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

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

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

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

Background: Dalbavancin is increasingly used for management of serious gram-positive infections, even beyond those for which it has formal FDA approval. Barriers to dalbavancin prescription commonly faced in the private sector, such as high drug acquisition costs, insurance prior authorizations, and challenges coordinating infusions, are more easily managed within the VA system. Since dalbavancin was initially approved by the FDA in 2014, VA providers have prescribed approximately 11,500 doses nationally. We surveyed VA providers to understand their perceptions and experiences in using dalbavancin. Methods: We conducted a cross-sectional, 39 question survey via RedCap, which was distributed to approximately 400 VA infectious disease providers across 141 medical centers. The survey remained open from September 10 – November 10, 2025. Results: We received 82 responses from 63 (77%) infectious disease providers (physicians and advanced practice providers) and 18 (22%) pharmacists representing 50 unique VA facilities, spanning all 18 VA geographic regions. At nearly all facilities (48/50, 96%), dalbavancin was available and approval by an infectious disease specialist was required for use. While the median estimated dalbavancin use among VA providers was reported to be 1-2 prescriptions/month, there was wide variability in reported prescribing rates of dalbavancin overall (Figure 1). The majority of VA providers had used dalbavancin for skin and soft tissue infections, bloodstream infections, and osteoarticular infections. However, a minority reported use for endovascular infections. (Figure 2). Most providers perceived dalbavancin was efficacious against gram-positive organisms, excluding vancomycin resistant enterococci. (Figure 3). Half of providers reported drug cost as a barrier to prescribing dalbavancin (41/82, 50%), though few providers experienced objections or resistance from hospital leadership for dalbavancin prescription (14/80, 17%). Most providers (64/81, 78%) reported prescribing dalbavancin as a 2 dose regimen (doses 1 week apart). A minority (29/77, 38%) of participants felt it is important to obtain safety labs for patients receiving dalbavancin. Providers reported that the most important factors in choosing dalbavancin included ease of administration for the patient and concerns about non-adherence to other standard care therapies. Conclusion: The widespread administration of dalbavancin across the VA underscores its attractiveness as a treatment option within this system. It is often used beyond FDA-approved indications with wide variability in perceptions of effectiveness, depending on the pathogen. The lack of inclusion in the national VA formulary and the absence of formal stewardship guidelines highlight the need for future efforts. Notably, our survey was conducted following a recent clinical trial showing that dalbavancin is not inferior to other therapies for treating gram-positive infections. Developing stewardship guidelines and investigating experiences with dalbavancin outside the VA system is planned.

Background: Candidozyma auris is an emerging multidrug-resistant pathogen characterized by environmental persistence and healthcare-associated transmission. Genomic epidemiology can help clarify transmission networks linking clinical isolates, shared equipment, and contaminated surfaces. Methods: We integrated environmental surveillance culturing with whole-genome sequencing (WGS) to characterize environmental reservoirs and genomic diversity of C. auris at University Hospitals Cleveland Medical Center, a tertiary-care hospital. Environmental surveillance samples were collected from high-touch surfaces, shared equipment, and other environmental sites within patient care areas and C. auris clinical isolates were obtained. All C. auris isolates underwent whole-genome sequencing. Dendrograms were constructed using single nucleotide polymorphism (SNP) distances to assess genetic relatedness (isolates with <13 SNP differences were considered related) and evaluate overlap between clinical and environmental isolates to infer transmission-relevant patterns. Results: Two genetically distinct C. auris clades, Clade III and Clade IV, circulated concurrently in April to May 2025. Three patients were infected with genomically related Clade III isolates (Figure 1.A) and 3 were infected with related Clade IV isolates (Figure 1.B). For both clades, multiple related isolates were present in the environment, including patient room surfaces, portable equipment, floors, and shoes of personnel. For Clade III, a distinct isolate (31 SNP difference from prior isolates) was detected in the environment in June 2025 with no concurrent clinical isolates. Conclusions: Our findings are consistent with previous evidence that high-touch surfaces and portable equipment frequently become contaminated with C. auris and suggest that floors and shoes may be an underappreciated source of dissemination. Integrating environmental surveillance with whole-genome sequencing can help identify likely reservoirs, clarify transmission dynamics, and guide targeted infection prevention interventions.

