Background: Blood culture contamination leads to unnecessary clinical interventions and increased healthcare costs. Estimations indicate each contamination incurs over $4,500 in avoidable cost. The 2024 IDSA/ASM guideline advises blood culture collection via peripheral venipuncture and cultures from existing vascular catheters should be reserved for suspected Central line associated bloodstream infection (CLABSI) and paired with a peripheral set. It was observed that routine ordering and collection of blood cultures from central venous catheters (CVC) was common practice at our institution and our blood culture contamination rate was above the recommended 1% goal. A multidisciplinary quality improvement plan was implemented to reduce inappropriate catheter blood culture collection. Methods: A pre-post intervention study was conducted at a large quaternary medical center from January 1, 2023 to December 31, 2024 (pre-intervention) and January 1, 2025 to December 31, 2025 (post-intervention). The intervention included simultaneous updates to 1) provider clinical practice guidelines for blood culture indications, 2) nursing policies on culture collection techniques and 3) nutrition policies regarding surveillance cultures from CVCs prior to initiation of total parenteral nutrition. Education was provided and reinforced at multidisciplinary quality rounds as well as various meetings, huddles and lectures. Blood culture contamination was defined using CLSI criteria and rates and collection sites were compared pre and post intervention. CLABSI was determined using National Healthcare Safety Network (NHSN) definitions. CLABSI rates and blood culture collection sites were compared pre and post-intervention. Results: During the study period, 185,030 sets of blood cultures were collected. The number of blood cultures collected from a CVC significantly decreased (Table 1) and the contamination rates of cultures significantly decreased from both peripheral venipuncture and CVC. By reducing collection from lines, 29 estimated contaminations were avoided, with an associated cost savings of $131,602 and a reduction of 203 antimicrobial days. There was a significant decrease in CLABSI rate in the post-intervention period (Figure 1). There were significantly fewer blood cultures drawn from CVCs in patients with NHSN CLABSI in the post-intervention period (70% vs 50%, p = 0.0005). Conclusions: The simultaneous policy change and multifaceted reinforcement with strong senior leadership support resulted in rapid adoption and sustained change in blood culture ordering and collection practices. There was a significant decrease in the proportion of blood cultures drawn from CVCs, blood culture contamination and CLABSI rate in the post-intervention period leading to significant cost savings, fewer antimicrobial days and improved patient outcomes.

Background: Patients in the intensive care unit (ICU) often require two concurrent central venous catheters (CVCs) – a temporary CVC for medication administration and a hemodialysis (HD) catheter (HDC). Having concurrent CVCs increases the risk of central line-associated bloodstream infections (CLABSIs). Triple-lumen HDCs have an additional lumen, which may reduce the need for concurrent CVCs as compared to double-lumen HDCs. We evaluated CVC utilization and prevalence of concurrent CVCs in patients with HDCs in an academic ICU after implementing triple-lumen HDC use. Methods: We analyzed data from patients with newly placed HDCs, admitted to a 20-bed medical ICU in an academic hospital in Atlanta, GA from November 2022-January 2025. Triple-lumen HDCs were introduced February 2024. Data were obtained from the electronic health records. Concurrent CVC was defined as having a newly placed HDC and any other simultaneous CVC for at least one calendar day during the ICU admission. Central line-days were defined as number of CVCs in place per 1000 patient-days and lumen-days were defined as number of lumens in place per 1000 patient-days. We analyzed CVC and lumen utilization and prevalence of concurrent CVCs after the intervention by interrupted time series analysis (ITS). ITS with Poisson regression determined if there was a decrease in lumen-days or admissions with concurrent CVCs in the post-intervention vs. pre-intervention time period. An exploratory analysis compared the number of CLABSIs (as defined by NHSN) pre- and post-intervention. Results: Conclusion: After the introduction of triple-lumen HDCs to an academic medical ICU, the total prevalence of patients on HD requiring concurrent CVCs decreased, however our sample size was too small to demonstrate statistical significance by ITS. Decreasing the need for concurrent CVCs may reduce CLABSIs in this ICU but additional time post-intervention is needed.

