Background: New York City (NYC) is vulnerable to antimicrobial resistant pathogens given its population density, mobile population of travelers and immigrants, and multiple health systems in close proximity. While some NYC health systems make institutional antibiograms publicly available, it remains challenging for clinicians, antimicrobial stewardship programs, and public health institutions to understand regional antimicrobial resistance trends. Multifacility antibiograms can raise awareness of regional trends in resistance and potentially serve as a benchmark for local facilities. We created and distributed an annual regional antibiogram based on facility-level data from NYC healthcare systems. Method: Using Clinical Laboratory Standards Institute guidance, facility antibiograms for calendar years 2021, 2022, and 2023 were solicited by the NYC Health Department and voluntarily submitted by NYC healthcare systems. NYC regional antibiograms were generated for each calendar year by Firstline (Firstline.org, Vancouver, BC), a vendor with technical expertise in creating multifacility antibiograms. When sufficient data were received and facility confidentiality could be ensured, data were stratified to create additional antibiograms by facility borough, setting (i.e., emergency departments), or patient type (i.e., pediatric patients). Antibiogram data were uploaded to Firstline’s clinical decision support application for patient-facing NYC prescribers. Result: Of 56 NYC hospitals, 45 (80%) submitted antibiogram data during the project period, comprising 19,766/25,929 (76%) of NYC hospital beds. Of these hospitals, 40 (89%) submitted antibiogram data suitable for inclusion in >1 year of the citywide antibiogram (average: 31 hospitals/year). Annual antibiograms were created for Manhattan, Brooklyn, and Queens; insufficient data were received to create borough-level antibiograms for Staten Island (except 2022) and the Bronx. Annual pediatric and emergency department antibiograms were generated from citywide data. Citywide resistance rates for select pathogens and antibiotics appeared stable across the 3 years (Figure 1A-D). Antibiogram data received 417 views on Firstline between November 14, 2023–December 18, 2024. Conclusion: Through voluntary antibiogram submission from health systems, the NYC Health Department generated annual citywide antibiograms that comprised the majority of hospital beds in NYC. We achieved a high rate of voluntary participation because health systems submitted existing institutional antibiograms. Additionally, distributing the NYC antibiogram via a clinical decision support application allowed clinicians to access up-to-date citywide antimicrobial resistance rates in NYC. Despite high participation, differences in data reporting limited our ability to pool antibiograms across facilities (e.g., Figure 1B), reducing representativeness. In future antibiogram iterations, in addition to increasing facility participation, we will explore using susceptibility data electronically reported to the Health Department.

Background: The role of environmental sampling to monitor airborne fungal loads (AFL) in healthcare facilities is controversial due to a paucity of data to guide the interpretation of results. Systematic surveillance for infections that might result from exposure to airborne fungal spores is furthermore limited by the lack of standardized definitions for healthcare-associated invasive mold infections (IMI).

Setting: 490-bed tertiary-care pediatric hospital Methods: Retrospective ecological study of the relationship between AFL and IMI. Volumetric samples for fungal culture from 1000 L of air were obtained approximately monthly from November 2018 through October 2023 with a bioaerosol impactor on units caring for patients at risk for IMI. Fungi in environmental cultures were classified as opportunistic fungal pathogens versus those that are rarely pathogenic. Prospective surveillance was conducted using standard definitions for proven and probable IMI. Cases with symptom onset after one week of hospitalization or in patients with either a previous hospitalization or more than one ambulatory encounter at our facility during the month prior to admission were considered healthcare-associated events. Poisson regression was used to examine the association between AFL and monthly average IMI rates. AFL values were also categorized to analyze the association with IMI rates using the chi-square test for trend. Results: During the period of AFL surveillance, 51 healthcare-associated proven or probable IMI were identified of which 33 were in hematology/oncology patients (including stem-cell transplant recipients) and 7 were in cardiac patients. The median total AFL on occupied inpatient units was 2 CFU/m3, and the most frequent pathogens identified were Penicillium species, dematiaceous molds, and Aspergillus species. No significant association was found between IMI rates and the average house-wide AFL for opportunistic fungal pathogens. The hematology/oncology IMI rate, however, increased by 1.48-fold (95% CI 1.00-2.19, P = .05) in association with an increase of 1 CFU/m3 in the pathogen AFL on units caring for these patients. The local AFL of Aspergillus species demonstrated an even stronger association with the hematology/oncology IMI rate (15.9-fold increase for an increase of 1 CFU/m3 [95% CI 2.8-90.7, P = .002]). The figure summarizes trends in hematology/oncology IMI rates across different ranges of average monthly AFL values. Conclusions: Environmental surveillance for AFL on appropriate hospital units may identify periods of increased risk for IMI among hematology/oncology patients. Additional work is needed to define the role that routine AFL surveillance may serve in infection prevention activities for immunocompromised patients.

