Clostridioides difficile infection (CDI) is a leading healthcare-associated infection, with significant morbidity, mortality, and healthcare costs. Effective environmental decontamination is critical for infection control, as C. difficile spores persist on surfaces despite standard cleaning protocols. Ultraviolet (UV) light devices have been proposed as adjuncts to standard disinfection methods, yet their real-world effectiveness in reducing environmental contamination remains unclear. This study evaluates the impact of UV devices on environmental contamination in hospital rooms previously occupied by symptomatic CDI patients and asymptomatic C. difficile carriers. We conducted a prospective interventional before-after study in a tertiary hospital’s internal medicine wards. Environmental samples were collected from ten high-touch sites in 33 rooms occupied by CDI patients (n = 5) or asymptomatic carriers (n = 28). Following routine daily cleaning with sodium hypochlorite (bleach), UV disinfection was performed, and samples were taken before and after UV application using sponge environmental wipes and cultured to quantify colony-forming units (CFUs). A contamination scale (0–4) was used to assess overall contamination levels, incorporating both CFU counts and the number of affected sites. Statistical analysis included Student’s t-test and chi-square tests. Before UV disinfection, 27

BACKGROUND:Carbapenem-resistant Acinetobacter baumannii (CRAB) infections carry high case-fatality rates. Although the incidence of these infections is increasing and therapeutic options are limited, effective interventions to prevent the cross-transmission of CRAB have rarely been tested. AIM:To assess the impact of cohorting CRAB patients combined with intensified environmental cleaning on CRAB bloodstream infections (BSIs). METHODS:A quasi-experimental study at a tertiary hospital during January 2022 to June 2024. All patients with CRAB (either colonization or infection) hospitalized in the internal medicine departments were cohorted. Simultaneously, a twice-daily routine and a double terminal cleaning of all hospital rooms occupied by CRAB patients were performed. The monthly acquired CRAB BSI rates were calculated and the incidence rate ratio (IRR) estimated using Poisson regression discontinuity analysis with robust standard errors controlled for the influx of CRAB patients into the hospital. FINDINGS:During January 2022 to June 2024, 610 hospitalized patients with CRAB were identified, 350 (57%) of whom acquired the bacterium in hospital and 138 (39%) developed BSI. The average overall 30-day mortality rate was 61% and remained relatively similar throughout the study period. Cumulative BSI incidence decreased by 55%, from 1.43 per 10,000 hospitalization-days before the intervention to 0.65 afterwards. The slope of the BSI incidence rate decreased by 9% per month (adjusted IRR: 0.909; 95% CI: 0.834-0.990; P = 0.029). CONCLUSION:Cohorting CRAB patients in the internal medicine departments, combined with intensified cleaning throughout the hospital, significantly reduced the incidence of CRAB BSI across the entire institution.

Since May 2024, Israel has been experiencing a large West Nile virus (WNV) outbreak. We aimed to compare the clinical characteristics and outcomes of hospitalized cases to previous years and identify predictors of poor outcomes. A retrospective study. We compared WNV infection cases hospitalized during the 2024 outbreak (from 29 May to 29 July) to cases hospitalized during 2018–2023. For the entire cohort, risk factors for poor outcomes were investigated using multivariable analyses. The primary outcomes were death and a composite outcome of 30-day all-cause mortality, prolonged hospitalization (≥ 28 days), or discharge to an institution. We included 134 patients, 103 admitted during 2024 and 31 during 2018–2023. The majority (109/134, 81

The emergency department (ED) is the initial point of contact between hospital staff and patients potentially infected with SARS-CoV-2, thus, prevention of inadvertent exposure to other patients is a top priority. We aimed to assess whether the introduction of antigen-detecting rapid diagnostic tests (Ag-RDTs) to the ED affected the likelihood of unwanted SARS-CoV-2 exposures. In this retrospective single-center study, we compared the rate of unwarranted exposure of uninfected adult ED patients to SARS-CoV-2 during two separate research periods; one before Ag-RDTs were introduced, and one with Ag-RDT used as a decision-support tool. The introduction of Ag-RDTs to the ED significantly decreased the relative risk of SARS-CoV-2-negative patients being incorrectly assigned to the COVID-19 designated site ("red ED"), by 97%. There was no increase in the risk of SARS-CoV-2-positive patients incorrectly assigned to the COVID-19-free site ("green ED"). In addition, duration of ED admission was reduced in both the red and the green ED. Therefore, implementing the Ag-RDT-based triage protocol proved beneficial in preventing potential COVID-19 nosocomial transmission.

