Background: Sinks in hospital patient rooms are potential reservoirs of hospital acquired infections (HAI) pathogens and outbreaks; sink colonization can occur in new buildings soon after patient occupancy and persist. To control this source, it is important to understand how occurrence and concentrations of organisms in sinks and drains change over time. This study longitudinally measures the occurrence and concentration of Acinetobacter, Pseudomonas aeruginosa, and Klebsiella pneumoniae in sinks and drains of new inpatient hospital rooms after patient occupancy. Methods Three inpatient units of a newly constructed cancer hospital were studied. Ten randomly selected rooms per unit were sampled biweekly for seven months for Acinetobacter, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Surface samples were swabbed from a 4x4 cm section of the sink basin around the drain. Water was sampled from the p-trap via the drain. Results Approximately 400 sink and drain samples were taken. Acinetobacter was the most commonly detected organism, and Klebsiella the least. Based on the unit, 90-100% of sink and 50-90% of drain samples by the end of the study period had detectable Acinetobacter, 90-100% of sink and 50-80% of drain had Pseudomonas, and 0-10% of sink and 0-30% of drain had Klebsiella. In samples with detectable organisms, Acinetobacter concentrations ranged from 1.3-8 logCFU in sinks and 1.6-6.7 log CFU/mL in drains. Pseudomonas aeruginosa ranged from 2.8-7.4 log CFU in sinks and 2.2-6.1 log CFU/mL in drains, and Klebsiella from 2.6-4.5 logCFU in sinks and 1.6-4.9 logCFU/mL in drains. There was low to no correlation between occurrence of detectable bacteria in sink basin and drain water samples from the same room; median correlation estimates across ten rooms for the three units were -0.09 (-0.3; 0.46 95% CI), 0.21 (0.02; 0.67 95% CI) and 0.36 (-0.18; 0.52 95% CI) for Acinetobacter, 0.07 (-0.32; 0.45 95% CI), 0.09 (-0.32; 0.53 95% CI), and 0.18 (-0.21; 0.39 95% CI) for Pseudomonas and -0.25 (-0.3; -0.17 95% CI), 0.04 (-0.29; 0.55 95% CI), and 0.25 (-0.4; 0.54 95% CI) for Klebsiella. Conclusions Over 7 months, Acinetobacter and Pseudomonas aeruginosa were common in basins and drains of patient room sinks. Klebsiella was less common but still detected. Concentrations fluctuated over time but could reach levels up to 6-7 login the sink basin. These results suggest that sinks and drains in inpatient rooms are potentially a consistent source of HAI organisms in the hospital environment.

Background: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infection in the United States. Diagnostic stewardship is a core element of reducing inappropriate CDI testing. Methods: In response to rising rates of hospital onset CDI (HO-CDI), our institution implemented a “hard-stop” clinical practice alert (OPA) in the Electronic Medical Record (EMR) in July 2024, shown in Figure 1. The OPA fired when a CDI test was ordered on patients hospitalized greater than 48 hours who had received laxatives within the previous 48 hours or who had a positive test within the previous 7 days and was active from 7AM-5PM Monday through Friday. OPA completion to order CDI testing required approval from either the Infection Prevention & Control Medical Directors (IPCMD) or a consulting Infectious Disease (ID) physician if patient was followed by ID. To facilitate communication, a dedicated “chat group” was created in the EMR instant messaging to specifically respond to a request for testing by the IPCMDs and a link to the chat was included in the OPA. EMR documentation of the approving IPCMD was required, and logs were regularly reviewed for compliance. Every HO-CDI case at our institution undergoes a multidisciplinary review with the staff and primary providers involved in the care of the patient at time of diagnosis to identify a “driver” for the case. Testing Stewardship, defined as inappropriate testing due to noncompliance with institutional CDI testing guidance, is one of the 5 drivers that can be assigned during this review process. Results: Over the 12.5 months following implementation the OPA was triggered 432 times on 214 unique patients with testing performed 79 times (0.18 tests per trigger). Twenty of 79 tests (25%) were positive for toxigenic C. difficile. In the 12 months prior to the OPA, there were 17 of 88 HO-CDI cases attributed to Testing Stewardship compared to 4 of 58 in the 12 months after the OPA (18/80 vs 4/58 by fiscal year). In the context of multiple interventions, NHSN-defined HO-CDI declined from 68 in FY 2023, 80 in FY 2024 to 58 in FY2025, corresponding to rates of 2.22, 3.13 and 1.7 per 10,000 patient days, respectively. Conclusion: A multicomponent OPA requiring approval for CDI testing for specific parameters was successfully implemented. This intervention contributed to improved diagnostic stewardship and reduction on HO-CDC cases Figure 1: C. difficile Hard Stop OPA example for patient with recent laxative administration

