BACKGROUND:Knowledge-practice gaps hinder consistent compliance with multidrug-resistant organism (MDRO) prevention measures. We evaluated the impact of an integrated closed-loop audit and feedback system on infection prevention and control (IPC) adherence. METHODS:This prospective pre-post study (2024 - 2025) implemented standardized checklist audits, fluorescent marker monitoring, and real-time mobile application feedback. Data were analyzed using generalized estimating equation (GEE) and Pareto analysis to identify independent predictors and key improvement drivers. RESULTS:The intervention independently increased overall compliance by 24.97 percentage points (95% CI: 22.28 - 27.66, P < 0.001), with median compliance rising from 58.82% to 84.62%. Pareto analysis showed that 13 key measures, including terminal cleaning, intensive caregiver engagement, and standardized isolation protocols, drove 82.34% of improvements. Bedside and single-room isolation were positive predictors, while informal caregiver presence was a negative predictor (β = -13.11, P < 0.001). Environmental cleaning compliance was 82.58%, with deficiencies noted on small, irregular surfaces. Post-intervention MDRO detection rates remained consistently below the 34.37% baseline. CONCLUSIONS:The closed-loop system significantly enhanced compliance with IPC. Sustainable containment requires integrating precision micro-isolation and structured caregiver management into clinical workflows.
BACKGROUND:Despite high infection risk among home healthcare (HHC) patients, little is known about home environmental conditions that may affect infection prevention and control (IPC). METHODS:We conducted a cross-sectional study of 250 HHC patients and caregivers from two Medicare-certified agencies. In-home surveys and structured observations assessed household hazards, and, in more detail, cleanliness and clutter. Multivariate linear regression examined associations between home environment and sociodemographic, clinical, and community factors. RESULTS:On average, at least one household hazard was observed; poor lighting and clutter were the most common, followed by infestation. Homes were predominantly assessed as mostly clean but exhibited moderate clutter. Older age, being Hispanic, and more favorable IPC attitudes were associated with greater cleanliness. Difficulty paying medical bills was associated with higher clutter scores. High neighborhood deprivation was associated with lower clutter scores. DISCUSSION:Although homes were mostly clean, clutter and hazards were common and may impede IPC practices. Individual-level factors, particularly difficulty paying medical bills and attitudes towards the home environment, were most strongly associated with home environmental conditions. CONCLUSIONS:Incorporating structured home environment assessments into HHC practice may help identify modifiable barriers to IPC and inform targeted interventions in home-based care.
BACKGROUND:Evidence on long-term, hospital-wide antimicrobial stewardship in county-level hospitals remains limited. We evaluated a pharmacist-led bundled program in a county-level tertiary referral hospital. METHODS:We conducted a retrospective interrupted time-series study using monthly hospital-level data from January 2019 through December 2024. The program combined multidisciplinary governance, departmental accountability, tiered antimicrobial authorization, computerized pre-prescription review, and ward-based pharmacist stewardship. The primary outcome was antimicrobial use density (AUD), expressed as defined daily doses per 100 patient-days; prescribing appropriateness was an exploratory process outcome. RESULTS:Annual hospital-wide AUD decreased from 55.93 in 2019 to 31.10 in 2024. Monthly AUD was already decreasing before implementation (-0.90 per month; 95% CI, -1.47 to -0.32). The immediate level change in January 2020 was not significant (-2.59; 95% CI, -6.18 to 1.01; P =.155), whereas the post-intervention trend remained downward (-0.14 per month; 95% CI, -0.21 to -0.07; P <.001). Appropriateness of sampled special-use antimicrobial prescribing increased from 63.00% to 94.58%. CONCLUSIONS:The bundled program was associated with continued reductions in inpatient antimicrobial use and improved exploratory prescribing-appropriateness indicators over five post-intervention years. Transferability and economic feasibility require further evaluation.
Background Ethanol flushing is commonly used during terminal drying of digestive endoscopes, but its impact on residual protein removal remains unclear. This study compared compressed air drying alone with ethanol plus compressed air drying during endoscope reprocessing. Methods In this prospective randomized comparative study, 900 digestive endoscope reprocessing cycles were allocated 1:1 to ethanol plus compressed air drying or compressed air drying alone. Adenosine triphosphate (ATP), microbial culture outcomes, and protein residue were assessed. Results A total of 874 cycles were analyzed (435 ethanol plus compressed air and 439 compressed air drying alone). ATP values in both groups met the acceptable threshold (≤200 RLU). Disinfection qualification rates and microbial culture negativity rates did not differ significantly between groups (all P > 0.05). Baseline protein residue levels were comparable, while post-disinfection protein residue levels were significantly lower with compressed air drying alone (all P < 0.001). Conclusion Compressed air drying alone was associated with lower residual protein levels, with no significant differences in microbiological outcomes. These findings support further evaluation of compressed air drying as a potential terminal drying strategy.
