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

We conducted a two-phase randomized controlled trial evaluating routine versus automated hydrogen peroxide–peracetic acid disinfection of inpatient clinician-assigned phones. Both strategies significantly reduced microbial bioburden and clinically important pathogens. High baseline contamination under routine practice suggests adherence, rather than intrinsic efficacy, is the primary determinant of device cleanliness.

Community-dwelling older women (age >50) with lived experience of incarceration (LEI) are an increasing yet mostly unacknowledged group with long-term health challenges. Research addressing aging-related health in older women with LEI is rare, and almost none engages collaboratively and equitably with older women to understand their aging-related health needs, preferences, and priorities. To foster awareness and readiness for engagement in outcomes research, we co-planned, implemented, and evaluated a sequence of interlinked activities and outputs with older women, clinicians and researchers, and community advocates. The Older Women Leading Healthy Aging Research Together (OWLHART) network met monthly from November 2024 to June 2025. Four to six women, two clinician-researchers, two community advocates, and a project team shared aging-related health beliefs, concerns, and outcome priorities; learned the basics of research and benefits of patient-centered outcomes research; created tools to teach about older women’s health after incarceration and the role of research; and developed outreach to disseminate the work. OWLHART models an equity-focused capacity-building approach for research engagement outside the clinical setting and with a patient group that has been overlooked as patients and as research partners.

Introduction: The prevention of colonization of new inpatient room sinks with epidemiologically important pathogen (EIP) is poorly understood. Methods: We performed a randomized controlled trial and microbiological analysis to describe the timing and frequency of EIP contamination of in-room handwashing sinks in a renovated general medicine unit and to test the efficacy of a disinfectant on wastewater drains. Unit renovations included new distal plumbing for all unit sinks. Sinks were randomized 1:1 to intervention and control. 15 intervention sinks underwent the application of a foamed disinfectant into each study sink’s drain (Virasept [Ecolab]) every Monday, Wednesday, and Friday. 15 control sinks underwent standard disinfection. Microbiological samples were taken every week from 3 locations from each study sink: the top of the bowl, the tail pipe, and the p-trap. The primary outcome was sink conversion events (SCEs), defined as species-specific-EIP contamination of a sink in which that EIP had not previously been detected. EIPs were defined as Enterobacterales, Acinetobacter spp., Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Sink hygiene compliance was also measured. Results: Sink samples were obtained 11 times from July 2024 to October 2024 giving 990 total cultures, 495 in each study arm. The first sampling occurred after renovations were completed and one week before patients returned to the unit. In total, 314 patients were admitted to the study unit during the study period. We observed 15 SCEs (68%) overall; 3 sinks (20%) in the intervention and 12 (80%) in the control arms (p < 0 .01) (Figure 1). Overall, 135 EIPs were recovered: 27 from intervention and 108 from control sinks (p < 0 .01). On the first sampling, 6 intervention and 3 control sinks already harbored EIP. Of those, all 6 in the intervention arm were not detected in subsequent samplings whereas all 3 in the control arm were. The [DAM1] [A2] most common organisms recovered were Acinetobacter spp. (70 [52%]), Stenotrophomonas maltophilia (29 [21%]), and Enterobacter spp. (23 [17%]). Of the 300 opportunities to measure sink hygiene compliance, 229 (76%) did not meet compliance, most commonly containing absorbent pads. Discussion: In a renovated general medicine unit, the application of the intervention led to significantly lower SCEs (20% vs. 80%) and EIPs (27 vs. 108) recovered from study stinks compared to control. Sink hygiene compliance was suboptimal, with 76% of observed instances involving inappropriate sink use. These findings highlight the importance of effective sink disinfection and sink hygiene protocols in reducing the risk of pathogen transmission.

Background: Crisp Regional Hospital (CRH) in Georgia initiated a quality improvement project to address the excessive and inappropriate urine culture orders among inpatients. The project aimed to reduce these orders by at least 30% by June 2024, targeting the prevalent issues of increased healthcare costs and antibiotic misuse stemming from unnecessary testing. Methods: Using the Institute for Healthcare Improvement (IHI) framework, the project implemented a series of multidisciplinary strategies. These included nursing education on proper urine collection, policy updates to facilitate accurate specimen collection from specific patient groups, medical staff education on appropriateness of urine test ordering and a change in reflex criteria for urine testing. Data was analyzed using statistical process control and T-tests to assess the impact of the interventions. Results: The intervention led to a reduction in urine tests from 618 to 570. Tests reflexed to culture decreased significantly from 34.63% to 18.95% (p Conclusion: The quality improvement initiative at CRH significantly reduced unnecessary urine cultures, optimized resource use, and maintained diagnostic integrity. The interventions implemented were effective and scalable, demonstrating substantial cost savings and enhanced patient care quality. Further efforts will focus on analyzing the impact of removing pre-checked orders and implementing mandatory testing indications to continue improving urine testing practices.