Background: central line–associated bloodstream infections (clabsis) remain a leading cause of preventable morbidity and mortality in hospitalized patients. although evidence-based guidelines for central venous catheter (cvc) insertion and maintenance are well established, variability in knowledge, procedural practice, and access to essential equipment persists across hospitals and clinical settings. Methods: between january 2019 and march 2020, a mobile classroom simulation-based training (sbt) program was implemented in 26 of 30 public acute-care hospitals in israel, representing a nationwide large-scale initiative. the program combined standardized curricula, hands-on simulation, and structured feedback for cvc insertion (physicians and nurses) and maintenance (nurses). for physicians undergoing cvc insertion training, the program also included a dedicated hands-on workshop focused on ultrasound-guided central venous catheter insertion. training sessions were video-recorded using a closed internal system, allowing participants to review their performance. each trainee completed two standardized simulation scenarios, enabling real-time feedback, iterative improvement, and experiential learning. of approximately 1,700 healthcare workers who participated in the program, 1,551 (91.2%) completed both pre- and post-training questionnaires. questionnaires assessed procedural knowledge, satisfaction, and availability of cvc-related equipment. knowledge outcomes were compared using paired t-tests, and associations between hospital characteristics, equipment availability, and knowledge improvement were evaluated using chi-square analyses. Result: knowledge scores improved significantly across all participant groups (p<0.001). mean knowledge gains were 18.6% for physician cvc insertion, 26.5% for nurse insertion, and 16.4% for nurse maintenance. the largest improvements were observed in sterile technique, minimal barrier precautions, and maintenance-related clinical decision-making. higher baseline knowledge was associated with icu settings, larger hospitals, and availability of full personal protective equipment (ppe) kits and disinfectant wipes (p<0.05). knowledge improvement was independently associated with refresher training, structured feedback during simulation, and access to full ppe kits, whereas hospital size and professional seniority were not consistently associated with learning gains. substantial variability in availability of essential cvc equipment was observed across departments. Conclusion: a nationally coordinated simulation-based training program significantly improved cvc insertion and maintenance knowledge among physicians and nurses across diverse hospital settings. structured feedback and reliable access to essential equipment emerged as key drivers of learning gains. these findings support simulation-based training as a scalable, policy-relevant strategy for strengthening clabsi prevention and standardizing practice at the national level, particularly in smaller hospitals and non-icu settings. background: central line–associated bloodstream infections (clabsis) remain a leading cause of preventable morbidity and mortality in hospitalized patients. although evidence-based guidelines for central venous catheter (cvc) insertion

Background Enhanced Barrier Precautions (EBP) aim to reduce multidrug-resistant organism transmission in long-term care settings. Infection preventionists play a critical role in implementing EBP, yet their experiences navigating operational challenges, staff adherence, and resident safety remain underexplored. Understanding these perspectives informs strategies for effective infection control and policy development. Methods A 42-item electronic survey was distributed via Qualtrics to 578 Florida nursing homes between May and September 2024, addressed to “Infection Control.” Ninety valid responses were received. Thirty-seven respondents provided 58 comments across seven prompts—six linked to specific survey questions and one to an open-ended prompt to share questions or thoughts about EBP. Comments were coded into nine categories and analyzed using MAXQDA Analytics Pro. Results The coding categories were: 1) Citation or Feedback, 2) Clarity and Scope of Criteria, 3) Cost and Resource Burden, 4) Effect on Infection Control Practice, 5) Effectiveness of EBP, 6) Resident Experience, 7) Staff Confusion, 8) Staffing, Workload, and Compliance, and 9) Support for EBP. Fourteen coded comments fell under Citation or Feedback, mostly related to corrective feedback or citations during F880 survey experiences, including, “Facility interpreted an action to be low contact and therefore not needing EBP while surveyor considered action to be high contact requiring full EBP”. Staffing, Workload, and Compliance had 13 coded comments, including six responses to a survey prompt asking about challenges in implementing EBP. One respondent wrote, “Non compliance in donning. No one wants to take the time to don when they are strapped for time.” Clarity and Scope of Criteria had ten coded comments, with four specifically mentioning wounds. One wrote, “I think that small skin tears should not be included into the EBP, so there is such a gray area on who should be on EBH [sic] and who doesn’t need to be. So maybe clarify skin tears.” Seven comments addressed Resident Experience, with mixed views on resident reactions. Cost and Resource Burden, Support for EBP, and Effectiveness of EBP each had four comments; Staff Confusion had two, and Effect on Infection Control Practices had one. Conclusions Infection preventionists reported significant challenges in implementing EBP, particularly staffing limitations, unclear criteria, and resource constraints. While many supported EBP’s intent, concerns about feasibility and resident impact persist. Addressing these barriers through clearer guidance, staff education, and resource allocation is essential for successful adoption and sustained infection control in long-term care settings.