BACKGROUND:The advent of artificial intelligence (AI) presents an opportunity to enhance infection prevention practices. However, its use among infection preventionists (IP) remains unknown. METHODS:We analyzed responses from IPs participating in the 2025 APIC MegaSurvey to assess (1) current utilization of AI (2) familiarity and perceived usefulness of AI, (3) organizational readiness, (4) barriers and (5) training and support needs. RESULTS:A total of 4,269 IPs participated in the survey, of whom 3,220 participants responded to the AI section. Among respondents, 12.6% (n=404) reported using AI. Of those that use AI, 65.7% (n=266) used generative AI tools such as ChatGPT to draft policies, educational content, or to synthesize research followed by AI-powered chatbots to support triage or deliver staff education (35.6%, n=144), risk stratification (32.8%, n=133) and predictive modeling (21.7%, n=88). Most respondents perceived AI as useful (80%, n=2657) and were interested in learning more (n=2413, 74.9%). Lack of organizational readiness, limited access, concerns about accuracy, data privacy and job displacement were among barriers identified. DISCUSSION:AI use among IPs remains low, despite interest and perceived value. There remain concerns about accuracy, data privacy, and job displacement. CONCLUSIONS:Findings highlight a gap between interest in AI and its integration into IP practice. Efforts to improve training, access, and organizational readiness will be essential to support safe and effective adoption.
BACKGROUND:Urinary tract infections (UTI) are the most prevalent health care associated infection in residential aged care homes (RACH), affecting 23.6% of older people in any settings. Management strategies vary significantly. This scoping review evaluates best practice UTI management in RACHs over the last 13 years. METHODS:A systematic search of Medline, CINAHL, and Embase was conducted to identify studies reporting UTI management using current diagnostics criteria. Studies published between January 2013 to January 2026 were included. RESULTS:Of 1,112 studies identified, 33 met inclusion criteria. Studies were categorized by outcome with 9 evaluating UTI interventions and measuring UTI rates, 10 measuring diagnostic accuracy and 19 reporting antimicrobial prescribing and several reporting multiple outcomes. DISCUSSION:Multifaceted UTI management programs including antimicrobial stewardship and a combination of staff education, guidelines, decision-support tools and use of change champions effectively reduced UTI rates. Diagnostic inconsistencies exist when applying McGeer surveillance criteria, Loeb's minimum criteria, and specific organizational criteria potentially resulting in inappropriate antimicrobial prescribing. CONCLUSIONS:A standardized, validated UTI definition is needed to improve diagnostic accuracy and support antimicrobial stewardship for older populations. Further, multifaceted programs are effective but additional research is warranted to evaluate the full impact of interventions and aspects that work.
BACKGROUND:Surgical site infections (SSIs), including prosthetic joint infections (PJI), are one of the many complications that can occur after total hip arthroplasty. In this report, we examined risk factors associated with SSI following hip arthroplasties among patients in a 10-hospital safety network in New York City. METHODS:Data were obtained from the National Healthcare Safety Network (NHSN) on patients who underwent hip arthroplasty between 2015 and 2023. Surgical site infections were defined per NHSN criteria. Propensity score matching using NHSN risk adjustment variables was used to create a closely matched control group. RESULTS:Over the 8 years, 3,679 hip arthroplasties were performed across the 10 hospitals, which resulted in 54 SSIs (1.5%). Patients with SSIs had significantly higher body mass indexes (BMIs) and ASA scores (both P < .05). When examining the socioeconomic differences between our cases and controls, we found higher rates of infections occurred in geographical areas of higher poverty (P < .001). Lastly, Hispanic or Black patients had higher occurrences of SSIs compared to other races (P < .05). CONCLUSION:Our report demonstrated the association of poverty level with SSIs following hip arthroplasty. This underscores the need for comprehensive and aggressive post-discharge programs in under resourced communities in the prevention of SSI following hip arthroplasty.
