Acute otitis media (AOM) is a major driver of paediatric antibiotic prescriptions. We assessed the impact of oral and topical antibiotics on middle ear, nasopharyngeal, and gut microbiome compositions, and the gut resistome, in children with AOM and ear discharge (AOMd). Fifty-eight children with AOMd and ear pain and/or fever were randomized to oral amoxicillin suspension (n = 31) or hydrocortisone-bacitracin-colistin eardrops (n = 27) for 7 days. From 57 out of 58 children, baseline, and Week-2 middle ear fluid (MEF) and nasopharyngeal (NP) samples were sequenced, along with baseline, Week-2, and Month-3 faecal samples. At baseline, the top 5 MEF genera were Streptococcus, Haemophilus, Turicella, Staphylococcus and Alloiococcus and NP genera Moraxella, Haemophilus, Streptococcus, Corynebacterium, and Dolosigranulum. At Week-2, the ear discharge had resolved in all but four children (oral n = 3, eardrops n = 1). In NP samples, the relative and absolute abundances of Streptococcus decreased to a greater extent after oral than eardrop treatment, but Moraxella and Haemophilus increased only following oral treatment. Neither treatment significantly altered the faecal microbiome or resistome at Week-2 and Month-3. Therefore, both treatments resolved the middle ear discharge in most children, but oral amoxicillin suspension may reduce NP Streptococcus more than hydrocortisone-bacitracin-colistin eardrops at the cost of potentially increasing other NP pathobionts.

Background: We used human factors engineering (HFE) methods to define processes of care in LTCF and assess healthcare professionals’ (HCP) hand hygiene (HH). Methods: We created an HFE observation template on which to record the types of items and patient sites HCP touched during care sequences (CS) and the order in which they touched them. We filled out the template as we shadowed HCP at 3 LTCF during 198 CS and entered data into Excel. We did descriptive analyses of the CS and HH compliance for the 3 facilities together and separately. We used chi-square, Fisher’s exact, Kruskal-Wallis, and Wilcoxon tests as appropriate. We used first-order Markov transition probabilities from the step-by-step CS to estimate the probability of HH before entry and exit and before and after each touch type. Results: We observed 63 CS at both LTCF1 and LTCF3 and 72 at LTCF2. 83 (41.9%) CS were short (1-7 touches), 51 (25.8%) were medium (8-13), and 64 (32.3%) were long (14-103). HH on exit decreased significantly from 31.2% and 39.2% after long and medium CS, respectively, to 19.3% for short CS. HH opportunities during CS comprised 82.8% of all opportunities. HH compliance was 27.8% on room entry, 28.3% on room exit, and 1.7% during CS. Overall HH compliance was low at each LTCF but it was significantly lower at LTCF3 than at LTCF1. HH on entry and exit at LTCF1 (38.1%; 38.5%) was significantly higher than at LTCF3 (20.6%; 20.6%) and insignificantly higher than at LTCF2 (25%; 27.8%). Touches of the environment, supplies/equipment, and clean patient sites were the most common touches, accounting for 55.5-70.9% of touches. Dirty/contaminated touches comprised only 4.2%- 5.8%. We observed only 2 clean/aseptic touches at LTCF3. The highest transition probabilities from specific touches to HH were from the environment (0.460) and from supplies/equipment (0.264) touches and the lowest were from dirty/contaminated and from HCP’s sites (both 0.011). The highest transmission probabilities for touches immediately after HH were for dirty/contaminated sites (0.105) and for eating-related items (0.105) and the lowest were for clean/aseptic touches (0.000). Conclusions: Most CS are short and involve touches of the environment, supplies/ equipment, and clean patient sites. Low HH compliance on exit and entry increase the risk of pathogen transmission among residents. Although dirty/contaminated touches and clean/aseptic touches were rare, HH during CS was also rare and the transition probabilities indicate that HH compliance is low at critical care transitions.

