To evaluate the impact of implementation of a conditional reflex urine culturing strategy on urine culture rates, antimicrobial use, and clinical outcomes in hospitalized adults.

Pre-post quasi-experimental study.

Emergency departments and inpatient units within a large, integrated healthcare system in Northeast Ohio, comprising 10 medical centers.

Adult patients with a urine culture ordered from June 1, 2018, to May 31, 2023.

A system-wide intervention was implemented on June 1, 2020, requiring urinalysis (UA) with pyuria findings to trigger a urine culture order. We compared urine culture rates, antimicrobial use (measured by days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC]), and clinical outcomes between pre-and post-intervention periods.

The intervention resulted in an 85.4% reduction in urine culture rates (0.54 vs 3.71 per 100 patient days). Antimicrobial use decreased, with DOT per 100 patient days dropping by 11.5% and DASC/DOT by 16.1%. No significant differences were observed in Clostridioides difficile infection rate, subsequent bloodstream infections with urinary pathogens, or mortality between pre- and post-intervention groups.

A conditional reflex urine culturing strategy implemented as part of a diagnostic stewardship framework reduced urine culture and antimicrobial use without adverse clinical outcomes. This highlights the potential of diagnostic stewardship to optimize antimicrobial use in hospitalized adults.

Dispersal of gram-negative bacilli from sink drains has been implicated as a source of transmission in multiple outbreaks.

In an acute care hospital, we assessed how often patient care supplies and other frequently touched items were within 1 meter of sink drains. We tested the efficacy of a ceiling-mounted far ultraviolet-C (UV-C) light technology for decontamination of sink bowls and surfaces near sinks with and without a wall-mounted film that reflects far UV-C light.

Of 190 sinks assessed, 55 (29%) had patient care supplies or other frequently touched items within 1 meter of the drain. The far UV-C technology reduced Pseudomonas aeruginosa, Enterobacter cloacae and Candida auris on steel disk carriers by ≥1.5 log10 colony-forming units (CFU) in 45 minutes. On inoculated real-world items, ≥1.9 log10 CFU reductions in P. aeruginosa were achieved on sites in line with the light source versus 0.4–1.8 log10 CFU reductions on shaded surfaces. The addition of the reflective surface significantly enhanced efficacy in shaded sites (P < 0.01).

In a hospital setting, patient care supplies and other frequently touched items were often in proximity to sinks. The far UV-C light technology could potentially be useful for sink decontamination in high-risk areas.

The incubation period for Clostridioides difficile infection (CDI) is generally considered to be less than 1 week, but some recent studies suggest that prolonged carriage prior to disease onset may be common.

To estimate the incubation period for patients developing CDI after initial negative cultures.

In 3 tertiary care medical centers, we conducted a cohort study to identify hospitalized patients and long-term care facility residents with negative initial cultures for C. difficile followed by a diagnosis of CDI with or without prior detection of carriage. Cases were classified as healthcare facility-onset, community-onset, healthcare facility-associated, or community-associated and were further classified as probable, possible, or unlikely CDI. A parametric accelerated failure time model was used to estimate the distribution of the incubation period.

Of 4,179 patients with negative enrollment cultures and no prior CDI diagnosis within 56 days, 107 (2.6%) were diagnosed as having CDI, including 19 (17.8%) with and 88 (82.2%) without prior detection of carriage. When the data were censored to only include participants with negative cultures collected within 14 days, the estimated median incubation period was 6 days with 25% and 75% of estimated incubation periods occurring within 3 and 12 days, respectively. The observed estimated incubation period did not differ significantly for patients classified as probable, possible, or unlikely CDI.

Our findings are consistent with the previous studies that suggested the incubation period for CDI is typically less than 1 week and is less than 2 weeks in most cases.