Although single-patient rooms are recommended for hospital design to reduce healthcare-associated infections, construction is costly, and supporting evidence remains limited. Most studies rely on pre/post time series analyses that cannot account for concurrent infection control and antimicrobial stewardship initiatives. To address this gap, we used comprehensive, hospital-wide whole-genome sequencing (WGS) surveillance to compare Staphylococcus aureus transmission rates in single- versus multi-bed rooms during routine clinical operations. Across two hospitals in an urban health system, ∼3,000 patients per month underwent active S. aureus surveillance using admission nasal swabs. Surveillance and clinical (blood, sputum, wound) isolates collected between October 2022 - December 2023 underwent WGS. Closely related isolates (< 20 single nucleotide polymorphisms) that were epidemiologically linked based on timestamped patient location data were classified as high-probability transmissions. We compared S. aureus transmission rates among single, two-bed, and four-bed rooms, all of which underwent identical cleaning and sporicidal disinfection protocols. Over 14-months, >5,000 isolates from 4,000 patients underwent WGS, 85% of which were from surveillance cultures. Of admissions, 21% were to single rooms, 59% to two-bedded rooms, and 20% to four-bedded rooms. Transmission risk was lowest in single rooms (0.5 transmissions per 1000 admissions), increased in two-bed rooms (1.2 per 1000 admissions), and was nearly ninefold higher in four-bed rooms compared to single rooms (4.4 transmissions per 1000 admissions). In this large WGS-based surveillance study, single and semi-private (two-bed) rooms were associated with substantially lower S. aureus transmission rates compared to four-bed rooms. These findings indicate that room occupancy is a modifiable factor in transmission risk and that standard infection control practices may be insufficient; therefore, innovative, continuous disinfection strategies are warranted. Ongoing work is adjusting for potential differences in patient populations across room types to refine estimates of the impact of room occupancy on transmission. All Authors: No reported disclosures

Background: Staphylococcus aureus is a leading cause of healthcare-associated infections and is associated with high mortality. While decolonization has been effective in reducing methicillin-resistant S. aureus (MRSA) infections in adult and neonatal intensive care units (NICUs), little is known about the impact of decolonization on transmission of S. aureus. Here, we evaluated whether weekly screening and targeted decolonization reduce genomically defined transmission of S. aureus in a NICU. Methods: Infants admitted in 2022-2024 to the NICU at Tisch Hospital received weekly screening cultures of the nares, axilla and groin for MRSA and methicillin-susceptible S. aureus (MSSA). Colonized infants received topical decolonization with chlorhexidine 2% bathing and nasal, buttock, and umbilical mupirocin, with frequency and duration of decolonization based on postmenstrual age (gestational plus chronological age). Genome sequencing was used to identify transmission events, defined as genetically linked S. aureus isolates with <20 single nucleotide variants identified in two infants with overlapping stays. Transmission risk was analyzed using time-to-event (TTE) analyses, and the absolute risk reduction and number needed to treat (NNT) were estimated. Results: Among 1,597 screened infants, 188 (11.8%) were colonized with S. aureus (85.6% MSSA; 14.4% MRSA). Colonized infants had a median NICU length of stay of 96 days, and 39 (20.7%) were involved in at least one transmission event. Of these infants, 84.6% received full decolonization. Across the cohort, 389 conversions from colonization negative to positive were observed, including 97 recolonization events; 55 (56.7%) of these infants became colonized ? 3 times during their stay, indicating sustained exposure and transmission pressure. TTE modeling predicted a 30-day transmission risk of 0.6% if all patients were decolonized, and 8.9% risk if no patients were decolonized. This corresponds to a 30-day absolute risk reduction for transmission of 8.2% and an NNT of 12; decolonizing 12 infants prevented one S. aureus transmission. Conclusions: Genomically informed modeling indicates that weekly screening and targeted decolonization reduce S. aureus transmission in the NICU. Frequent recolonization supports the importance of weekly S. aureus screening and suggests that decolonization prevents infection partly by limiting spread to susceptible hosts, with implications for the spread of resistant strains. Future analyses incorporating time-varying eligibility and exposure will further refine these transmission estimates.