Background: Whooping cough, caused by Bordetella pertussis (BP), is a vaccine-preventable illness spread through respiratory droplets. As the disease disproportionally impacts infants and children, vaccination is part of the routine childhood series in Canada. However, vaccine hesitancy and resultant declining rates of community immunity increase the risk of disease. We leveraged our existing wastewater-based surveillance (WBS) network to assess its ability to track clinical disease in response to an outbreak in southern Alberta. Methods: For seven months before and after the declaration of a January 2023 outbreak, wastewater samples were collected at approximately weekly intervals from five municipalities in southern Alberta (~1.05 million residents). 24-hour composite wastewater was pelleted, mechanically lysed, and DNA extracted. B. pertussis gene BP283 was quantified by qPCR and normalized against total-bacterial 16s rRNA. De-identified clinical data was obtained from Alberta Health Services (AHS) and vaccination rates collected from the AHS Interactive Health Data Application dashboard (http://www.ahw.gov.ab.ca/IHDA_Retrieval/). Per local guidelines, cases could be diagnosed through molecular testing, or if an individual had a strong epidemiological link to a known case and compatible whooping cough symptoms (https://open.alberta.ca/publications/pertussis). Cases were mapped to sewershed areas using forward sortation areas. Fishers exact test was used to determine the association of the categorical variables of positive wastewater samples and clinical cases diagnosed in the week following, as well as to compare rates of wastewater positivity before and after the outbreak was declared. Results: Over the study period 296 cases of whooping cough were identified, with 256 after the outbreak was declared. No wastewater samples were positive for BP prior to the outbreak (0%) and 22 were positive during the outbreak (19.8%), p = 0.0006 (Figure 1). Of the positives, the median ratio of BP:16s rRNA was 8.89x10-9 (IQR: 5.31x10-9 to 4.19x10-8). Detection of BP in the wastewater did not necessarily predict the occurrence of cases the following week within individual municipalities, but there was an association when all sites were aggregated (OR 2.47 [CI: 1.01–6.05], p = 0.04). Vaccination rates in the communities ranged from 40.9% to 72.2%, and did not associate with wastewater detected Bordetella pertussis. Conclusion: BP can be detected in wastewater during outbreak periods, though infrequently and in very low concentrations. For WBS to be used as an effective tool to monitor and potentially mitigate cases of whooping cough for WBS (and other respiratory pathogens which are not readily amplified in the gastrointestinal tract), assay sensitivity will need to be improved.

Background: Racial and ethnic disparities have been demonstrated across a range of healthcare outcomes and services, including infectious disease burden. Individuals who reside in communities with increased social vulnerability are more likely to experience worse infection-related outcomes. These disparities are likely exacerbated by structural and systemic inequities experienced during inpatient care, even for common diagnoses, such as urinary tract infections. We explored the relationship between race, population-level social vulnerability, and urine culture results in the inpatient setting. Methods: We conducted a retrospective cohort study at Stanford Health Care from January–December, 2023. We included all adult inpatients who had a urine culture collected. The Center for Disease Control’s Social Vulnerability Index (SVI) was used as a composite measure of social vulnerability. Patient addresses from electronic health records (EHR) were geocoded to determine census tract-level SVI designation using the California-specific SVI database, and out-of-state addresses were excluded. Unhoused patients were identified by a discrete field in the EHR. We included demographics, urine culture results, and time of urine culture collection. Community-associated positive urine cultures were defined by a collection time ≤48 hours from admission, while healthcare-associated positive cultures were collected >48 hours from admission. Results: There were 5,374 admissions with urine cultures collected in 2023. The overall median SVI was 0.34. Compared to the statewide median overall vulnerability of 0.50[IQR: 0.25–0.75], our inpatient population resided in less vulnerable areas. When comparing patients with positive and negative urine cultures, the overall SVI, the four-specific SVI themes and SVI quartiles were similar. Unhoused patients were more likely to have a negative culture than a positive culture. Patients who identified as Asian were more likely to have a healthcare-associated positive urine culture than a community-associated positive culture. Patients who identified as Hispanic were more likely to have a community-associated positive culture than a healthcare-associated positive urine culture. Patients who identify as white or black had similar likelihood of developing a community-associated or healthcare-associated positive culture. Discussion: We did not find any differences in SVI among patients based on urine culture positivity. However, when stratified by community- vs healthcare-associated we found that patients who identify as Asian or Hispanic may be more likely to have a positive urine culture. These differences in outcomes are likely complex and multifaceted, potentially related to various social drivers of health present both before and during admission. Further exploration is needed to understand what is contributing to these findings.

