Infection Control & Hospital Epidemiology

We describe two cases of XDR Pseudomonas aeruginosa infection caused by a strain of public health concern recently associated with a nationwide outbreak of contaminated artificial tears. Both cases were detected through database review of genomes in the Enhanced Detection System for Hospital-Associated Transmission (EDS-HAT), a routine genome sequencing-based surveillance program. We generated a high-quality reference genome for the outbreak strain from one of the case isolates from our center and examined the mobile elements encoding blaVIM-80 and blaGES-9 carbapenemases. We then used publicly available P. aeruginosa genomes to explore the genetic relatedness and antimicrobial resistance genes of the outbreak strain.

Identifying COVID-19 outbreaks in hospitals at an early stage requires active surveillance. Our objective was to assess whether floor swabs correlated with COVID-19 outbreak status in hospital. We swabbed the floors of an inpatient ward at Mount Sinai Hospital for 32 weeks, from October 31, 2022 to June 15, 2023 and RT-qPCR analysis provided a quantification cycle of detection for each positive swab. 182 swabs were processed for SARS CoV-2, of which 98.4% were positive. Two COVID-19 outbreaks were declared during the study period. The median viral copy number was 210 (IQR, 49 to 1018) during non-outbreak periods and 653 (IQR, 300 to 1754) during outbreak periods. Analyzing the number of viral copies of SARS-CoV-2, instead of percentage positivity, gave a clearer view of changes in outbreak status over time, thereby illustrating the benefits of this approach to monitor pathogen load in hospital settings.

BackgroundHealthcare-associated infections (HAIs) constitute a significant financial strain on healthcare systems across the world, with surgical site infections (SSIs) being the costliest form. Despite the existence of diverse sources of infection in the operating room (OR), current literature focuses on human and procedural sources of contamination that could lead to an infection. Comparatively, the OR built environment is understudied as a potential disease transmission interface between the environment, patients, and surgical staff. This systematic literature review aims to investigate how the physical characteristics and components of the built environment impact airflow, infection risk, aerosols, particle counts, contamination, and pathogens in operating rooms. Methods and FindingsLiterature searches were conducted in the PubMed and Web of Science Core Collection databases on December 21, 2020, ultimately retrieving 2,965 articles after duplicates were removed. During abstract screening, all abstracts were independently reviewed by two authors and conflicts were resolved by a third author. All articles published since January 1, 2010, that reported primary data investigating an aspect of the built environment inside an OR in relation to airflow, contamination, and/or infection for which the full text in English was available were included. This resulted in the inclusion of 138 articles, which includes studies conducted in ORs during active surgeries, computer modeling studies, and simulations in which a real OR was used for a mock surgical procedure. Six major built environment categories were identified based on the collected literature: OR layout, disinfection systems, surgical lights, doors, ventilation, and portable airflow devices. A survey created on Qualtrics software was used to record the aspect of the built environment and the outcome of each study, as well as the relationship between the two. ConclusionsWhile OR ventilation has been studied extensively, the OR built environment as a whole is understudied in relation to airflow, contamination, and infection. The current literature is inconsistent in both its findings and subsequent recommendations, making it difficult to inform hospital design in the context of SSIs. No articles were identified that discussed respiratory infection transmission in the OR, and very few addressed healthcare worker (HCW) safety in relation to the OR built environment. The significant discrepancies in the literature identified in this review highlight the need for future studies that assess the quality and bias of these studies before firm recommendations can be made. Future work should also focus on addressing the lack information regarding respiratory infection transmission in the OR, especially in the context of HCW safety.