Asymptomatic colonization with Clostridioides difficile (CDiff) is common among hospitalized patients and may increase risk of symptomatic C. difficile infection (CDI) after hospitalization. Oral vancomycin prophylaxis (OVP) can reduce the risk of recurrent CDI and has been studied as primary prophylaxis in subsets of transplant recipients with no history of CDI. We compared CDI and vancomycin-resistant Enterococcus (VRE) rates among transplant recipients receiving primary OVP, CDiff screening and targeted OVP, and controls who received no CDiff screening or OVP.C. difficile screening and diagnostic testing results by groupThe proportion of each group who tested positive for CDiff screening or CDiff diagnostic testing.Clinical culture results positive for Vancomycin-resistant enterococcus by groupThe proportion of each group who had a clinical culture that was Vancomycin-resistant enterococcus Solid organ (SOT) and bone marrow transplant (BMT) patients were evaluated in three groups: (1) abdominal SOT patients screened for CDiff and given OVP if CDiff positive and receiving systemic antibiotics (Oct 2022 – Oct 2024), (2) BMT and thoracic SOT patients given universal OVP without screening (Oct 2022 – Oct 2024), and (3) historical control abdominal SOT patients without CDiff screening or OVP (Mar – Oct 2022). Patients were included from the date of first admission until date of final discharge from a transplant unit. CDiff screening was performed on admission. Hospital-onset CDI was monitored for the duration of the follow up and was defined as a positive CDiff stool test sent on hospital day 4 or later. Monitoring for clinical cultures positive for VRE occurred from the first admission to the transplant unit up to three months after the last admission. Rates of CDI and VRE were compared among groups by chi-square. 2263 patients were included; 1192 (53%) in the CDiff-screened group, 643 (28%) in the universal OVP group and 428 (19%) historical controls. Cdiff screening positivity was 10.8% in group 1, who also had higher rates of symptomatic CDI (2.6%, n=31/1192) compared with the universal OVP group (0.5%, 3/643) and historical controls (1.4%, 6/428) (p< 0.001). Rates of VRE were lower in patients screened for CDiff (3.8%, 45/1192) compared with those receiving universal OVP (4.7%, 30/643) and historical controls (5.8%, 25/428) (p< 0.001). Universal OVP effectively reduces the risk of CDI but is associated with higher rates of VRE in SOT and BMT patients. All Authors: No reported disclosures

INTRODUCTION:Patients with a suspected high-consequence infectious disease (HCID), such as Ebola virus disease, may require routine laboratory testing to guide management. We assessed the capabilities of frontline hospitals and the barriers they face performing laboratory testing for patients with a suspected HCID. METHODS:A one-time confidential REDCap survey querying capabilities to safely perform laboratory tests that the Centers for Disease Control and Prevention considers critical for patients with a suspected HCID was sent to 95 institutions in Baltimore, MD, Boston, MA, New York City, NY, and Washington, DC, from January to May 2025. RESULTS:Fifty (53%) institutions responded, mostly teaching hospitals (96%), with 24% reporting prior experience evaluating a patient with suspected Ebola virus disease. While many hospitals could perform on-site blood gas (70%), hemoglobin/hematocrit (68%), and lactate (68%) tests on a suspected HCID patient, fewer could safely perform a chemistry panel (64%), a urinalysis (60%), a complete blood count with differential (56%), and a malaria rapid diagnostic test (RDT) (48%) on a suspected HCID patient. The five tests respondents most often considered extremely or very important were hemoglobin/hematocrit (91%), chemistry panel (90%), CBC with differential and platelet count (89%), malaria RDT (88%), and blood gas (88%). Reported barriers to performing routine laboratory testing included issues related to patient and staff safety, infection control, lack of appropriate space, and funding. CONCLUSIONS:Our survey identified several barriers to implementing safe laboratory testing. The inability to conduct these laboratory tests may result in delays in care when an HCID is suspected.

Background: Staphylococcus aureus is a leading cause of healthcare-associated infections and is associated with high mortality. While decolonization has been effective in reducing methicillin-resistant S. aureus (MRSA) infections in adult and neonatal intensive care units (NICUs), little is known about the impact of decolonization on transmission of S. aureus. Here, we evaluated whether weekly screening and targeted decolonization reduce genomically defined transmission of S. aureus in a NICU. Methods: Infants admitted in 2022-2024 to the NICU at Tisch Hospital received weekly screening cultures of the nares, axilla and groin for MRSA and methicillin-susceptible S. aureus (MSSA). Colonized infants received topical decolonization with chlorhexidine 2% bathing and nasal, buttock, and umbilical mupirocin, with frequency and duration of decolonization based on postmenstrual age (gestational plus chronological age). Genome sequencing was used to identify transmission events, defined as genetically linked S. aureus isolates with <20 single nucleotide variants identified in two infants with overlapping stays. Transmission risk was analyzed using time-to-event (TTE) analyses, and the absolute risk reduction and number needed to treat (NNT) were estimated. Results: Among 1,597 screened infants, 188 (11.8%) were colonized with S. aureus (85.6% MSSA; 14.4% MRSA). Colonized infants had a median NICU length of stay of 96 days, and 39 (20.7%) were involved in at least one transmission event. Of these infants, 84.6% received full decolonization. Across the cohort, 389 conversions from colonization negative to positive were observed, including 97 recolonization events; 55 (56.7%) of these infants became colonized ? 3 times during their stay, indicating sustained exposure and transmission pressure. TTE modeling predicted a 30-day transmission risk of 0.6% if all patients were decolonized, and 8.9% risk if no patients were decolonized. This corresponds to a 30-day absolute risk reduction for transmission of 8.2% and an NNT of 12; decolonizing 12 infants prevented one S. aureus transmission. Conclusions: Genomically informed modeling indicates that weekly screening and targeted decolonization reduce S. aureus transmission in the NICU. Frequent recolonization supports the importance of weekly S. aureus screening and suggests that decolonization prevents infection partly by limiting spread to susceptible hosts, with implications for the spread of resistant strains. Future analyses incorporating time-varying eligibility and exposure will further refine these transmission estimates.