Background: Candida auris, an emerging multidrug-resistant yeast, spreads rapidly in healthcare settings and is associated with difficult-to-control outbreaks. Prevalence has risen significantly in the Metro Detroit area, driven by interfacility transfers and inconsistent communication of colonization status. Patients can remain colonized for prolonged periods and shed the organism into the environment, where it persists for months. Active surveillance testing (AST) can support earlier detection and containment. We describe the implementation of a C. auris AST program across a multi-hospital health system. Methods: Screening for C. auris colonization can be either prevention?based or response?based. Response?based strategies, such as point prevalence surveys (PPS), are recommended by the Centers for Disease Control and Prevention when a new case is identified. Prevention?based AST is also recommended to detect cases early among high?risk groups. In April 2025, we launched a C. auris AST program across five hospitals in Southeast Michigan. Composite axilla–groin swabs were tested by real?time polymerase-chain reaction (PCR). High?risk patients were defined as those presenting from long?term acute care hospitals, skilled nursing facilities, subacute rehabilitation facilities, or inpatient rehabilitation centers who required ED admission or transfer from another healthcare facility (including internal transfers) and had one or more of the following: indwelling devices (e.g., endotracheal or tracheostomy tubes), chronic or non?healing wounds, or colonization/infection with multidrug?resistant or carbapenem?resistant organisms. Upon order signing in the electronic health record, an alert prompted providers to order C. auris PCR and initiate contact precautions. Patients were retested upon readmission. PPS were also performed per state health department recommendations following identification of new cases. Results: During the 6?month surveillance period, 2,710 unique patients underwent AST, with 3,044 total tests completed. Of these tests, 969 (31%) were ordered in the emergency department at the time of admission. Overall, 37 patients (1.2%) screened positive for C. auris colonization (Table). During the same period, 1,354 tests were performed through 77 unit?based PPS, yielding 22 positive results (1.6%). Conclusion: Although AST was implemented as a prevention?based strategy, PPS remained necessary for identifying additional cases. Positivity rates were low across both approaches, yet each required substantial coordination, staff time, and laboratory resources. These findings highlight the need to balance the benefits of early detection with operational demands. Alternative approaches beyond widespread screening should be explored to optimize resource utilization while maintaining effective C. auris prevention and control.

Background: Candidozyma auris is an emerging healthcare-associated pathogen that colonizes human skin and survives on healthcare surfaces for up to two weeks. As C. auris re-contaminates the healthcare environment within hours of disinfection, a continuously active disinfectant may provide an advantage over traditional disinfectants in healthcare environments with high rates of C. auris colonization. Water-stable organosilanes (WSOs) have demonstrated continuously active disinfection against bacterial and viral species but have not been studied against C. auris. Goldshield® GS75 (Locust Valley, NY) is a WSO composed of a siloxane bonding agent providing surface coating, a nitrogen molecule for organism attraction, a long carbon chain for cellular penetrance, and a quaternary ammonium compound for disinfection. We tested the efficacy and duration of effect of GS75 on survival of C. auris in vitro. Methods GS75 was applied to C. auris colony forming units (CFUs). After one hour, coupons were swabbed using premoistened sponge-sticks (Neogen Sponge-Stick with proprietary neutralizing buffer active against chlorine and QACs; Neogen, Lansing, MI), processed using the stomacher method and plated quantitatively to Sabouraud Dextrose agar (RemelTM, Lenexa, KS) then incubated for 48 hours at 37°C in ambient air. Duration of GS75 activity was assessed using the same method, with C. auris re-inoculated daily to simulate repeated contamination from a C. auris colonized or infected patient, and recovery attempted at 4 hours, 24 hours, 48 hours, 72 hours, 7 days, 14 days, 21 days, and 28 days after coupon treatment. (Figure). A separate set of coupons was wiped daily with a dry microfiber cloth or a 10% sodium hypochlorite bleach wipe (Sani-Cloth®, PDI, Woodcliff Lake, NJ) before daily re-inoculation to simulate routine environmental cleaning practices that might be necessary even with use of a continuously active disinfectant. Results Mean C. auris CFUs recovered from untreated coupons exceeded 145 at all sampling times, while GS75-treated coupons showed significantly reduced C. auris recovery. The addition of daily bleach or microfiber cloth wiping had minimal effect on GS75 activity (Table). Conclusion One application of GS75 reduced survival of C. auris on a common healthcare facility surface material for up to 28 days, despite repeated C. auris challenge and with minimal reduction in activity after physical or chemical cleaning. These findings support evaluation

