items capturing demographics, geographic region, areas of expertise, sources of program awareness, post-IAP activities, and ongoing engagement with SHEA. Descriptive statistics were calculated, followed by inferential analyses. Chi-square tests were used to assess associations between categorical variables, including geographic region and continued engagement with SHEA, as well as source of program awareness and participation in specific activities (training organization and conference presentations). One-way ANOVA was used to compare the mean number of reported activities across sources of program awareness. Statistical significance was set at p<0.05 (two-tailed). Results: Of 191 contacted ambassadors, 54 responded (27% response rate). Respondents were primarily based in Asia (50.9%), Latin America and the Caribbean (22.6%), and Africa (18.9%). Infection prevention and antimicrobial stewardship were the most common areas of expertise (51%), and nearly half learned about the program through former ambassadors. Over half (55.6%) reported ongoing engagement with SHEA through committees or other activities. No statistically significant associations were observed between geographic regions and continued SHEA engagement (p=0.065); also, no significant associations were observed between source of program awareness and organizing training programs (p=0.885) or conference presentation (p=0.897). Similarly, there was no significant difference in the mean number of reported activities by source of program awareness (ANOVA, p=0.621). Our findings indicate that post-program engagement and productivity were not dependent on recruitment pathway. Thematic analysis identified cost, time zone constraints, and language barriers as the most frequently reported obstacles to sustained participation. Conclusion: The SHEA IAP demonstrates meaningful global reach and impact on infection prevention activities. Ambassadors remain highly motivated and active, particularly in resource-limited settings, yet financial and logistical barriers limit long-term engagement. Addressing these challenges may enhance the program’s sustainability and global impact.

At a Canadian ambulatory hospital, a quasi-experimental quality improvement initiative evaluated penicillin-allergy education modules using pre–post surveys. Among 61 clinicians, Module 1 was not associated with change in penicillin allergy label-clinical impact knowledge. Modules 2 and 3 improved allergy-history, severity-assessment, and prophylaxis-prescribing preparedness (P < .01). Acceptability was high: documentation tool 92%, algorithm 88%.

Background: Hand hygiene is the most effective way to prevent hospital acquired infections, and thus evaluating hand hygiene compliance is critical to ensure patient safety. The Leapfrog Group is a non-profit organization that, in part, evaluates organizations' commitment to hand hygiene as a component of their overall hospital safety grades. For those performing manual observations, Leapfrog requires most inpatient units to complete at least 200 observations per month to achieve an "A" grade. At our facility, hand hygiene observations are performed manually by trained unit-based caregivers as well as by Infection Preventionists (IPs) who serve as “validators.” Between January 2022 and June 2023, on average only 37.4% of inpatient units met their Leapfrog goals; IPs (n=10) performed an average of 294 validation observations per month. Our goal was to improve organizational commitment to hand hygiene compliance, increase IP validator rounds, and achieve <95% of units meeting their monthly Leapfrog goals systemwide throughout FY24 and beyond. Methods: ChristianaCare is a 3-hospital, <1400-bed community-based academic healthcare system based in northern Delaware. In March 2023, leadership committed to meeting and maintaining established Leapfrog goals for hand hygiene observations for inpatient units systemwide. Nursing leadership, in conjunction with IP and the Hand Hygiene Steer Committee, became actively involved with monitoring and meeting these goals. The Hand Hygiene Steer Committee initiated active conversations with individual units, as well as established real-time reporting of progress towards 95% goal to units. IP also initiated a robust recognition program, recognizing units as well as individual caregivers for their successes in hand hygiene observations and meeting goals. Results: Between Oct 2022-June 2023, the percentage of units meeting their Leapfrog observation goal rose from 37.4% to 96.2% (Figure 1). From July 2023 onwards, the average Leapfrog goal compliance for inpatient units was 96.2% (a 58.8% increase; Figure 2). In addition, the average monthly number of observations performed by the Infection Prevention Department was 690 (a 235% increase). A total of 8 inpatient units and 7 individual caregivers were recognized systemwide for their hand hygiene efforts, successes, and improvements. Conclusion: Maintaining hand hygiene compliance and a systemwide hand hygiene observation program requires commitment and significant effort throughout the organization. Continued monitoring, ongoing discussions, and targeted interventions have demonstrated ChristianaCare’s ability and commitment to hand hygiene and meeting The Leapfrog Group’s goals for patient safety.