Background: Respiratory viral infections cause substantial acute morbidity among older adults; however, their impact on short-term health-related quality of life (HRQoL) and functional recovery remains incompletely characterized. Methods: We conducted a prospective observational analysis among adults aged ?65 years enrolled in the U.S. Flu Vaccine Effectiveness Network. Multivariable linear regression was used to examine associations between respiratory virus test positivity (influenza, COVID-19, and respiratory syncytial virus [RSV]) and follow-up HRQoL. Outcomes included EQ-5D utility scores and self-rated health measured using a visual analog scale (VAS). Models adjusted for baseline HRQoL, demographics, household characteristics, and comorbidities. Bias-reduced CR2 cluster-robust standard errors were used to account for heteroskedasticity and within-site clustering. Multicollinearity was assessed using variance inflation factors, all of which were <2. EQ-5D coefficients were rescaled to a 0–100 metric to improve interpretability. Results: After multivariable adjustment, respiratory virus test positivity was not consistently associated with worse follow-up HRQoL. Influenza test positivity was not associated with follow-up EQ-5D scores (? = ?0.4 points on a 100-point EQ-5D scale, 95% CI ?12.5 to 11.6) and showed a positive but non-significant association with follow-up VAS scores (? = 5.9, 95% CI ?2.0 to 13.8). COVID-19 test positivity was associated with higher follow-up EQ-5D scores (? = 21.6, 95% CI 6.0–37.2), but not with follow-up VAS scores. RSV test positivity was not associated with follow-up EQ-5D (? = ?2.1, 95% CI ?16.6 to 12.4) or VAS scores (? = 13.6, 95% CI ?23.4 to 50.6). Across all EQ-5D models, baseline EQ-5D was the strongest predictor of follow-up EQ-5D. In contrast, baseline self-rated health demonstrated weaker and less consistent associations with follow-up VAS scores. Household and social factors showed stronger and more consistent associations with VAS outcomes than infection status, including a significant association between comorbidities and lower follow-up VAS scores in the COVID-19 model. Conclusions: Among adults aged ?65 years with acute respiratory illness, respiratory virus test positivity was not associated with worse short-term HRQoL after adjustment for baseline health and social factors. Baseline health status and social context were more strongly associated with subsequent HRQoL and functional recovery than viral etiology.

Background Central-line–associated bloodstream infections (CLABSIs) are healthcare-associated infections occurring in critically-ill patients where central veins are accessed using central venous catheters (CVCs). Use of antimicrobial CVCs has been recommended to reduce CLABSI rates in acute care settings. 1 Reducing CLABSI rates in community hospitals remains a challenge due to variability in the type of CVC used, CVC bundle compliance, interdisciplinary collaboration, and overall culture related to central line (CL) use. Methods A quality improvement project (QIP) conducted at two acute care community hospitals evaluated the impact of standardized CL insertion bundle, interdisciplinary collaboration, and shared accountability on CLABSI rates. The QIP was conducted at facilities, A and B, within the same hospital system, from October 2018–September 2025, where both facilities used a CVC kit containing a silver-platinum-carbon (SPC)-impregnated CVC for vascular access. From January 2020–June 2024, in addition to the CL kit, key interventions implemented sequentially included daily infection prevention (IP) emails regarding CL status; multidisciplinary CLABSI rounds to discuss CL indications/culturing practices; chlorhexidine gluconate (CHG) bathing documentation transition to medical administration records; optimization of CVC device maintenance order placement in an electronic health record system; initiation of CHG/isopropyl alcohol device swab for hub scrubbing for all CL access; and blood cultures ordered through a care pathway incorporating blood culturing stewardship. CLABSI rates were calculated in terms of events per 1,000 CL days to assess the impact of these interventions on CLABSI prevention. Results The post-intervention CLABSI rate for Facility A was significantly lower than the pre-intervention rate (0.100 vs 0.728; P = 0.0409). The post- and pre-intervention CLABSI rates for Facility B were 0.494 and 0, respectively; although clinically significant, no statistical difference in rates was observed (P = 1). For both facilities, the observed monthly CLABSI rates exhibited a gradual long-term decline without significant impact of specific interventions. The decline was statistically significant for Facility A (P = 0.00992) whereas for Facility B the decline was non-significant (P = 0.152). Conclusions Continuous implementation of the SPC-impregnated CVC-containing kit likely established a stable baseline for infection prevention. Subsequent interventions did not result in statistically significant changes in monthly CLABSI rates, suggesting gradual improvements attributable to ongoing process maturation rather than discrete intervention effects. References

This paper investigates variation in the realization of the happy vowel in Manchester, England, that is, the final vowel in happy, baby, etc., which is often described as extremely lax. It is based on the acoustic analysis of 109 speakers, stratified for age, gender, social class, and ethnicity. The vowel is a rarely reported case of a stable vocalic variable, with no change in apparent time but with clear conditioning by social class (with higher social classes having tenser vowels) and by ethnicity. Style-shifting is minimal, statistically insignificant, and appears to result from durational effects; we conclude that the variable lies largely below speakers’ conscious awareness within the speech community. We explore the long-standing Labovian hypothesis that internal linguistic constraints operate independently of social factors and find that the results largely support this hypothesis for the happy vowel. This suggests a shared underlying system despite social differentiation in overall vowel realization.