Background: PNGS technology to identify microbial DNA in blood, is used to diagnose infections not identified with standard cultures. The National Healthcare Safety Network (NHSN) defines central line associated bloodstream infection (CLABSI) as an NHSN defined laboratory confirmed bloodstream infection (LCBI) in the presence of an eligible central line. The LCBI definition was updated in 2020, to include pNGS as a non microbiologic test to define CLABSI, not accompanied by a standard blood culture. This study describes the adverse impact of pNGS on CLABSI rates at a pediatric hospital. Methods: CLABSI events attributed to pNGS results, were identified through hospital infection control records from January 2020 through June 2025. Medical charts were reviewed for blood cultures, indications for testing, prior pNGS, and changes in antimicrobial therapy based on pNGS results. CLABSIs associated with mucosal barrier injury (MBI) were not included as these are not part of nationally reported rates. Results: 138 eight CLABSI events were identified during this timeframe, with 21(15.2%) defined by pNGS results. CLABSI rates are shown in the Table. Of pNGS defined CLABSI events, 11 patients had sites of infection other than blood, and 6 had pNGS done only to follow up prior pNGS results. Eight children with organisms identified on pNGS were already being treated and 8 new organisms on pNGS results were considered not clinically significant and not treated. Antimicrobial therapy was given in response to pNGS results for 5 patients: a neonate with candida and ureaplasma on pNGS, a pancreatitis patient with Enterococcus avium and Staphylococcus epidermidis on pNGS, a patient started on ganciclovir due to CMV, and 2 patients treated for organisms on pNGS associated with previously identified non bloodstream infections. Conclusion: Inclusion of pNGS defined CLABSI events increased reported CLABSI rates by a mean 19.2% per year. Most pNGS results were associated with non bloodstream infections. The clinical significance of pNGS results is uncertain and positive results do not correlate with bacterial bloodstream infections. PNGS results should not be considered comparable to traditional blood cultures and should not be used to define CLABSI events.

Background: Central-line-associated bloodstream infections (CLABSI) are a costly yet preventable healthcare-associated infections, contributing to increased morbidity and mortality. We describe the impact of a multidisciplinary multi-faceted approach on CLABSI rates at our institution. Methods: This is a pre—post quasi-experimental retrospective study across an 877-bed, quaternary care academic hospital in Southeast Michigan. The CLABSI rate per 1,000 central-line days, blood culture (BC) order rate per 1,000 patient days, standardized infection ratio (SIR) and standardized utilization ratio (SUR) in the pre-intervention period (1/2023-6/2024) to the post-intervention period (9/2024-8/2025) were compared. CLABSI was determined using National Healthcare Safety Network criteria. The multi-faceted intervention comprised of: (1) implementation of a diagnostic stewardship guideline with an algorithm-based approach to improve appropriate blood-culture ordering; (2) prompt notification of CLABSI-eligible patients to facilitate early evaluation for secondary sources; and (3) use of an electronic central line indications checklist to promote early removal of unnecessary lines, supported by an interprofessional stakeholder meeting in June 2024 that designated unit-level champions for execution and feedback. Results: The CLABSI rate significantly decreased from 1.604 to 1.044, resulting in a 35% reduction (p<0.017) [Table]. The SIR significantly decreased from 1.315 to 0.857, a 35% reduction (p=0.011). The SUR significantly decreased from 0.911 to 0.832, a 9% reduction (p<0.001). The BC order rate per 1,000 patient days decreased from 89.2 in the pre-intervention period to 70.7 post-intervention, a 21% reduction (p<0.001). Discussion: A significant reduction in CLABSI rates, central-line utilization, and blood-culture orders was observed following implementation of a multi-faceted approach supported by multidisciplinary collaboration. These findings demonstrate that a coordinated bundled strategy, executed in close collaboration with primary clinical teams, can significantly reduce CLABSI burden in a large academic medical center.

Clostridioides difficile (C. difficile) negatively impacts patient care and health care costs. Monitored as a safety metric, hospital onset- C. difficile infections (HO-CDI) occur after day 3 of admission. Standardized Antimicrobial Administration Ratio values for antibacterial agents posing highest risk for C. difficile infection (CDI SAAR) provides national benchmarking and assesses the impact of interventions aimed at improving prescribing practices to reduce C. difficile rates. We implemented several antimicrobial stewardship interventions to evaluate whether these reduced CDI SAAR values and C. difficile rates. Before 2023, C. difficile testing consisted of PCR alone after meeting certain criteria. This changed so that a positive PCR test reflexes to an EIA for toxin B; if negative, CDI is ruled out. Stewardship interventions in 06/2023 provided targeted education and feedback on CDI SAARs to ICU pharmacists to improve antimicrobial use. In 10/2023, a second intervention targeted high SAARs in the medical step-down unit (MSD) through daily patient review for antibiotic optimization. By early 2025, the antimicrobial stewardship pharmacist and physician initiated twice-weekly meetings to assess antimicrobial appropriateness. Patients were identified via chart review or pharmacist referral, and recommendations were communicated to the providers and documented in the chart. HO-CDI decreased both in the ICU and hospital wide after changing to two-step testing, decreasing from 0.55 to 0.25 infections/10,000 patient days (PD) hospital wide (Figure 1) and from 1 to 0.5/10,000PD in ICUs (Figure 3). In 2023, prospective audit and feedback by stewardship pharmacists in MSD patients resulted in a decrease in CDI SAAR from 1.26 to 1.12 (Figure 2). In October 2023, targeted education to ICU pharmacists coincided with reduction of ICU CDI SAAR from 1.57 to 1.43 (Figure 4). After biweekly stewardship rounds were implemented in 2025, HO-CDI decreased from 0.25 to 0.12/10,000PD hospital wide (Figure 1) and from 0.5 to 0.12/10,000PD in our ICUs (Figure 3). Special cause with 5 points at or below the line is noted in our hospital wide SAAR (Figure 2). Also noted special cause with increase in our hospital wide HO-CDI in November 2025 but an investigation did not identify a known cause. Interventions that reduce CDI SAAR values decreased HO-C difficile infections. Targeted interventions like prospective audit and feedback and educating team pharmacists on SAARs improved antibiotic utilization. Handshake stewardship rounding not only reduced SAAR but also decreased HO-CDI in our experience. Antibiotic Stewardship Programs help hospitals improve clinical outcomes and minimize harm by improving antibiotic prescribing.