Objectives To evaluate two-year, side-by-side outcomes of a prospective audit and feedback (PAF)-based antimicrobial stewardship program (ASP) in a quaternary ICU in Ghana, comparing diagnostic stewardship, antimicrobial prescribing patterns, and clinician adherence to stewardship recommendations between 2024 and 2025. Longitudinal PAF data from low- and middle-income countries (LMIC) quaternary ICUs are scarce; this study addresses that evidence gap. Methods A retrospective comparative analysis of routine Antimicrobial Stewardship (AMS) surveillance data was conducted at the University of Ghana Medical Centre ICU: 102 visits in 2024 and 63 in 2025. Proportions were compared by chi-square or Fishers exact test; continuous variables by Mann-Whitney U. Wilson score 95% confidence intervals (CIs) were computed for primary proportions. Results Biomarker-guided prescribing rose from 86.3% to 100% of visits (p=0.005) and culture and sensitivity testing from 74.5% to 90.5% (p=0.02). Targeted (culture-guided) therapy increased significantly from 23.5% to 41.7% of antibiotic recipients (p=0.03), while empiric prescribing declined correspondingly. Overall antibiotic utilization remained high in both years (96.1% vs 95.2%; p=1.00), and meropenem use rose from 42.9% to 56.7% (p=0.13). AMS interventions were recommended in 67.6% and 63.5% of visits, respectively. Clinician acceptance improved markedly from 40.6% (95% CI: 29.8-52.4%) to 67.5% (95% CI: 52.0-79.9%) (p=0.01). Conclusions Two years of PAF in a Ghanaian quaternary ICU demonstrated progressive program maturation: universal biomarker adoption, a significant shift toward targeted prescribing, and markedly enhanced clinician acceptance. Persistently high antibiotic utilization and rising carbapenem dependence underscore the need for sustained surveillance and carbapenem-sparing strategies in LMIC critical care.

BackgroundPathogen whole genome sequencing (WGS) has significant potential for improving healthcare-associated infection (HAI) outcomes. However, methods for integrating WGS with epidemiologic data to quantify risks for pathogen spread remain underdeveloped. MethodsTo identify analytic strategies for conducting WGS-based HAI surveillance in high-burden settings, we modeled patient- and facility-level transmission risks of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a long-term acute care hospital (LTACH). Using rectal surveillance data collected over one year, we fit three pairwise regression models with three different metrics of genomic relatedness for pairs of case isolates, a proxy for transmission linkage: 1) single-nucleotide variant genomic distance, 2) closest genomic donor, 3) common genomic cluster. To assess the performance of these approaches under real-world conditions defined by passive surveillance, we conducted a sensitivity study including only cases detected by admission surveillance or clinical symptoms. ResultsGenomic relatedness between pairs of isolates was associated with room sharing in two of the three models and overlapping stays on a high-acuity unit in all models, echoing previous findings from LTACH settings. In our sensitivity analysis, qualitative findings were robust to the exclusion of cases that would not have been identified with a passive surveillance strategy, however uncertainty in all estimates also increased markedly. ConclusionsTaken together, our results demonstrate that pairwise regression models combining relevant genomic and epidemiologic data are useful tools for identifying HAI transmission risks. Key MessagesO_LIWhole genome sequencing of healthcare associated infections (HAI) is becoming more common and new methods are necessary to integrate these data with epidemiologic risk factors to quantify transmission drivers. C_LIO_LIWe demonstrate how pairwise regression models, in which the outcome of a regression model represents genomic similarity between a pair of isolates, can identify known transmission risk factors of carbapenem-resistant Klebsiella pneumoniae in a long-term acute care facility. C_LIO_LIPairwise regression models could be used with rich epidemiologic data in other settings to identify risk factors of endemic HAI transmission. C_LI

Decontamination of N95 respirators has become critical to alleviate PPE shortages for healthcare workers in the current COVID-19 emergency. The factors that are considered for the effective reuse of these masks are the fit, filter efficiency and decontamination/disinfection level both for SARS-CoV-2, which is the causative virus for COVID-19, and for other organisms of concern in the hospital environment such as Staphylococcus aureus or Clostridium difficile. In its guidance entitled Recommendations for Sponsors Requesting EUAs for Decontamination and Bioburden Reduction Systems for Surgical Masks and Respirators During the Coronavirus Disease 2019 (COVID19) Public Health Emergency (May 2020)[1], the FDA recommends a 6-log10 reduction in either the most resistant bacterial spores for the system or in a mycobacterium species to authorize the use of a decontamination method of N95 respirators for single or multiple users. While the goal is primarily inactivation against SARS-CoV-2, testing of decontamination methods against the virus may not always be available. For decontamination methods considered for only single users, the recommendation is a 6-log10 reduction in the infective virus concentration of 3 non-enveloped viruses or in the concentration of two Gram (+) and two Gram (-) bacteria. Based on these recommendations, we explored the efficacy of vaporized H2O2 (VHP) treatment of N95 respirators against surrogate viruses covering a wide range of disinfection resistance for emergency decontamination and reuse to alleviate PPE shortages for healthcare workers in the COVID-19 emergency.

