Background: Prospective audit and feedback (PAF), a cornerstone of antimicrobial stewardship programs (ASP), relies on infectious disease (ID) clinicians’ direct review of electronic health records (EHR). We assessed the consistency of ID clinicians’ EHR-based assessments on real-world patient data. Methods: Antibiotic orders were randomly selected from a list of hospitalized adults at UCSF medical center. ID specialists (physicians and pharmacists) independently reviewed orders in real time using data from the EHR. Reviewers assessed the stated need for antibiotics, their agreement with necessity and choice, and overall appropriateness as defined by the National Antimicrobial Prescribing Survey (NAPS) tool. We measured agreement with either Cohen’s kappa or weighted Cohen’s kappa for ordinal observations. Results: Conclusion: We observed only modest agreement between independent ID clinicians’ reviews of antibiotic orders in a real-world assessment of inter-rater agreement. Discrepancies in assessments likely reflect a mixture of practice pattern variation, the intrinsic difficulty of assessing antibiotic choice without directly evaluating the patient, and variation due to the instruments used to collect information. Reference: Khanina A, Douglas AP, Yeoh DK, et al. Validation of the Antifungal National Antimicrobial Prescribing Survey (AF-NAPS) quality assessment tool. J Antimicrob Chemother. 2023;78(6):1367-1377. doi:10.1093/jac/dkad085

Background: The rapid clinical translation of human gene therapy products, particularly those utilizing replication-deficient viral vectors such as adenovirus and adeno-associated virus, has introduced novel biosafety considerations regarding "shedding"—the dissemination of the vector through patient urine, saliva or stool. While therapeutic protocols focus on patient outcomes, unintentional exposure of healthcare workers, caregivers, or other close contacts to these viral vectors represents a critical, yet under-analyzed, epidemiological event. Objective: To critically evaluate the hazards posed by accidental exposure to recombinant viral vectors from an epidemiological perspective, focusing on risks of horizontal transmission and immunological interference. Discussion: Although modern viral vectors are engineered for safety, unintentional exposure via mucosal contact or accidental inoculation poses multiple risks that warrant critical evaluation. First, immunological priming or seroconversion in an exposed individual can induce development of neutralizing antibodies against the specific vector capsid. Such "silent" immunization may preclude an individual from receiving future gene therapies, creating a long-term public health barrier. Second, while rare, the risk of in vivo recombination with wild-type viruses (e.g., a natural adenovirus infection) could theoretically result in the rescue of replication-competent viral variants. Third, the biodistribution and persistence of a transgene in non-target populations remains poorly characterized. Identifying and tracking these events is essential for refining risk to public health, the environment and development of adequate containment guidelines for human gene therapy treatments utilizing viral vectors. Conclusion: Unintentional exposure to recombinant viral vectors represents a significant, under-recognized epidemiological hazard. To ensure the safe expansion of genetic medicine, it is imperative to move beyond patient-centric monitoring and treat unintentional exposures as epidemiological data points. Systematic surveillance of these events is vital for establishing a real-world safety profile of genetic medicines, refining biosafety protocols and safeguarding public health.

Background: Portable medical equipment is a potential source for transmission of healthcare-associated pathogens. However, cleaning and disinfection of equipment is suboptimal in most healthcare facilities. Methods: On a long-term care facility (LTCF) ward, we examined the impact of an intervention in which a far ultraviolet-C wand was used to provide low-level disinfection of portable equipment and high-touch items in common areas. The surrogate markers bacteriophage MS2 and cauliflower mosaic virus DNA were inoculated onto 5 portable medical devices in the morning on day 1; in the afternoon on days 1, 3, and 7 swabs for recovery of the markers and culture for pathogens were obtained from 50 surfaces including portable equipment, common areas, and resident rooms. The percentages of sites with contamination were compared for the week of the intervention versus for a control week without far UV-C exposure. Results: In the control period, the DNA marker and bacteriophage MS2 disseminated widely and were detected on non-inoculated equipment, the nursing station, and in resident rooms. In comparison to the control period, there was a significant reduction in contamination with the DNA marker during the far UV-C intervention period (P<0.01), and a trend toward reduced contamination with bacteriophage MS2 (P=0.20) and pathogens (P=0.11) (Figure). Conclusions: Surrogate markers inoculated onto portable medical equipment disseminated widely throughout a LTCF ward. Daily low-level disinfection using a far UV-C wand reduced dissemination of the surrogate markers and there was a non-significant reduction in pathogen contamination.