Background: The U.S. is on track to lose measles elimination status after experiencing the highest number of cases in <30 years. With ongoing transmission and falling vaccination rates, health systems must prepare for measles, focusing on minimizing secondary cases and maximizing prevention. We describe a taskforce approach for comprehensive measles (with a lens towards all-hazard)preparedness across our enterprise. Methods: Our mitigation and preparedness taskforce included four workstreams (Figure 1): Early MMR vaccination for children with international travel: Consistently offer and administer initial or second MMR vaccine, as appropriate, for infants and children travelling abroad. Optimize exposure and testing management: Develop tools to expedite the identification of exposed non-immune patients and optimize processes for high volume testing and result tracking. Optimize screening processes at points of entry (POE): Develop streamlined processes for reliable travel and exposure screening at all enterprise wide POEs. Contingency planning for larger scale exposure events/community spread: Develop post-exposure prophylaxis (PEP) delivery procedures to respond to large-scale community exposure events and establish partnerships with local public health (PH) departments. Results: Increase in vaccination for non-immune travelers in primary care: We built an EMR (electronic medical record) prompt into all child visits to screen for travel, which interfaced with vaccine clinical decision support to offer/administer vaccines. From May through 12/28/25 we administered 1325 early MMRs to travelling children (Figure 2). EMR-based report to identify exposed individuals and their immune status: This report allows all sites to rapidly identify patients needing PEP after exposure. We also developed processes for pre-emptive approval for large scale testing, result tracking, and high-volume patient notification. Optimization of Screening and POE with EMR upgrades, PPE kits: We are upgrading our EMR to better integrate travel & exposure screening. We developed additional resources including screening supports for non-English languages and PPE kits for immediate use at POE when patients screen positive. Development of PEP clinics and PH Collaboration: We developed processes to stand up PEP clinics at our hospitals to expedite large volume PEP administration. We worked with PH to outline roles, capabilities and resources for response to community outbreaks, optimized staff fit testing and developed drills across all care settings. Conclusions: Preparedness for highly contagious infectious diseases and emerging PH threats is critical. A taskforce approach provides a structured framework for collaboration and mobilization of resources. By utilizing an all-hazards lens, this framework is broadly applicable for vaccine preventable infections and other infectious threats.

Background: Carbapenemase-producing organisms (CPOs) can cause serious, difficult-to-treat infections and spread rapidly in healthcare settings. Although pediatric CPO cases are uncommon, they may be increasing in the United States. We describe CPO surveillance practices and patient and specimen characteristics among patients admitted to a California pediatric specialty hospital that regularly receives high-acuity patients referred from healthcare facilities outside the US. Methods: Carbapenem-resistant organisms identified from clinical specimens underwent molecular testing to identify the “big-5” carbapenemases (i.e., KPC, NDM, OXA-48 like, VIM, IMP); carbapenem-resistant Acinetobacter baumannii (CRAB) isolates were also tested for additional oxacillinase (OXA) variant carbapenemases at a public health laboratory. In August 2024, the hospital began screening patients upon admission from non-US healthcare facilities by collecting rectal swabs for molecular testing for big-5 carbapenemases, and culture-based screening for CRAB with molecular testing to identify the big-5 and additional OXA variant carbapenemases. We collected patient and specimen data from the hospital and public health case reports. We defined a case as carbapenemase(s) detected in a clinical or screening specimen from a pediatric patient (ages 1–18 years), either during admission or within 3 days of transfer from the hospital from January 2022 to August 2025. Result: Among 28 total cases, 17 (61%) were in clinical specimens (10 wound, 3 blood, 3 respiratory, and 1 tissue) and 11 (39%) in 34 rectal swab specimens (32% positivity) collected through admission screening starting in August 2024 (Figure 1). The most common carbapenemases were OXA-23-like (32%) and OXA-24/40-like (32%) and the most common organism was A. baumannii (79%). Of the 27 patients (one had two cases), the median age was 11 years; 20 (74%) were Hispanic and 21 (78%) were non-US residents. Twenty-two (82%) were admitted for burn injuries and 24 (89%) had international healthcare exposure. Conclusion: Admission screening based on international healthcare exposures had a high (32%) yield and identified more than half of all CPO cases since implementation. The majority of CPO cases were OXA variant-producing CRAB, highlighting the role of culture-based screening to identify carbapenemase-producing CRAB that otherwise would not be detected by screening with molecular testing for big-5 carbapenemases only. Risk-based admission screening is a key component of a comprehensive CPO prevention strategy by facilitating rapid detection of cases and timely implementation of focused infection prevention and control measures to prevent further spread among a vulnerable population.

Current wound closure methods have drawbacks when used in minimally invasive surgery. Traditional sutures are complicated and time-consuming to apply in this context, and synthetic adhesives can be toxic when used internally. The class of bioadhesives address these challenges, however their independent use in practice is limited due to their low tensile strength. In this work, we develop Kelserra, a novel bioadhesive derived from brown algae with maximized tensile strength and biocompatibility to address a current unmet need in the surgical field. Kelserra’s uniaxial yield stress peaked at 7.19 ± 0.47 kPa when the formulation contained 50 mg/mL alginate, 5 mg/mL phloroglucinol, 10 mg/mL xanthan gum and 2.09 mg/mL Ca-EDTA and was pre-cured using saturated aqueous gluconic acid for 45 minutes. Kelserra’s uniaxial strength was higher than its lap shear strength when pre-cured. Additionally, the type of curing medium (air or PBS) did not significantly influence adhesive strength. This study is intended as a preliminary work inquiring into the possibility of the exploration of internal bioadhesives such as Kelserra, and further validation is required for translational applications. Internal bioadhesives like Kelserra could decrease surgery times, aid in the prevention of postoperative complications and reduce the burden on the healthcare system.