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We assessed factors associated with increased risk to loss of follow-up with infectious diseases staff in OPAT patients. Discharge to subacute healthcare facilities is strongly associated with loss to follow-up. We did not identify sociodemographic disparities. Poor communication between OPAT providers and subacute healthcare facilities remains a serious issue.

Abstract Objective: To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication. Design: Retrospective cohort study. Setting: Four hospitals within NYU Langone Health (NYULH). Patients: All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission. Results: Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio [OR], 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001). Conclusions: Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.

Purpose of review The purpose of this review is to summarize recent literature on nontuberculous mycobacteria in water of healthcare systems. Despite improvement in identification techniques and emergence of infection prevention and control programs, nontuberculous mycobacteria remain present in hospital water systems, causing outbreaks and pseudo-outbreaks in healthcare settings. Recent findings Waterborne outbreaks and pseudo-outbreaks of nontuberculous mycobacteria continue to affect hospitals. Improvements in methods of identification and investigation, including MALDI-TOF and whole genome sequencing with evaluation of single nucleotide polymorphisms, have been used successfully in outbreak and pseudo-outbreak investigations. Recent studies have shown control of outbreaks in immunocompromised patients through the use of sterile water for consumption, as well as control of pseudo-outbreaks by using sterile water for procedures. Construction activities have been implicated in outbreaks and pseudo-outbreaks of nontuberculous mycobacteria. Water management programs are now required by the Joint Commission, which will likely improve water risk mitigation. Summary Improvement in detection and identification of nontuberculous mycobacteria has led to increasing recognition of waterborne outbreaks and pseudo-outbreaks. Water management programs are of vital importance in infection prevention.

Background: Outpatient parenteral antimicrobial therapy (OPAT) is used in the outpatient setting to treat infectious conditions that require a prolonged course of antimicrobials. OPAT has been shown to decrease length of hospital stay and healthcare costs without compromising patient care and has become a widely accepted practice nationally. Due to this trend, the study of OPAT is of vital importance and will continue to be relevant moving forward. Currently, few studies have explored risk factors associated with OPAT complications, and most are limited in their analysis by indication. Further work should be performed to expand upon what is currently known. We characterized factors associated with increased OPAT complication risk. Methods: We conducted a retrospective cohort study at 4 sites across NYU Langone Health in patients admitted from 2017 to 2020. We applied the following inclusion criteria: aged ≥18 years and discharged with OPAT. Complications were defined as follows: vascular-access-related (line occlusion, thrombosis, dislodgement, central-line associated bloodstream infection or CLABSI) and antimicrobial-related (laboratory derangement, drug reaction, Clostridioides difficile infection), all-cause 30-day readmission, and OPAT-related readmission. Data were obtained from electronic medical records and the OPAT database. This study was granted a waiver from informed consent by the NYU Institutional Review Board. Multivariate logistic regression was performed, adjusting for confounding variables (sex, age, hospital of admission, history of chronic medical conditions, line type, and line duration). Results: Overall, 1,846 patient encounters of 5,951 reviewed met inclusion criteria. The median age was 66 (IQR, 26), 42.2% were female. Moreover, 810 (44%) received a peripherally inserted central catheter (PICC) and 1,036 (56%) received a midline cathether. Also, 563 (30.5%) were discharged to subacute rehabilitation (SAR). The most frequent complications were line dislodgement (4.2% of all patients), laboratory derangement (3.0%), and drug reaction (2.4%). Furthermore, 27 patients (1.5%) developed CLABSI. Patients discharged to SAR were more likely to develop CLABSI (OR, 4.1l; P = .005), and they had higher rates of OPAT-related 30-day readmissions (OR, 2.675; P = .004) compared to those who were discharged home, after adjusting for key confounders. Conclusions: Discharge to SAR is strongly associated with increased risk of readmission for OPAT-related complications and CLABSI, after adjusting for key confounders. CLABSI prevention during SAR admission is a critically needed public health intervention.Funding: NoneDisclosures: None

Introduction: It is common among microbiology laboratories to blind the Clostridioides difficile (C. difficile) Bio -Fire FilmArray GI Panel result in fear of overdiagnosis. Methods: We examined the rate of missed community-onset C. difficile infection (CDI) diagnosis and associ-ated outcomes. Adult patients with FilmArray GI Panel positive for C. difficile on hospital admission who lacked dedicated C. difficile testing were included. Results: Among 144 adults with a FilmArray Panel positive for C. difficile, 18 did not have concurrent dedi-cated C. difficile testing. Eight patients were categorized as possible, 5 as probable and 4 as definite cases of missed CDI diagnosis. We observed associated delays in initiation of appropriate therapy, intensive care unit admissions, hospital readmissions, colorectal surgery and death/discharge to hospice. Five out of 17 lacked risk factors for CDI. Conclusion: The practice of concealing C. difficile FilmArray GI Panel results needs to be reconsidered in patients presenting with community-onset colitis. (c) 2021 Elsevier Inc. All rights reserved.