Background: Urine testing is common among hospitalized patients with indwelling urinary catheters, yet variation in collection practices may compromise diagnostic accuracy and contribute to unnecessary downstream interventions. Guidelines recommend avoiding sampling from indwelling catheters when feasible to reduce contamination and detection of asymptomatic colonization. However, real-world compliance and its relationship to diagnostic urine test results, subsequent UTI diagnosis, and antimicrobial prescribing remain incompletely characterized. Methods: We conducted a retrospective medical record review of adult patients who underwent urine testing between March and November 2024 and had an indwelling urinary catheter or catheter removal within the prior 24 hours. Urine samples were classified as compliant if obtained after catheter removal and noncompliant if collected with a catheter in place. Analyses included all urine samples, with urinalysis-specific analyses limited to samples with available results. Urine collection practices, urinalysis parameters, urine culture outcomes, provider-documented UTI diagnoses, concordance with symptom-based criteria and IDSA/NHSN definitions, and antimicrobial prescribing following urine testing (receipt, timing, route, and duration) were summarized descriptively and stratified by compliance status. Results: A total of 921 urine samples were included; 663 had an initial urinalysis with reflex urine culture, while the remainder underwent urine culture alone. Samples compliant with recommended collection practices accounted for 59% of cases. Among samples with urinalysis, overall positivity was similar in compliant and noncompliant samples (57% vs 55%), with comparable urinalysis component positivity across compliance groups. Urine culture positivity was also similar across compliance groups in both reflex-culture and culture-only samples (29% vs 27% and 27% vs 29%). Gram-negative organisms predominated (13-15%), followed by fungi (7-12%) and Gram-positive organisms (2-4%), with fungal isolates more common among noncompliant samples. Antimicrobial therapy was prescribed in 19% of compliant samples compared with 15% of noncompliant samples and was frequently initiated before culture results in both groups. Median treatment duration was similar (7 vs 6 days). Provider-documented UTI diagnoses were common (80% vs 84%); however, only a portion met standardized UTI definitions (IDSA criteria: 41% compliant vs 32% noncompliant), with greater concordance observed among compliant samples. Conclusion: Recommended urine collection practices were followed in just over half of samples, with similar urine test positivity across compliance groups. Differences in organism distribution, antimicrobial prescribing, and concordance between provider-documented and standardized UTI diagnoses suggest that urine collection practices may influence diagnostic classification and antimicrobial decision-making in hospitalized adults.

Background: Pyogenic arthritis is a commonly encountered condition by Infectious Diseases clinicians and can occur in native joints as well as prosthetic joints. Synovial fluid culture is key in identifying the pathogen but there is a high incidence of culture-negative infections – up to 40% in native pyogenic arthritis and up to 15% in prosthetic joint infections. Multiplex polymerase chain reaction (PCR) testing offers the potential for rapid organism identification but real-world data on utilization of the test is lacking. Methods: A health system in the Chicagoland area recently began use of the BIOFIRE® Joint Infection Panel, which tests for 39 common bacterial and fungal causes of joint infection, as well as several markers of antimicrobial resistance. If the PCR is ordered, a synovial fluid culture must also be ordered. Of note, coagulase-negative staphylococci and Cutibacterium acnes are not targets on the PCR panel. A retrospective review was conducted of synovial fluid PCR testing among 5 hospitals from 1/1/25 – 12/6/25. Result: A total of 168 synovial fluid PCR tests were sent and 48 (28.4%) were positive. Age, gender, and race/ethnicity were similar between the PCR-positive and PCR-negative groups. In the PCR-positive and PCR-negative groups, 54.2% and 57.5% of patients had a prosthetic joint, respectively. All patients also had a synovial fluid culture obtained. Among patients with a positive PCR test, PCR and culture results were concordant for 31 (64.6%) patients. Of the 17 patients with a positive PCR but a discordant culture result, 14 had a negative synovial fluid culture and 3 had a culture identifying the organism found on PCR but also a second bacteria (Staphylococcus epidermidis, C. acnes, Finegoldia magna). Additionally, 90.8% of negative PCR tests had a corresponding negative culture result. Among the 12 patients with a negative PCR and a positive culture, six (50%) had growth of organisms included on the PCR panel (Staphylococcus aureus [n=2], Pseudomonas aeruginosa [n=2], Escherichia coli [n=1], Streptococcus infantarius [n=1]). The remaining isolates (Pasteurella multocida, Corynebacterium striatum, S. epidermidis [n=2], Dermabacter hominis, and Haemophilus parainfluenzae) were off-panel organisms. Conclusion: Synovial fluid PCR paired with culture can decrease the incidence of pyogenic arthritis without an identifiable pathogen among patients with native and prosthetic joint infections. Further research should examine the impact of the PCR test on antibiotic use, including time to targeted therapy, which may inform diagnostic stewardship recommendations regarding the test.