Background: Clostridioides difficile infection (CDI) remains a leading healthcare-associated infection (HAI) in the United States. To prevent outbreaks and transmission within healthcare facilities, providers must quickly recognize signs of CDI, correctly diagnose it, and implement measures to contain it. Nucleic acid amplification tests (NAATs) are highly sensitive but may over diagnose CDI, while toxin enzyme immunoassays (EIAs) risk false negatives. Two-step diagnostic algorithms have been recommended to improve diagnostic accuracy; however, national trends in their adoption have not been well described. Method: We conducted a secondary analysis of data from the Preventing Infections Through Appropriate Staffing (PITAS) study, which includes annual National Healthcare Safety Network (NHSN) hospital survey data from 347 U.S. acute-care hospitals from 2011-2024. Hospitals reported CDI testing methods annually, which were categorized as one-step, two-step, or other algorithms. Temporal trends in two-step testing adoption were assessed using mixed-effects linear regression with hospital as a random effect and adjustment for bed size and academic affiliation. Stratified analyses were performed by hospital size and academic status. Result: A total of 347 acute care hospitals contributed data from 2011-2024. In 2012, the predominant testing method was NAAT alone, which was utilized by 58% of hospitals while only 6.25% of hospitals utilized two-step methodologies. In 2017, the year of publication of the updated Infectious Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) Clinical Practice Guidelines, 28.75% of hospitals used two-step methods. By 2024, 66.18% of surveyed hospitals utilized two-step methodologies for CDI. Academic hospitals consistently demonstrated higher adoption rates than non-academic hospitals (11.11% vs 2.92% in 2012 and 67.35% vs 59.18% in 2024). Hospitals with 501-1000 beds had significantly higher odds of adopting two-step testing compared with the smallest hospitals. Conclusion: Use of two-step CDI testing methods increased substantially in U.S. acute-care hospitals from 2011- 2024, particularly following the 2017 IDSA and SHEA guideline update. As hospitals increasingly adopt two-step testing, policymakers and healthcare epidemiologists should consider how testing methods influence reported infection rates.

Background: Current antimicrobial and epidemiology literature has shown that most antibiotics are prescribed in the outpatient setting. Therefore, antimicrobial stewardship programs play a significant role in the reduction of inappropriate antibiotic utilization. JPS Health Network antimicrobial stewardship team presented provider education to the network’s community health clinics, aimed at reducing inappropriate antibiotic utilization in the outpatient setting. Providers receiving education in these community clinics included MD/DOs, medical residents, and advanced practice providers. Along with education, antibiotic prescribing scorecards were sent to individual clinic directors, allowing for direct comparison of individual clinics’ antibiotic prescribing patterns for sinusitis. The present quality improvement initiative aims at assessing the impact of these interventions on antibiotic prescribing patterns for sinusitis at JPS Health Network. Primary objective: Determine the rate of patients who received antibiotics for sinusitis at JPS Health Network’s community health clinics setting before and after provider education and implementation of sinusitis scorecards. Methods: Retrospective observational data was collected from the Electronic Health Record database (Epic) as part of the quality improvement initiative to assess antibiotics prescribing rate in patient diagnosed with sinusitis (ICD10-CM code included any variation of “J01” (acute sinusitis) or “J32” (chronic sinusitis) both before the interventions were implemented (September 1, 2024 through November 30, 2024) and after the interventions were implemented (January 1, 2025 through March 31, 2025). Results: A total of 1,807 patient encounters with sinusitis were recorded during the specified time frame. Of these, 151 patient encounters were excluded due to concurrent infections. A total of 603 antibiotics were prescribed in the preintervention group out of 788 patient encounters (77%) and 640 antibiotics were prescribed in the post-intervention group out of 868 patient encounters (74%) (p antibiotics prescribed for sinusitis. Conclusions: The antimicrobial stewardship interventions at the JPS Health Network’s community health clinics did result in a decrease in the overall prescribing of antibiotics for sinusitis. This finding reveals the significant role that antimicrobial stewardship program can play in outpatient settings to reduce the antibiotic utilization. Further research into outpatient antimicrobial stewardship interventions is warranted.