Background: Patient bathing plays a vital role in patient care and cleanliness, as well as in the prevention of infections, assisting in the removal of transient skin flora, which are predominately gram-positive organisms, particularly Staphylococci. However, there are inherent risks that come with the use of water in healthcare facilities, particularly the potential for acquisition of pathogenic bacteria from surfaces by residents. Current cleaning and disinfection protocols encourage the disinfection of the shower facilities in between each patient, but adherence to this practice can be a challenge with the staffing shortages seen in environmental services linked to long-term care facilities. The purpose of this point-prevalence study was to identify Staphylococci contamination in shower facilities at a long-term care and rehabilitation center Methods: Five shower room facilities in a long-term care and rehabilitation center were cultured on one day in July 2024. Five surfaces in the shower facility/room were cultured: the shower bench, the faucet, the floor drain, the grab bar, and the shower curtain. A total of 25 cultures were obtained using sterile transport swabs with liquid Stuart’s medium (Fisherbrand, Fisher Scientific, Suwanee, GA) and immediately placed in ice for transport to a microbiology lab. At the lab, the swabs were plated onto two different agars: CHROM MRSA agar and mannitol salt agar (MSA) and incubated for 48 hours. Plates were then read and assigned a qualitative “Yes/No” value if at least 1 colony forming unit of interest was seen. Results: Of the five surfaces cultured in the shower facilities, the bench shower seats were the most heavily contaminated. All of the bench shower seats tested positive for coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus (MSSA), and 40% of the bench seats tested positive for Methicillin-Resistant Staphylococcus aureus (MRSA). The floor drains were the second most contaminated surfaces, with 80% of surfaces testing positive for both CoNS and MRSA, respectively. Grab bars were the least contaminated surface examined, with only 40% of surfaces testing positive for MSSA and CoNS. Conclusion: This study showed that there was a high prevalence of Staphylococci organisms in the shower facilities, including showers that were marked “clean”. Finding 40% of shower benches contaminated with MRSA is concerning, particularly for some of the elderly patients using these showers. These findings highlight the lack of adherence to the cleaning and disinfection protocols. Further research should be done if adherence to their protocols will reduce Staphylococci surface burden.

Specialty Infectious Disease physician.

Clinical Associate Professor University of South Dakota Medical School

Consultants for South Dakota Department of Health regarding antibiotic stewardship

Consultants West Virginia Hospital Association regarding antibiotic stewardship Background: An equitable distribution of antibiotic stewardship expertise is a challenge for rural communities across the United States. The advantage rural communities have is that there are fewer barriers for implementation of effective antibiotic stewardship strategies.

The authors worked with several rural communities in the United States over the paste several years implementing a proven antibiotic stewardship strategy that has been shown to decrease Clostridioides infection. Method: Strategy employed was avoidance of the more common microbiome damaging broad spectrum antibiotics in favor of more targeted narrow spectrum antibiotics based on local antibiogram data. Additionally, ongoing infectious disease and antibiotic stewardship access for questions as well as data review with feedback were provided.

Findings: Clostrioides infection was eliminated in some communities and others markedly decreased as shown by a very low percentage of toxin positive, PCR positive to toxin negative PCR positive isolates expected for that region. Conclusion: This strategy is translatable to other communities accompanied by antibiotic stewardship expertise and support and can be a model for community wide antibiotic stewardship which further optimizes patient and resident safety from Clostidioides infection.