AimOur antimicrobial guidelines (AGs) were changed in 2021 to recommend once-daily ceftriaxone in place of three-times-daily cefuroxime as preferred cephalosporin. This analysis sought to assess the effects of this on incidence of Clostridioides difficile infection (CDI), third-generation cephalosporin resistant Enterobacterales (3GCR-E), and resource utilisation. MethodBefore and after analysis of 30-day CDI and 3GCR-E incidence following receipt of cefuroxime/ceftriaxone pre- and post-AG change. Total nursing time and waste production relating to cefuroxime/ceftriaxone delivery were calculated pre- and post-change. ResultsCDI incidence was 0.6% pre- and 1.0% post-change (adjusted odds ratio [aOR] 1.44, p=0.07) and 3GCR-E incidence 3.5% and 3.1% (aOR 0.90, p=0.33). Mean per-quarter estimated nursing administration time decreased from 2065 to 1163 hours (902 nurse-hour reduction) and antibiotic-related waste generation from 1131kg to 748kg (383kg reduction). Overall days of therapy per-quarter of cefuroxime/ceftriaxone were unchanged between periods. ConclusionThis simplification of our AG from a three-times-daily to a once-daily antibiotic resulted in considerable savings for our hospital (roughly 1.7 full-time equivalent nurses and over a tonne of waste yearly), with no significant increases in CDI or 3GCR-E. The impact of dosing schedules on non-antibiotic-spectrum factors, such nursing time and resource usage, is worthy of consideration when designing AGs.

The study was undertaken to record the amount of dental aerosol created using 3-in-1 syringe, air rotor, and ultrasonic scaler using high volume suction (HVS) in 5 primary care dental surgeries. The time for the aerosol to dissipate following completion of the procedure was also recorded. The amount of aerosol created above the background level for the surgery corresponding to the operating positions of the nurse, dentist, and patient was recorded using particle meters measuring the number of 2.5{micro}m (PM2.5) and 10{micro}m (PM10) particles respectively. The procedures were recorded in triplicate for each surgery and average change calculated for each procedure, lasting 90 seconds. PM2.5 remained at or very near background readings during all procedures, whereas PM10 increased with use of the air rotor and to a much lower extent with both 3-in-1, and ultrasonic scaler. The means time to return to background reading level was 2.5 minutes. It was concluded that PM2.5 levels did not rise and although PM10 increased for all procedures the increase was low and with a return to background readings within 2m:50s (95% CI: 2:34 to 3:37) of completing the procedures that a minimum fallow period of 5minutes would allow be more than ample to be safe.

IntroductionThe impact of workflow changes and total laboratory automation (TLA) on microbiology culture processing time was evaluated in an academic-affiliated regional hospital. Materials and MethodsA retrospective analysis of microbiological data in a research database was performed to compare turnaround time (TAT) for organism identification (ID) before and after implementation of TLA (2013 versus 2016, respectively). TAT was compared using the {chi}2 test for categorical variables and log-transformed t-test for continuous variables. ResultsA total of 9,351 predefined common and clinically important positive mono-bacterial culture results were included in the analysis. Shorter TAT (hours) in 2016 compared to 2013 (p<0.0001) for positive result pathogen ID were observed in specimen types including blood (51.2 vs. 70.6), urine (40.7 vs. 47.1), wound (39.6 vs. 60.2), respiratory (47.7 vs. 67), and all specimen types combined (43.3 vs. 56.8). Although shorter TATs were not observed from all specimen categories for negative result pathogen ID, TAT for all specimen types combined was shorter (p[&le;]0.001) in 2016 compared to 2013 (94 vs. 101). ConclusionsTotal laboratory automation and workflow changes--including process standardization--facilitate shorter organism ID TAT across specimen sources.