Background: Staphylococcus aureus is a leading cause of healthcare-associated infections and is associated with high mortality. While decolonization has been effective in reducing methicillin-resistant S. aureus (MRSA) infections in adult and neonatal intensive care units (NICUs), little is known about the impact of decolonization on transmission of S. aureus. Here, we evaluated whether weekly screening and targeted decolonization reduce genomically defined transmission of S. aureus in a NICU. Methods: Infants admitted in 2022-2024 to the NICU at Tisch Hospital received weekly screening cultures of the nares, axilla and groin for MRSA and methicillin-susceptible S. aureus (MSSA). Colonized infants received topical decolonization with chlorhexidine 2% bathing and nasal, buttock, and umbilical mupirocin, with frequency and duration of decolonization based on postmenstrual age (gestational plus chronological age). Genome sequencing was used to identify transmission events, defined as genetically linked S. aureus isolates with <20 single nucleotide variants identified in two infants with overlapping stays. Transmission risk was analyzed using time-to-event (TTE) analyses, and the absolute risk reduction and number needed to treat (NNT) were estimated. Results: Among 1,597 screened infants, 188 (11.8%) were colonized with S. aureus (85.6% MSSA; 14.4% MRSA). Colonized infants had a median NICU length of stay of 96 days, and 39 (20.7%) were involved in at least one transmission event. Of these infants, 84.6% received full decolonization. Across the cohort, 389 conversions from colonization negative to positive were observed, including 97 recolonization events; 55 (56.7%) of these infants became colonized ? 3 times during their stay, indicating sustained exposure and transmission pressure. TTE modeling predicted a 30-day transmission risk of 0.6% if all patients were decolonized, and 8.9% risk if no patients were decolonized. This corresponds to a 30-day absolute risk reduction for transmission of 8.2% and an NNT of 12; decolonizing 12 infants prevented one S. aureus transmission. Conclusions: Genomically informed modeling indicates that weekly screening and targeted decolonization reduce S. aureus transmission in the NICU. Frequent recolonization supports the importance of weekly S. aureus screening and suggests that decolonization prevents infection partly by limiting spread to susceptible hosts, with implications for the spread of resistant strains. Future analyses incorporating time-varying eligibility and exposure will further refine these transmission estimates.

Background: Candida kefyr, a non-albicans-yeast species, is recognized as a potential emerging pathogen among immunocompromised patients. Previous epidemiological studies have indicated that hematologic malignancy is a key risk factor for invasive infection among patients with cancer and those with neutropenia; however, the clinical impact is not well defined. Methods: As part of a clinical inquiry, we conducted a retrospective review of laboratory-confirmed cases of C. kefyr to understand its occurrence and distribution at an NCI-designated comprehensive cancer center from January 2024 through September 2025. Demographic, laboratory, and clinical outcome data were extracted from the electronic medical record. Epidemiologic data were reviewed to evaluate for potential trends or characteristics of patients with C. kefyr infection or colonization Results: Overall, 24 isolates were identified from 21 distinct patients. The majority were from urinary sources (71.4%). The majority of cases were considered colonizers (61.9%), but eight (38.1%) patients had clinical infections, including two (25%) bloodstream infections. The majority of patients were female (15, 71.4%) with a median age of 70 years old and an Eastern Cooperative Oncology Group (ECOG) score of 3 or greater (13, 62%). In contrast to published literature, a majority (17, 81.0%) of patients had solid tumors, and hematologic malignancy was less common, with only one patient having severe neutropenia at the time of culture. The majority (16, 76.2%) of patients had some form of central venous catheter. Only two (9.5%) patients were receiving antifungal therapy at the time of culture, with one additional patient having received antifungal therapy within the preceding 90 days. Overall, the 90-day mortality in patients with C. kefyr isolated was high (14/21; 66.7%), though not necessarily related to the organism. Conclusions: C. kefyr is a potential emerging pathogen, and patients with colonization or infection were noted to have substantial 90-day mortality. In contrast to prior studies, we observed several cases in non-neutropenic patients with solid tumors. Additional comparative studies with other organisms or Candida species are needed to better characterize risk factors, clinical impact, and the role of this organism in cancer patients.

