Background: Optimizing antimicrobial use is essential to reducing antimicrobial resistance and healthcare-associated infections. The Standardized Antimicrobial Administration Ratio (SAAR), reported through the National Healthcare Safety Network (NHSN), provides a risk-adjusted benchmark for antimicrobial utilization, yet its use as a structured feedback tool across multiple hospitals remains limited. In June 2025, a jurisdiction-led antimicrobial stewardship intervention was implemented to provide standardized, data-driven feedback to acute care hospitals. This analysis evaluates early changes in facility-level SAARs following implementation. Methods Five acute care hospitals participated in a monthly feedback intervention adapted from a previously piloted quarterly model. Public health analysts generated standardized written reports using routinely submitted NHSN SAAR data for adult inpatient antimicrobial use. Reports included facility-level SAAR benchmarking, peer comparisons across participating hospitals, and qualitative assessment of prescribing patterns, including empiric therapy selection, de-escalation opportunities, and duration of therapy. Facility-level SAAR trends from January 2024 through December 2025 were examined using descriptive time-series review. Percent change relative to the June 2025 baseline was calculated for July–December 2025. Year-over-year comparisons to the same months in 2024 were used to account for seasonality. Results Pre-intervention SAARs varied across hospitals, with several facilities demonstrating upward trajectories. Following implementation, three of five hospitals demonstrated relative declines in overall SAARs, while two hospitals showed stabilization after previously increasing trends. Percent-change analyses for July–December 2025 showed reductions of approximately 0.5% to 7% compared with the June 2025 baseline, with three hospitals achieving declines of 5–7%. Year-over-year comparisons indicated reductions of approximately 3–10% in three hospitals, with the remaining facilities showing stable use (≤2% change). Conclusions Early findings suggest that a jurisdiction-led, SAAR-based feedback model may support measurable improvements or stabilization in antimicrobial use across diverse acute care hospitals. Leveraging routinely available NHSN data to provide consistent, structured feedback represents a feasible, low-burden approach to strengthening antimicrobial stewardship efforts. Ongoing analyses will evaluate unit-specific and antimicrobial-specific SAAR categories to further characterize the intervention’s impact.

During the early months of the COVID-19 pandemic, infection prevention and control (IP&C) for women in labor and mothers and newborns during delivery and receiving post-partum care was quite challenging for staff, patients, and support persons due to a relative lack of evidence-based practices, high rates of community transmission, and shortages of personal protective equipment (PPE). We present our IP&C policies and procedures for the obstetrical population developed from mid-March to mid-May 2020 when New York City served as the epicenter of the pandemic in the U.S. For patients, we describe screening for COVID-19, testing for SARS-CoV-2, and clearing patients from COVID-19 precautions. For staff, we address self-monitoring for symptoms, PPE in different clinical scenarios, and reducing staff exposures to SARS-CoV-2. For visitors/support persons, we address limiting them in labor and delivery, the postpartum units, and the NICU to promote staff and patient safety. We describe management of SARS-CoV-2-positive mothers and their newborns in both the well-baby nursery and in the neonatal ICU. Notably, in the well-baby nursery we do not separate SARS-CoV-2-positive mothers from their newborns, but emphasize maternal mask use and social distancing by placing newborns in isolates and asking mothers to remain 6 feet away unless feeding or changing their newborn. We also encourage direct breastfeeding and do not advocate early bathing. Newborns of SARS-CoV-2-positive mothers are considered persons under investigation (PUIs) until 14 days of life, the duration of the incubation period for SARS-CoV-2. We share two models of community-based care for PUI neonates. Finally, we provide our strategies for enhancing communication and education during the early months of the pandemic.

OBJECTIVES:The disease caused by severe acute respiratory syndrome coronavirus 2, known as coronavirus disease 2019, has resulted in a global pandemic. Reports are emerging of a new severe hyperinflammatory syndrome related to coronavirus disease 2019 in children and adolescents. The Centers for Disease Control and Prevention has designated this disease multisystem inflammatory syndrome in children. Our objective was to develop a clinical inpatient protocol for the evaluation, management, and follow-up of patients with this syndrome.DATA SOURCES:The protocol was developed by a multidisciplinary team based on relevant literature related to coronavirus disease 2019, multisystem inflammatory syndrome in children, and related inflammatory syndromes, as well as our experience caring for children with multisystem inflammatory syndrome in children. Data were obtained on patients with multisystem inflammatory syndrome in children at our institution from the pre-protocol and post-protocol periods.DATA SYNTHESIS:Our protocol was developed in order to identify cases of multisystem inflammatory syndrome in children with high sensitivity, stratify risk to guide treatment, recognize co-infectious or co-inflammatory processes, mitigate coronary artery abnormalities, and manage hyperinflammatory shock. Key elements of evaluation include case identification using broad clinical characteristics and comprehensive laboratory and imaging investigations. Treatment centers around glucocorticoids and IV immunoglobulin with biologic immunomodulators as adjuncts. Multidisciplinary follow-up after discharge is indicated to manage continued outpatient therapy and evaluate for disease sequelae. In nearly 2 months, we admitted 54 patients with multisystem inflammatory syndrome in children, all of whom survived without the need for invasive ventilatory or mechanical circulatory support. After institution of this protocol, patients received earlier treatment and had shorter lengths of hospital stay.CONCLUSIONS:This report provides guidance to clinicians on evaluation, management, and follow-up of patients with a novel hyperinflammatory syndrome related to coronavirus disease 2019 known as multisystem inflammatory syndrome in children. It is based on the relevant literature and our experience. Instituting such a protocol during a global pandemic is feasible and is associated with patients receiving treatment and returning home more quickly.