ObjectivesThis study was undertaken to assess the amount of dental aerosol created in a primary care dental surgery. MethodsTwo particle meters were placed a set distances round a volunteer patient whilst undergoing simulated dental treatment using a high speed dental handpiece, and 3-in-1 air/water syringe, moisture control was managed with high volume suction and a saliva ejector. Measurement were taken every thirty seconds with the surgery environment set a neutral ventilation and with the windows open plus fan assistance. ResultsFrom the cessation of aerosol generation it took between 6 and 19 minutes for the surgery to return to baseline. The ventilated surgery had faster aerosol dispersal, returning to background levels within 5 minutes. ConclusionIt is concluded for the surgery under investigation the dental aerosol had dissipated after 30 minutes using HVS and optimal surgery.

Decontamination of N95 respirators has become critical to alleviate PPE shortages for healthcare workers in the current COVID-19 emergency. The factors that are considered for the effective reuse of these masks are the fit, filter efficiency and decontamination/disinfection level both for SARS-CoV2, which is the causative virus for COVID-19, and for other organisms of concern in the hospital environment such as Staphylococcus aureus or Clostridium difficile. The efficacy of inactivation or eradication against various pathogens should be evaluated thoroughly to understand the level of afforded disinfection. Methods commonly used in the sterilization of medical devices such as ionizing radiation, vaporized hydrogen peroxide, and ethylene oxide can provide a high level of disinfection, defined as a 6 log10 reduction, against bacterial spores, considered the most resistant microorganisms. CDC guidance on the decontamination and reuse of N95s also includes the use of moist heat (60{degrees}C, 80% relative humidity, 15-30 min) as a possible recommendation based on literature showing preservation of fit efficiency and inactivation of H1N1 on spiked masks. Here, we explored the efficacy of using moist heat under these conditions as a decontamination method for an N95 respirator (3M 1860S, St. Paul, MN) against various pathogens with different resistance; enveloped RNA viruses, Gram (+/-) bacteria, and non-enveloped viruses.

BackgroundInfectious aerosols and droplets generated by SARS-CoV-2-positive patient aerosol generating procedures (AGPs), coughing, or exhalation could potentially contaminate surfaces, leading to indirect SARS-CoV-2 spread via fomites. Our objective was to determine SARS-CoV-2 surface contamination frequency in Emergency Department (ED) patient rooms with respect to patient SARS-CoV-2 status and AGP receipt. MethodsSwabs were collected from fixed surfaces or equipment in the rooms of patients under investigation for COVID-19 or known to be SARS-CoV-2-positive. Environmental swabs were tested for SARS-CoV-2 RNA by RT-qPCR; RNA-positive samples were cultured in Vero E6 cells. Room contamination was also evaluated by clinical severity of COVID-19 and time since symptom onset. ResultsIn total, 202 rooms were sampled: 42 SARS-CoV-2-positive AGP patient rooms, 45 non-AGP SARS-CoV-2-positive patient rooms, and 115 SARS-CoV-2-negative AGP patient rooms. SARS-CoV-2 RNA was detected on 36 (3.6%) surfaces from 29 (14.4%) rooms. RNA contamination was detected more frequently in rooms occupied by non-AGP SARS-CoV-2- positive patients than SARS-CoV-2-positive AGP patients (28.9% vs 14.3%, p=0.078). Infectious virus was cultured from one non-AGP SARS-CoV-2-positive patient room. There was no significant difference in room positivity according to COVID-19 severity or time since symptom onset. ConclusionSARS-CoV-2 RNA contamination of ED room surfaces was highest and most frequent in rooms occupied by SARS-CoV-2-positive patients who did not undergo an AGP, which may be attributable to disease stage and viral shedding; however, there was no difference in room contamination according to COVID-19 severity or time since symptom onset.

