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.

Background: Wastewater surveillance has emerged as a powerful tool for monitoring community pathogen burden. However, its role in hospital infection prevention remains unclear. We evaluated hospital wastewater for detectable multidrug-resistant organisms (MDRO) at an academic tertiary-care center (AH) and a community hospital (CH). Methods: From April-September 2024, wastewater was collected longitudinally from an AH and a CH. Samples were collected from selective plumbing draining intensive care beds at both facilities. After a 24-hour collection, samples were processed using digital droplet PCR to detect and quantify resistance genes and pathogens, including blaCTX-M, blaTEM, blaCMY-2, blaSHV, IMP, VIM, OXA-48, KPC, NDM, and Candida auris. Results were reported as gene copies per swab. Concurrent hospital isolation logs were reviewed to identify unit isolation with corresponding MDROs at the time of sampling. Results: Wastewater from both hospitals consistently contained multiple MDRO genetic markers across all sampling periods (Figures 1-4). Extended-spectrum beta-lactamase (ESBL) genes blaCTX-M, blaTEM, and blaSHV were detected in every sample, often at high copy number. Carbapenemase (CRE) genes IMP, KPC, and VIM were frequently detected, whereas NDM and OXA-48 were present at low and variable levels. C. auris was rarely detected. Across both sites, quantitative gene copy numbers varied over time. AH demonstrated persistently high ESBL and CRE gene burdens with temporal surges (Figure 1-2), while CH showed lower and more episodic detection patterns (Figure 3-4). Isolation needs for ESBL and CRE at both hospitals are reported in Figures 1-4. Conclusion: Hospital wastewater harbors diverse MDRO genetic signatures that do not reliably track with isolation practices, reflecting contributions from both silent patient shedding and environmental sources. ESBL genes often remained high even when no patients required isolation, whereas carbapenemase surges frequently preceded increases in CRE isolation, suggesting wastewater may provide early warning of rising resistance pressure. Differences between hospitals likely reflect both patient populations and environmental persistence. Wastewater surveillance may complement infection prevention efforts but should not be interpreted as a direct surrogate for patient colonization. Figure 1. Temporal trends in ESBL-producing resistance genes in wastewater and isolation needs at an academic center Figure 2. Temporal trends in CRE-producing resistance genes in wastewater and isolation needs at an academic center Figure 3. Temporal trends in ESBL-producing resistance genes in wastewater and isolation needs at a community hospital Figure 4. Temporal trends in CRE-producing resistance genes in wastewater and isolation needs at a community hospital

Background: Community-acquired pneumonia (CAP), a heterogeneous clinical entity with a wide range of inciting pathogens, remains a significant cause of morbidity and mortality worldwide. The recent COVID-19 pandemic and subsequent shifts in clinical and diagnostic practices necessitate an updated understanding of the contemporary epidemiologic and etiologic landscape for non-COVID CAP. Method: This retrospective cohort study included adult patients hospitalized with CAP between January 1, 2017, and December 31, 2024, across 68 hospitals participating in the Michigan Hospital Medicine Safety consortium. Eligible patients included hospitalized adults with a pneumonia discharge code, symptoms and imaging consistent with pneumonia, and receipt of antibiotic treatment on hospital day 1 or 2. Patients admitted to intensive care, those with concomitant infections, positive SARS-CoV-2 tests, or severe immunosuppression were excluded. Diagnostic testing methods and the pathogens detected were reviewed and summarized by year. Result: A total of 62,340 patients were included. Mean age was 69.0 ±15.9 years, and 50.3% (31,359) were male. 94.0% (58,613) received a chest X-ray and 53.1% (33,084) received a CT, with use of CTs increasing over time. Microbiological evaluation was performed in 92.8% (57,820) of patients, with a median 4 [IQR 2-6] etiologic tests per patient. Blood cultures were the most common microbiologic test (74.7%; 46,566) with use slightly decreasing over the study period. In contrast, the use of molecular respiratory pathogen assays increased substantially from 28.2% in 2017 to 77.1% in 2024 (overall performed in 55.6%, 34,655). Over the entire study period, one or more pathogens were detected in 15.9% (9,915) of patients: 10.5% (6,515) had a bacterial pathogen, 6.3% (3,908) had a viral pathogen, and 0.8% (508) had both. The most common pathogens were Streptococcus pneumoniae (2.6%), influenza virus (2.6%), Pseudomonas aeruginosa (1.6%), and human rhinovirus (1.4%). Conclusion: The 2019 CAP guideline recommendations to limit traditional bacterial tests to severe CAP patients appear to have had minimal impact on diagnostic practices. Despite a substantial post-pandemic increase in molecular diagnostic use, pathogen detection rates remained low, revealing an etiology in only a minority of patients. These findings underscore the need for a reassessment of the diagnostic approach to optimize resource allocation and ensure high-value testing in hospitalized CAP patients.

