After implementation of a molecular syndromic panel for infectious diarrhea, a significantly greater proportion of C. difficile results were classified as colonization rather than infection compared to the pre-implementation period. Routine C. difficile reporting from multiplex panels should be re-evaluated to minimize diagnostic uncertainty in some patients.

Engaging residents of long-term care homes (LTCHs) in their home’s environment, programs, and operations is required in some jurisdictions and could improve resident quality of life and other outcomes. This scoping review summarized existing research on resident engagement in LTCH organizational design and governance, including associated enablers, barriers, approaches, and outcomes. The database search yielded 5,580 records (after deduplication), and 62 articles covering 59 studies were included. These studies predominantly described Residents’ Councils (n = 38; 64%) and enablers or barriers pertaining to resident and home perspectives, as well as implementation and sustainability infrastructure. Few studies described approaches to considerations of resident diversity (n = 8; 14%) or the presence of dementia and/or cognitive impairment (n = 12; 20%). Ten studies reported quantitative data evaluating resident engagement, and only four with resident-reported outcomes. Robust, evidence-informed frameworks that are co-designed with residents, staff, and others in the LTCH sector are needed to engage residents in their LTCHs.

Background: Carbapenem-resistant Enterobacterales (CRE) are reportable statewide with required isolate submission to the Minnesota Department of Health (MDH) Public Health Laboratory (PHL), where carbapenemase production and mechanism identification is confirmed. MDH reviews all detected carbapenemase-producing organisms (CPOs) for potential transmission. Suspected transmission clusters are assessed for relatedness using whole genome sequencing (WGS). In 2022, increased detection of multiple bacterial genera of Klebsiella pneumoniae carbapenemase (KPC)-CRE occurred at acute care hospital-A, (ACH-A) and in 2023 the increase in KPC-CRE was accompanied by an increase in New Delhi metallo-β-lactamase (NDM)-CRE detection. Methods: MDH partnered with ACH-A to review increased CPO detection. MDH-PHL conducted WGS including multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis on isolates. WGS suggested clusters of relatedness spanning multiple years and epidemiologic data revealed common room occupancy. Infection prevention and control (IPC) principles were reinforced in cluster areas and audits verified adherence, prompting consideration of an environmental reservoir. An environmental screening plan was developed focusing on sink drains from common rooms. In May 2024, 94 swabs from sink drains were collected and CPO culture-based screening was conducted using selective media followed by molecular testing of bacterial growth by MDH-PHL. Results: There was detection of CPOs from 28 of 94 (29.8%) sink drains. Eight environmental KPC-CRE isolates and one NDM-CRE isolate appeared genetically related to 22 unique patients over a 10-year period (Figure 1). Three sink drain isolates showed genetic similarity to each other, but not to patient isolates. Three CPO clusters, representing 14 patients, had genetically similar isolates without an associated environmental isolate. However, isolates were collected over months to years suggesting an undetected reservoir. In August 2024, ACH-A initiated mitigation strategies to prevent CPO transmission from environmental reservoirs, including modification of sink plumbing, maintaining a splash zone, refraining from disposal of bodily fluids in sinks, optimizing sink hygiene, and monthly screening of inpatients in units with known CPO sink contamination. From August to December 2024, 325 patients were screened with 1.2% of specimens detecting KPC-CRE colonization. Conclusion: Sink drains containing CPOs on multiple hospital units that correlated with patient cases were identified at ACH-A. WGS suggests intermittent transmission of different CPOs over 10 years, and clusters of transmission appear to be related to environmental sources. Strict implementation and adherence to IPC measures, including those that minimize the spread of CPOs from facility premise plumbing, are critical to prevent CPO transmission despite widespread premise plumbing contamination.

Background: Effective integration of antimicrobial resistant organism (ARO) admission screening into clinical information systems (CIS) can facilitate prompt identification of patients at risk of an ARO and interrupt transmission. However, ARO admission screening remains suboptimal in Alberta, Canada following implementation of the ARO admission screening tool in the provincial CIS. We sought to understand the determinants of adherence with the use of the ARO admission screening tool in the CIS. Methods: A mixed-methods study was conducted using a survey, human factors observations, and qualitative focus groups. Eligible participants included nursing staff and physicians from emergency departments and inpatient units in acute care and acute rehabilitation facilities where the ARO admission screening tool was utilized in the CIS in Alberta, Canada from September 6, 2023 to June 18, 2024 (n=100). A survey (REDCap) explored staff perceptions and experiences using the tool in the CIS. Observations and interviews of nursing staff completing the tool were guided by the Systems Engineering Initiative for Patient Safety model. Virtual (Zoom) semi-structured focus groups explored barriers and enablers of using the tool guided by the Theoretical Domains Framework. Descriptive analysis of survey responses was conducted using Microsoft Excel (Version 2409). Field notes and focus group transcripts were used for a rapid qualitative, thematic analysis. A weaving narrative by theme was used to integrate survey results with findings from the observations and focus groups. Results: There were 527 survey respondents representing all 5 health zones, 5 nurses observed and 20 interviews conducted by the human factors team, and 24 participants in 6 focus groups. Focus group participants represented different sized hospitals (12-1,099 beds) with varying ARO admission adherence rates (29-83%). Three emergent themes arose: context, the ARO admission screening tool, and the individual. Contextual factors included time constraints, increasing nursing workload, competing priorities, lack of patient cooperation, and a need to increase interactions with infection prevention and control programs. Attributes of the tool impacting completion included location of the tool within the CIS, lack of prompts, and multiple sources of information required to complete the tool. At an individual level, themes arose related to experience, perceptions of ARO screening, and lack of training that influenced completion of the tool. Conclusions: Among the emergent themes, multiple determinants were identified influencing the use of the ARO admission screening tool in the provincial CIS. These findings will help inform future strategies to improve ARO admission screening and reduce ARO transmission.