Background: Candida auris (C. auris) is an emerging pathogen that is often resistant to antifungal treatments and is exceptionally transmissible in the healthcare environment. C. auris colonization confers risk for invasive infections, such as bloodstream infections, surgical site infections and hardware-associated infections. Further, colonization or infection frequently delays or disrupts access to various healthcare venues. Infection prevention (IP) measures including strict contact isolation, specific cleaning and disinfection protocols, and surveillance testing are commonly used strategies to decrease the risk of C. auris transmission. Early identification of patients with C. auris is critical to prevent transmission in the healthcare setting. Methods: PCR-based C. auris surveillance testing via surface E-swab of the axillae and inguinal folds was implemented in April 2024 at our large midwestern academic hospital. Testing strategies include Ring Surveillance (targeting patients admitted to adjacent rooms of index patients with C. auris), Travel Screening (i.e., recent hospitalization outside the U.S.), and long-term accute care (LTAC) Screening (targeting recent admission to a long-term acute care or inpatient rehabilitation/nursing facility). A retrospective review of adult patients who underwent C. auris surveillance testing between May 1, 2025 – October 31, 2025, was performed. Patient demographics (sex, race, ethnicity, mean age at admission) were analyzed along with admission source, comorbidities, and admission diagnosis. Patients with positive results were compared based on testing indication; specifically, those tested as part of Ring Surveillance and those tested on admission due to Travel or LTAC Screening. Results: In the 6-month study period, 4624 patients were tested for C. auris and only 170 (0.6%) had positive results; 118 through ring surveillance and 52 found with an admission testing indication. Positive patients had a mean age was 59 years old and 67% identified as male. 73.5% of positive patients were hospitalized within the last 6 months. Conclusions: Prevention of C. auris transmission in the healthcare setting remains an IP challenge. The prevalence of C. auris was low in our cohort of patients who were primarily tested as part of a Ring Surveillance program. Development of a predictive model to optimize early identification of patients colonized with C. auris is important to guide surveillance testing and decrease transmission risk to other patients in the healthcare setting.

Background: Clostridioides difficile infection (CDI) remains a major healthcare challenge, particularly in resource-limited settings. Methods: This retrospective, single-centre study analyzed CDI epidemiology and treatment outcomes among 528,887 hospitalized patients at the University Hospital in Kraków Poland, between 2016 and 2022. Results: A total of 2,341 CDI cases were confirmed, with an overall incidence of 4.32 per 1,000 admissions. The highest rates were observed in geriatric and infectious diseases units. During the COVID-19 pandemic, healthcare-associated CDI cases surged, accounting for up to 89.2% of infections in 2020 with incidence rate 3.8 per 1000 admissions, compare with 2,5 per 1000 admissions in 2016. Vancomycin-based therapy was associated with significantly lower mortality (OR 0.73, 95% CI 0.56-0.95) compared to metronidazole, while combination therapy (vancomycin + metronidazole) showed the highest recurrence rate (17%). Fidaxomicin use was minimal (0.4%) due to limited availability. Recurrent CDI occurred in 14.2% of cases, with a relapse-free survival advantage observed in vancomycin-treated patients. The overall in-hospital case fatality rate associated with CDI was 22.5%. Conclusions: Despite stable overall CDI incidence, the study highlights the impact of increased antibiotic consumption during the pandemic on HA-CDI dynamics. Findings underscore the need for improved antimicrobial stewardship, broader access to advanced therapies such as fidaxomicin and bezlotoxumab, and enhanced diagnostic protocols. In settings with restricted therapeutic options, vancomycin remains a valuable treatment, particularly for reducing mortality.

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) is a highly-transmissible multidrug-resistant organism. In November 2024, the Georgia Department of Public Health (DPH) identified a multi-facility CP-CRAB outbreak in central Georgia and applied whole-genome sequencing (WGS) to guide containment. Methods: During November 2024–May 2025, Georgia and Tennessee Public Health Laboratories confirmed 31 CP-CRAB cases. 24 isolates underwent WGS on Illumina MiSeq; sequences were processed with CDC’s PHoeNIx pipeline, and single-nucleotide polymorphism (SNP) heatmaps were generated with Snippy and Python. Epidemiologic data were abstracted from medical records; risk factors and network analyses were conducted using Excel, with case pairs ?10 SNPs prioritized for analysis. Results: WGS identified 18 cases in three sub-clusters, plus 2 related and 4 unrelated cases; SNP distances ranged 0–34, with 16/49 (33%) case pairs ?10 SNPs. Facilities included four acute-care hospitals (ACH-1–ACH-4, primary ACH-1), with prior exposures to 3 skilled-nursing facilities (SNFs), 1 ventilated-SNF (vSNF), and 1 long-term ACH (LTACH). Sub-cluster 1 (n = 8; 0–26 SNPs; 12/29 pairs ?10 SNPs) specimen sources included 3 respiratory, 2 urinary, 2 wound, and 1 blood specimens from ACH-1–ACH-4. 6 cases formed 12 ?10-SNP pairs, with collection dates 3–52 days apart; 3/6 cases were admitted to ACH-1 from vSNF with direct overlap, 4/6 had prior exposure to ACH-1, and 2/6 had no epidemiologic links. Prior healthcare exposure and intra-facility (ACH-1) movement were observed among all 6 cases. Sub-cluster 2 (n = 5; 2–22 SNPs; 3/10 ?10) involved 5 ventilated respiratory cases, 4 from ACH-1 and 1 from ACH-2. Conclusions: Integrating WGS with epidemiologic data revealed sub-clusters—multiple introductions, distinct transmission pathways, and related cases with wide ranges between collection dates—enabling sub-cluster-specific containment recommendations. These findings informed Georgia’s first multi-facility CP-CRAB outbreak investigation, contributing to the development of a multi-facility engagement model that improved interfacility communication and provider awareness of transmission. Routine WGS–epidemiologic integration is critical for targeted containment and coordinated regional response.