Background: Adherence with antimicrobial resistant organism (ARO) admission screening is suboptimal, despite clinical support tools in clinical information systems (CIS) to facilitate the process. Behaviour change techniques to improve adherence are needed. However, in a resource-constrained healthcare system, strategies that motivate healthcare workers (HCWs) to align their practices with infection prevention and control (IPC) policies need to be prioritized. Methods: An online survey (REDCap) and a virtual (Zoom) consensus meeting using a modified nominal group technique with online voting was conducted among HCWs, IPC, and the CIS staff in September and October 2024, respectively, to achieve consensus on a prioritized list of interventions to improve ARO admission screening at acute care and acute rehabilitation facilities (n=100) in Alberta, Canada. Interventions from the Behaviour Change Wheel were mapped to barriers/enablers influencing screening adherence. Each intervention was judged across the APEASE criteria (Acceptability, Practicality, Effectiveness, Affordability, Side Effects, Equity) using a 5-point Likert Scale. Consensus to include interventions required >4 criteria with >80% agreement, consensus to exclude required >4 criteria with 80%. Interventions that did not reach consensus were discussed to determine whether to include in the final candidate list. Attendees were asked to vote on their top three interventions from the final candidate list. Results: There were 15 barriers and one enabler to ARO admission screening, mapped to 43 unique interventions. Of these, 16 interventions addressed more than one barrier/enabler, while 27 interventions only addressed a single barrier. Fifty-nine respondents completed the survey. Most respondents (63%) were IPC staff, 20% were nurses, and 17% were other HCWs (including IPC physicians). Nine interventions met criteria to include in the candidate list, 26 were excluded, and 8 interventions did not reach consensus in the survey and were discussed. There were 32 attendees at the consensus meeting (53% IPC staff and physicians, 34% clinical staff, 13% other provincial teams). Three interventions were selected: 1) creating a nursing task to complete the tool in the CIS when an admission order is signed, 2) add a banner on the CIS Storyboard when the tool is not complete, and 3) develop a best practice guideline for frontline staff on ARO admission screening. Conclusions: The survey and consensus meeting were efficient methods to determine a prioritized list of interventions, which will be implemented and evaluated, to improve ARO admission screening in Alberta.

Background: Universal decolonization using chlorhexidine gluconate (CHG) foaming soap in a hospital system has been shown to reduce healthcare-associated infections (HAIs) and colonization by multidrug-resistant organisms. Limited data exist on optimal strategies to improve compliance, and the impact of improved compliance on HAI rates. This study evaluates the effect of increasing CHG compliance on MRSA HAI rates. Methods: In 2022, our acute care VA hospital started universal CHG bathing treatment, by requiring a daily CHG bath for all patients in intensive care units and medical/surgical floors, unless contraindicated. Despite this, compliance was below goal. We performed root cause analyses to identify factors contributing to poor compliance, and then initiated a bundled intervention, including nursing staff education on the benefits of CHG bathing to reduce HAIs, how to reframe discussions with patients about refusals, removal of one alternative soap product from the inventory, and moving the CHG bathing product in clean supply rooms to be in proximity with other patient hygiene products for easier access. We evaluated the utilization of CHG bathing products through inventory data on utilization of 4 fluid ounce bottles of 4.0% weight/volume CHG solution, documentation of at least one CHG bath in the electronic medical record (EMR) per unique hospitalization, and HAI rates per National Healthcare Safety Network (NHSN) definitions for methicillin resistant Staphylococcus aureus (MRSA), before (08/2023-02/2024) and after (03/2024-12/2024) implementation of the bundle. Results: Identified barriers to CHG adherence included use of less effective alternative soap agents, perceptions of patient skin irritation from CHG, difficulty integrating CHG into existing workflows, and lack of understanding of the benefits of CHG bathing. After bundled interventions, inventory usage CHG bottles increased from 170 to 270 bottles per 1,000 bed days of care (BDOC) (p Conclusion: An intervention of staff education, removal of an alternative soap product, and improving access to CHG bathing products in supply rooms, resulted in improved CHG bathing adherence, and was associated with a reduction in MRSA HAIs in an acute care VA hospital. Interestingly, the decrease in MRSA HAIs was achieved despite an absence of complete adherence. Further data on additional strategies to improve compliance and strategies to improve healthcare worker documentation should be explored.

Background: The selection of agent for antimicrobial prophylaxis for urological procedures is guided by the results of urine cultures taken prior to the day of surgery, which can lead to variability. National society guidance recommends single-dose antimicrobial prophylaxis immediately before urologic surgery; however, significant heterogeneity remains among practicing urologists with regards to pre-treating (or post-treating) bacteriuria identified on preoperative urine culture as well as choice of antimicrobial administered. As part of an institutional quality improvement initiative, we endeavored to optimize antimicrobial selection and duration of therapy through the use of a dedicated preoperative urine culture paired with recommendations. Method: This was a single-center, prospective study of urological surgeries. A dedicated preoperative urine culture was created in partnership with our institution’s microbiology lab and antimicrobial stewardship program intended solely for the selection of preoperative prophylaxis. Antibiotic stewardship program members reviewed these urine cultures and provided recommendations to urologic surgeons. Primary outcome was postoperative infectious complication within 90 days, with sub-analyses performed for stone and prosthetic cases, which carry higher infectious complication risks. Result: The preoperative urine culture was ordered prior to 381 urology cases from 9/27/23-4/15/24. There were 41 (10.8%) infectious postoperative complications. 64/381 (16.8%) patients received pretreatment for asymptomatic bacteriuria at the surgeon’s discretion, deviating from protocol recommendations for single-dose prophylaxis. Similarly, 44/381 (11.5%) patients received postoperative antimicrobials off-protocol per surgeon discretion. There was no statistically significant difference in infectious postoperative complication rates among patients who received pretreatment (15.6%, n=10/64) versus those who did not (9.8%, n=31/317 [p=0.18]), nor in those who received postoperative antimicrobials (13.6% (n=6/44) versus not (10.4%, n=35/337 [p=0.44]). Subgroup analyses of patients with nephrolithiasis or prosthetic material showed no benefit with supplemental antimicrobials. There were 294 total days of therapy in cases with guidance-based prophylaxis (n=294), and 611 days for pre- and/or post-treated cases (n=87), representing an excess of 524 days of antimicrobial therapy. Conclusion: We implemented a specific antimicrobial stewardship initiative linking a urine culture ordering process to succinct evidence-based advice. Deviation from advice did not result in improved outcomes but did result in excess antimicrobial days. Subgroup analysis also suggested single-dose prophylaxis is appropriate for patients considered higher risk for infectious complications. These findings support the recommendation from the American Urological Association that a single dose of antimicrobial prophylaxis is sufficient for the majority of urologic cases and demonstrate a multidisciplinary approach to ability to safely implement such practice.