In a world of increasing human movement and displacement, language learning is an educational concern with significant implications for social inclusion in contexts of migration. This review of recent research analyses 40 empirical studies which explore various aspects of language education with adult migrants, investigating what they reveal regarding pedagogical approaches and the impact of policy on language learning, teaching, and assessment. It identifies issues in relation to diversity among adult migrant learners, the value of multilingual practices and the recognition of multiliteracies, as well as the potential of digital learning and affective approaches to language teaching. In addition, this review shows how migration and integration policies can influence language instruction, considering programme design, testing requirements, the learning of minoritised languages, and the role of educators in this field. It outlines directions for further research in areas including critical multilingual approaches to language teaching, equitable forms of assessment, trauma-informed pedagogy, the development of inclusive policies, and teacher education. This paper can thus inform educators, researchers, and policymakers by providing insights which may guide language-related educational support for adult migrants.

Background: Central line-associated bloodstream infection (CLABSI) is one of the four most common healthcare-associated infections worldwide and often results in serious consequences, including prolonged treatment duration, increased antibiotic usage costs, and higher mortality risk. In Vietnam, the CLABSI rate in intensive care units (ICUs) remains high, ranging from 5 to 10 episodes per 1,000 central venous catheter (CVC)-days. Therefore, implementing a CLABSI prevention bundle in ICUs is urgently necessary to ensure patient safety. Methods: A CLABSI prevention bundle was developed, consisting of an insertion bundle and a maintenance care bundle. Training and implementation were conducted in three ICU units: Neurosurgical ICU Dept. (NsICU), Internal Cardiology Dept. (IC), and Cardiac surgery resuscitation Dept. (CSR) from February to September 2025. External audits were conducted on all CVC insertion cases and 5% of CVC maintenance care opportunities in the three departments. Results: The total number of insertion bundle observation opportunities in NsICU, IC, and CSR were 67, 35, and 43 respectively, with average compliance rates increasing over time as follows: 96.76% (range 91.67–100%), 89.46% (range 79.63–95.83%), and 97.18% (range 85–100%). The total number of maintenance care observation opportunities in NsICU, IC, and CSR were 86, 63, and 53 respectively, with average compliance rates over time increasing as follows: 78.07% (range 70–87.5%), 87.75% (range 75–100%), and 82.41% (range 72.73–100%). Despite this, there were certain periods with low compliance rates for both the insertion and maintenance care bundles, particularly in areas such as proper hand hygiene procedures, insufficient antiseptic contact time, and non-compliance with drying time requirements. The average CLABSI rates post-intervention compared to pre-intervention in NsICU, IC, and CSR decreased from 2.38 to 1.6 (P=0.54), from 3.15 to 2.57 (P=0.68), and from 2.4 to 2.02 (P=0.75), respectively. Conclusion: The initial implementation of the CLABSI prevention bundle in three clinical departments led to progressively improved compliance with both CVC insertion and maintenance care practices, contributing to a reduction in CLABSI rates compared to the pre-intervention period.