Social network experiments provide a powerful framework for identifying causal network effects but also allow a specific form of network endogeneity. Random assignment eliminates the correlation between individual differences and treatment assignment but not between individual differences and treatment response. Individual differences can shape how participants enact their assigned networks. We use data from three networks to demonstrate an underappreciated approach for estimating causal network effects in the presence of endogeneity. The pre-experiment network captures individual differences, the treatment network defines the assigned structure, and the behavioral network reflects the interactions that occur during the experiment. Because the treatment network is exogenously assigned, it can serve as an instrument for the behavioral network, isolating the causal component of behavioral network effects. Using data from a coordination experiment, we estimate the causal effect of brokerage in the behavioral network on an important team outcome: perceived leadership. We also examine the influence of pre-experiment networks, finding that individuals who enter with closed networks sometimes emerge as brokers. The result shows that behavioral networks form through interdependent choices and interactions among multiple individuals and that endogenous network structures can generate effects beyond the control or intentions of any single individual.

Introduction Carbapenem Resistant Acinetobacter Baumannii complex (CRAB) is classified as an urgent public health threat by the Centers for Disease Control and Prevention (CDC). Tennessee conducts population-based CRAB surveillance collaborating with CDC as part of the Emerging Infections Program (EIP). Methods A case was defined as Acinetobacter baumannii complex isolated from normally sterile sites, urine, lower respiratory tract specimens or wound specimens resistant to meropenem, imipenem or doripenem from a resident of the surveillance area. Polymerase chain reaction (PCR) testing was performed for gene detection on the available isolates submitted to the state public health lab since 2018. Epidemiologic and clinical data was collected by reviewing the medical records. A chi-square test was run comparing categorical variables, and logistic regression was done comparing odds ratios controlling for potential confounders. Data analysis was done using SAS 9.4 Results From 2014–2024, 249 cases were identified from the surveillance region. Mean age among cases was 60.9 years. There were 98(39.4%) females, 167 (67.1%) white persons, 77 (30.9%) African Americans and 5 (2.0%) other races. Carbapenemase-producing (CP) genes were detected from 108 (82.4%) of 131 available isolates tested at the state public health lab. The proportion of isolates with CP-genes increased to 85.7% and above since 2020, compared to the rate in 2019 (35%) (P<0.001). OXA-24/40, OXA-51, and OXA-23 were identified from 44.6%, 35.8%, and 19.6% of tested isolates, respectively. Additionally, 38.8% of these positive isolates had multiple gene types. OXA-23 was the most prevalent gene until 2020 (53.8%). OXA-24/40 and OXA-51 have become predominant since 2021, accounting for 44.4% and 35.8% of all reported cases, respectively. Hospital admission rates among patients with invasive infection were 10-fold higher (OR=10.03, P= 0.025) compared to non-invasive. The average length of hospital stay was 17 days. Most of the cases (93.1%) were healthcare-associated infections, and there was no significant change in the proportion of community-associated infections across the years (P=0.289) Conclusion The proportion of isolates with CP-gene has increased over the years. Most of the infections required hospital admission with longer hospital stay compared to the state average of 4.84 days, suggesting the infection is associated with higher medical costs and severe infection. The findings from this surveillance analysis assert the importance of infection prevention in healthcare settings as CP-CRABs are increasing. Monitoring the trends of CP-genes is vital as the types of CP-genes change over time.