There are unique infection prevention issues associated with pediatric long-term care facilities, behavioral health units, rehabilitation hospitals, and other residential facilities. All of these facilities provide care to children with complex, chronic medical conditions. These children are at increased risk for healthcare-associated infection due to factors such as age-related vulnerability to infections, especially respiratory viral infections; chronic exposure to indwelling medical devices such as tracheostomies, gastrostomy tubes, and central venous catheters; and frequent close contact with other children and healthcare providers during therapeutic and social activities. This chapter provides infection prevention and control guidance in special healthcare settings outside of acute care, including pediatric long-term care, behavioral health, and residential facilities. The adaptation of strategies such as transmission-based precautions while maintaining a homelike environment is described. Recommendations for infection surveillance in these setting are provided, along with algorithms for managing respiratory and gastrointestinal illness.

Antimicrobial use data in adult nursing homes have been used to direct antimicrobial stewardship (AS) efforts for this healthcare setting. However, little is known about antimicrobial use in pediatric post-acute care facilities (pPACFs). The purpose of this study was to describe antimicrobial use in pPACFs. We performed a point prevalence study of antimicrobial use in six geographically diverse pPACFs on two study dates: January 20 and July 20, 2016. Eligible facilities cared for residents 21 years old. Collected data were extracted from residentsÕ medical records and included antimicrobial agents given on the 2 study days; the indication for use, categorized as treatment of an infection, non-infectious use, e.g., dysmotility, or prophylaxis; and route of administration. Chi-squared tests were performed as applicable; P values < 0.05 were considered statistically significant. On January 20, 10% (67/666) of residents received 82 antimicrobial agents of which 45% were given to treat an infection (Figure 1). On July 20, 7% (49/677) of residents received 58 antimicrobial agents of which 51% were given to treat an infection. Skin and soft-tissue infections (SSTIs) were the most common infectious indication, accounting for 24% and 27% of residents given an antimicrobial for infection in January and July, respectively (Figure 2). Respiratory tract infections (RTI) accounted for 3% of residents given an antimicrobial for infection in January compared with 16% in July (P < 0.01). For treatment of infections, there was no significant difference between the use of systemic (oral and intravenous) agents in January (63%) compared with July (48%, P = 0.2, Figure 3); cephalosporins (32%) were the most common agents used. In July, topical antimicrobials were more common (52%) of which mupirocin and clindamycin were most common. In pPACFs, antimicrobial agents were less commonly given for infections than for non-infectious indications and prophylaxis. SSTIs were the most common infection and topical agents were more commonly used to treat infections in July. Surprisingly, treatment of RTIs was more common in July. This study suggests that care guidelines could be useful in promoting AS efforts for pPACFs. All authors: No reported disclosures.

A major focus of implementation science is discovering whether evidence-based approaches can be delivered with fidelity and potency in routine practice. This randomized trial compared usual care family therapy (UC-FT), implemented without a treatment manual or extramural support as the standard-of-care approach in a community clinic, to nonfamily treatment (UC-Other) for adolescent conduct and substance use disorders. The study recruited 205 adolescents (M age = 15.7 years; 52% male; 59% Hispanic American, 21% African American) from a community referral network, enrolling 63% for primary mental health problems and 37% for primary substance use problems. Clients were randomly assigned to either the UC-FT site or one of five UC-Other sites. Implementation data confirmed that UC-FT showed adherence to the family therapy approach and differentiation from UC-Other. Follow-ups were completed at 3, 6, and 12 months postbaseline. There was no between-group difference in treatment attendance. Both conditions demonstrated improvements in externalizing, internalizing, and delinquency symptoms. However, UC-FT produced greater reductions in youth-reported externalizing and internalizing among the whole sample, in delinquency among substance-using youth, and in alcohol and drug use among substance-using youth. The degree to which UC-FT outperformed UC-Other was consistent with effect sizes from controlled trials of manualized family therapy models. Nonmanualized family therapy can be effective for adolescent behavior problems within diverse populations in usual care, and it may be superior to nonfamily alternatives.