Background: Nasal colonization with Staphylococcus aureus is a well-established risk factor for central line–associated bloodstream infections (CLABSIs). Many institutions have adopted screening and targeted decolonization strategies using intranasal mupirocin; however, real-world implementation remain incompletely characterized. Methods: We conducted a retrospective cohort study at University Hospitals Cleveland Medical Center to evaluate implementation of S. aureus screening and decolonization protocol among hospitalized adults undergoing central venous catheter (CVC) or peripherally inserted central catheter (PICC) placement. All patients aged ≥18 years admitted between October 1, 2023, and May 5, 2025, who had a catheter placed were included. Patients with documented bloodstream infection at the time of catheter placement were excluded. Primary implementation outcomes were: (1) proportion of patients screened for S. aureus colonization, and (2) proportion of colonized patients who received prophylactic intranasal mupirocin. Secondary outcomes included overall mupirocin use, bloodstream infection (BSI), and CLABSI rates. Mixed effects logistic regression was performed to identify factors associated with screening uptake. Results: Among 11,107 central lines placed, 63.4% underwent S. aureus screening. Of those screened, 22.6% tested positive for Staph aureus. Only 21.2% of colonized patients received intranasal mupirocin, corresponding to an overall mupirocin use rate of 5.3%. Across all central lines placed during the study period, the overall BSI and CLABSI rates were 0.91% and 0.67%, respectively. In adjusted analyses, screening was more likely among patients with arm insertion sites (OR 1.68, 95% CI 1.34–2.12), left-sided catheter (OR 1.18, 95% CI 1.07–1.29), increasing catheter lumens (three lumens: OR 1.27, 95% CI 1.11–1.47; four lumens: OR 2.22, 95% CI 1.58–3.12), ICU location (OR 1.66, 95% CI 1.49–1.84), and hematology–oncology services (OR 1.51, 95% CI 1.12–2.03). Although catheter type itself was not independently associated with screening, patients receiving PICCs demonstrated a positive, though non-significant, trend toward higher screening uptake compared with CVCs (OR 1.15, 95% CI 0.91–1.47). Tunneled catheters (OR 0.87, 95% CI 0.79–0.97) and a higher number of prior inpatient admissions were associated with lower odds of screening, while demographic characteristics and most comorbidities were not. Conclusions: S. aureus screening uptake among patients with central lines was low, and gaps at subsequent steps in the process resulted in fewer than one quarter of colonized patients receiving mupirocin. This stepwise breakdown in implementation highlights opportunities to improve protocol reliability by reducing decision points through more standardized approaches.

Background: High-level disinfection (HLD) of ultrasound probes is a required patient safety and regulatory practice. Automated vaporized hydrogen peroxide (VHP) systems, widely implemented for HLD since 2011, involve sizable capital costs, substantial maintenance requirements, and lengthy probe turnaround times. Chlorine dioxide foam has been used for ultrasound probe HLD in Europe since the late 1990s and received U.S. Food and Drug Administration clearance in 2023, consistent with the ANSI/AAMI ST58 standard. Evidence describing operational impact and feasibility in U.S. outpatient practice remains limited. Objective: To compare workflow and probe turnaround times between two ultrasound probe HLD methods and to evaluate the feasibility of chlorine dioxide foam implementation, including staff training requirements and adherence to reprocessing protocols. Methods: From October 2025 to January 2026, we conducted a quality improvement study examining the transition from automated VHP to manual chlorine dioxide foam for transducer HLD in an outpatient urology practice. A total of six registered nurses and four medical assistants participated in the study. Training provided to staff included manufacturer-provided online training, 1:1 in-person instruction, and direct observation to confirm competence with the new reprocessing protocol. Workflow steps for both HLD methods were mapped and compared. Outcomes measured included probe turnaround time (defined as the interval from immediate post-use handling to readiness for subsequent clinical use); number of workflow steps; feasibility of protocol-specific staff training; and adherence to the reprocessing protocol. Results: Each of the methods had a comparable number of workflow steps. Average probe turnaround time for chlorine dioxide was four minutes, while the automated VHP system required 14–15 minutes. Most participants completed manufacturer-provided online training. All participants received 15 minutes of 1:1 in-person instruction and direct observation. Overall, direct observation demonstrated high adherence to the reprocessing protocol. The manual foam process was integrated into routine clinical workflows without disruption to patient care. Conclusion: In a single outpatient urology practice, manual chlorine dioxide foam disinfection was feasible to implement and integrated into existing workflows with considerably shorter probe turnaround time while maintaining staff adherence. Results informed our policy on workflow steps, training, and documentation. Observations were conducted over a limited period, and findings may not be generalizable to other clinical settings.

Background: Patients with NAAT positive/toxin EIA-negative C. difficile infections (TNCDI) represent a spectrum from fulminant infection to asymptomatic colonization. We assessed differences in patient and provider factors associated with TNCDI treatment. Methods: A retrospective review was performed of all hospitalized patients ≥ 18 years with TNCDI from Jan 1st 2018 to Dec 31st 2024. Patients who received anti-CDI treatment were compared to those who did not using chi squared and Mann-Whitney U test. Variables with P≤0.2 were considered for inclusion in the final multivariable model. Results: We identified 550 patients with TNCDI; 488 (88.7%) received treatment while 62 (11.3%) did not (Table). The annual number of cases of untreated TNCDI significantly increased from 2018 to 2024 (p=0.026) (Figure). There were no significant differences in age, race, BMI, or provider services between the two groups. A higher proportion of untreated TNCDI occurred among women and in community-acquired cases. In multivariate analysis, community-acquired diagnosis of infection (within 72 hours of admission) was the only significant predictor of treatment (OR for treatment 0.50, p=0.03) (Table). In unadjusted analysis, treated TNCDI patients had higher LOS after diagnosis and mortality compared to untreated patients. Conclusion: The vast majority of TNCDI received anti-CDI treatment, though the proportion of untreated TNCDI cases increased significantly over time, likely reflecting antibiotic stewardship-based improvements. Patient and provider factors were similar between treated and untreated TNCDI groups, although small sample size of untreated TNCDI patients limited power. Treated TNCDI was associated with significantly longer LOS and mortality compared to untreated TNCDI.