Background: Previous studies demonstrated that the addition of anterior nares to axilla/groin skin testing substantially improved the detection of Candidozyma auris colonization (Proctor et al., Nature Medicine, 2021; Sansom et al., CID, 2024), but these observations were limited by small sample sizes and reflected mostly nursing home residents. We aimed to assess the benefit of adding nares testing to axilla/groin testing among hospitalized patients participating in C. auris point prevalence surveys (PPSs). Methods We conducted a prospective observational study at three long-term acute care hospitals (LTACHs) in the Chicago region, one of which also included distinct inpatient rehabilitation floors. Facilities participated in quarterly public health-led C. auris PPSs from May 2024 to October 2025. Patients underwent swab sampling at two sites: composite bilateral axillae/groin (swab 1) and bilateral anterior nares (swab 2). Samples were processed at a central laboratory for C. auris detection by PCR using a validated assay with enzymatic preprocessing and automated DNA extraction. Primary analyses were restricted to patients with results available from both sampling sites; a positive C. auris test from either body site was considered the reference standard. Analyses were performed using R v4.5.2 (www.r-project.org) and Stata/SE v18.0 (Stata Corp., College Station, TX). Results Across 18 PPSs, 769 of 867 (89%) eligible patients participated. The overall C. auris prevalence was 46% (317/685) among LTACH patients and 15% (13/84) among rehabilitation patients. Among all patients who tested positive for C. auris, 64% were in Contact Precautions for any reason at time of PPS and 34% were previously known to be C. auris colonized. After excluding 16 patients who were missing a body site specimen, 753 patients were eligible for analysis (670 LTACH, 83 rehabilitation). Among 320 patients with C. auris detected at any body site, 301 were detected by axilla/groin screening (94% sensitivity; 95% confidence interval 91% to 96%) and 234 (73%) tested positive at the anterior nares for C. auris. Inclusion of nares swabbing identified 19 additional patients who would have been missed by axilla/groin screening alone, corresponding to an incremental increase of 6%. Conclusion Among LTACH and rehabilitation patients, C. auris colonization was common and PPSs identified a substantial number of patients not previously known to be colonized. The incremental benefit of adding nares screening was modest compared to axilla/groin screening alone. Testing more body sites can identify more C. auris colonized patients, but facilities should balance benefit versus cost of expanded screening approaches.

Background: Community-acquired pneumonia (CAP) is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis or atypical bacteria. Legionella pneumonia is most commonly associated with contaminated man-made water systems. The 2019 CAP guidelines endorsed by the American Thoracic Society and Infectious Diseases Society of America are the only national guidelines that recommend the Streptococcus pneumoniae urinary antigen test (UAT) in patients presenting with severe CAP, and the Legionella UAT in patients presenting with either severe CAP or with recent travel to an area associated with a Legionella outbreak. Since the publication of this guideline, several publications have questioned the utility of these UATs in clinical practice. Methods: We conducted a retrospective review of Streptococcus pneumoniae and Legionella UATs ordered for inpatient adult patients at the University of Kentucky Healthcare during the calendar year 2024. Chart review was conducted for all patients with a positive UAT to determine indication and appropriateness of test ordering, and details of antimicrobial prescription and duration. Results: Of the 6,421 orders, only 168 (2.8%) were positive – 153 Streptococcus pneumoniae UAT and 15 Legionella UAT. Patients with a positive test were reviewed to determine diagnostic indication for the test as well as to evaluate antibiotic de-escalation practices. Of the positive UATs, 37.5% of the orders were obtained in patients who did not have CAP. Most common indications were VAP, HAP, aspiration pneumonia, acute respiratory failure, sepsis, COPD exacerbations, and CHF exacerbations. None of the patients with a positive Streptococcus pneumoniae UAT were narrowed to amoxicillin to target the pathogen. Most commonly, patients were narrowed from cefepime to ceftriaxone or atypical coverage was discontinued. For patients with Legionella pneumonia, macrolide therapy was extended beyond the typical three-day regimen used in CAP or changed to a respiratory fluoroquinolone. Conclusion: Based on our review, we are recommending removing the Streptococcus pneumoniae UAT from our institution’s formulary and optimizing the Legionella UAT order by limiting use to patients with risk factors. This proposal will result in significant cost savings as our enterprise spent $164,211 on UATs that did not significantly influence care for most patients.