Background: Identified risk factors for Candida auris infection are generally markers of disease severity and/or medical vulnerability. A regional C. auris outbreak in 2022 led to extensive admission and point-prevalence testing in tertiary care hospital. We retrospectively reviewed charts to identify novel risk factors for progression from colonization to infection in a universally medically complex population. Methods: A case-control study was performed to compare patients developing invasive infection (cases) from those remaining colonization. Inclusion criteria were patients newly identified to be colonized with C. auris during a hospital admission from 1/2023 through 5/2025. Patients diagnosed with clinical infection as their first evidence of colonization were excluded. Risk factor variables included ICU status, other drug resistant organisms (MDROs), length of stay (LOS), time to colonization (days from admission to identification of C. auris), antimicrobial coverage with broadly acting agents, operative and other procedures, type/number of devices. Factors were compared between cases and controls using Fisher’s Exact Tests for categorical variables and Mann-Whitney U Tests for continuous variables using SAS 9.4. Results: During the study, 74 patients became colonized and 17 went on to develop invasive infection. The following were associated with infection: colonization with other MDROs, tracheostomy, liver failure, dialysis (though not renal failure), transplant w/in last year (driven by liver, N=7), number of drains at colonization (table 1). Several factors associated with severity of illness (ICU status, antibiotic pressure) were not associated with progression to infection in this cohort. Discussion: In a medically complex population, several risk factors associated with illness severity were not associated with progression from C. auris colonization to infection, whereas liver disease and transplantation, along with other MDROs, tracheostomy, and number of drains were. Targeted interventions attempting to decolonize tracheostomy or drain sites, and/or liver disease patients in general may help prioritize infection prevention where it is most needed.

Background: Measles is a highly transmissible virus. A single case can result in significant exposures within a healthcare facility and prompt action is needed to prevent secondary cases. In October 2025, Infection Prevention and Control (IPAC) was notified of a patient being admitted to our facility with recent international travel and symptoms consistent with measles. The patient was unvaccinated and had five healthcare facility visits prior to measles being suspected and subsequently confirmed. Objective: To describe our facility’s effective identification, prioritization, and prophylaxis of individuals exposed to measles. Methods: IPAC leveraged the electronic medical record to identify potentially exposed patients. Patients were quickly assessed for age and immune status, then prioritized and assigned to primary care teams. These teams promptly contacted patients and coordinated PEP administration. Results: Across five encounters, the index patient exposed 539 other patients. Due to delayed notification, our teams had less than four days to administer PEP for those exposed and still within PEP window. PEP administration began within hours of the index case’s positive test and patients received PEP within three days (Table 1). No secondary measles cases occurred within our facility. Conclusion: Timely and coordinated multidisciplinary effort enabled us to rapidly respond to our first measles case and control secondary transmission. Although the index case resulted in a large exposure, patients that were exposed and eligible for PEP were quickly prioritized to prevent secondary transmission.

Background: Optimizing antimicrobial use is essential to reducing antimicrobial resistance and healthcare-associated infections. The Standardized Antimicrobial Administration Ratio (SAAR), reported through the National Healthcare Safety Network (NHSN), provides a risk-adjusted benchmark for antimicrobial utilization, yet its use as a structured feedback tool across multiple hospitals remains limited. In June 2025, a jurisdiction-led antimicrobial stewardship intervention was implemented to provide standardized, data-driven feedback to acute care hospitals. This analysis evaluates early changes in facility-level SAARs following implementation. Methods Five acute care hospitals participated in a monthly feedback intervention adapted from a previously piloted quarterly model. Public health analysts generated standardized written reports using routinely submitted NHSN SAAR data for adult inpatient antimicrobial use. Reports included facility-level SAAR benchmarking, peer comparisons across participating hospitals, and qualitative assessment of prescribing patterns, including empiric therapy selection, de-escalation opportunities, and duration of therapy. Facility-level SAAR trends from January 2024 through December 2025 were examined using descriptive time-series review. Percent change relative to the June 2025 baseline was calculated for July–December 2025. Year-over-year comparisons to the same months in 2024 were used to account for seasonality. Results Pre-intervention SAARs varied across hospitals, with several facilities demonstrating upward trajectories. Following implementation, three of five hospitals demonstrated relative declines in overall SAARs, while two hospitals showed stabilization after previously increasing trends. Percent-change analyses for July–December 2025 showed reductions of approximately 0.5% to 7% compared with the June 2025 baseline, with three hospitals achieving declines of 5–7%. Year-over-year comparisons indicated reductions of approximately 3–10% in three hospitals, with the remaining facilities showing stable use (≤2% change). Conclusions Early findings suggest that a jurisdiction-led, SAAR-based feedback model may support measurable improvements or stabilization in antimicrobial use across diverse acute care hospitals. Leveraging routinely available NHSN data to provide consistent, structured feedback represents a feasible, low-burden approach to strengthening antimicrobial stewardship efforts. Ongoing analyses will evaluate unit-specific and antimicrobial-specific SAAR categories to further characterize the intervention’s impact.

