Healthcare workers’ attire is prone to microbial contamination, potentially facilitating pathogen transmission. In our study, attire was almost universally contaminated, mainly with skin commensals; among non-commensals, Staphylococcus aureus predominates. Sleeves were less contaminated, possibly due to “bare below the elbows” policies. Easier access to dispensers may increase attire change.

We evaluated the impact of silencing penicillin cross-reactivity alerts on perioperative antibiotic prescribing and surgical site infections (SSIs) in 6 hospitals using an interrupted time series analysis. Silencing the alerts minimally increased cefazolin prescribing among penicillin allergy labeled patients (sensitivity analysis only; P = 0.03) and had no influence on SSIs (P = 0.32).

Background: Adverse perioperative outcomes remain a major public health challenge despite being largely preventable. Surgical site infection (SSI) is a common preventable healthcare-associated infection (HAI) following surgery. The Barnes-Jewish Hospital anesthesiology department developed an innovative telemedicine model, the Anesthesia Control Tower (ACT), to improve intraoperative care delivery and address predisposing factors for adverse outcomes. The ACT is staffed by anesthesiologists and certified nurse anesthetists who use a customized, electronic monitoring system, bolstered with machine-learning forecasting, to provide real-time clinical decision support to anesthesia providers in the operating room (OR). In the ACT randomized control trial, alerts are generated during surgical procedures and ORs are randomized to receive ACT input based on alerts or not. We were interested in determining the effect of the ACT on infectious outcomes. Methods: We used the existing ACT study design, a randomized control trial, to determine the impact of the ACT monitoring system above on SSI, CLABSI and CAUTI. HAI surveillance was performed by IP specialists using CDC NHSN definitions for SSI, CLABSI and CAUTI. We included CABG, colon, abdominal hysterectomy, hip, and knee arthroplasty procedures performed during ACT hours of operation from July 1, 2018 to January 31, 2023 and compared outcomes among patients by randomization to receive ACT. Here, we report on the intention-to-treat analysis based on randomization status. Results: The final cohort included 8,993 procedure dates including 862 CABG procedures, 2,654 colon surgeries, 2,732 abdominal hysterectomies, 2,105 hip arthroplasties, and 833 knee arthroplasties. Baseline characteristics (e.g. age, comorbidities, wound class) were balanced by randomization status. Characteristics captured during the procedure (e.g., temperature, oxygen) were also similar by randomization status. The infectious outcomes revealed that there was no difference in likelihood of SSI (4.0% vs 4.0%), 60-day CLABSI (0.2% vs 0.3%), or 60-day CAUTI (0.0% vs 0.1%) whether the procedure was randomized to receive ACT input or not. Thirty-day mortality (2.0% vs 1.9%) and readmission (16.6% vs 15.9%) did not differ by randomization. Conclusions: In this intention-to-treat analysis of the impact of a novel anesthesiology monitoring system on HAI outcomes, we did not find a difference in the incidence of SSI, CLABSI or CAUTI. Next, we will analyze the study data in a per-protocol fashion. This RCT was conducted in a resource-rich environment with robustly implemented best practice where a second layer of anesthesiology supervision may confer little benefit. The concept of an ACT may still be helpful in resource-limited settings.

Background: A survey was conducted to understand the current state of infection prevention (IP) in Missouri (MO) long-term care facilities (LTCF) following the COVID-19 pandemic. The survey focused on staffing, training and education, and program elements. Method: The survey was developed and managed in Qualtrics™. It was distributed via email to 1468 individual email addresses for 1122 unique LTCF across Missouri in partnership with the Missouri Department of Health and Senior Services. The survey was available from July 29, 2024 through August 16, 2024. Survey results were anonymized; participants had the option to provide facility or contact information if desired for follow up. Results: The survey response rate was 11.1%, with 164 responses collected. Participants worked in LTCF categorized as long-term care, assisted living, memory care, short-term skilled nursing, short-term rehabilitation, residential, and behavioral health. The size of LTCF varied in numbers of residents and employees. Most respondents (82%) reported having a dedicated IP professional for their facilities, but only 2% stated they were allocated full-time to IP responsibilities. Job titles also varied widely. Over 50% of respondents stated their IP professionals had less than five years of IP experience, but 80% stated the person received specific training for the IP role.