Background: On April 1, 2024, the U.S. Centers for Medicare and Medicaid Services mandated the implementation of Enhanced Barrier Precautions (EBP) in all nursing homes. EBP, which are intended to reduce MDRO transmission while avoiding the adverse effects associated with prolonged use of contact precautions, require the use of gowns and gloves during high-contact resident care activities for individuals with a history of MDRO colonization or infection, non-healing wounds, or indwelling medical devices. While EBP may offer important infection prevention benefits, concerns exist about increased costs, staff workload, and potential resident stigmatization. To date, there are no published data examining infection preventionists’ perceptions of EBP, and few studies have looked at methods of EBP implementation. Methods: To address these gaps, this study assessed experiences, challenges, and perceptions related to EBP implementation in nursing homes across Florida (UCF IRB 00007601). From May through September 2025, individuals with responsibility for infection control and EBP in their facilities were invited to take a cross-sectional, 42-item Qualtrics survey. The survey invitation was mailed to 578 free-standing nursing homes in Florida with 60 or more beds, and 90 responses were received (15.6% response rate). Results: Among the demographic results, the majority (96.7%) of respondents worked in infection control, with most (45.3%) having 1 to 3 years of experience as an infection preventionist and approximately 25% holding a certification in infection control from the Certification Board of Infection Control and Epidemiology. Regarding implementation of EBP, the most frequently targeted pathogens were ESBL–producing Enterobacterales (87.3%), VRE (85.9%), MRSA (84.5%), and drug-resistant Streptococcus pneumoniae (84.5%). Some methods of initial staff education included posted guidelines/signage (83.3%), structured in-person sessions (77.4%), and informal staff meetings and discussions (72.6%). Facilities mainly used signage outside the resident’s door (93%), documentation in the resident’s care plan (79.1%), and EHR alerts (77.9%) to indicate EBP. When assessing perceptions of EBP, most respondents (47.3%) reported a somewhat or very negative perception of staff attitudes towards EBP, while (33.3%) reported a somewhat or very positive perception. Over half of respondents (58.3%) believed that EBP increases the overall cost of care in their facility. Conclusion: These findings provide important insight into real-world EBP implementation in nursing homes and identify perceived barriers and facilitators to adoption. Understanding infection preventionist perspectives is essential to refining EBP guidance, improving implementation strategies, and ensuring that MDRO prevention efforts in long-term care settings balance effectiveness with staff feasibility and resident-centered care.

The growing availability of information sources has offered central banks new opportunities to enhance their statistical, analytical, and policy functions. By linking—or integrating—various data sets, they have been able to produce more granular, timely, and diverse statistics in a cost-efficient way. These advancements have also enabled a better use of information available in society, such as administrative records, to improve statistical agility in responding to user needs. Yet integrating alternative data—often generated as a by-product of other processes—also raises challenges, including concerns over accuracy, representativeness, and reliability. This paper aims to review systematically the opportunities and limitations of data integration in central banks, taking stock of their experience thus far. Results underscore the need for strengthening the global statistical infrastructure through adequate data governance, management, and public resources.

The density of a rational language can be understood as the frequency of some pattern in the shift space, for example, a pattern like ‘words with an even number of a given letter’. We study the density of group languages, that is, rational languages recognized by morphisms onto finite groups, inside shift spaces. We show that the density with respect to any given ergodic measure on a shift space exists for every group language, because it can be computed by using any ergodic lift of the given measure to a skew product between the shift space and the recognizing group. We then further study densities in shifts of finite type (with a suitable notion of irreducibility) and then in minimal shifts. In the latter case, we obtain a closed formula for the density under the condition that the aforementioned skew product has minimal closed invariant subsets that are ergodic under the product of the original measure and the uniform probability measure on the group. The formula is derived in part from a characterization of minimal closed invariant subsets for skew products between shifts and finite groups relying on notions of cocycles and coboundaries. In the case where the whole skew product is ergodic under the product measure, then the density is just the cardinality of the subset of the group that defines the language divided by the cardinality of the group. Moreover, we provide sufficient conditions for the skew product to have minimal closed invariant subsets that are ergodic under the product measure. Finally, we investigate the link between minimal closed invariant subsets, return words, and bifix codes.