Background: Deviations from expected relative humidity ranges in operating room (OR) sterile cores raise concern for compromise of sterile supply packaging and frequently result in large-scale disposal of supplies. Data guiding salvage versus discard decisions following humidity exposure are limited. Following two humidity events, we performed a two-experiment bench study to evaluate whether elevated ambient humidity or direct moisture exposure results in moisture penetration or microbial contamination of Tyvek-packaged sterile supplies. Methods: Experiment 1 evaluated direct moisture exposure by applying saturated compresses to package exteriors for 0.5, 1, 5, 30, or 60 minutes. Experiment 2 evaluated elevated ambient humidity by incubating packages at 37°C and 70% relative humidity without direct moisture contact. For Experiment 1, ambient temperature and relative humidity were continuously monitored, with humidity documented at swab timepoints (4, 8, 24, and 48 hours). For both experiments, moisture content of package exteriors and interiors was measured at baseline and serial timepoints up to 48 hours. Internal package surfaces were aseptically swabbed at each timepoint, plated onto general culture media, and incubated for 48 hours at 37°C. Negative controls without moisture or humidity exposure were included. Results: In Experiment 1, ten items were evaluated, including five exposed to direct compress application and five controls. External moisture content increased following compress exposure (range: 0.9–2.2) and decreased over time. Internal moisture content remained low across all samples, including controls (range: 0–1.4). No microbial growth was detected from any internal swab across all samples and timepoints (0/10 items; 0 CFU recovered). In Experiment 2, ten items were incubated under elevated ambient humidity. Occasional low-level external moisture readings were observed (maximum: 1.2), while internal moisture content remained 0 throughout the study period. All internal cultures were negative (0/10 items; 0 CFU recovered). Conclusion: Differences in absolute internal moisture measurements between experiments 1 and 2 reflect the use of a moisture meter reporting relative units influenced by ambient conditions and the fact that experiments were not conducted in parallel. Interpretations were therefore within experiments. Tyvek-packaged sterile supplies-maintained barrier integrity under both direct moisture exposure and sustained elevated ambient humidity, with no evidence of internal microbial contamination. These findings suggest that, in the absence of visible package compromise or internal condensation, salvage of Tyvek-packaged sterile supplies following humidity excursions may be reasonable. These findings provide bench-level evidence to support data-informed infection prevention decisions during OR humidity events and may help reduce unnecessary waste and operational disruption.

Despite the increasing adoption of technologies that generate, process, and analyze digital objects, the final stages of the data life cycle—archiving and preservation—remain insufficiently addressed across cultural heritage disciplines. The rapid inclusion of technologies such as Geographic Information Systems (GIS), photogrammetry, 3D scanning, and remote sensing in cultural heritage has exponentially increased the volume and types of data produced. However, many cultural heritage projects lack adequate long-term planning, infrastructure, and institutional support for the proper stewardship of digital objects, leading to significant risks of data degradation, obsolescence, or complete loss. The Digital Curation Crisis refers to a critical challenge in managing, preserving, and ensuring access to the vast and ever-growing body of digital objects generated within cultural heritage. This new type of crisis is occurring adjacent to the already recognized curation crisis, and it is in this line of thinking that we structure this article. We utilize readily recognized terms and concepts associated with physical archaeological curation to convey standardized definitions, benefits, and recommendations for data producers (i.e., museum professionals, historic preservationists, and archaeologists across different sectors) and data preservationists (i.e., curating individuals and institutions) needing guidance for actionable steps toward their own digital curation journey.

Background: vSNFs are known for exceedingly high MDRO prevalence, raising questions about the role of environmental contamination and persistence in this healthcare setting. Methods: Environmental sampling was conducted May-June 2025 in two vSNFs. High-touch objects in common areas (mobile/shower equipment, staff breakrooms, dining rooms, rehabilitation gyms) and resident rooms were swabbed using spongesicles, homogenized in trypticase soy broth, incubated 18-24 hours, and cultured for MRSA, VRE, ESBL, C. auris, CRAB, and CRE. On the same day, resident carriage of the same organisms was assessed at nares, hands, axilla/groin, and peri?rectal sites. All ventilator-capable (vBed) and non-vBed occupied beds were sampled except for one facility’s non-vBeds, which randomly sampled 50 beds due to size. The proportion of positive common area objects was compared with MDRO carriage prevalence using two-sample tests of proportions. Within resident rooms, object contamination was compared among carriers and non-carriers for each pathogen, overall and stratified by vBed status, using Fisher’s exact tests. Results: Sampling included 96 common area objects and 245 objects from 39 resident rooms (20 vBed, 19 non-vBed). MDRO contamination of high-touch objects in common areas was extensive (73.9%), including 77.8% of mobile equipment and 58.3% of common area objects (37.5% staff breakroom, 87.5% rehabilitation gym, 50.0% dining objects). The most frequently detected MDROs on objects were MRSA>CRAB>VRE>ESBL>C. auris>CRE, which differed from the sequence of MDRO carriage among residents: MRSA>ESBL>VRE>C. auris>CRAB>CRE. Object contamination and resident carriage were similar for MRSA (65.6% vs. 60.5%, p=0.43), VRE (19.8% vs. 23.3%, p=0.54), and CRE (1.0% vs. 4.1%, p=0.27). In contrast, contamination was markedly lower than carriage for ESBL (8.3% vs. 43.6%, p<0.001) and C. auris (3.1% vs. 25.6%, p<0.001), while CRAB contamination far exceeded carriage (21.9% vs. 11.0%, p=0.02) (Figure 1). Among bedrooms, all sampled rooms had some MDRO contamination, including all rooms of non-carriers. MRSA contamination was similar in the rooms of carriers and non-carriers; all other pathogens, contamination was substantially greater in rooms of carriers (Figure 2). Conclusions: The relationship between MDRO contamination and resident carriage in vSNFs showed clear pathogen?specific patterns. MRSA and VRE contamination closely mirrored resident carriage, whereas ESBL and C. auris were less frequent on surfaces despite high carriage. Notably, CRAB was disproportionately common in the environment, suggesting environmental persistence. Bedrooms of carriers had higher contamination, yet MDROs were also present in non-carrier rooms, contributing to ongoing transmission risk. Effective containment likely requires universal strategies supplemented by targeted, pathogen-specific efforts.