The field of public health is facing greater demand, significant staff turnover, and an increasing number of public health emergencies and threats. This is further compounded by an unprecedented unmet need for infection preventionists (IPs) in the workforce. The integration of infection prevention and control (IPC) material into existing public health (PH) academic programming could bridge this gap. There are very few IPC-concentrated Masters of Public Health (MPH) programs and the extent of IPC focused content in existing graduate PH programs is unknown. This project seeks to define the extent to which graduate public health courses include IPC concepts and identify potential inclusion points for these topics.

Syllabi for core PH courses were requested from all Council on Education for Public Health (CEPH) accredited graduate schools, of which there were 137 at the time of retrieval. Received syllabi (n = 245) were reviewed and coded for inclusion of IPC topics such as antibiotic resistance and antibiotic stewardship (AR) and healthcare acquired infections (HAIs). These syllabi represented 54 programs (39%) and 34 states. An additional six (6) states had no applicable programs.

Seventy-six (31%) syllabi had specific IPC content, while an additional 119 (49%) had potential inclusion points for IPC content. Seventy-two courses (30%) had neither IPC content nor potential inclusion points; these courses tended to be biostatistics, health policy and management, or environmental health classes. All analyzed MPH academic programs had at least one area within the core courses that served as a potential inclusion point for IPC content, supporting the argument that public health core competencies naturally align with IPC domains outlined in the Association for Professionals in Infection Control and Epidemiology (APIC) Infection Preventionist competency model.

Observations from this review indicate both the capability to seamlessly integrate IPC material into MPH programs and the existing deficit where this opportunity is unrealized. These findings can guide the development of tool kits to integrate the outlined inclusion points into existing graduate public health curricula guiding future workforce development to address current limitations.

This study provides the first case reported of Paraprionospio treadwelli (Hartman, 1951) in the Gulf of Mexico. Based on 242 individuals collected between 20.8 and 176 m depth during three oceanographic expeditions, we describe in detail the morphology of the identified specimens, including the description of the pygidium, so far unknown in this species, and provide SEM photographs to support their identification. Paraprionospio treadwelli was originally found in Chesapeake Bay, Northwestern Atlantic, and we now extend its distribution southwards to the Western Gulf of Mexico. Remarks on the environmental conditions where this spionid species was found and the observed abundance seasonal pattern are also provided.

Background: Increasing influenza vaccination rates can significantly reduce the onset of severe symptoms and the risk of complications, thereby alleviating the burden on hospitals during flu seasons. However, the overall vaccine uptake has been decreasing in the United States, which is expected to increase the burden of disease. This study aims to estimate the impact of low influenza vaccination rates on disease burden and U.S. hospital system resources. Methods: The impact of reduced flu immunization rates was estimated using a dynamic age-stratified transmission model. Two U.S. flu seasons (2011-2012 for low incidence and 2017-2018 for high incidence) were analyzed to simulate flu epidemic variations. This study assessed four different flu vaccination rates: 25%, 30%, 35%, and 40%. Outcome measures included the number of infections, outpatient visits, hospitalizations, intensive care unit (ICU) stays, and deaths. The flu vaccine effectiveness (VE) rate was taken from CDC reports, estimating an average VE of 42% for all ages over the last 10 seasons. Vaccination rates by age group were also estimated using CDC reports, assuming immunization with quadrivalent flu vaccines for all ages. The total number of acute hospital and ICU beds available for influenza in the U.S. was assumed to be 300,000 and 30,000, respectively. Results: Using the U.S. flu immunization rate from the 2023-2024 season (approximately 35%), a high flu incidence season is expected to result in 71 million symptomatic infections, 29 million office visits, 0.94 million hospitalizations, and 133,670 deaths. Any scenario with an immunization rate below 45% will generate significant pressure on the U.S. hospital system and saturate the number of ICU beds during high incidence seasons. Only increasing the flu immunization rate to 50% or higher may prevent the saturation of acute hospital or ICU beds, regardless of the flu season’s incidence. Conclusions: The analysis shows the critical need to increase U.S. flu immunization rates to at least 50% to improve health outcomes and avoid the saturation of hospital system resources, especially ICU beds.