Although syntactic priming is often studied in a purely cognitive framework, individual differences in rates of syntactic priming may be related to other social-cognitive and sociolinguistic factors. One such factor may be perspective-taking, in that the ability to take into account the thoughts and feelings of another person may relate to individual differences in the frequency of syntactic priming. To date, however, the limited research investigating this question has used non-interactive measures of perspective-taking in which participants self-report their perspective-taking tendencies or reason about third-party characters. To address this gap, participants in the present study will complete three different perspective-taking tasks, and we will examine whether individual differences in perspective-taking relate to syntactic priming rates during an interactive task. Given some evidence that perspective-taking scores are higher in bilingual versus monolingual individuals, we will also estimate perspective-taking scores and rates of syntactic priming based on participants’ multilingualism scores. Analyzing whether and how perspective-taking and multilingualism relate to variability in rates of structural priming will help inform our understanding of the social-cognitive mechanisms that contribute to linguistic alignment.

We classify the imaginaries in a large class of equicharacteristic zero henselian valued fields that contains all those with bounded inertia group, and more. To do so, we consider a mix of sorts introduced in earlier works of the two authors and prove elimination of imaginaries down to the field, the k-linear imaginaries, and the imaginaries of the value group.

Background: Antibiotic-resistant infections cause 2 million illnesses and 35,000 deaths annually in the U.S., driven partly by unnecessary antibiotic prescribing. Emerging evidence raises concern over prescription rates in primary and urgent care telemedicine settings, where limitations to conducting physical exams and fewer dedicated antibiotic stewardship resources pose challenges. More information is needed about how to implement antibiotic stewardship in these settings. To reduce inappropriate antibiotic prescribing over telemedicine, we implemented the first large-scale quality improvement (QI) intervention for antibiotic stewardship in telemedicine. Methods: The Safety Program for Telemedicine enrolled 522 practices representing 49 organizations offering telemedicine in an 18-month QI program. Participating organizations varied in size (1-100+ clinicians), care type (e.g., primary, urgent, pediatric), and structure (e.g., direct-to-consumer, integrated health system). The program included: 1) 18 webinars on antibiotic stewardship, diagnosing and treating common infections over telemedicine, virtual physical exams, and patient communication; 2) QI adviser support; 3) office hours; 4) practical tools (e.g., patient and clinician handouts); 5) benchmarking reports; and 6) sustainability guidance. We conducted 25 virtual interviews with program participants from 23 practices to identify challenges and opportunities to improve antibiotic prescribing in telemedicine and program facilitators and barriers. Transcripts were coded in NVivo. Using rapid deductive qualitative analysis, we organized data into predefined domains while identifying emergent themes and synthesized summaries to identify cross-cutting patterns. Monthly QI adviser reports on implementation successes and challenges were also qualitatively analyzed to explore themes. Results: Key themes revealed 1) challenges to appropriate antibiotic prescribing in telemedicine, 2) resources to support antibiotic stewardship, 3) facilitators to successful program implementation, and 4) barriers to program engagement. Challenges reported by participants included concerns about patient satisfaction, limitations in conducting physical exams, and inadequate telemedicine-specific education. Patient communication tools and telemedicine-specific clinical guidance were noted as resources to support appropriate prescribing. Facilitators to successful program implementation included live and asynchronous learning options, case-based materials in various formats (discussion guides, handouts, slides), one-on-one support, and sharing prescribing data in benchmarking reports. Barriers included limited provider time, competing organizational priorities, and difficulties extracting data from electronic health record systems. Conclusions: Leaders of antibiotic stewardship efforts in telemedicine settings can apply these findings by offering telemedicine-specific guidance to clinicians, flexible learning, ongoing support/coaching, individualized benchmarking reports, and proactively addressing patient satisfaction through patient education. This program also provides a scalable model for implementing QI interventions in telemedicine settings that can be adapted to other clinical areas.