Background: Active surveillance for carbapenem-resistant Acinetobacter baumannii (CRAB) is essential for infection prevention in endemic settings. Skin screening using pre-moistened sponges with enrichment has demonstrated the highest sensitivity for CRAB detection and is considered the reference standard. However, sponge-based sampling is labor-intensive and less feasible for routine use. Prior studies reported limited sensitivity of swab-based screening. We evaluated whether an optimized swab-based protocol, incorporating expanded skin sampling sites, could improve sensitivity compared with sponge sampling among known CRAB carriers. Methods: This paired-method study included hospitalized patients with documented prior CRAB carriage withing prior 3 months. On the day of screening, skin samples were collected before bathing simultaneously using Polywipe sponges and dry E-Swabs (Copan Italia S.P.A., Brescia, Italy), from opposite sides of the body. Swabs were used to sample multiple skin sites, including palm, interdigital spaces, antecubital fossa, axilla, groin, knee crease, sole of the foot, and toe webs, encompassing moist skin folds known to favor Acinetobacter colonization. Skin samples were collected from patients’ arms and legs (groin and downward), Sponge samples were incubated overnight in brain–heart infusion (BHI) broth at 37 °C, vortexed, and plated onto CHROMagar MDR Acinetobacter. Swabs were broken directly into 3 mL BHI broth, incubated overnight, vortexed, and plated identically. Sponge sampling was defined as the gold standard. Sensitivity of swab screening was calculated among sponge-positive samples. Results: Among 134 paired screening samples from known CRAB carriers, 95 (70.9%) were positive by sponge sampling. Of these, 78 were also positive by swab screening, yielding a swab sensitivity of 82.1% (95% CI, 73.2–88.5). Thirty-nine patients (29.1% of the cohort) screened negative by both methods on the day of sampling, despite prior documented carriage. Discordant results were predominantly sponge-positive/swab-negative. Conclusions: Among patients with known CRAB carriage, an optimized swab-based skin screening protocol achieved substantially higher sensitivity than previously reported swab methods, though sensitivity remained lower than sponge-based screening. The inclusion of moist skin folds (such as the knee creases and toe webs), which are known to harbor Acinetobacter spp. but are not routinely sampled in previous studies, may explain the improved detection observed. The high proportion of negative screeing among known carriers highlights the dynamic and intermittent nature of CRAB skin colonization and the limitations of single time-point screening.

Infectious diseases fellowship programs for physicians seek to train the next generation of leaders in antimicrobial stewardship, but few published resources are available to guide educational experiences. As an adaptable tool for training programs, we created a list of entrustable professional activities and suggested tasks to achieve competency during fellowship.