Background: In 2024, US hospitals were affected by the Becton Dickinson (BD) BACTEC blood culture bottle shortage with little time to respond and conserve supply. The extent of the impact of this shortage on clinical practice has not been explored. Methods: We developed a 7-question online poll with the Emerging Infections Network (EIN) exploring the extent to which facilities were impacted by the shortage, geographic distribution and facility type of institutions affected, actions taken to mitigate the shortage, and the impact on clinical management of fever and Staphylococcus aureus bacteremia. The link was sent to >3100 EIN listserv members 3 times during September 2024. Descriptive and thematic analyses were performed on quantitative and qualitative responses. Results: Of 202 respondents from 39 states, 129(64%) responded their hospital had limited blood cultures available, 8(4%) were unsure how their hospitals were affected, and 65(32%) indicated their hospitals were not affected (Fig1). The most affected hospital facility types with >10 respondents were Community (27/39, 69%), University (48/72, 67%), Children’s (7/11, 67%), Non-university teaching (33/52, 65%), and the VA/DOD was least affected facility type (3/11, 27%). Respondents not affected by the shortage most commonly used alternate blood culture media. Top mitigation strategies included publishing algorithms for best practice use (103/202, 51%), restricting follow-up blood cultures (88/202, 44%), using single blood culture sets (86/202, 43%), and implementing EMR-based alerts on blood culture orders (71/202, 36%). Important clinical themes identified by affected respondents included limitations on blood culture use (147 responses), concerns with overall treatment and care including delays and disruptions in discharges or prolonged antibiotic use (15 responses), concerns with bacteremia management (15 responses), and increased diagnostic stewardship opportunities (21 responses) (Fig2). The most prevalent theme in S. aureus bacteremia management was limitations in repeat blood cultures (61/163, 37%) with concerns about confirming bacteremia clearance, while the most common theme in inpatient/ER management of fever was limitations in initial blood cultures (64/159, 40%), with common comments about reducing inappropriate blood cultures. 61/202 respondents commented in the open-ended question with the most common theme highlighting increased diagnostic stewardship as a positive outcome of the shortage (19/61, 31%). Conclusion: The BD BACTEC blood culture bottle shortage caused widespread clinical impact. The themes identified highlight the challenges placed on healthcare systems during times of shortage as well as the effects on patient care. Mitigation strategies implemented during the shortage may create future opportunities for diagnostic stewardship.

Background: Hand hygiene is an important strategy for reducing healthcare-associated infections. While efforts to improve nursing home (NH) staff hand hygiene have been prioritized, there are few if any policies in-place to improve resident hand hygiene. Further, CMS guidance requires that residents be bathed “twice a week.” The objective of this study was to characterize resident hand hygiene knowledge and habits as well as bathing practices to identify barriers in a setting where new intervention strategies could be aimed. Methods: The survey was administered at 20 NHs across the United States between December 2023 and July 2024. Verbal consent was obtained from residents before survey administration. Survey questions explored residents’ hand hygiene knowledge and differences in hand hygiene habits and bathing practices since entering the NH from their last place of residence. Three knowledge-based questions assessed residents’ understanding of the recommended length of time to wash hands and use hand sanitizer in addition to when hand washing should be utilized instead of hand sanitizer. Frequency of hand washing, either through soap and water or hand sanitizer, instances of when and how residents wash and dry their hands, and whether resident’s faced challenges were assessed. Results:Of the 495 residents who completed the survey, only 142 (29%) residents answered all three knowledge-based questions correctly. Residents who answered two or three questions correctly reported washing their hands more frequently at their previous residence compared to residents who answered zero or one correct (Figure 1). Frequency of hand hygiene was lower at the NH compared to their previous residence across a variety of indications (Figure 2). More residents faced challenges with washing their hands at the NH compared to their previous residence (30% vs. 7%, P<.001). The most common challenges included: mobility limitations, medical issues, need for assistance, bathroom accessibility and inadequate bathroom supplies/equipment. About half the residents (53%) reported never being reminded to wash their hands; 60% reported that they would use hand sanitizer if it was easily accessible. 51% of residents reported bathing with soap and water less at the NH compared to their previous residence with reported causes being needing help and not receiving it, nursing home policy, medical issues, and mobility limitations. Conclusions: Survey results indicate opportunities for interventions aimed at reducing the barriers to hand hygiene practice and improving bathing practices in NHs. Policy changes and hand hygiene educational opportunities addressing these barriers could serve as potential strategies.