This article explores the discursive and multimodal strategies through which leadership is accomplished collectively among the coaches of a professional football team. We demonstrate the benefits of using a modified version of Drath and colleagues’ (2008) DAC ontology in sociolinguistic research, and we show what can be gained by conceptualising leadership as a process rather than a set of behaviours or traits associated with an individual in a senior position. Drawing on authentic audio- and video-recordings of the interactions among the coaches of a national football team during a live match, and utilising the analytical concepts of epistemic and deontic status and stance (Stevanovic & Peräkylä 2014), we describe some of the complex discursive and multimodal processes through which leadership unfolds across a web of different interactions, taking place at different moments and in different locations throughout the match. (DAC ontology, collective leadership, professional football, web of leadership)

Background: Surgical Site Infections (SSI) are one of the most significant morbidities following surgical procedures, contributing substantially to prolonged length of stay, mortality and increased healthcare costs. Prevention bundles tailored to colon surgery have proven to be effective quality improvement interventions when implemented with high adherence, yet sustained compliance remains challenging across healthcare systems. Methods: A comprehensive colon-specific SSI prevention bundle was implemented across a large multi-state health system in 2019. The bundle encompasses perioperative interventions including preoperative measures (surgical antibiotic prophylaxis, mechanical and oral bowel preparations, appropriate hair removal, chlorhexidine bathing), intraoperative protocols (normothermia maintenance, chlorhexidine skin preparation, wound protectors, oxygen optimization), and closure techniques (separate sterile instrument sets, gown/glove changes, triclosan-coated sutures, silver dressings), with perioperative glycemic management maintained throughout. Bundle compliance was systematically monitored from 2019-2025, with SSI outcomes tracked using National Healthcare Safety Network (NHSN) criteria. Standardized Infection Ratios (SIRs) and compliance trends for key bundle elements were analyzed to assess intervention effectiveness. Results: From 2019-2025, implementation of the comprehensive SSI bundle across 14,355 colon procedures resulted in a 36.1% reduction in colon SIR (0.821 to 0.525). Significant improvements in key bundle compliance were observed: Surgical Antibiotic Prophylaxis (SAP) adherence increased 40.5% (41.9% to 82.4%), mechanical bowel preparation compliance rose 39% (64.2% to 89.3%), and oral bowel preparation adherence demonstrated a 119% increase (38.2% to 83.6%). Strong correlation was observed between bundle compliance rates and sustained SSI reduction, with the greatest improvements occurring in facilities achieving ?80% adherence with the SSI prevention bundle interventions. Conclusion: Sustained adherence to a comprehensive colon SSI prevention bundle significantly reduces postoperative infections, as demonstrated by a 36.1% SIR reduction over six years. Success requires systematic implementation, real-time compliance monitoring, institutional commitment to quality improvement, and ongoing evaluation of prevention bundle components to ensure adherence with current evidence-based national standards. The data suggest that optimizing SAP timing, mechanical bowel preparation, and oral antibiotic prophylaxis represent high-impact interventions warranting prioritization in resource-limited healthcare settings.

Background: A measles case requires immediate action to identify and administer prophylaxis to exposed individuals in healthcare settings. Infection preventionists (IPs) often balance proactive contact tracing with waiting for a positive test result. Objective: To develop a tool that enables IPs to stratify suspect measles cases by risk level, thereby supporting the decision to prioritize or defer active intervention while awaiting test results. Methods: In spring 2025, we developed a preliminary matrix and used 19 additional suspect patients to further refine the scoring of the tool. In August 2025, we deployed a finalized tool. The two-dimensional risk matrix incorporated both epidemiological risk factors and clinical risk factors, each scored numerically based on yes or no questions. The sum of both categories was used to assign a final risk level that determined the recommendations for IPs (Figure 1). The study population included patients tested for measles during the implementation period. Descriptive statistics were used to summarize the distribution of risk categories and outcomes. Among the whole cohort, Firth’s logistic regression was used to evaluate the association between clinical or epidemiological risk score and measles diagnosis. Among the production cohort, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate the diagnostic performance. Results: Since implementation, the matrix was applied to 56 patients tested for measles. Of these, 10.7% (n=6) were categorized as high risk, 32.1% (n=18) as medium, and 57.1% (n=32) as low. Four of the 56 patients were positive for measles, 3 were categorized as high-risk and 1 as medium risk. Each one-unit increase in epidemiological risk was associated with a 2 folds increase in the odds of a positive measles diagnosis (odds ratio = 2.0; 95% CI, 1.3–3.6). The low-risk category had an NPV of 1, indicating that all low?risk patients tested negative, thus supporting safe workload reduction by deprioritizing these cases. Conclusion: The Measles Exposure Response Risk Matrix effectively stratified cases and supported IP prioritization efforts. Low-risk groups required no action, expedited testing was reasonable for medium-risk cases, and proactive actions were reserved for high-risk cases. Clinical and epidemiologic risk scores progressed from arbitrary assignment to validated metrics, confirmed by statistical analysis. The flexible design permits adaptation to other infectious diseases, including avian influenza and mpox. With rising measles incidence, tools like this matrix will be essential to support rapid, evidence-based actions by infection prevention teams.