Background Decolonization decreases risk of healthcare-associated and post-discharge infections. Most decolonization data are derived from methicillin-resistant Staphylococcus aureus (MRSA) studies, although results have been extended to other multidrug-resistant organisms (MDRO). Understanding MDRO target outcomes and preferred product characteristics may inform new decolonization protocols, products, and strategic integration into infection prevention practices. Methods We surveyed 134 Society for Healthcare Epidemiology of America (SHEA) Research Network-affiliated US healthcare facilities on MDRO surveillance, isolation, and deisolation practices. The survey asked about decolonization practices, needs, and gaps. The survey was administered via REDCap from 1/7/25-2/25/25, and responses were de-identified. Frequencies and proportions were analyzed in REDCap and Excel. This survey was considered nonhuman subjects research by the Mass General Brigham Institutional Review Board. Results Of 134 facilities surveyed, 52 (39%) completed the decolonization section of the survey. 38/52 (73%) facilities reported performing some form of decolonization. Of these, 87% said the most important decolonization outcome is reduced risk of progression to infection. Lab-based clearance (8%) and reduced risk of transmission (5%) were considered less important. Using carbapenem-resistant Enterobacterales (CRE) as an example of an MDRO without established decolonization products or protocols, respondents’ interest in decolonization increased with patient vulnerability to invasive disease (Figure 1). Preferred decolonization agent characteristics varied by patient population, e.g. a majority selected transmission interruption in the non-intensive care unit compared to patient-specific efficacy in the transplant population (Figure 2). Half of the surveyed facilities reported having unmet decolonization needs. Across all patient types, the most commonly reported reasons not to decolonize were “efficacy not worth the effort”, “wouldn’t protect the patient” and “effect won’t last” (Figure 3). Approximately one quarter of respondents said they would not want to decolonize for “other” reasons including, “no established protocol” and “unclear evidence”. Conclusions Facilities reported valuing decolonization as a means to prevent progression to infection, but transmission prevention was rarely selected as an important outcome of decolonization. Due to reported preferences of agent characteristics by patient population, there may be opportunities for development of population-specific products. Product design should prioritize decolonization agents that are easy to administer, highly effective, and provide long-lasting impact. Evidence-based, standardized decolonization protocols, particularly for gram negative MDRO, are needed to address barriers and support decolonization in prevention of transmission as well as infection.

Background: Parvovirus B19 causes a spectrum of illness in children, from asymptomatic infection to severe organ-invasive disease, particularly in immunocompromised hosts. Current infection prevention guidelines recommend prolonged isolation for patients with chronic infection, yet no validated quantitative PCR threshold exists to guide discontinuation of precautions. This uncertainty may lead to extended isolation and resource utilization. Objective: To evaluate the association between quantitative parvovirus B19 PCR levels and clinical manifestations in pediatric patients and explore implications for infection control practices. Methods: We conducted a retrospective observational study of patients aged 0–18 years who underwent quantitative parvovirus B19 PCR testing in a quaternary care hospital system from January–December 2024. Demographics, clinical features, and treatment were abstracted from the electronic medical record. Encounter-level and patient-level characteristics were summarized using Fisher’s exact and Kruskal-Wallis tests. Multivariable generalized estimating equation (GEE) models assessed factors associated with symptomatic infection. Optimal viral load cut-off associated with symptomatology was determined using Youden’s index. A patient with symptomatic infection was defined as having one or more signs/symptoms associated with clinical parvovirus B19 infection (fever, rash, arthropathy, cytopenias, carditis, hepatitis, etc.) that was not explained by a pre-existing underlying condition. Results: Among 103 patients (median age 7 years [IQR 4–11]), 224 encounters were analyzed; 57% were symptomatic (Table 1). Median viral load was 647,500 IU/mL (IQR 6,800–15,500,000) in symptomatic encounters versus 2,000 IU/mL (IQR 900–8,400) in asymptomatic (p<0.001). An optimal threshold of ?25,000 IU/mL (log10 ?4.4) was strongly associated with symptoms (adjusted OR [aOR] 6.54, 95% CI 1.98–21.64; p=0.002). Additional predictors associated with symptoms included hemoglobinopathy (aOR <700; p<0.001) and diagnostic testing indication (aOR 155.01, p<0.001). Viral load was not associated with organ-invasive disease or treatment response. Conclusions: Higher parvovirus B19 viral loads are associated with symptomatic infection, but not with organ invasion or treatment initiation. A threshold of ?25,000 IU/mL may inform future infection prevention guidance, potentially helping to modify isolation practices and improving resource utilization.