Early detection and active management of invasive group A Streptococcus (iGAS) infection outbreaks are essential. Here, we describe the changing epidemiology of outbreaks of iGAS in England between 2015 and 2019, a period of increasing incidence of iGAS infection. Data on iGAS infections were extracted from national public health management records and laboratory records. Outbreaks were described in size, duration, setting, and emm type. Overall, 194 outbreaks were identified, and reports increased each year, from 16 outbreaks in 2015 to 61 in 2019. The median outbreak size was 3 cases (n = 37; 19%), with 27% of outbreaks recording 4–10 cases (n = 53) and 7% recording more than 10 cases (n = 13). Outbreak duration ranged from 0 to 170 weeks (median 7). Settings of outbreaks changed over the study period, with increasing numbers observed in multiple settings. This study provides new insights into the changing burden of iGAS infection and outbreaks in England.

Background: Environmental sampling and detection methods for fungi in healthcare settings are not well-established. We previously refined methods for fungal sampling and detection in a controlled laboratory environment and aimed to validate them in a real-world healthcare setting. Methods: We performed a microbiological analysis of air and surfaces in three inpatient units at a tertiary care center. Surface samples were obtained with foam sponges from 3 locations in patient rooms (Patient bedrails, bathroom floor, HVAC export) and 5 locations in units (HVAC exports 3x, clean linen storage, soiled linen storage). Air samples were taken with an active air sampler directly below HVAC exports. Sponges were processed using the stomacher technique. Samples underwent DNA extraction followed by qPCR with FungiQuant primers targeting the 18S rRNA gene. Amplicons from positive samples were sequenced (NextSeq 1000, 300bp PE) and SmartGene databases were used to interpret sequence data. For comparison to culture methods, samples were also plated onto Sabouraud and HardyCHROM Candida + auris medias. Fungal growth underwent DNA extraction, 18S PCR and Sanger sequencing for genus and species identification. Results: A total of 85 samples were obtained, from 15 patient rooms and three units resulting in 61 surface and 24 air samples. Patients in study rooms had a median age of 53, 9 (60%) were male, and no patients had an invasive fungal infection during their hospital encounter. 44 (53%) and 39 (46%) samples were positive for fungi via qPCR and culture, respectively. Of the 44 positive qPCR samples, microbiome analyses identified at least one fungi to the species, genus and family levels in 43 (98%), 28 (64%), 18 (41%) samples, respectively (Table 1). 114 total isolates were identified of which the most common were Mallassezia restricta (30 [26%]), Malassezia globose (29 [25%]), and Pennicillium paradoxum (4 [4%]). 39 genera were identified of which the most common were Mucor (19 [49%]) and Candida (8 [21%]). Of the 39 culture positive samples, 90 total isolates were recovered. The most common species were Paradendryphiella arenariae (19 [21%]), Aspergillus niger (12 [13%]) and Penicillium commune (12 [13%]). Conclusion: These results demonstrate the presence of diverse fungal species in both air and surface samples across inpatient units. Higher sensitivity was noted utilizing qPCR, however, identified genera and species were markedly different between qPCR and culture methods. Larger studies are needed to assess the efficacy of qPCR for fungal detection in the healthcare environment.

Background: Candida auris is an emerging threat to hospitalized patients and invasive disease is associated with high mortality. This study describes clinical and microbiological characteristics of nine patients identified with C. auris at Ohio State Wexner Medical Center discovered through active surveillance or clinical investigation and uses whole genome sequencing (WGS) to compare isolates. Methods: In November 2022, an active C. auris surveillance program was implemented to screen patients admitted to high-risk units (intensive care units and progressive care units). Bilateral axilla and groin swabs were obtained upon unit admission and, if positive, were submitted for C. auris polymerase chain reaction (PCR) with culture and sensitivity testing. Patients with a positive screening or clinical isolate from November 2022 to November 2023 underwent chart review for clinical characteristics, microbiologic data, and index admission information. For each isolate, DNA was extracted and WGS was performed. Core single nucleotide polymorphism (SNP) variation identified from the sequence data was used to infer genetic relationships among the isolates. Results: Nine patients were identified between November 2022 and November 2023. The clinical and microbiologic characteristics are summarized in Table 1. All patients were hospitalized at various acute care facilities across the state at least once in the preceding 12 months. C. auris was determined to be present on admission for 6 patients. For 5 of these patients, it was their first interaction with our healthcare system. Three patients were not in contact isolation for >3 days before C. auris was identified. Unit wide point-prevalence screening was completed in these cases and no evidence of transmission was found. WGS showed eight of the nine isolates were related with 28 or less core SNP differences between isolates (Figure 1). One isolate (8) was genetically distinct with >45000 core SNP differences. Five isolates were highly related with a range of 4-15 SNP differences. No temporal or spatial overlap at our institution was identified among these five patients. Conclusions: The active surveillance program identified several patients colonized with C. auris in addition to those found through clinical testing. Multiple risk factors for C. auris were identified with high patient mortality (67%). Majority of the isolates were closely related without association with a known outbreak or epidemiologic link, suggesting a possible diffuse common reservoir. Next steps with surveillance in acute care and long-term care facilities will be critical for early detection to halt transmission of this organism.

We evaluated sampling and detection methods for fungal contamination on healthcare surface materials, comparing the efficacy of foam sponges, flocked swabs, and Replicate Organism Detection And Counting (RODAC) plates alongside culture-based quantification and quantitative polymerase chain reaction (qPCR). Findings indicate that sponge sampling and qPCR detection performed best, suggesting a foundation for future studies aiming to surveillance practices for fungi.