Background: Surgical Site Infection (SSI) surveillance in pediatric cardiac surgery requires an accurate denominator. Many programs use National Healthcare Safety Network (NHSN) selected CPT codes as these are available in real time. However, prior research demonstrates that these lists exclude many congenital operations, especially in infants. Society for Thoracic Surgery (STS) index procedures are comprehensive, but are not mapped to CPT codes and cannot drive routine surveillance. Objective: Develop and validate an expanded CPT code set that captures pediatric STS index cardiac procedures more completely than the NHSN CPT code set while maintaining specificity. Methods: We mapped STS pediatric index procedures performed at our institution during a derivation period to CPT codes. We restricted codes to cardiovascular procedures and organized additions into pediatric extensions of NHSN cardiac categories (P-CARD, P-CABG, P-PACE) plus a new arteries/veins group (P-ARTV). We then applied these codes to a second validation period to assess specificity. Results: The NHSN CPT set contains 176 codes. We added 62 CPT codes (P-CARD 50; P-ARTV 9; P-CABG 2; P-PACE 1). In the derivation period (2010–Feb 2022), 1,508 STS index cases were identified; 344 (25%) were not captured by the NHSN CPT set. Under-capture was greatest in infants (<1 year) with 242/724 (33.4%) missed, versus 102/784 (13.0%) missed in children (?1 year). Missed infant cases were associated with certain groups of procedures: aortic coarctation/arch/interrupted aortic arch (67/101, 66.3% expanded-only), pulmonary blood flow modification (62/66, 93.9% expanded-only), and single-ventricle staged palliation (62/128, 48.4% expanded-only) together accounted for 191/242 (78.9%) of missed cases. The standard NHSN set also captured only 1/11 patent ductus arteriosus procedures and none of vascular ring/aortopexy procedures (n = 5). NHSN capture was near-complete for conotruncal/right ventricular outflow tract repairs (119/120 infants; 106/109 ?1 year) and septal/atrioventricular canal repairs (139/139 infants; 124/125 ?1 year). In validation (Feb 2022–Mar 2024), the expanded set identified 317 cases; 258 were STS index (81.3%). Of 59 non-STS cases, 52 were captured by standard NHSN. The remaining 7 additional non-standard-NHSN, non-STS procedures were judged clinically relevant on review. Conclusions: The standard NHSN code set incompletely captures pediatric STS index procedures, especially procedures correcting congenital anomalies in infancy. A focused expansion of 62 CPT codes creates a more complete denominator to accurately monitor SSI rates.

Modern aviation supports an ever-broader range of civil and military missions, and the airframes designed for these missions must satisfy stringent safety and performance requirements. The takeoff and landing phases are the most accident-prone portions of a flight despite representing only a short interval of the total block time, which makes the accurate prediction of takeoff speed a safety-relevant problem. A previous machine learning study addressed the takeoff-speed prediction problem of the Boeing 737-300 with classical regressors using pressure altitude, outside air temperature, gross weight and flap angle as the predictors. In the present work, the same regression problem is revisited under the deep learning paradigm. Four neural architectures are trained on an identical pre-processing pipeline and train-validation partition, namely a multilayer perceptron, a one-dimensional convolutional network, a long short-term memory network and a wide-and-deep architecture incorporating multi-head self-attention. Among the four candidates, the long short-term memory network attains the lowest root mean square error and mean square error on the unseen test file and is subsequently subjected to Bayesian hyperparameter optimisation through the Keras Tuner library. The predicted and the measured takeoff speeds are reported side by side for the first time in the deep learning literature for this airframe, and the simulation results indicate that the developed networks constitute an effective alternative tool for takeoff-speed prediction.