Most respondents reported having policies for monitoring and improving hand hygiene, managing communicable illnesses, and screening for infectious diseases (ID). Nearly all respondents (99%) reported that policies remain for managing residents, employees, and visitors with COVID-19. However, most programs lack a dedicated budget for IP initiatives and a defined relationship with an ID clinician or healthcare epidemiologist. Conclusions: This is, to our knowledge, the first statewide survey of infection prevention in Missouri long-term care facilities. One limitation of this study is the small response rate, and another is a response bias in which facilities with robust IP programs are more likely to respond.

There are employees and programs dedicated to preventing infections in residents of MO LTCF. The workforce varies in IP experience, though considerable IP-specific training is occurring which fosters competency advancement. Lack of full-time allocation to IP responsibilities and variation in job titles may indicate role overlap of IP with other specialties. Limited funding and partnerships with ID clinicians may affect the scale and scope of IP programs. This survey demonstrated that IP resources are available in MO LTCF, and there may be opportunities to enhance their impact through increased staffing, funding, and professional collaborations.

Background: The dimorphic fungus Coccidioides is endemic in the Southwestern USA and most commonly causes respiratory infection (“Valley Fever”). While the true community prevalence of this respiratory infection is unknown, experts estimate that 30% of community-acquired pneumonia (CAP) cases in Southern Arizona are due to Coccidioides. We were interested in determining how often patients admitted for CAP are tested for coccidioidomycosis. Methods: We identified patients who were admitted to Banner University Medical Center – Phoenix with community-acquired pneumonia from 1/1/2019-6/30/2024 by the ICD-10 code J18.9. Among this patient population, we determined the percentage tested for coccidioidomycosis (via serological test) and the percentage that tested positive. Regarding management, we elicited whether an infectious diseases consultation occurred during the hospitalization and if treatment included the antifungal fluconazole versus ceftriaxone and Azithromycin. Results: We identified 9,677 patients admitted with an ICD-10 code J18.9 between 1/1/2019 and 06/30/2024. The mean age (SD) was 60.3 (17.2) years and 56.3% were males. 3,536 (36.5%) patients were tested for coccidioidomycosis, and 389/3,536 (11%) had a positive serology. 14.2% of CAP patients were seen by an ID specialist. Among those with coccidioidomycosis, 56.3% (n=219) were seen by an ID specialist. Only a small fraction (n=974, 10.1%) of all CAP patients received fluconazole. Among the 389 with Valley Fever, 52.2% received fluconazole, while almost 70% were given ceftriaxone and/or azithromycin at any point during the admission. Transfer to the ICU, length of stay and hospital mortality were not significantly different in those with detected coccidioidomycosis versus others. Conclusions: In this large observational study in an area endemic for coccidioidomycosis, only 36.5% of those admitted for community-acquired pneumonia were tested for coccidioidomycosis 11% of those who got tested were found to have Valley Fever. Positing a similar coccidioidomycosis prevalence in the remaining 63.5% of CAP patients who were not tested for it, one could extrapolate a total of 676 missed cases based on 11% positive serology rate. To determine the true prevalence of coccidioidomycosis in our region, broader testing should be implemented. Our data also indicate that antifungals are rarely offered for coccidioidal CAP, while unnecessary use of antibacterials for this endemic mycosis is a target for antimicrobial stewardship.

A COVID-19 pandemic gown conservation strategy for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) asymptomatically colonized patients caused no significant difference in healthcare-associated MRSA (HA-MRSA) bacteremia, healthcare-associated VRE (HA-VRE) bacteremia, or healthcare-associated Clostridioides difficile infections (HA-CDI) versus prepandemic contact precautions (CP). Postpandemic HA-VRE and HA-CDI rates mirrored national trends.

A 54-question survey about System Healthcare Infection Prevention Programs (SHIPPs) was sent out to SHEA Research Network participants in August 2023. Thirty-eight United States-based institutions responded (38/93, 41%), of which 23 have SHIPPs. We found heterogeneity in the structure, staffing, and resources for system infection prevention (IP) programs.