Background: Adherence with antimicrobial resistant organism (ARO) admission screening is suboptimal, despite clinical support tools in clinical information systems (CIS) to facilitate the process. Behaviour change techniques to improve adherence are needed. However, in a resource-constrained healthcare system, strategies that motivate healthcare workers (HCWs) to align their practices with infection prevention and control (IPC) policies need to be prioritized. Methods: An online survey (REDCap) and a virtual (Zoom) consensus meeting using a modified nominal group technique with online voting was conducted among HCWs, IPC, and the CIS staff in September and October 2024, respectively, to achieve consensus on a prioritized list of interventions to improve ARO admission screening at acute care and acute rehabilitation facilities (n=100) in Alberta, Canada. Interventions from the Behaviour Change Wheel were mapped to barriers/enablers influencing screening adherence. Each intervention was judged across the APEASE criteria (Acceptability, Practicality, Effectiveness, Affordability, Side Effects, Equity) using a 5-point Likert Scale. Consensus to include interventions required >4 criteria with >80% agreement, consensus to exclude required >4 criteria with 80%. Interventions that did not reach consensus were discussed to determine whether to include in the final candidate list. Attendees were asked to vote on their top three interventions from the final candidate list. Results: There were 15 barriers and one enabler to ARO admission screening, mapped to 43 unique interventions. Of these, 16 interventions addressed more than one barrier/enabler, while 27 interventions only addressed a single barrier. Fifty-nine respondents completed the survey. Most respondents (63%) were IPC staff, 20% were nurses, and 17% were other HCWs (including IPC physicians). Nine interventions met criteria to include in the candidate list, 26 were excluded, and 8 interventions did not reach consensus in the survey and were discussed. There were 32 attendees at the consensus meeting (53% IPC staff and physicians, 34% clinical staff, 13% other provincial teams). Three interventions were selected: 1) creating a nursing task to complete the tool in the CIS when an admission order is signed, 2) add a banner on the CIS Storyboard when the tool is not complete, and 3) develop a best practice guideline for frontline staff on ARO admission screening. Conclusions: The survey and consensus meeting were efficient methods to determine a prioritized list of interventions, which will be implemented and evaluated, to improve ARO admission screening in Alberta.

Background: Targeted admission screening of high-risk patients for antimicrobial resistant organisms (AROs) is a key component of infection prevention and control. However, adherence with screening is suboptimal, risking a negligible impact on the prevention of ARO transmission. Clinical decision support tools in clinical information systems (CIS) may improve ARO screening adherence. This study evaluated the adherence of ARO admission screening using a tool in the provincial CIS in Alberta, Canada and the relationship between adherence and hospital ARO rates. Methods: A population-based, sequential cross-sectional study was completed on all admissions to acute care and acute rehabilitation facilities where ARO admission screening occurs on any unit, and where the CIS was implemented in Alberta between January 1, 2020 and March 31, 2024 (n=100). Mental health facilities/units, continuing care, newborns Results: There were 97 (97% of eligible facilities) facilities that implemented the CIS across seven launch periods included. Overall adherence ranged from 43% to 65%. After controlling for bed size and health zone, adherence decreased by the number of months each facility was active on the CIS (aIRR 0.987, 95%CI 0.986-0.987). There was no seasonality in trends. There was a negative relationship between adherence and overall MRSA infection rate (rs = -0.68) and after adjusting for bed size, health zone, and number of months active on the CIS (aIRR 0.99, 95% CI 0.986-0.994). Analysis could not be completed for CPO due to small numbers. Conclusions: While increased ARO admission screening adherence was associated with lower overall MRSA infection rates, the IRR was close to one and may not be clinically significant. With adherence decreasing over time, further work is needed to understand barriers to ARO admission screening and implement strategies to support healthcare providers in completing appropriate surveillance for AROs.

ASPIRE! (Accountability and Safe-space to Promote, Inspire, Recharge, and Empower) is a peer mentoring group and peer/near-peer mentoring program established in 2016 by a group of seven early career clinician and non-clinician, research faculty. All founding members participated in the TRANSFORM KL2 Program at Columbia University Irving Medical Center’s Irving Institute for Clinical and Translational Research. In this short communication, we describe the origins of this peer mentoring group established to support these seven early-career KL2 scholars. We also provide a summary of the development of an institution-wide peer mentoring program, created by the seven members of the initial peer mentoring group. We highlight how being at similar career stages, coming from different institutional departments, and sharing common academic goals in a safe space may have contributed to the success of the peer mentoring group. Our individual successes and experiences demonstrate that peer mentoring can be a powerful tool for enhancing the early-career academic experience.