Background: Candida auris (C. auris) is a pathogen that causes high morbidity in patients due to its resistance to antimicrobials. Endemic patient colonization poses an infection risk that may be mitigated by no touch disinfection systems through interruption of the infection chain reservoir step. We evaluated the efficacy of continuous dry hydrogen peroxide (DHP) exposure on C. auris hospital onset colonization to evaluate the interruption of the transmission post hospital admission. Methods: The study was conducted in two intensive care units within a large tertiary-care center from October 2024 to January 2025. DHP-emitting systems were installed in the Medical Intensive Care Unit (MICU) HVAC system. Trauma Surgical Intensive Care Unit (TSICU) had no DHP installed. Admission and post admission testing was completed on all patients present in both units. All non-positive patients were tested twice per week and removed from testing if positive. Presence of C. auris was determined by polymerase chain reaction (PCR) from composite swabs from axillae and groins. Patients were screened for C. auris risk factors according to a standard risk assessment (Figure 1). The study goal was to determine if there was a statistically significant difference (PC. auris days to critical care days for TSICU and MICU patients with hospital-onset C. auris using the N-1 Chi-squared test (proportion comparison). Results: Risk assessments for MICU (268) and TSICU (297) were evaluated. The MICU population showed a higher risk for C. auris in each category compared to TSICU (Figure 1). MICU had double the dialysis, triple the admissions from group environment, and 5 times more wounds present on admission. The length of stay in TSICU was about 2.3 days less than MICU. There is a statistically significant difference (PC. auris days to critical care days for TSICU and MICU. No adverse effects were reported by patients, visitors, or personnel associated with the DHP systems. Conclusion: This study demonstrates that DHP was effective in reducing the proportion of hospital-onset C. auris colonization when comparing the MICU (DHP installed) to the TSICU (without DHP). This effect was observed despite the MICU having a longer average length of stay and a higher percentage of patients with known risk factors for C. auris. The findings support DHP as a valuable no-touch disinfection method. Figure 1: Risk assessment results by location, MICU or TSICU

Background: Trypan blue is commonly used during mature cataract surgery to improve visualization of the anterior capsule. Although FDA-approved since 2004, it remains unapproved in Japan. Many clinics perform sterile filtration prior to use; however, no standardized sterilization protocol exists. Methods: This retrospective case series included all patients diagnosed with Sarocladium kiliense endophthalmitis after cataract surgery at Kyorin University Hospital between 2015 and 2025. Results: In 2025, six microbiologically confirmed cases of S. kiliense endophthalmitis were identified; none occurred before 2024. One case originated from Clinic A and five from Clinic B. All cataract surgeries used trypan blue, which had been sterile-filtered at each institution. Discussion: Endophthalmitis is a rare postoperative complication of cataract surgery, and S. kiliense is an uncommon pathogen. We were informed that similar cases occurred sporadically in 2025 from a reference laboratory center. One institution confirmed contamination of the trypan blue product (unpublished data). The same organism was isolated from dye obtained from Clinic B. All affected clinics used trypan blue from the same manufacturer. Off-label product use may pose significant safety concerns due to limited data. While other off-label dyes (e.g., Lugol’s solution, India ink) are widely used in Japan, they are applied superficially. We hypothesize that contaminated trypan blue migrated into the vitreous cavity via lens zonules, causing the outbreak. Physicians bear responsibility for off-label use and should employ unapproved products only when benefits clearly outweigh risks.

Background: Recently, the Society for Healthcare Epidemiologists of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) have released full time equivalent (FTE) staffing recommendations for hospital epidemiologists (HE) (at least 0.3 FTE for 0-50 beds, 0.5 FTE for 51-300 beds, 1.0 FTE for <300 beds) and infection preventionists (IP)(between 1 IP: 69 beds and 1 IP: 100 beds depending on size and patient acuity) for acute care hospitals. As these important roles become more complex for a variety of reasons, the necessity for appropriate staffing is becoming more apparent. The purpose of this project was to utilize data from the 2025 APIC MegaSurvey to describe current staffing for HEs and IPs. Methods: The 2025 APIC MegaSurvey was distributed to over 13,000 members and shared through email, QR codes at the APIC national conference and social media campaigns from June 6 through July 31, 2025. The respondents provided the number of FTEs for HE and IPs in acute care hospitals along with hospital characteristics including bed size, physical setting, academic affiliation, ownership status, and hospital type. The average FTEs for HE (more FTEs = more HE support) and the 1 FTE: per number of beds ratio (lower the ratio = more IP support) for IPs were calculated and stratified by the hospital characteristics. Results: There were 1,471 respondents who reported the FTEs for HE with an average of 0.97 FTE. The FTE IP: number of beds reported for the 1,533 respondents was 1 FTE:103.3 beds. Rural hospitals reported the lowest FTE for HE (0.3, n=418) and yet had the lowest 1 FTE: number of beds ratio (1:67.7, n=453). Smaller hospitals (<50 beds) reported the lowest FTE for HE (0.5, n=380) with the lowest 1 FTE: number of beds ratio (1:34.1, n=319). As the hospitals increased in size, the FTE for HE increased with 1.7 FTE for hospitals <500 beds (n=307) but also reported the highest 1 FTE: number of beds ratio of 1:132.8 (n=336). Conclusions: The data suggest that staffing for HE and IPs are impacted by numerous factors including bed size, ownership, academic affiliation and physical location. The dyad model that includes the HE and IP leaders improves communication, collaboration, and successful attainment of institutional goals. Future efforts should focus on determining the positive impacts of appropriate staffing utilizing the dyad model.