Background: Central-line associated bloodstream infections (CLABSI) are defined as bacteremia, or fungemia, in patients with a central intravascular device and no other apparent source of infection. In cases where devices are not removed, treatment of CLABSI involves eradication of intraluminal infection with systemic antibiotics and supratherapeutic concentrations of antibiotics inside the catheter, creating an antibiotic lock. Antibiotic locks can also be used in selected high-risk individuals and those with recurrent CLABSI for prevention. In this review, we evaluated the use of antibiotic locks for the treatment and prevention of CLABSI at South Texas Veterans Health Care System (STVHCS) to assess if use has been in accordance with standard of care. Methods Retrospective data review of STVHCS electronic medical records from 2020-2025. Data collected is limited to age, catheter type, purpose of antibiotic lock (treatment or prevention), organism targeted, antibiotic used for lock, duration, use of systemic antibiotics, and if the intervention was successful at 30 and 90 days. Appropriate lock used was defined as in accordance with the IDSA 2009 CLABSI treatment guidelines, or the 2022 SHEA compendium. Results Data available demonstrated that over the past 5 years there have been 18 instances of antibiotic lock use in 16 patients. Of this population, 13 of 18 lines involved were tunneled hemodialysis catheters with the remaining being ports (3), and tunneled central lines (2). Six of these instances were used for prevention of CLABSI due to long-term hemodialysis catheters/recurrent CLABSI, while the remaining 12 were used as treatment. Per IDSA CLABSI guidelines, removal of a catheter was recommended for 8 of 18 cases, (Staphylococcus aureus, Enterococcus spp., and metastatic infection). Of those cases, 6 patients had removal of catheter, whereas the remaining 2 patients had catheter salvage. The retention of the catheters were in accordance with IDSA guidelines as they received systemic antibiotics with concomitant lock therapy and had no alternative venous access and removal was contraindicated. We found at 30 days, all patients had survived. Whereas at 90 days, 4 patients had expired due to other all-cause mortality and unrelated to recent CLABSI infection. Conclusions Based on this retrospective review, there were 18 instances of antibiotic lock therapy that appeared to be in accordance with clinical guidelines for both prevention and treatment of CLABSI. This data review is part of the antibiotic stewardship program and will be used to develop future quality improvement processes.

Background:?Residents of long-term care facilities (LTCFs) are particularly vulnerable to infection and colonization with multidrug-resistant organisms (MDROs) due to immunologic vulnerability and prolonged healthcare exposure. Interfacility transfers (IFT) of these residents between LTCFs and acute care hospitals are common. Understanding trends in MDRO admission prevalence among LTCF transfers is important for hospitals considering targeted screening and implementation of protocols to prevent transmission. While the COVID-19 pandemic stalled national progress in MDRO prevention, it is unclear how MDRO admission prevalence trends among LTCFs transfers shifted. We aimed to (1) identify longitudinal trends in MDRO admission prevalence and (2) analyze shifts in these trends relative to the pandemic onset. Methods:?Hospital discharge data from the Healthcare Cost and Utilization Project Arizona State Inpatient Databases were evaluated from Oct 2015–Dec 2023. Acute care admissions for patients over 18 years old with LTCF identified as the admission source were included in the study; 12 epidemiologically important MDROs were identified via ICD-10 codes for each admission. The annual frequency and proportion of patients transferred to hospitals from LTCFs with evidence of MDRO prevalence at admission were described. Longitudinal trends in MDRO admission prevalence among all LTCF-hospital transfers were evaluated using the Cochran-Armitage trend test. Multivariable logistic regression was used to model the odds of MDRO admission prevalence – defined as documented colonization, history, or infection POA – by year, adjusting for age, sex, race, ethnicity, and rurality of patient residence. Results:?Among 14,195 Arizona IFTs from LTCFs to acute care hospitals during the 8.25-year study period, the mean age was 62.6 years, 53.1% were female, and 12.3% contained an ICD-10 diagnosis code indicating MDRO admission prevalence. Of these (n=1,741), 1,341 were documented as MDRO-POA infections, and 256 were documented as carriers or individuals with a known history of an MDRO. From 2015–2023, MDRO admission prevalence among LTCF transfers increased significantly from 6.8% to 14.9% (z=9.3, p<0.0001). Compared to 2016, the odds of MDRO admission prevalence were statistically unchanged for 2017, 2018, and 2019. From 2020-2023 odds increased annually in a dose-response pattern, peaking in 2023 with 58% higher odds compared to 2016 (p<0.001). Conclusions: MDRO prevalence among Arizona LTCF-to-hospital transfers more than doubled from 2015–2023. While pre-pandemic rates remained relatively stable, during the post-2020 period, MDRO admission prevalence increased steadily and significantly. These findings underscore the importance of interfacility communication and health record flagging to accurately capture MDRO prevalence upon admission from LTCFs.