BACKGROUND:To establish a standardized framework for interpreting color changes in chemical indicators (CIs) in sterilization, and improve accuracy and clinical feasibility. METHODS:A questionnaire was administered to 902 health care professionals to evaluate their interpretation difficulties, confusion rates, and support for a unified color standard. In addition, pre- and post-sterilization CI color data were collected across 4 sterilization modalities: steam (n = 74), hydrogen peroxide plasma (n = 63), ethylene oxide (n = 38), and formaldehyde (n = 28). Data were compared with ISO 11140-1:2014 and GB/T 18282.1-2025. RESULTS:Among clinical staff, 32.71% reported interpretation difficulties, with the main reasons being ambiguous color changes (58.3%) and non-uniform standards (41.7%), and 25.17% had confused indicators for different sterilization modalities. Notably, 87.36% supported a unified color standard. Post-sterilization color changes varied markedly across and within modalities: steam predominantly turned black, plasma predominantly turned yellow, ethylene oxide predominantly turned green/blue, and formaldehyde predominantly turned green. CONCLUSIONS:The current lack of cross‑manufacturer harmonization in CI color‑change schemes leads to confusion and misinterpretation risks among clinical staff. A unified, intuitive color‑change standard, preferably based on an international safety color system, is urgently needed to improve the accuracy and practicality of sterile package assessment, thereby ensuring patient safety and reducing clinical risks.
BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic prompted proactive infection control measures, including improved hand hygiene and mask-wearing; however, viral respiratory infections, such as those caused by rhinoviruses, were not fully controlled by such public health measures during the pandemic. Because rhinovirus, a member of the Picornaviridae family, has a smaller particle size compared with coronaviruses, we investigated the protective performance of personal protective equipment (PPE), including protective clothing and masks, against picornaviruses. METHODS:We analyzed the protective performance of 4 medical fabrics used in commercially available PPE, categorized by International Organization for Standardization (ISO) grades, under realistic viral aerosol and liquid conditions. The evaluation experiments were conducted using a newly developed test device with inactivated poliovirus (IPV), Picornaviridae family, and quantitative real-time polymerase chain reaction (qPCR). RESULTS:Woven and nonwoven fabrics of higher ISO grades provided substantial resistance to IPV aerosols. Testing via qPCR showed that resistance to IPV-aerosol penetration differed significantly, even between fabrics within the same ISO category. In contrast, the fabrics in the lower ISO grades did not exhibit lower resistance to liquid drops than those in higher grades. CONCLUSIONS:Our findings may serve to inform optimal PPE selection by healthcare workers.
BACKGROUND:Needlestick and sharps injuries (NSIs) are a major occupational hazard among healthcare workers, yet data on preventability, recurrent events, and COVID-19-related temporal trends remain limited. METHODS:This retrospective study analyzed NSI events reported between 2018 and 2025 at a tertiary-care hospital. Injury mechanisms were classified from narrative reports, and preventability was assessed using predefined criteria. Incidence per 100 person-years was calculated. Poisson and multinomial logistic regression models were used for risk and preventability analyses. RESULTS:A total of 354 NSI events were included. Median age was 25 years, and 72.6% were female. Nurses had higher incidence than physicians (IRR 1.84; 95% CI 1.28-2.64). Hollow-bore needles accounted for 83.6% of injuries, and procedural injuries were most common (48.0%). Overall, 42.4% of injuries were preventable and 48.0% partially preventable based on study-specific predefined criteria. Cleaning staff had higher odds of preventable injuries. NSI incidence declined over time, with higher rates in the pre-pandemic period compared with the post-pandemic period. Recurrent injuries occurred in 4.5%, and only 11.3% adhered to follow-up. CONCLUSION:Mechanism-based classification identified a substantial proportion of preventable NSIs, suggesting that a considerable fraction of occupational exposures may be reduced through targeted infection control interventions. These findings highlight the importance of focusing on modifiable procedural and waste-management-related factors to improve healthcare worker safety.
This pilot study evaluates the implementation of a High Consequence Infectious Disease (HCID) screening process using the "identify, isolate, and inform" (III) framework across three emergency departments in Minnesota. The study compares adherence rates from a COVID-19-specific screening baseline to broader, disease-nonspecific screenings. Findings indicate stable adherence rates, suggesting that incorporating HCID protocols into regular hospital operations can sustain compliance and streamline enhanced infection prevention processes. The screening tool guidance is available for public use.1.
BACKGROUND:The 2025 United States (US) measles outbreak supports concerns that measles may have significant resurgences. The study's objectives were to characterize measles serologic testing rates, estimate measles IgG seronegativity rates, and determine independent variables associated with seronegativity across the US Veterans Health Administration (VHA). METHODS:A nationwide retrospective, observational study was conducted, collecting data from veterans with measles IgG antibody testing performed from January through June in 2024 (preoutbreak) and 2025 (outbreak). Endpoints included determining independent variables associated with 1) measles IgG testing within the outbreak period vs the preoutbreak period, and 2) measles IgG seronegativity within the outbreak period. RESULTS:In total, 16,446 veterans had measles IgG testing in the outbreak period, a 60.3% increase in the testing rate compared with the nonoutbreak period. Seronegativity was found in 1,220 (11.9%) veterans in the nonoutbreak period and 1,509 veterans (9.18%) in the outbreak period (P < .0001). Independent variables associated with seronegativity included age 64 years or below (OR 5.65, 95% CI 4.59-6.94), Janus kinase inhibitor use (OR 3.54, CI 1.24-10.1), and immunodeficient condition (OR 3.10, CI 2.34-4.11). CONCLUSIONS:As measles re-emerges, certain populations were identified that may be at higher risk of infection and transmission, particularly those with immune compromise.