Background: Effective infection prevention and control is integral to the delivery of safe patient care, and with ever increasing demands on their attention, systems to help navigate policy-based guidance can support infection preventionists (IPs) and their healthcare colleagues. Here we present the validation process and results for an internal infection control chatbot. Methods: Eleven frequently asked questions were selected to evaluate the performance of ChatUCM, an AI-powered chatbot. Each question was posed five times and response quality was scored by intent recognition, relevance, accuracy, completeness, and consistency. A category pass threshold was set at 75%. IP feedback was incorporated in a ChatUCM update and response quality was scored again. Reference document edits and real-time prompt modifications were made based on post-update scores. A final round of scoring was performed using similar validation metrics. Two IPs scored a subset of five out of the eleven frequently asked questions to assess interrater reliability. Six nursing managers were invited to ask ChatUCM any questions and score its responses by intent recognition, their ability to trust response accuracy, whether their question was fully answered, the achievement of intended goals, and ease of use. 29 questions were submitted. An IP reviewer also scored these ChatUCM responses as optimal, suboptimal/ no harm, and suboptimal/ possible harm. Results: The impact of the update on scores was variable. ChatUCM performed well on the same 7 out of 11 questions before and after validation round 1 (Fig. 1). After the final round of retraining, ChatUCM passed all categories with high interrater reliability for our frequently asked questions (Fig. 2). Response quality was less predictable outside of these eleven questions (Fig 3, Fig 4). To ensure its safe use, multiple safety checks were created, including disclaimer language, citation links, education, and a query report to facilitate audits. We encountered multiple surprises while validating ChatUCM. The first update resulted in significant improvements, such as the ability to digest data in table and flow diagram formats. It also saw category scores decrease for six questions, three of which had overall scores drop. ChatUCM struggled with accuracy for questions that required accounting for multiple clinical factors (ex: shingles guidance). Conclusions: These findings suggest that ChatUCM could substantially reduce IP workload by accurately answering questions contained in internal SOPs and policies. Additional development will be needed to improve reliability before the tool can function independently without human oversight, particularly when multiple clinical factors must be taken into account.

Background: Despite implementing standard infection prevention measures, our long-term care facility faced catastrophic outbreaks in units with cognitively impaired residents, where such interventions proved either ineffective or impractical due to staffing and resident-related challenges. Project Design: Confronted with constraints related to staff, residents, and resources common in long-term care facilities, we explored options for adjunctive measures to address these challenges, ultimately implementing dry hydrogen peroxide technology in these specialized areas. Outcomes and Lessons Learned: This intervention resulted in drastic reductions in microbial burden, the total number of outbreaks, outbreak attack rates, severity, and duration, while optimizing resident quality of life without placing additional strain on staff. Through this process, we learned that infection prevention interventions tailored to the characteristics of the population and facility yield maximum effectiveness.

Background: There is no gold standard approach to Clostridioides difficile (C. difficile) testing clinically. The National Healthcare Safety Network (NHSN) uses the last test in a series to determine if positive testing will be considered a healthcare associated infection (HAI) and there is concern that this may impact testing choice. Increasingly, healthcare facilities are considering 2-step testing algorithms, but limited data exists on clinical or surveillance motivations for algorithm choice. Methods: In October and November 2023, we distributed electronic surveys to Veterans Affairs Medical Center (VAMC) infection preventionists and infectious diseases physicians asking about current facility C. difficile testing practices, motivations for their current strategy, and considerations for change. Only one response was included per facility. Duplicate responses from the same facility were combined. Data were analyzed using Chi-squared tests. Results: Among 126 VAMCs, 72 (57%) completed the survey. The most common testing strategies were polymerase chain reaction (PCR) with reflex to toxin (n=31, 43%) and PCR with reflex to glutamate dehydrogenase (GDH)/toxin (n=20, 28%) when PCR is positive. Less common strategies included PCR alone (n=9, 13%), GDH/toxin with reflex to PCR when discordant (either GDH or toxin positive) (n=5, 7%), GDH/toxin alone (n=1, 1%), and other (n=6, 8%). Factors associated with testing strategy selection were avoidance of overdiagnosis (78%), to decrease rate of C. difficile HAIs (56%), and ease of interpretation (33%) (Figure 1). When comparing 2-step testing algorithms, avoiding overdiagnosis was a motivation for positive PCR with reflex to toxin or GDH/toxin (84%) as well as GDH/toxin with reflex to PCR (80%) (p=0.8). When compared to PCR with reflex to toxin or GDH/toxin, sites using GDH/toxin with reflex to PCR more frequently reported test turn-around-time (80% vs 14%, p≤0.001) and cost (60% vs 8%, p≤0.001) as motivating factors. Sites using PCR with reflex to toxin or GDH/toxin were more motivated by decreasing HAIs than GDH/toxin with reflex to PCR (63% vs 40%), although not statistically significant. Notably, 40% of facilities reported switching their testing strategy within 2 years of survey and 24% were actively considering a change. Conclusion: The most common testing strategy among VAMCs is a 2-step algorithm starting with PCR, then reflex to either toxin or GDH/toxin when PCR positive, driven by desire to avoid overdiagnosis and decrease HAI rates. It is unclear how this actually impacts rates or if this will change if facilities move to healthcare facility-onset, treated C. difficile infection metrics.