Background: Hospitals are increasingly consolidating into networks and integrating infection prevention (IP) into system infection prevention programs (SIPP). Very little has been published about these programs. This survey sheds light on the current state of SIPPs. Methods: We used the survey generator Alchemer.com for setting up the questionnaire, and tested a beta version among peers. The final version was sent out to SHEA Research Network participants in August 2023. Raw data was compiled and analyzed. Results: Forty institutions responded (40/104, 38%), of which 25 (63%) had SIPPs. These SIPPS reported health systems with a median of 4.5 acute care hospitals (range, 1-33); 16 SIPPS reported a median of 2 critical access hospitals (range, 1-8); 4 SIPPs reported 1-3 LTACHs, and 6 SIPPS reported a median of 1.5 nursing homes. All except 3 (88%) contained an academic center; 48% (11/23) of the U.S. based programs operate in multiple states. Four programs have been in place >20 years, four < 2 years, and the remainder a median of 8 years (range, 2-18). Physician directors also have clinical (20/25, 80%), teaching (19/25, 76%), research (15/25, 60%), antimicrobial stewardship (8/25, 32%), quality (8/25, 32%), and/or patient safety (5/25, 20%) roles. Seventeen (68%) report having a written job description. Nineteen (76%) report having an infection preventionist in a system IP director role; only 7/25 (28%) have a dedicated system IP team that operates independent of individual hospitals. Sixteen (64%) report administrative support, 10/25 (40%) have a data manager/analyst, and 4/25 (16%) include IT expert or programmer support. 15/25 (60%) report having done a formal system-wide IP needs assessment. While 16/25 (64%) have some automation in HAI surveillance (predominantly using Bugsy [Epic] or Theradoc [Premier]), while only 5/25 (20%) run fully automated surveillance. 10/25 (40%) have implemented centralized surveillance. 12/25 (48%) have “system IP policies” that are hierarchically above individual site policies. The biggest challenges appear to be gaps in 1) clear governing structure, 2) communication, 3) consistent staffing, 4) data management support, and 5) dedicated, empowered IP expert FTEs. Conclusions: To our knowledge, this is the first U.S. survey to explore present-day system infection prevention. In this sample of hospital networks, we found heterogeneity in the structure, staffing and resources for system IP with significant opportunities for improvement. In this era of healthcare consolidation, our findings highlight the urgent need to more clearly delineate and support system IP needs in order to enhance their functionality.

In recent years, it has become increasingly evident that surveillance metrics for invasive device-associated infections (ie, central-line–associated bloodstream infections, ventilator-associated pneumonias, and catheter-associated urinary tract infections) do not capture all harms; they capture only a subset of healthcare-associated infections (HAIs). Although prevention of device-associated infections remains critical, we need to address the full spectrum of potential harms from device use and non–device-associated infections. These include complications associated with additional devices, such as peripheral venous and arterial catheters, non–device-associated infections such as nonventilator hospital-acquired pneumonia, and noninfectious device complications such as trauma, thrombosis, and acute lung injury. As authors of the device-associated infection sections in the SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, we highlight catheter-associated urinary tract infection as an example of the strengths and limitations of the current emphasis on device-associated infection surveillance, suggest performance metrics that present a more comprehensive picture of patient harm, and provide a high-level overview of similar issues with other infection surveillance measures.

This survey of infectious disease providers on long COVID care revealed a lack of familiarity with existing resources, a sentiment of missing guidelines, and scarcity of dedicated care centers. The low response rate suggests that infectious disease specialists do not consider themselves as the primary providers of long COVID care.

In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) Transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and deimplementation, 6) healthcare outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the “neighbors,” 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1–5 are presented in part I of the article and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the post-pandemic phase) will make healthcare systems more resilient when facing future crises.

In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and de-implementation, 6) health care outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the “neighbors”, 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1–5 are presented in part I of the article, and chapters 6–10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the postpandemic phase) will make healthcare systems more resilient when facing future crises.

Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients,1 leading to substantial morbidity, mortality, and excess healthcare expenditures,1 and persistent gaps remain between what is recommended and what is practiced.

The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes2 in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.3

The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.