BACKGROUND:The oral cavity may serve as a reservoir of hospital-associated bacterial pathogens in critically ill patients. However, the prevalence of oral colonization and associated clinical factors remain incompletely characterized. METHODS:This multicenter cross-sectional study included 120 adult ICU patients from two Brazilian hospitals. Oral samples collected from the dorsal surface of the tongue were analyzed using conventional culture-based microbiological methods. Patients were classified according to ventilatory support (without invasive ventilation, endotracheal tube ventilation, or tracheostomy). Factors associated with oral colonization were evaluated using univariable and multivariable logistic regression analyses. RESULTS:Oral colonization by hospital-associated bacterial pathogens was identified in 77 patients (64.2%). Prevalence differed according to ventilatory support, affecting 42.5%, 60.0%, and 90.0% of patients without invasive ventilation, receiving endotracheal tube ventilation, and with tracheostomy, respectively (P < .001). Klebsiella pneumoniae (46.8%), Pseudomonas aeruginosa (28.6%), and Acinetobacter spp. (22.1%) were the predominant bacterial pathogens identified. Longer ICU stays were observed among colonized patients than non-colonized patients (17.7 ± 13.0 vs 9.4 ± 10.6 days, mean ± SD; P < .001). Tracheostomy remained independently associated with oral colonization (adjusted OR, 7.77; 95% CI, 2.18-27.75; P = .002). CONCLUSIONS:Oral colonization by hospital-associated bacterial pathogens was highly prevalent and more frequent with increasing invasiveness of ventilatory support. Tracheostomy was independently associated with colonization, supporting systematic oral assessment and evidence-based oral healthcare within multidisciplinary ICU infection prevention strategies.
BACKGROUND:Healthcare-associated infection (HAI) surveillance relies on standardized case definitions, yet variation in diagnostic criteria across surveillance frameworks may affect interpretation and comparability of infection indicators. METHODS:Official surveillance manuals and guidance documents from 13 international, regional, and national HAI surveillance frameworks were reviewed. Seven systems with sufficiently detailed diagnostic criteria were included in a structured comparative analysis. Four infection categories (CLABSI, CAUTI, pneumonia, and surgical site infection) were evaluated across 4 diagnostic domains: clinical criteria, microbiological evidence, device/procedure association, and temporal thresholds. RESULTS:Seven surveillance systems yielded 52 surveillance definitions and 208 coded diagnostic elements. Comparative analysis identified variation in how surveillance frameworks operationalized clinical criteria, microbiological evidence, device/procedure association, and temporal thresholds. Device/procedure association and temporal thresholds were consistently specified, whereas microbiological requirements varied across infection types and surveillance contexts. Pneumonia definitions demonstrated the greatest heterogeneity in diagnostic specification across surveillance frameworks. DISCUSSION:Structural differences in surveillance definitions may influence how infections are identified and reported within surveillance systems, potentially affecting interpretation of benchmarking data and cross-system comparisons. CONCLUSIONS:Structural variation in HAI surveillance definitions should be considered when comparing infection indicators, implementing automated surveillance systems, or adapting surveillance frameworks across healthcare settings.
BACKGROUND:Inappropriate antibiotic treatment of asymptomatic bacteriuria (ASB) remains common in hospitalized patients. This study evaluated the impact of 2 electronic stewardship interventions across 5 hospitals. METHODS:This multicenter, retrospective study included adult patients (≥ 18 years old) admitted between January 2020 and January 2026 with confirmed ASB. Patients were excluded for death within 48 hours, neutropenia, receipt of antibiotics for an active infection, or urologic procedure with mucosal involvement. Two electronic interventions were implemented 1 year apart: a best practice advisory (BPA) prompting appropriate urine culture ordering, followed by a microbiology nudge at the time of urine culture results to encourage reassessment of therapy. Patients were categorized into pre-BPA, BPA, and BPA plus nudge (BPAN) cohorts. The primary outcome was antibiotic treatment for more than 24 hours. RESULTS:A total of 903 patients were included (pre-BPA n = 572, BPA n = 112, BPAN n = 219). Antibiotic treatment beyond 24 hours occurred in 53.7% of patients in the pre-BPA cohort, compared to 34.8% in the BPA cohort and 45.7% in the BPAN group (P < .01). CONCLUSIONS:Electronic stewardship interventions reduced unnecessary antibiotic treatment of ASB. Active alerts at the time of urine culture ordering were more effective than passive reminders introduced later in care. Interventions that require immediate action appeared to be more effective than passive reminders.