Background: Admission to a room previously occupied by a patient with Clostridioides difficile infection (CDI) has been identified as a risk for CDI. However, previous studies have not included molecular typing to definitively link healthcare-associated CDI (HA-CDI) cases to prior room occupants or to residual spore contamination on surfaces. Methods: In an acute care hospital, we conducted a 1-year cohort study to determine the proportion of HA-CDI cases linked to prior room occupants with CDI or to room surfaces remaining contaminated after post-discharge cleaning and disinfection. Cultures were collected from post-discharge CDI and non-CDI rooms. Whole genome sequencing was used to determine relatedness of isolates. We calculated the percentage of HA-CDI cases infected with isolates genomically related to prior room or ward-level exposures. Results: Of 5,746 patients admitted, 22 had community-associated CDI and 55 were diagnosed with HA-CDI. C. difficile was recovered from 79 of 327 (21%) post-discharge rooms, including 14 of 36 (39%) CDI rooms and 83 of 287 (29%) non-CDI rooms. Of 1,773 patients with room-level exposure to prior CDI patients or contaminated surfaces, 21 (1%) developed HA-CDI, but none were infected with genomically-related isolates (Figure 1.A). Of 49 patients developing HA-CDI after ward-level exposures, 3 were infected with isolates genomically related to prior CDI patients or contaminated surfaces on the ward (1.B). Conclusion: Despite frequent exposure to rooms previously occupied by patients with CDI or contaminated with C. difficile, no HA-CDI cases were linked to prior room exposures based on whole genome sequencing.

Background: Device stewardship is an important infection prevention opportunity for catheter-associated urinary tract infection reduction. This starts with the avoidance of initial catheter placement without definitive clinical need, especially with the option of alternative of non-invasive foley devices for both male and female anatomy. Urinary catheter placement in the Emergency Department (ED) is an area of opportunity where catheter placement could be avoided in favor of non-invasive management. This study assessed potential unnecessary catheter placement in a community hospital-based ED with a focus on ED-placed urinary catheters removed within 24 hours of admission. Methods: All patient encounters with an indwelling urinary catheter placed in 3 community hospital EDs from May 20, 2024 through September 29, 2025 were included. Encounters for patients who required chronic urinary catheterization (defined as the presence of a urinary catheter for ≥ 45 days) who had catheter replacement in the ED were excluded. The frequency of possible unnecessary catheter placement was defined as the number of catheters removed within 24 hours out of the total encounters. A subset of charts for encounters with a possible unnecessary catheter placed were reviewed to assess for commonalities to guide quality improvement. Results: During the study period, across all 3 facilities, 27.7% (385/1391) of urinary catheters placed in the ED were removed within 24 hours with a similar frequency at each individual facility (Hospital 1 = 24.6% (82/334), Hospital 2 = 24.9% (121/486), Hospital 3 = 31.9% (182/571)). The monthly frequency of possible unnecessary catheter placement ranged between 12.5% to 48.4% (Figure 1). Based on chart review, several common themes were noted, including placement in patients with altered mental status without hemodynamic instability and in patients with brief transient hemodynamic instability weaned from low dose inotropic medications and ventilation within 24 hours of admission. A clinical decision-making tool was created targeting recurrent scenarios that might warrant catheter avoidance (Figure 2). Discussion: ED placement of urinary catheters that were quickly removed by clinical teams upon admission was common across 3 community-based hospitals, highlighting possible unnecessary placement upon evaluation by the inpatient teams. A proposed clinical decision tool was created to help guide physicians in the reasoning behind the perceived need for catheter placement in the ED versus waiting to evaluate clinical need upon admission based upon patient course and failure of alternative methods for urine output management.

