Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed.

We retrospectively analyzed data on HA-CRE cases and antimicrobial utilization (AU) from two community hospital networks, the Duke Infection Control Outreach Network (DICON) and the Duke Antimicrobial Stewardship Outreach Network (DASON) from January 2013 to June 2023. The zero-inflated negative binomial regression model was used owing to excess zeros.

126 HA-CRE cases from 36 hospitals were included in the longitudinal analysis. The pooled incidence of HA CRE was 0.69 per 100,000 patient days (95% confidence interval [95% CI], 0.57–0.82 HA-CRE rate significantly decreased over time before COVID-19 (rate ratio [RR], 0.94 [95% CI, 0.89–0.99]; p = 0.02), but there was a significant slope change indicating a trend increase in HA-CRE after COVID-19 (RR, 1.32 [95% CI, 1.06–1.66]; p = 0.01). In 21 hospitals participating in both DICON and DASON from January 2018 to June 2023, there was a correlation between HA-CRE rates and AU for CRE treatment (Spearman’s coefficient = 0.176; p < 0.01). Anti-CRE AU did not change over time, and there was no level or slope change after COVID.

The incidence of HA-CRE decreased before COVID-19 in a network of community hospitals in the southeastern United States, but this trend was disrupted by the COVID-19 pandemic.

We investigated gender differences in psychosocial determinants that affect hand hygiene (HH) performance among physicians.

The survey included a structured questionnaire with 7 parts: self-assessment of HH execution rate; knowledge, attitude, and behavior regarding HH; internal and emotional motivation for better HH; barriers to HH; need for external reminders; preference for alcohol gel; and embarrassment due to supervision.

The study was conducted across 4 academic referral hospitals in Korea.

Physicians who worked at these hospitals were surveyed.

The survey questionnaire was sent to 994 physicians of the hospitals in July 2018 via email or paper. Differences in psychosocial determinants of HH among physicians were analyzed by gender using an independent t test or the Fisher exact test.

Of the 994 physicians, 201 (20.2%) responded to the survey. Among them, 129 (63.5%) were men. Male physicians identified 4 barriers as significant: time wasted on HH (P = .034); HH is not a habit (P = .004); often forgetting about HH situations (P = .002); and no disadvantage when I do not perform HH (P = .005). Female physicians identified pain and dryness of the hands as a significant obstacle (P = .010), and they had a higher tendency to feel uncomfortable when a fellow employee performed inadequate HH (P = .098). Among the respondents, 26.6% identified diversifying the types of hand sanitizers as their first choice for overcoming barriers to improving HH, followed by providing reminders (15.6%) and soap and paper towels in each hospital room (13.0%).

A significant difference in the barriers to HH existed between male and female physicians. Promoting HH activities could help increase HH compliance.