Point-prevalence surveys (PPSs) support antimicrobial stewardship, but surgical antimicrobial prophylaxis (SAP) estimates may be shaped by visibility windows. Using PPS and prospective surgical site infection surveillance (SNICh) data, we compared crude procedure-level, visibility-weighted PPS-like, and PPS-observed estimates of prolonged SAP. The crude SNICh estimate was 12.44%, increasing to 40.86% after visibility weighting, close to the PPS-observed 39.87%, supporting visibility-sensitive interpretation of PPS SAP indicators.
BACKGROUND:Antiseptics and disinfectants are heavily used in healthcare facilities, and these germicides are an essential part of infection control practices and aid in the prevention of nosocomial infections. METHODS:This synopsis will discuss 2 published papers that reviewed outbreaks and pseudo-outbreaks of antiseptics and disinfectants over several decades. RESULTS:In the time period prior to 2006, a total of 39 outbreaks and pseudo-outbreaks were reported in the English literature from contaminated antiseptics and 5 from contaminated disinfectants. During the period 2006-2024, 21 outbreaks and 4 pseudo-outbreaks were reported associated with contaminated antiseptics and disinfectants globally. CONCLUSIONS:Antiseptics and disinfectants are not self-sterilizing. Mitigation strategies reduce the risk of extrinsic contamination.
Background Before 1970, US hospitals conducted scheduled culturing of the air and environmental surfaces. Currently, routine environmental culturing is not recommended. Targeted microbiologic sampling is only recommended for research purposes, outbreak investigations, and when there are validated culture methods and action level based on culture results. Methods The paper is a commentary. The literature was reviewed to find published guidelines that provide recommendations for appropriate microbiologic sampling of the hospital environment based on validated culture methods and provide action levels based on culture results. Results Microbiologic sampling of the hospital environment is recommended in the following circumstances: Biological monitoring of sterilization processes, cultures of water/dialysate used for hemodialysis, dental waterlines, specified locations in pharmacies performing sterile compounding, surveillance for Legionella, and sampling of duodenoscopes. Conclusions Health care facilities should only perform routine microbiological sampling of the environment when recommended by guidelines.
BACKGROUND:Mpox, Nipah virus, and Andes virus are emerging infectious diseases that cause outbreaks associated with nosocomial transmission. METHODS:This narrative review summarizes the Mpox, Nipah virus, and Andes virus epidemiology, clinical manifestations, diagnosis, and treatment with a focus on environmental survival, susceptibility to antiseptics and disinfectants, and infection prevention. RESULTS:Mpox, Nipah virus, and Andes virus all survive in the environment and are capable of indirect transmission. All these viruses are enveloped and susceptible to commonly used antiseptics and surface disinfectants. CONCLUSIONS:Rapid identification of patients with known or suspected infections of these emerging viruses coupled with adherence to infection prevention recommendations will prevent healthcare-associated transmission.
BACKGROUND:Investigation of endoscopy-associated outbreaks has underscored the importance of ensuring that reusable endoscopes are clean, intact, and dry to prevent pathogen survival and transmission. METHODS:Researchers compiled evidence from recent peer-reviewed articles, standards, and reports from governmental agencies, including adverse event reports, safety communications, and inspection reports by state health departments. Researchers created narratives, tables, and figures to illustrate issues with endoscope processing effectiveness. These included sterile processing breaches found during outbreak investigations and the proportion of endoscopes with visible defects, residual soil or microbes, or retained fluid. RESULTS:Nonadherence with standards for endoscope processing is widespread, and inadequate quality assurance has been linked to outbreaks of infection and other adverse outcomes. High-level disinfection did not reliably eliminate microbes, and studies found most patient-ready endoscopes in real-world settings were damaged and dirty. CONCLUSIONS:To improve processing outcomes and reduce the risk of patient exposures and infections, routine audits and quality assurance steps including cleaning verification tests and visual inspection, are needed. Sterilization may offer a greater margin-of-safety than high-level disinfection because it is capable of a larger reduction in microbial load, utilizes automated systems, has embedded quality indicators, and provides an endoscope that is packaged and protected from contamination.