Introduction: Grouping of medical tests in an order panel or set may facilitate standardized care but could have the unintended consequence of increasing unnecessary testing. At our institution, one such panel includes studies performed on stool for the purposes of diagnosing infectious diarrhea (Figure 1). We removed stool enterovirus polymerase chain reaction (PCR) from this order panel given limited data supporting its use in the diagnosis of the etiology of diarrhea. Objectives: We aimed to evaluate the impact of removing the stool enterovirus PCR from this panel and whether there were associated decreased costs from this intervention. Methods: We conducted an interrupted time series to estimate the initial impact of implementing this order panel, followed by the later removal of the enterovirus order from the panel, using gastrointestinal (GI) bacterial PCR orders as a control. Additionally, we conducted a cost-savings analysis by multiplying the cost per test by the decrease in tests/month after removing the order from this panel averaged over a year. Results: After the panel’s creation, there was an immediate significant increase in enterovirus stool PCR ordering from a predicted mean of 28 tests/month to 43 tests/month (difference of 15 tests/month, p < 0 .0001) (Figure 2, blue). Similarly, the bacterial stool PCR ordering increased from a predicted mean of 98 tests/month to 136 tests/month (increased by 37 in the month following panel creation, p < 0 .0001). Conversely, after the removal of enterovirus PCR from the panel, there was an immediate significant decrease in testing from a predicted mean of 60 tests/month to 17 tests/month (decreased by 43 tests/month, p < 0 .0001), without a significant change in bacterial stool PCR ordering (16 test/month decrease, p=0.10) (Figure 2, red). We estimate that this simple intervention will save an average of $8,500 annually in direct costs each year. Discussion: Enterovirus PCR ordering significantly increased after the introduction of an order panel bundling stool studies targeted at diagnosing diarrhea. When this order was removed from the panel, there was a significant decrease in ordering without a change in infectious stool testing overall, as evidenced by no significant change in GI bacterial panel ordering. We hypothesize that clinicians utilize this panel to craft a differential for acute-onset diarrhea. Therefore, when the stool enterovirus PCR option was removed from this panel, it is possible that it was no longer considered on the differential. Reviewing such order panels may be helpful in reducing unnecessary testing and costs to healthcare systems.