Background: The 2024 blood culture (BCx) bottle shortage highlighted the importance of BCx stewardship. During the shortage period, an electronic medical record alert (Figure 1) was implemented to conserve BCx bottle supply and subsequently maintained after shortage conclusion. An alert fired when repeat BCx were ordered within 48 hours of prior BCx and required written justification of the order to proceed. Sustainable mechanisms to implement BCx stewardship using clinical decision support are needed. This study evaluates whether written justification for bypassing the alert adhered to institutional BCx guidance. Methods: A retrospective cohort study of repeat BCx orders where the alert fired and was bypassed in adult patients in first 6 months after implementation (8/12/2024-2/11/2025) was evaluated at a single academic hospital. Primary outcome was the adjudicated adherence to institutional BCx guidance for alert-triggered BCx. Additional outcomes included true positive and contamination rates based on adherence, timing of repeat BCx, and whether repeat blood cultures were obtained <40 hours from initial BCx, serving as a measure of appropriate timing. Falsely triggered alerts were defined as initial BCx orders that were canceled yet triggered the alert or when clinicians added BCx to initial orders within <6 hours. Results: Among 162 BCx episodes, 130 were included (exclusions: 7 pediatric, 25 falsely triggered alerts). These 130 BCx episodes consisted of 247 repeat BCx sets in 105 patients. Characteristics of initial and repeat blood culture episodes are in Figure 2. The median time from initial to repeat BCx was 45.6 hours (IQR 35.5-49.3) (Figure 3). Repeat blood cultures were obtained after 40 hours in 67.7% of episodes (Figure 4). Repeat BCx adhered to local guidance for appropriate repeat BCx in 79/130 (60.8%) of episodes with higher yield of true pathogens in adherent indications (20/79, 25.3%) compared to nonadherent indications (3/51, 5.9%) (Figure 5). The indications with highest positivity were retained infected central venous catheters (35.7%) and Staphylococcus aureus bloodstream infection (35.3%). Repeat BCx obtained ≥40 hours had higher adherence compared to those obtained <40 hours (70.5% vs 40.5%). Conclusion: Overall adherence to local BCx guidance for repeat BCx via an alert was 60% with higher positivity when ordered for appropriate indications and with appropriate timing. The alert did create falsely triggered alerts, and clinician judgement outside the guidance identified rare cases of persistent bloodstream infection.

In hospital corridors, nursing staff often call on to coworkers and enlist them for the realization of some practical activity, as part of their teamwork. Sometimes, the coparticipants produce a summons-answer (SA) sequence as a preliminary to the recruiting move, for instance the request. They thus check and display the summoned party’s availability for interaction, for talk, and for a new activity foretold by the summons. In this article, we show that they may also convey, through the SA sequence, some understanding of this activity’s nature and specificities. In this regard, we present practices that the summoned party deploys when enacting limited availability for the upcoming recruitment by continuing their current involvement, merely suspending it instead of abandoning it, and in some cases also displaying being disrupted. The data are video-recordings of nursing staff corridor interactions with coworkers in a hospital outpatient clinic in the French-speaking part of Switzerland. (Multimodal conversation analysis, summons-answer sequence, availability, recruitment, nurse, hospital corridor interaction)

Introduction: The BioFire® FilmArray® meningitis/encephalitispanel can be a helpful test for early diagnosis of community acquired central nervous system infection. However, excessive ordering can lead to patient harm, increased healthcare costs, and excessive environmental impact. Despite a diagnostic stewardship algorithm in place at our institution, ME panels are frequently nondiagnostic, prompting inquiry into whether our diagnostic stewardship algorithm could be improved and if a ME panel ordering decision rule could improve test utility. Objective: Review ME panels performed over a one month period and evaluate for adherence to our institution’s diagnostic stewardship pathway. Methods: We performed a retrospectivechart review of ME panels performed on adult patients over a one month time period at our institutionfor order indication,progress note clinical indication, other cerebrospinal fluid (CSF) test results, ME panel result, and patient outcome. Adherence to our current microbiology lab diagnostic stewardship algorithm and clinical utility were evaluated. The current algorithm calls for ME panels to be performed only on CSF collected via lumbar puncture (LP) with CSF total nucleated cells (TNC) <5, low glucose (<40 mg/dL), or abnormal protein (<15 mg/dL or <45 mg/dL) in non-neutropenic adults. Our electronic medical record (EMR) also provides hard stops if order indication for ME panels include “Evaluate for ventriculoperitoneal shunt infection” or “Evaluate for brain mass/abcess.” An “other” option was made available to prompt an infectious disease consult to discuss clinical indication for the test. Results: Twenty-three ME panels were performed on adult inpatients and outpatients at our healthcare system over the month reviewed. All 23 ME panels resulted as normal for all 14 pathogens. Eleven out of 23 ME panels met clinical indication outlined in our microbiology lab’s diagnostic stewardship algorithm. Ten out of 23 were ordered for meningitis in an immunocompromised host, although none of the patients had WBC <1 or ANC <0.5. Five out of 10 panels were ordered on immunocompromised individuals who did not were not appear immunocompromised upon chart review. Two out of six ME panels were run for community acquired meningitis despite completely normal CSF parameters. Conclusion: There is a discrepancy between our institution’s diagnostic stewardship algorithm indications for for ME panels and actual ME panel ordering and completion. There is also a high rate of negative ME panel test results which may indicate test overuse. Re-evaluation of our ME panel algorithm and the utility of a clinical decision rule are warranted.