Background: The indications for the use of cardiac and endovascular implants have expanded worldwide. With increased utilization, there has been a proportional increase in implant-related complications, including infections. Epidemiological factors influencing patient outcomes in cardiac and endovascular implant infections (CEVII) are poorly characterized. We aimed to evaluate the epidemiology of CEVII and further, how healthcare utilization (HCU) patterns and the timing of infectious disease (ID) consultation influence hospital length of stay, a known surrogate of patient morbidity and quality of care. Methods: This retrospective study included patients admitted between 2010 and May 2025 with a CEVII encounter ICD-10 diagnosis of T82.7XXA, excluding deaths. For patients with multiple admissions, only the first encounter was analyzed. Descriptive statistics summarized patient characteristics, and we evaluated associations with the timing of ID consultation, HCU, and LOS. LOS modeling used generalized linear mixed models with a negative binomial distribution and log link, including categorical predictors and their interactions; significant interactions indicated effect modification. Model-adjusted mean LOS and 95% confidence intervals were obtained by exponentiating model coefficients. Analyses were performed in SAS 9.4, with p? Results: Among 763 patients with CEVII (1,168 admissions from 2013–May 2025), most were male (62%), White (76%), and Medicare beneficiaries (63%), with a median age of 61 years, median LOS of 8 days, and median Charlson Comorbidity Index (CCI) of 5.5. Early ID consult (<48 hrs.) occurred in 58.1% of cases, while 24% had no ID consult. Age and CCI were independent predictors of LOS, with no significant interaction with HCU. After adjustment, insurance type and the timing of ID consult significantly influenced LOS (p=0.0067), with late ID consults being associated with longer stays among Medicare and private insurance beneficiaries. Timing of ID consultation also interacted with admission period (pre-COVID, COVID, and post-COVID), with early ID consultationconsistently reducing LOS, while late consults resulted in the longest LOS, a difference amplified during the pandemic. Conclusion: Older patients with suspected CEVII who have high HCU and severe CCI experience longer LOS, underscoring the need for proactive care bundles to reduce excess stay and associated burden. Early ID consultation is critical, especially for Medicare and privately insured patients, where delays can lead to LOS penalties. Strengthening coordinated workflows to prevent delayed ID consultations during system strains, such as pandemics, can help avoid unnecessary prolonged hospitalizations and their impacts.

Purpose: Wastewater surveillance effectively monitors pathogens. This pilot study evaluated the feasibility and utility of hospital-level wastewater surveillance by integrating wastewater and electronic health record (EHR) data. Analyses focused on hospital-acquired infections (HAI) and temporal lags between wastewater and clinical detection. Methods: From August to December 2024, wastewater autosamplers operated across five hospital pavilions at Yale New Haven Hospital, collecting samples every five minutes during a 24-hour period three times per week. Samples were analyzed by dPCR for SARS-CoV-2, Influenza (A/B), and additional pathogens. Deidentified EHR data included admissions, diagnoses, and laboratory data. The primary focus was lab-confirmed HAI SARS-CoV-2 and Influenza. HAI was defined as infections diagnosed during hospitalization without evidence at admission. Clinical and wastewater data were used to calculate the proportion of positive samples, and correlation was assessed using Spearman’s rank correlation coefficient (rho). Correlations were evaluated for lagged associations across 1–3-week lags. A sensitivity analysis was conducted by including all SARS-CoV-2 encounters. Results: Among 33,579 patient encounters, 62 SARS-CoV-2 and 74 Influenza HAI encounters were identified. This corresponded to 97 and 148 tests for SARS-CoV-2 and Influenza, respectively. Of 187 wastewater samples collected 60 (31.1%) and 1 (0.5%) were positive for SARS-CoV-2 and Influenza respectively. Due to only a single detection of Influenza in the wastewater, correlation analysis was limited to SARS-CoV-2. A correlation test of the data found no statistically significant correlation between wastewater and clinical data when aligned temporally (rho: -0.21, p: 0.51). Lagged correlations between wastewater and clinical SARS-CoV-2 positivity were evaluated across 1–3-week temporal lags. These lagged correlations were not statistically significant, but rho increased in magnitude from a 1-week lag (rho: -0.04, p: 0.89) to a 3-weeks lag (rho: 0.46, p:0.21). The sensitivity analysis found no statistically significant correlation between wastewater and clinical positivity. Conclusions: Hospital-level wastewater surveillance shows potential as an early indicator of HAI SARS-CoV-2 infections, with exploratory trends suggesting a ~3-week lead time results in stronger associations between clinical and wastewater data. Although limited by small HAI sample sizes and a short wastewater sampling period, these findings support further evaluation in larger cohorts and highlights pathogen-specific limitations as observed for Influenza. Follow-up studies should employ longer wastewater sampling windows and further refine methods to account for community-associated SARS-CoV-2 contributions to hospital wastewater, an area of active investigation by our group.