Introduction: Transmission of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) is stochastic in nature. Largescale NDM-CRE outbreaks have been observed throughout the world. Within the United States (US), the incidence of NDM-CRE infections increased by 5-fold between 2019 and 2023, highlighting concern for large outbreaks. Given this, estimating how large an NDM-CRE outbreak is likely to be (i.e., the probability of final cluster size) is a valuable first step in characterizing NDM-CRE transmission dynamics and informing outbreak response. Methods: The National Center for Biotechnology Information (NCBI) Pathogen Detection database is a global, public tool that identifies clusters of bacterial pathogen genomes based solely on genetic relatedness. We included all NDM-CRE genomes associated with a US cluster and uploaded between January 2009 and September 2025. Using cluster data, we estimated the dispersion parameter (k), which reflects transmission chain variance. Because we assume that NCBI does not capture all NDM-CRE cases in a cluster, we compared the estimated k values for the NDM-CRE clusters to simulated k values. Our simulations varied the probability of case identification and assumed the average number of new cases from each infection was 1.1 (based on literature; see Figure 1A). Using these simulated k values, we estimated the probability of final cluster size (see Figure 1B). Results: We included 1,104 clusters with a mean size of 5 genomes (standard deviation=20). The estimated k value was comparable to, but higher than, simulated k values, supporting our assumption that NCBI cluster data are incomplete (Figure 1A). Comparing the probability of the final cluster size between estimated k values, which were likely biased (<0.3), to simulated values k values <=0.3, final cluster sizes are most likely to have two cases and a low probability of clusters <=10 cases (Figure 1B). Conclusions: Unlike many other infectious diseases, NDM-CRE cluster dispersion values remain unknown, which is a critical gap. We estimated dispersion to show that US NDM-CRE clusters have a high probability of being small. However, additional analysis is needed since standardized NCBI cluster data may be subject to biological, technical, and sampling limitations and do not allow for assessing why US clusters were small. Strong infection prevention and control practices and assessment of patient travel history continue to be best practices for mitigating NDM-CRE outbreaks. Moreover, as the NDM-CRE epidemiology continues to evolve, monitoring US NDM-CRE clusters will provide insight into outbreak dynamics, including emergence of highly successful clones.

Background: The COVID-19 pandemic placed unprecedented strain on infection prevention and control (IPC) departments across the country. Infection Preventionists (IPs) found themselves tasked not only with sustaining routine IPC activities, but also with managing acute, crisis-driven responsibilities. The rapid increase in workload exposed long-standing gaps in staffing, communication, preparedness, and organizational support. There are limited first-hand accounts from IPC professionals and most focus on data collected during the height of the pandemic. This study examines their retrospective lessons learned to inform future preparedness. Methods: We analyzed responses to an open-ended item from the national 2023 AHRQ-funded Prevention of Infection Through Appropriate Staffing (PITAS) survey. Survey respondents were asked to list the three most important lessons learned from the pandemic that might help other institutions cope with future pandemics. Two study investigators performed a qualitative content analysis using an inductive-deductive approach to categorize responses into overarching themes and subthemes. Themes were then mapped to the Resilience Engineering framework (Anticipate, Monitor, Respond, Learn) and CDC Public Health Emergency Preparedness and Response (PHEPR) Capabilities to assess alignment with established public health preparedness domains. Results: We received 514 survey responses that mapped onto eight key themes. The most frequently cited themes emphasized the need for transparent, multi-directional communication (n = 152), especially regarding the ability to communicate frequently evolving guidance. There was emphasis on the need for adaptive, evidence-based staff education (n = 145) regarding PPE usage and pandemic preparedness. Participants also highlighted the importance of collaborative, inclusive teamwork across departments (n = 128) and the necessity of maintaining a sustainable, flexible workforce capacity (n = 123). Additional lessons focused on the value of agile policies and procedures (n = 114), comprehensive preparedness and response infrastructure (n = 113), and essential resources such as PPE and supply-chain systems (n = 99). Participants also underscored the importance of cultivating a resilient mindset and effective coping strategies (n = 100) to navigate and persevere through prolonged crisis conditions. Conclusion: Reflecting on the COVID-19 pandemic, IPs across the country emphasized the importance of strengthening communication systems, increasing workforce capacity, fostering cross-disciplinary collaboration, and ensuring resource reliability. Improvements in organizational infrastructure, increased leadership support, and the development of personal coping strategies will be essential for enhancing institutional resilience during future infectious disease emergencies. These lessons provide actionable guidance for supporting IPC programs and improving institutional readiness for future infectious disease emergencies.