Spirometra is a genus of zoonotic cestodes with an ambiguous species-level taxonomic history. Previously, Spirometra mansonoides was considered the only species present in North America. However, recent molecular data revealed the presence of at least three distinct species in the USA: Spirometra sp. 2 and 3, and Spirometra mansoni. This study aimed to elucidate the diversity and potential host associations of Spirometra species among companion animals in the USA. Samples (N = 302) were examined from at least 13 host species, including mammals, amphibians and reptiles. Sample types included eggs isolated from faeces (n = 222), adult specimens (n = 71) and plerocercoids (n = 9) from 18 different states and 2 territories across the USA. Extracted genomic DNA was subjected to PCR targeting a fragment of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Generated sequences (n = 136) were included in a phylogenetic analysis. Spirometra mansoni was detected in domestic cats (n = 76), dogs (n = 12), a White’s tree frog (n = 1), a Cuban knight anole (n = 1), a green iguana (n = 1) and a serval (n = 1) across 15 states and Puerto Rico. Spirometra sp. 2 was found only in dogs (n = 3) from Florida and Spirometra sp. 3 was found only in cats (n = 41) from 17 states. All plerocercoid samples were consistent with S. mansoni. The results confirm that at least three distinct Spirometra species are present and established in companion animals, such as dogs and cats, and likely are using various native and exotic species as paratenic hosts within the USA.

Objectives/Goals: This study tests how fiber microstructural integrity and myelination levels within the cingulum connectome are associated with information processing speed (IPS) in relapsing-remitting multiple sclerosis (RRMS). We investigate the functional impact of structural coherence, myelin content, and white matter hyperintensities (WMH) load on IPS. Methods/Study Population: Data from 63 RRMS and 25 healthy controls (HC) were used. We hypothesize that the structural integrity of the cingulum bundle and its structural network – or connectome – is distinctly associated with IPS function in people with RRMS (vs. HC) due to myelin-related plasticity across the wiring. Using diffusion spectrum imaging and high-resolution tract segmentation, we constructed individualized white matter connectomes. Diffusion quantitative anisotropy (QA) and myelin fractions (MWF) were used to quantify structural coherence and myelination. WMH load was measured with T2-FLAIR imaging. Bayesian–Pearson correlations, mixed-linear, and moderation models explored how fiber-specific QA, MWF, and WMH load relate to IPS function in RRMS, as measured by Symbol Digit Modalities Test (SDMT). Results/Anticipated Results: We theorize that (1) QA in the cingulum connectome correlates with SDMT performance dimensionally, indicating that structural coherence in the white matter supports IPS function among both groups; (2) increased myelination will strengthen the positive association between QA and SDMT scores, suggesting that connectome-specific myelin content facilitates IPS; (3) conversely, WMH load within the cingulum connectome is expected to inversely correlate with SDMT scores, reflecting the detrimental impact of lesion burden on IPS function; (4) myelination in specialized tracts within the cingulum connectome play a compensatory role to support IPS function in the RRMS group. These investigations can offer a mechanistic clue to potential neuroplastic targets for cognitive interventions in MS. Discussion/Significance of Impact: By linking white matter integrity to cognitive function at the connectome level, this study can support neuroregenerative strategies to mitigate cognitive burden in RRMS. Our findings may advance understanding of how structural coherence, tract myelination, and WMH affect IPS, shaping personalized prognostic and therapeutic interventions.

Objectives/Goals: Team science (TS) competency is important for translational science team collaboration. However, there are few educators available to assist teams. Asynchronous learning is an effective strategy for delivering TS content. The goal of this project is to expand TS education by providing online access to our learners using online modules. Methods/Study Population: The Collaboration and Team Science (CaTS) team at the University of Cincinnati provides a robust TS education and training program. As the need for team science gains recognition, CaTS has received increased requests for services, leading to a need to broaden TS offerings. To address this demand, the CaTS team created “Team Science 101,” an online, asynchronous, series of 15 modules covering basic team science concepts. Each module consists of an educational recording lasting an average of 20 minutes, optional topic resources, pre- and post-module surveys assessing learners’ confidence and satisfaction, post-module knowledge checks, and evaluation questions. Upon completing all modules, participants receive a completion certificate. Results/Anticipated Results: TS 101 will be piloted with a group of participants who expressed interest in asynchronous TS content and will be adjusted based on the feedback received. The associated pre- and post-module survey, post-module knowledge check, and evaluation questions will be monitored to determine learning levels and improve TS 101 overall. Canvas is the educational platform that houses these modules, allowing for participant follow-up and scalable dissemination. The CaTS team plans to disseminate TS 101 nationally and internationally for anyone interested in this resource. Discussion/Significance of Impact: There is a national effort to collect and curate TS education, training, and toolkits. TS 101 will be a useful educational tool that will expand the reach of team science educators, provide the foundation for educators to explore topics more deeply by building on the module topics, and provide education to broader audiences who lack access to TS experts.

Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.