Background: Hospital onset bacteremia (HOB) due to Methicillin Resistant Staphylococcus aureus (MRSA), defined as a positive blood culture obtained on admission day 4 or later, is associated with increased patient morbidity and mortality as well as excess healthcare utilization and costs. Determining patient risk factors as well as the most common sources of MRSA HOB can help identify patients at increased risk and guide infection prevention opportunities. Methods: A retrospective descriptive cohort study of patients with MRSA HOB was conducted at a quaternary care hospital from July 1, 2023 to June 30, 2025. Demographic and clinical data collected included comorbidities, hospital length of stay (LOS), chlorhexidine gluconate (CHG) treatment, presence of central venous catheter, and MRSA colonization/infection or hospitalization in prior 12 months. Clinical outcome data collected included infectious complications, need for intravenous (IV) antibiotics, IV treatment duration, 30 day mortality, 30 day readmission and discharge location. The primary source of MRSA bacteremia was determined by review of clinical chart documentation. Results: During the study period, 98 cases of MRSA HOB were identified. Demographics, clinical data and co-morbidities are detailed in Table 1. Primary sources of the MRSA bacteremia are detailed in Table 2 with the most common being vascular catheters, skin and soft tissue and pneumonia. Patient outcomes including infectious complications, 30 day mortality and 30 day readmission are detailed in Table 3. Overall healthcare worker hand hygiene compliance, measured via electronic hand hygiene monitoring system, was 83.3%. Discussion: Patients with MRSA HOB had several pre-existing co-morbidities with high exposure to the healthcare system. Less than half were found to have prior MRSA colonization/infection, but this is likely an underestimate since our institution does not perform active screening surveillance for MRSA. A majority of patients had a preventable source of bacteremia (vascular catheters and pneumonia) indicating opportunities for improvement with daily CHG treatment, hand hygiene and vascular access maintenance bundles. Proposed strategies to reduce hospital acquired pneumonia include improving oral care compliance and increasing patient mobility although further studies are needed. Patients with MRSA HOB had high rates infectious complications and over half required care in a facility post-discharge. More than a third of patients expired within 30 days of discharge. Targeted prevention strategies for MRSA HOB are needed and have the potential for significant impact in morbidity and mortality.

Background: In early 2024, a nationwide healthcare system disruption in South Korea led to temporary suspension of the antimicrobial stewardship program (ASP) at a tertiary care center due to critical workforce shortages, which was accompanied by increased use of antibiotics, particularly restricted agents. In November 2024, a national ASP pilot program enabled reimplementation of ASP activities. We evaluated changes in hospital-wide antibiotic consumption following ASP reimplementation. Methods This retrospective, single-center study evaluated hospital-wide antibiotic use from March 2024 to November 2025 at a 2,446-bed tertiary care center (Asan Medical Center, Seoul). Antibiotics were classified as restricted agents subject to ASP interventions (preauthorization and prospective audit and feedback) and nonrestricted agents without such interventions. Changes in monthly days of therapy (DOT) per 1,000 patient-days were analyzed using interrupted time-series analysis, with November 2024 defined as the intervention time point. Results Over a 21-month study period, a total of 1,070,544 patient-days were included. Following reimplementation of the ASP, interrupted time-series analyses showed a reduction in total antibiotic use, corresponding to a 7.9% relative decrease (95% CI, 12.6% to −2.2%). This overall change was driven primarily by restricted antibiotics, which demonstrated significant reductions in both level (−29.8 DOT per 1,000 patient-days; 95% CI, 50.6 to −9.05; P = .012) and trend (−5.03 DOT per 1,000 patient-days per month; 95% CI, −7.65 to −2.41; P = .0015), yielding a 29.7% relative reduction (95% CI, −36.0% to −21.8%) compared with projected counterfactual use. In contrast, nonrestricted antibiotics showed no statistically significant changes. Conclusion Although reductions in restricted antibiotic use following ASP implementation are well recognized, our findings demonstrate that stewardship effects can be effectively restored after temporary program interruption. This resilience underscores the role of antimicrobial stewardship as a system-level safeguard against inappropriate antibiotic escalation, particularly in the context of healthcare system disruptions.