OBJECTIVE:To assess the validity of Antigen rapid diagnostic tests (Ag-RDT) for SARS-CoV-2 as decision support tool in various hospital-based clinical settings.DESIGN:Retrospective cohort study among symptomatic and asymptomatic patients and Healthcare workers (HCW).SETTING:A large tertiary teaching medical center serving as a major COVID-19 hospitalizing facility.PARTICIPANTS AND METHODS:Ag-RDTs' performance was assessed in three clinical settings: 1. Symptomatic patients and HCW presenting at the Emergency Departments 2. Asymptomatic patients screened upon hospitalization 3. HCW of all sectors tested at the HCW clinic following exposure.RESULTS:We obtained 5172 samples from 4595 individuals, who had both Ag-RDT and quantitative real-time PCR (qRT-PCR) results available. Of these, 485 samples were positive by qRT-PCR. The positive percent agreement (PPA) of Ag-RDT was greater for lower cycle threshold (Ct) values, reaching 93% in cases where Ct-value was <25 and 85% where Ct-value was <30. PPA was similar between symptomatic and asymptomatic individuals. We observed a significant correlation between Ct-value and time from infection onset (p<0.001).CONCLUSIONS:Ag-RDT are highly sensitive to the infectious stage of COVID-19 manifested by either high viral load (lower Ct) or proximity to infection, whether patient is symptomatic or asymptomatic. Thus, this simple-to-use and inexpensive detection method can be used as a decision support tool in various in-hospital clinical settings, assisting patient flow and maintaining sufficient hospital staffing.

Background Several uses of Antigen rapid diagnostic tests (Ag-RDT) have been suggested. Analytical studies reported high specificity yet with lower sensitivity for detecting SARS-CoV-2 compared to qRT-PCR. Here, we present the use of these tests as a decision support tool in several settings. Methods Samples were collected for both Ag-RDT and qRT-PCR in three different clinical settings; 1. Symptomatic patients presenting at the Emergency Departments 2. Asymptomatic patients screened upon hospitalization and 3. Health-care workers (HCW) following SARS-CoV-2 exposure. Positive percent agreement (PPA), negative percent agreement (NPA), positive predictive value (PPV) and negative predictive value (NPV) were calculated. To estimate the association between Ct value, Ag-RDT and the number of days since SARS-CoV-2 exposure or symptomatic COVID-19, a mixed model was applied. Results A total of 5172 samples were obtained from 4595 individuals, with Ag-RDT and qRT-PCR results. Of these, 485 samples were positive by qRT-PCR. The PPA of Ag-RDT was greater for lower Ct values, reaching 93% in cases where Ct value was lower than 25 and 85% where Ct value was lower than 30. PPA was similar between symptomatic and asymptomatic individuals. The NPV and PPV were 96.8% and 99.1%, respectively. We observed a significant correlation between Ct value and time from infection onset (p<0.001). Lower Ct values were significantly associated with a positive Ag-RDT (p=0.01). Conclusions Ag-RDT can be used as a decision support tool in various clinical settings and play a major role in early detection of SARS-CoV-2 infected individuals, highly specific and with high sensitivity to the infectious stage of disease, whether symptomatic or asymptomatic.

ObjectiveThe role of school closure in mitigating coronavirus disease 2019 (COVID-19) transmission has been questioned. In our medical centre, during a 9-week national lockdown, an alternative school was opened for health-care workers' (HCW) children with a small number of children per class and strict symptom surveillance. After lockdown was lifted we screened children and their parents for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology.MethodsWe conducted a cross-sectional study of HCW parents and their children after one teacher contracted COVID-19 following exposure at home and 53 children were exposed, isolated and tested by RT-PCR. We compared families with children attending the alternative school with families whose children who remained at home during the 9-week lockdown. Epidemiological and medical data were collected using a short questionnaire; nasopharyngeal and oropharyngeal swabs were obtained and tested for SARS-CoV-2 by RT-PCR, and blood was collected for SARS-CoV-2 IgA and IgG titres.ResultsA total of 435 children attended the Sheba alternative school. Among the 53 children exposed to the infected teacher, none tested positive by RT-PCR. Of these, 18 children–parent pairs were tested for serology and all were negative. A total of 106/435 (24%) children and their 78 parents were recruited for the cross-sectional study; 70 attended the Sheba school and 36 did not. Approximately 16% of children in either group reported symptoms (11/70 in the school group and 6/36 in the ‘stay home’ group), but SARS-CoV-2 was not detected by PCR in any, and previous exposure, as determined by serological tests, was low and not significantly different between the groups.ConclusionIn an alternative school for children of HCWs, active during COVID-19 national outbreak, we found no evidence of increased infection compared with children that stayed home.