Background: The 2025 Measles outbreak has affected over 1900 people across the United States. Close collaborations between public health entities and training institutions can increase public knowledge and trust, promote vaccination, optimize options for testing, and reduce exposures. Methods: The Lexington Fayette County Health Department (LFCHD), Kentucky Department for Public Health (KDPH), and the University of Kentucky (UKY) partnered in February 2025 to develop a comprehensive plan to address measles in Kentucky. Priorities for the partnership were: community and provider education, delineation of roles/responsibilities between the health department and UKY, streamlined pathways for testing and post-exposure management, and centralized communication. Standardized educational sessions were developed and deployed widely to outline testing and post-exposure prophylaxis (PEP) resources. Infection Prevention and Control (IPAC) physicians triaged all testing requests in partnership with the health department using CDC criteria for testing. Measles, Mumps, and Rubella (MMR) vaccination campaigns were conducted, focusing on prevention and post-exposure management. For healthcare workers (HCW) at UKY, Epic® electronic health record (EHR) templates and order sets outlining CDC and KDPH algorithms were developed and distributed widely. Results: From March through October 2025, the standardized educational talk was given to 398 public health and medical professionals (Table 1). Six public health and healthcare systems adapted the public health-academic center partnership and protocol to their centers (Table 2). Joint media outreach and education resulted in 32 stories across Kentucky and Tennessee. Three Epic® EHR templates were developed and deployed widely (Figures 1-3). IPAC received and triaged approximately 50 calls/EMR messages from HCW about measles testing, resulting in 4 tests performed at the KDPH State Lab. One test returned positive and there were zero healthcare worker exposures. Immune globulin for PEP was offered to 2 exposed patients, though they declined to receive it (Table 2). MMR vaccinations increased by 16% and 53% in the 0-6 year and 6–18-year age groups, respectively from 2024 to 2025, during the same time periods. MMR vaccination in persons over 18 years decreased slightly (4.5%) (Figure 4). Conclusions: Combining the infrastructure, knowledge, and resources of a state and local public health systems with an academic medical center’s training and community trust can increase measles awareness, vaccination, and optimize resources during an outbreak.

Background: Community-acquired pneumonia (CAP) is among the top 10 reasons people seek emergency care and the most common indication for antibacterial use overall. Up to 40% of CAP is caused by viruses, now more easily detectable by rapid diagnostics. Although viral CAP is common, evidence on how to best to treat it is lacking—especially with regard to empiric antibacterials. The 2025 American Thoracic Society guidelines recommend viral CAP be treated with empiric antibiotics. In response, the Infectious Diseases Society of America removed its endorsement of the guideline. Here, we used a vignette survey to assess clinical practices and reasoning regarding early treatment of viral CAP. Methods: Between 10/2025 and 12/2025, we distributed an online clinical vignette survey to attending hospitalists and emergency medicine (EM) physicians from 3 academic medical centers. The vignette described a patient presenting to the emergency department with signs and symptoms of pneumonia (lobar infiltrate, fever, hypoxia) and a positive test for respiratory syncytial virus (RSV). In the survey, clinicians were asked which treatments they would prescribe, their rationale for doing so, and whether clinicians would be willing to enroll a similar patient in a clinical trial examining the need for empiric antibacterial therapy. Results: Respondents included 37 hospitalists and 39 EM physicians (25% response rate, summary in Figure 1). Treatments most commonly selected were supplemental oxygen (93%), inhaled bronchodilators (78%), and empiric antibiotics (63%). Most hospitalists and EM physicians (57% and 69%) selected empiric antibacterial therapy and estimated 72% of their colleagues would also do so. Primary reasons for antibacterial therapy (Figure 2) included covering for a potential bacterial co-infection, evidence suggesting bacterial infection, and local practices. Conversely, physicians who did not select antibacterial therapy favored supportive therapy and observation, interpreted available data as not supporting bacterial infection, and cited local practices. Most (97%) physicians supported enrolling similar patients in a clinical trial examining the need for empiric antibacterial therapy, citing an evidence gap supporting either decision. Conclusions: This vignette survey of EM and hospital medicine physicians showed wide variation in hypothetical use of empiric antibacterials for viral CAP. Factors related to treatment with empiric antibacterial therapy included: 1) covering bacterial infection “just in case” vs. watchful waiting, 2) heterogeneous interpretation of incomplete information as supporting vs. not supporting bacterial infection, and 3) local practice patterns. Most physicians (97%) supported conducting a clinical trial to provide evidence to guide empiric antibacterial therapy in viral CAP.