The article examines politically loaded catchphrases and their development and transformation in the discourses of Russian-speaking social media users. It focuses on how propaganda catchphrases, used to transmit political messages, acquire new meanings and applications in online communication, and how this process is shaped by the specific context of the Baltic states, where the Russian population underwent minoritization after the collapse of the Soviet Union. The data was collected in the course of longitudinal (2021–2025) ethnographic online observation, primarily from posts and comments in public Facebook groups localized in Estonia. Applying conversational analysis of online data, the article investigates the life cycle of specific words and phrases to show how they evolve into complex indexical signs and even systems of signs used to define not only the referenced objects but also the speaking subjects, their audiences, and the sets of ideas they tend to identify with. Using them as discourse devices, Baltic Russian speakers in their public online communication oppose the official discourses of their respective states; in doing so, however, they do not simply transmit the Kremlin propaganda, but rather creatively repurpose local discourses and contexts, building echo chambers of their own.

Background Use of automated antimicrobial susceptibility testing (AST) instruments are common in clinical microbiology laboratories, in part due to the quick turnaround time and automated result reading. Given the wide variability in validation and each individual instrument’s algorithms and parameters, AST data between clinical laboratories is not guaranteed to be comparable. Accurate AST is critical to ensure appropriate antimicrobial prescribing practices. In Tennessee little is known about the comparability of AST testing amongst clinical labs. This study aims to quantify differences in clinical automated testing instrument (ATI) performance when compared to broth microdilution (BMD). Methods Clinical laboratory AST data from Phoenix (PHX) and Microscan (MS) instruments were obtained for carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Acinetobacter baumannii (CRAB) via the Multi-site Gram-Negative Surveillance Initiative. Data were received from the residents of seven select counties in Tennessee from 2019–2024. Identified isolates were sent to the Tennessee State Public Health Laboratory’s Antimicrobial Resistance Lab Network (ARLN) program for additional testing, including BMD AST, which was used as the reference standard. Agreement between ATIs and BMD breakpoint interpretations were measured using a weighted Cohen’s Kappa calculated in SAS 9.4. Results There were 401 isolates included in this study. Eleven antibiotics were evaluated for agreement between MS and BMD, and ten were evaluated for agreement between PHX and BMD, shown in Table 1. Six antibiotics and four antibiotics showed lower agreement to BMD for PHX and MS respectively. Both MS and PHX showed near perfect agreement (κ<0.81) for four antibiotics. Additionally, MS and PHX both showed moderate agreement (κ<0.41) for five antibiotics, two of which were imipenem and meropenem. Agreement between ATI and BMD was poor for ertapenem across both MS and PHX, with the data showing clinical ATI are over-reporting resistance compared to BMD. Agreement between MS and BMD was also poor for cefotaxime (0.39). Conclusion While this study only evaluated a subset of isolates tested at the clinical laboratory, it still demonstrates that clinical AST instruments results are not necessarily comparable, with half of the antibiotics evaluated showing moderate to poor agreement when compared to BMD. The poor agreement reported for ertapenem is particularly concerning, as these represent overreported carbapenem resistance, which impacts treatment options, transmission-based precaution implementation, and unnecessary confirmatory testing through ARLN. This study demonstrates the need for laboratories utilizing commercial AST instruments to perform frequent quality control checks to ensure instruments are functioning within an acceptable performance standard range.