Introduction: First responders, including EMS and fire personnel, are essential to public safety, often facing high-risk environments with infectious agents. However, IPC training varies across the U.S., creating preparedness gaps. This study identifies training needs through a nationwide survey to offer evidence-based recommendations for effective IPC training, improving safety for first responders and the communities they serve. Methods: This study used an online survey to gather feedback from first responders (n=183) across all 50 states. We used the convenience sampling method to select participants based on contact information obtained from the department’s website (n=1,208). We collected demographic data and asked participants to choose from 18 IPC topics they believed should be included in the training, with an option to suggest additional topics. Respondents also rated the factors that influenced training effectiveness and indicated motivations for completing IPC training. An open-ended section allowed participants to share further opinions on IPC for EMS and fire services. Results: The most requested infection control topics were decontamination of apparatus and equipment (n=107, 7.21%), use of personal protective equipment (n=104, 7.01%), and transmission and types of communicable diseases (n=99, 6.67% each). The factors rated as most important in determining the effectiveness of training for EMS and fire personnel included “Examples of how the information applies to EMS and fire personnel” (n=76), “Inclusion of scenarios or real-world situations” (n=71), and “Availability of materials in a web-based format” (n=71). The main motivating factors for the completion of infection prevention and control training were identified as “personal health and safety” (n=99, 15.99%), “safety and health of my family” (n=93, 15.02%), and “safety and health of the patients” (n=90, 14.54%). Conclusion: These results signal that practical training with examples related to their field is preferred. A greater emphasis on real-life examples and web-based materials shows that the preference goes toward training that is relevant to daily operations and accessible in flexible formats. The first three motivational factors listed above emphasize the personal and professional stakes that first responders have in undergoing this training. This would therefore suggest that infection prevention programs need to be tailored to address the specific risks that first responders face and be delivered in ways that maximize engagement and practical application.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a reportable hospital -acquired condition that can cause significant harm to hospitalized patients. Our facility, a 629 bed acute tertiary care hospital, continued to observe Healthcare Facility-Onset (HO) MRSA bacteremia rates above the corporate goal despite our housewide MRSA decolonization protocol consisting of daily chlorhexidine gluconate bathing (CHG) and an alcohol nasal antiseptic twice per day for all adult inpatients ≥ 18 years of age. This prompted us to conduct a gap analysis and evidence-based practice review to address our current MRSA decolonization practices. Methods: In January 2024, a revised MRSA decolonization protocol was implemented for our adult inpatient population consisting of the addition of nasal mupirocin twice per day for 5 days for all Intensive Care Unit (ICU) patients, MRSA nasal screening for high-risk patients, and implementation of contact precautions (gown, gloves) for patients identified or known with MRSA colonization and/or infection. The nasal alcohol antiseptic was removed from the revised protocol. Multidisciplinary education on the protocol changes (MRSA screening, isolation, and discontinuation of the nasal antiseptic) were disseminated to nursing, pharmacy, and the medical staff. Mupirocin was added to the standing ICU order set in the electronic medical record (EMR). Pre-intervention (February 2023 - January 2024) and Post-intervention (February 2024-October 2024) time periods were used to assess the impact on the rate of HO MRSA bacteremia and were obtained from The National Healthcare Safety Network (NHSN) standardized infection ratio (SIR) 2015 baseline with analysis using the NHSN statistics calculator. Results: Following implementation of the decolonization protocol, the MRSA bacteremia cumulative SIR decreased 91% from 1.077 to 0.096 which was statistically significant with a two-tailed p-value of 0.0021 (95% Confidence interval: -99.6, -49.5). The housewide MRSA bacteremia rate decreased from 1.05 infections per 10,000 patient days to 0.090 per 10,000 patient days which reflected a significant decrease (p: 0.0016). The ICU MRSA bacteremia rate also showed statistical significance with a decrease from 4.2 per 10,000 patient days to 0.00 per 10,000 patient days (p: 0.0477). Conclusion: Revising the MRSA decolonization protocol significantly decreased our MRSA bacteremia rates. This included re-implementation of contact precautions, screening high-risk patients that could be carriers of MRSA, and mupirocin decolonization for ICU patients. Facilities should consider evaluation of their MRSA decolonization, isolation, and screening practices if unable to decrease their HO MRSA bacteremia rates.

Background: The prevalence of multidrug-resistant organisms (MDROs) in the post-acute care setting is well-documented in adults. Few studies have investigated the prevalence in children. Methods: We performed a prospective, single-center study including children with tracheostomy tubes age 2 months to 17 years admitted to a 24-bed post-acute care unit within a quaternary care children’s hospital. Index respiratory and stool specimens were obtained within two weeks of admission. Subsequent specimens were obtained weekly thereafter for up to eight weeks. MDROs were identified using methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase Enterobacterales (ESBL-E), and carbapenem-resistant Enterobacterales (CRE) selective media (CHROMagar, Hardy Diagnostics). ESBL-E and CRE colonies were additionally plated onto MacConkey agar and only lactose fermenting organisms were considered positive. Index MDRO status was defined using week one samples; if not available, week two results were substituted. New MDRO acquisition was defined as a negative index MDRO culture with a subsequent positive culture. Results: A total of 47 children were enrolled. Median age was 9 months (interquartile range [IQR], 5-31 months) and median hospital length of stay prior to post-acute care admission was 89 days (IQR 27, 158). The most common pre-existing medical conditions were congenital heart disease (19, 40%), severe neurologic impairment (19, 40%), and prematurity Conclusion: MDROs are common in children hospitalized in the post-acute care unit. Nearly half of this cohort acquired CRE following admission, highlighting the need for strict infection prevention and control measures and tailored empiric antibiotic strategies.

In this paper, we study the distribution of the temperature within a body where the heat is transported only by radiation. Specifically, we consider the situation where both emission-absorption and scattering processes take place. We study the initial-boundary value problem given by the coupling of the radiative transfer equation with the energy balance equation on a convex domain $ \Omega \subset {\mathbb{R}}^3$ in the diffusion approximation regime, that is, when the mean free path of the photons tends to zero. Using the method of matched asymptotic expansions, we will derive the limit initial-boundary value problems for all different possible scaling limit regimes, and we will classify them as equilibrium or non-equilibrium diffusion approximation. Moreover, we will observe the formation of boundary and initial layers for which suitable equations are obtained. We will consider both stationary and time-dependent problems as well as different situations in which the light is assumed to propagate either instantaneously or with finite speed.