Background: The accurate monitoring of blood glucose levels is critical in managing diabetes, and the Accu-Chek glucometer is a widely used tool for this purpose. Ensuring the proper cleaning and maintenance of these devices is essential to prevent cross-contamination and ensure reliable readings. This study evaluated the effectiveness of the cleaning process of Accu-Chek glucometers and assessed the competency of healthcare staff in adhering to the recommended two-step cleaning procedure. Methods: A study was conducted within the Audie l. Murphy Memorial Veterans Hospital (ALMMVH), a part of the U.S. Department of Veterans Affairs that provides comprehensive healthcare services to veterans. The VA is one of the largest integrated healthcare systems in the United States, serving millions of veterans annually. A standardized two-step cleaning protocol was implemented, which included an initial wipe with a cleaning solution followed by a disinfectant wipe. Initial compliance was evaluated across 46 clinical areas involving 159 staff members. Staff training sessions were subsequently conducted to educate on the importance and methodology of the cleaning process. Competency assessments were performed: pre- and post-training to evaluate the staff’s understanding and execution of the cleaning procedure. Follow-up evaluations were conducted in 28 clinical areas with 91 staff members participating. Compliance was compared between the pre- and post-intervention periods using the chi-square test. Results: Initial assessments indicated a compliance rate of 55%, with notable variability in staff competency regarding the cleaning process. Post-training evaluations demonstrated significant improvement, with compliance rising to 88% for the two-step cleaning process. (p<0.001 compared to the pre-intervention period). The study observed a significant reduction in the number of dirty machines. Initially, out of 91 machines, 37 were classified as dirty. After implementation of interventions, the number of dirty machines decreased markedly to five out of 57. The comparison of clean machines between pre- and post- periods results in a p-value of <0.0001. The study highlights the effectiveness of training in improving standard operating procedures. Conclusion: The study underscores the critical role of proper training and adherence to cleaning protocols in ensuring the safety and accuracy of blood glucose monitoring. By reinforcing a standardized two-step cleaning process, healthcare facilities can significantly reduce the risk of cross-contamination may enhance reliability of glucometer readings. Ongoing education and competency evaluations are essential to sustain these improvements.

The Hungarian Twin Registry (HTR) has operated as a population-based registry since 2021, following its establishment at Semmelweis University in Budapest. In recent years, the HTR infrastructure has been substantially expanded, including blood storage facilities, information technology systems, a phone bank and voicemail system, and administrative resources. Adult twins (aged ≥18 years) and relatives (parents, foster parents, or caregivers) of twins under 18 years of age can register via the registry’s website or by voicemail following a nationwide identification and notification process. The registration questionnaire consists of eight sections covering sociodemographic and anthropometric characteristics, smoking habits, and medical history, including diseases, surgeries, and therapies. By December 20, 2025, a total of 12,676 twin individuals and their parents or guardians had registered, including 7244 adult twins and 5432 parents or guardians of minors. Based on self-reported data, 44.1% of registered adult twins were monozygotic (MZ) and 55.9% dizygotic (DZ), while among registered children 23.5% were MZ and 76.5% DZ. Of the registered adult twins, 68.4% were female. The HTR offers substantial potential for linkage with national health databases, enabling enrichment of phenotypic and outcome data without additional participant burden. In particular, linkage with the Hungarian National Cancer Registry and other health-related databases is feasible under appropriate ethical approval and data protection procedures and may support long-term follow-up and disease-specific analyses. The article also summarizes current research projects conducted within the HTR, which has become the largest population-based twin registry in Central and Eastern Europe based on the number of registrations.

Background: Antibiotic prescribing varies across communities, and socioeconomic context may influence prescribing patterns. Prior studies have largely relied on aggregate deprivation indices, with limited integration of detailed neighborhood socioeconomic measures and prescriber-level Medicare Part D data. This study examined associations between census block-group socioeconomic characteristics, area deprivation, and antibiotic prescribing rates among Medicare Part D prescribers in Tennessee. Methods: Publicly available Medicare Part D (2023) antibiotic prescriber data were geocoded to exact practice addresses (n = 14,044) and linked to census block-group–level Area Deprivation Index (ADI) scores and socioeconomic indicators derived from the American Community Survey (ACS) 2019–2023 5-year estimates. Predictor variables included ADI decile and block-group measures of education, income, disability, veteran status, Social Security income, vehicle access, and health insurance coverage. Model diagnostics indicated over-dispersion; therefore, negative binomial regression with the logarithm of total claims as an offset was used to model antibiotic claims per prescriber. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) quantified associations. Additional models examined block-group–linked Medicare beneficiary race, ethnicity, and gender composition. Results: Higher ADI scores were modestly associated with increased prescribing (IRR = 1.01, p = 0.03), although this association was attenuated after accounting for rural–urban classification. Income-related indicators demonstrated the strongest relationships: block groups with a higher proportion of low-income residents exhibited substantially increased prescribing rates (IRRs ≈ 1.48–1.62, p < 0.001). Communities with greater reliance on Social Security income also had elevated prescribing (IRR ≈ 1.05, p < 0.001), as did disability prevalence (IRR = 1.06, p < 0.001) and limited vehicle access (IRR = 1.09, p < 0.001). Educational attainment and health insurance coverage were not consistently associated with prescribing patterns. In demographic models, block groups with higher proportions of Black (IRR = 0.92, p < 0.001) and Hispanic (IRR = 0.88, p < 0.01) Medicare beneficiaries were associated with lower prescribing rates, whereas higher proportions of male beneficiaries were associated with increased prescribing (IRR = 1.12, p < 0.001). Conclusion: Community socioeconomic context at the census block-group level was strongly associated with antibiotic prescribing among Medicare Part D prescribers in Tennessee. Income-related factors, disability prevalence, and limited mobility demonstrated the most consistent associations with higher prescribing rates. These findings underscore the importance of incorporating community context into antimicrobial stewardship strategies and support targeted interventions in areas where socioeconomic conditions may influence prescribing behaviors.