Background: Due to concern for ongoing colonization and substantial risks posed by horizontal transmission of RGN in acute care settings, it is common practice in many institutions to employ indefinite CP once a patient tests positive for resistant bacteria. However, it is important to recognize the adverse environmental and patient care costs of CP which has led institutions to consider structured CP discontinuation policies. Emerging evidence supports implementation of practices to safely discontinue CP in select patients following a defined period without subsequent positive cultures. Despite this, standardized methods to identify eligible patients remain unexplored. Objective: As a part of a larger study to evaluate our institution’s adopted policy of contact precaution (CP) discontinuation for resistant gram negative organisms (RGNs) after one year of no subsequent positive cultures, we aimed to assess the utility of a retrospective audit of medical records as a strategy to identify patients eligible for CP discontinuation. Methods: A retrospective chart review of patients with identified RGNs in the Children’s Hospital of Philadelphia (CHOP) electronic medical record (EMR) system from May 2021 to November. In concordance with the internal policy established November 202 recommending removal of contact precautions after one year without subsequent RGN culture positivity, each chart was assessed for the date and organism of the initial infection as well as last positive culture to determine eligibility for CP removal. Patients with carbapenem resistant organisms or those with cystic fibrosis were excluded from the review. Results: Of the/of the identified patients were determined to be eligible for de-labeling. The time required to determine eligibility status in the EMR was approximately 1 minute per patient totaling around 2.5 hours of review. Conclusion: This review identified a significant proportion of RGN-positive patients for whom standing CP were not removed in real time, allowing for an efficient update of CP status to align with hospital policy. Removal of CP not only alleviates a significant environmental and financial burden but also could contribute to a more positive patient/family experience during the hospital stay. The results of this study suggest that employing prospective plans for chart audits as CP discontinuation policies are modified would improve resource utilization.

Background: Timely conversion of intravenous (IV) antibiotics to oral (PO) therapy remains a core principle of antimicrobial stewardship. Appropriate transition from IV to PO medications reduces the potential for adverse events such as line infections and thrombophlebitis but may also reduce healthcare costs by potentially facilitating a timelier discharge. In addition, IV to PO supports sustainability initiatives by reducing the environmental impact of single-use IV bags and tubing, and PO antibiotics are prepared more quickly by pharmacy and administered easier by nursing, lessening staffing requirements. Methods: Emory Healthcare developed a fully automated dashboard to monitor IV to PO transitions and assess adherence to institutional protocols. The dashboard details antibiotic utilization and documented indication for select IV and PO agents among inpatients at Emory Healthcare from January 2024 to the current year-to-date. Selected antibiotics were chosen based on their inclusion in the Emory Healthcare IV to PO Medication Conversion by Pharmacist Protocol. The dashboard integrates data from the electronic health record including antibiotic selection, infection type, and days of therapy. The data is organized into sections and graphs for streamlined viewing and clear interpretation. Results: A dashboard was successfully created to monitor IV to PO therapy conversions. The first section (Figure A) shows days of therapy (DOT), which can be filtered by operating unit and indication. The second section (Figure B) displays DOT filtered by route and indication for the specific antibiotics included in the Emory Healthcare IV to PO conversion protocol. The third section (Figure C) displays DOT filtered by route and antibiotic for all indications. The antibiotic and indication charts can additionally be filtered to include any combination of antibiotics, indications, facility, unit type, and units. The dashboard also includes tables with antibiotic route of administration data stratified by facility, unit type (ie. oncology, emergency, operating room, acute care), and individual unit. Conclusion: The dashboard provides a novel tool for ASPs to continuously assess utilization and adherence to the Emory Healthcare IV to PO conversion protocol. The dashboard is interactive, customizable, and data is readily available, making it a key tool for optimizing stewardship practices. The data can also be used to identify stewardship opportunities, set quality improvement targets, and quickly display information to key stakeholders.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is an opportunistic organism that can cause serious infections that are difficult to treat. CRAB often possesses concerning resistance mechanisms, including carbapenemase enzymes, which can spread resistance through mobile genetic elements. Prevention-driven point prevalence surveys (PPSs), a strategy outlined in the Centers for Disease Control and Prevention’s multidrug-resistant (MDRO) prevention guidance, can enable early identification of colonized patients and inform targeted infection control measures to mitigate transmission. From 2024-2025, the Louisiana Office of Public Health partnered with a long-term acute care hospital (LTACH) to implement prevention-driven PPSs for CRAB. Methods: LTACHs were targeted due to the increased risk of MDRO colonization among high-acuity patients admitted for prolonged periods. A webinar was held for LTACH facilities in a region of the state with a high CRAB burden, and one facility agreed to participate. The PPSs were conducted quarterly for one year. Testing was performed by the Southeast Antimicrobial Resistance Laboratory Network (ARLN) and included organism confirmation, real-time polymerase chain reaction to detect carbapenemase genes, antimicrobial susceptibility testing, and whole genome sequencing (WGS). Methods are described on ARLN's website. Genetic relatedness and pairwise single nucleotide polymorphism (SNP) differences among isolates were analyzed using the National Center for Biotechnology Information Pathogen Detection Isolate Browser. Result: From February 2024 to January 2025, 121 specimens were collected from 87 patients. Screening sites included axilla-groin (71%), wounds (20%), and rectum (9%). Five percent (4/87) of the patients were found to be colonized with CRAB. These isolates were resistant to all carbapenems tested (meropenem, doripenem, and imipenem), produced OXA-23 or OXA-24/40 carbapenemases, and two of the isolates were pan-resistant. Three CRAB patients were identified within the same SNP cluster and were closely related, averaging 12 SNP differences. One CRAB patient was also colonized with Stenotrophomonas maltophilia. Additionally, 4 different patients (5%) tested positive for Pseudomonas aeruginosa; 3 were carbapenem-resistant, and of these, 1 was pan-resistant. Colonized patients exhibited typical risk factors for MDRO colonization, including underlying conditions, wounds, recent antimicrobial exposure, and indwelling device use. Conclusion: Screenings enabled routine assessment of CRAB colonization burden. PPSs identified colonized patients who may have otherwise gone unrecognized, allowing for timely implementation of infection control actions. WGS detected a previously-unknown cluster, indicating transmission within healthcare facilities. These findings align with and support current MDRO containment guidance and underscore the importance of conducting screenings in high-risk healthcare settings to reduce MDRO exposure among vulnerable patients.