Background: Effective infection prevention and control (IPC) strategies are essential for reducing the risk of transmission of infection in healthcare settings. Traditionally, implementation and discontinuation of transmission-based precautions (TBP) have relied on manual review by infection preventionists (IPs) or physicians with IPC expertise. During the COVID-19 pandemic, rapidly evolving protocols and surges in patient volume strained IPC teams, highlighting the need for scalable, automated IPC workflows. Many healthcare systems have adopted clinical decision support systems (CDSS) built into the electronic health record to support non-IPC workflows; however, the extent of CDSS use for IPC is not known.? Methods: We conducted this national survey of healthcare facilities within the SHEA Research Network to broadly assess CDSS use in IPC, identify automated features, and define barriers to implementation. The survey captured IPC tasks supported by CDSS, including initiation and discontinuation of TBP and perceived impact of CDSS on clinical and operational outcomes. To enable cross-institutional comparisons, we defined an “IPC Automation Index” (IAI) score as the number of automated IPC functions at a facility across 7 core tasks assessed. Results: Fifty facilities completed the survey (42% response rate); of these, 42 (84%) reported using a CDSS tool for IPC. Although most used multiple CDSS tools for IPC, automation was largely concentrated at the front-end of workflows, particularly for automated initiation of TBP. In contrast, automated discontinuation of TBP was uncommon, with the majority of facilities relying on manual review. Over 55% of facilities had an IAI score of at least 2, indicating at least 2 fully automated IPC functions by CDSS (Figure A). Automation feature combinations varied widely, with 31 distinct configurations observed among 42 facilities and no dominant combination observed. Facilities with higher IAI scores were more likely to report perceived reductions in workload and cognitive burden among IPs. Finally, the most frequently reported barriers to CDSS adoption included personnel constraints (~45%), challenges integrating CDSS into the EHR (~43%), and financial limitations (~36%). Conclusions: This study provides the first national assessment of CDSS use for IPC, highlighting current practices, key barriers to adoption, and opportunities. We propose a CDSS automation model that conceptualizes IPC workflows along a continuum of low-to-high automation (Figure B). Anchored by the IAI score, this framework enables comparisons of CDSS use for IPC across healthcare facilities and highlights opportunities to advance CDSS adoption for IPC.

Background: Faced with a national blood culture (BC) bottle shortage, our institution implemented a diagnostic stewardship intervention relying on multidisciplinary teams' education to enhance provider awareness, along with technological checkpoints. This initial effort resulted in a 60% reduction in BC orders and an estimated monthly savings of approximately $145,000, with no change in in-hospital sepsis mortality. The initial report covered the post-intervention period up to January 2025. As bottle availability normalized, acute-phase restrictions ended, while key stewardship components were deliberately maintained. The electronic medical record (EMR) best practice advisory (BPA) remained active, paired with continued clinician education and ongoing monitoring of blood culture utilization to reinforce appropriate practice. We subsequently evaluated the durability of this stewardship approach, focusing on long-term utilization drift and the net sustained reduction in blood culture use after the acute supply crisis resolved. Methods: We conducted a retrospective review of BC utilization at a 438-bed tertiary care academic center. The study compared the Pre-Intervention Baseline (P1: January 2023-July 2024) against the two post-intervention phases: the acute shortage (P2: August 2024–January 2025) and the sustainability phase (P3: February 2025–September 2025). The stewardship intervention in P3 included an EMR-based BPA, along with ongoing education and monitoring. The primary outcome was the mean monthly BC orders. Statistical stability in P3 was assessed using 95% confidence intervals (CI). Results: Blood culture utilization averaged 2,777 sets per month during the pre-intervention period (P1). Following the acute shortage (P2), utilization partially rebounded and then stabilized at a lower plateau during the eight-month sustainability phase (P3) at 2,098 monthly orders. This represents a sustained 24.45% reduction compared with the pre-intervention baseline. The stability of P3 is supported by a narrow 95% confidence interval (1,909.92 to 2,186.08) and a low margin of error of ±88.08 orders, confirming that the reduction reflects a reliable new steady state. Conclusion: Our long-term evaluation shows that a diagnostic stewardship intervention implemented during an acute supply shock resulted in a durable shift in practice. Even after the shortage was resolved, monthly blood culture utilization remained nearly one-quarter below baseline and stabilized with minimal variability, indicating the establishment of a reliable new steady state. These findings highlight that targeted education and system-level checkpoints can drive lasting reductions in unnecessary testing and recalibrate ordering behavior well beyond the immediate crisis.