Background: Blood culture contamination (BCC) is a persistent problem in the hospital, contributing to unnecessary antibiotic exposure, excessive diagnostic testing, increased length of stay, and higher costs. For patients with suspected or confirmed sepsis, BCC has particularly serious implications, as early identification of the causative pathogen and prompt initiation of appropriate antimicrobial therapy are critical. National benchmarks define <3% contamination as acceptable, yet emerging evidence supports a more ambitious goal of ?1%, particularly in high-risk populations such as patients with sepsis. Methods Using a sequential practice change across three time periods: (1) no blood culture diversion device (2019–2020), (2) implementation of manual blood diversion device (BDD) #1 (2021–2022), and (3) automatic BDD#2 (2023–present), we have achieved a 74% reduction in BCC (Figure 1). In this project, we further evaluated the impact of this overall reduction on patients admitted with suspected or confirmed sepsis. Results Data were extracted for adult patients admitted to the hospital who had a final discharge diagnosis of sepsis, regardless of their initial admission diagnosis. A total of 154 blood cultures were analyzed across the three time periods. During period 1 (2019 & 2020), 6/62 cultures were contaminated (9.7%). After implementation of manual BDD#1 (11/17/2021-2022), BCC decreased to 2/30 cultures (6.7%). After transition to automatic BDD#2 (1/20/2023-present), BCC further declined to 3/62 cultures (4.8%). One-way analysis of variance (ANOVA) demonstrated a statistically significant difference in BCC rates across the time periods, with post hoc comparisons showing a significantly lower contamination rate when using BDD#2 as compared with both no BDD and manual BDD#1. Additionally, manual BDD#1 was used in 48% (30/62) of the blood culture collections versus to 78% for automatic BDD#2, with staff feedback indicating greater ease of use with the automatic BDD#2 system. Conclusion Adoption of BDD was associated with a 50% (9.7-4.8%) reduction in BCC, with the lowest rates following implementation of automatic BDD#2. Compliance with BDD use was also highest with automatic BDD#2, and staff reported greater ease of use. These findings underscore the importance of optimizing BCC practices as a key component of sepsis management, antimicrobial stewardship, and patient safety efforts. Additional research is needed to identify strategies to further reduce BCC in sepsis patients, with particular attention to BDD usability, workflow integration, and process adherence during real-world use.

We give a new definition of matrix Schwarzian derivative, which is simpler than the Lagrange Schwarzian derivative and also provides an alternative to other definitions which appear in the literature. Some basic properties are discussed, in particular, analogs of Möbius invariance and the result of a change of independent variable, these being the two properties of the scalar Schwarzian derivative often considered to account for its universality. We then use our new definition of matrix Schwarzian derivative to construct new Schwarzian matrix ordinary and partial differential equation hierarchies: a Schwarzian matrix second Painlevé hierarchy and a Schwarzian matrix Korteweg–de Vries hierarchy, respectively. In addition, we define a new matrix second Painlevé hierarchy.