Structured abstractO_ST_ABSObjectivesC_ST_ABSWe aimed to design and produce a low-cost, ergonomic, hood-integrated Powered Air-Purifying Respirator (Bubble-PAPR) for pandemic healthcare use, offering optimal and equitable protection to all staff. We hypothesised that participants would rate Bubble-PAPR more highly than current FFP3 face mask respiratory protective equipment (RPE). DesignRapid design and evaluation cycles occurred based on the identified user needs. We conducted diary card and focus group exercises to identify relevant tasks requiring RPE. Lab-based safety standards established against British Standard BS-EN-12941 and EU2016/425. Questionnaire-based usability data from participating frontline healthcare staff before (usual RPE) and after using Bubble-PAPR. SettingOverseen by a trial safety committee, evaluation progressed sequentially through laboratory, simulated, low-risk, then high-risk clinical environments of a single tertiary NHS hospital. Participants15 staff completed diary cards and focus groups. 91 staff from a range of clinical and non-clinical roles completed the study, wearing Bubble-PAPR for a median of 45 minutes (IQR 30-80 [15-120]). Participants self-reported a range of heights (mean 1.7m [SD 0.1, range 1.5-2.0]), weights (72.4kg [16.0, 47-127]) and body mass indices (25.3 [4.7,16.7-42.9]). Outcome measuresPrimary: "How comfortable do you feel in your PPE?" (Likert scale bounded by 1 [very uncomfortable] to 7 [very comfortable]). Secondary outcomes: perceived safety, communication, anxiety, discomfort, and performance. ResultsBubble-PAPR mean comfort score was 5.64(SD 1.55) versus usual FFP3 2.96(1.44) (mean difference 2.68 (95% CI 2.23-3.14, p<0.001). There was a significant difference in favour of Bubble-PAPR across all secondary outcomes. ConclusionsBubble-PAPR achieved its primary purpose of keeping staff safe from airborne particulate material whilst improving comfort and the user experience. The design and development of Bubble-PAPR were conducted using a careful evaluation strategy addressing key regulatory and safety steps, in contrast to many devices rapidly developed and deployed during the pandemic. Trial registrationIRAS ID:288493, REC Ref:21/WA/0018. ClinicalTrials.gov (NCT04681365). Strengths and limitations of this studyO_LIWe employed user-centred design, engineering optimisation and staged feasibility testing to develop a novel Powered Air-Purifying Respirator (Bubble-PAPR) for use specifically in frontline healthcare settings. C_LIO_LIDiverse, frontline healthcare staff compared Bubble-PAPR with usual FFP3 face masks. C_LIO_LIThe design and development of Bubble-PAPR were conducted using a careful strategy addressing key regulatory and safety steps, in contrast to many devices rapidly developed and deployed during the pandemic. C_LIO_LIBubble-PAPR is an excellent example of developing a cosmopolitan network that could become a key feature of future system resilience. C_LI

Improving indoor air quality is one potential strategy to reduce the transmission of SARS-CoV-2 in any setting, including nursing homes, where staff and residents have been disproportionately and negatively affected by the COVID-19 pandemic. We used an interrupted time series design to compare trends in weekly COVID-19 cases and deaths before and after installation of ultraviolet air purification in 84 nursing homes in Florida, Georgia, North Carolina, and South Carolina from September 31, 2020 to December 27, 2020. Compared to pre-installation, weekly COVID-19 cases per 1,000 residents (-1.69, 95%CI: -4.32, 0.95) and the weekly probability of reporting any COVID-19 case (-0.02, 95%CI: -0.04, 0.00) declined in the post-installation period. We did not find any difference pre- and post-installation in COVID-19-related mortality (0.00 95%CI: -0.01, 0.02). Our findings from this small number of nursing homes in the southern US demonstrate the potential benefits of air purification in nursing homes on COVID-19 outcomes. We recommend a stronger experimental design to estimate the causal effect of installing air purification devices like this one on improving COVID-19 outcomes in nursing homes. Practical ImplicationsImproving indoor air quality is one potential strategy to reduce the burden of COVID-19 in nursing homes and nursing homes are eligible to receive Civil Monetary Penalty funding for purchases that improve air quality. Intervening on air quality may have a wide impact without placing significant burden on individuals to modify their behavior. In this pilot evaluation, we found that installing ultraviolet air purification may be an effective strategy to reduce COVID-19 cases in nursing homes. We recommend a stronger experimental design to determine the causal effect of indoor air interventions, such as air purification, on COVID-19 in this setting.

ImportanceThis study addresses the pressing clinical question of how variations in physician and nursing staffing levels influence methicillin-resistant Staphylococcus aureus (MRSA) rates, providing essential insights for optimizing staff allocation and improving patient outcomes in critical care settings. ObjectiveThe main objective is to assess whether variations in staffing ratios and workload conceptualization significantly alter the rates of MRSA acquisitions in the ICU setting. DesignThis simulation-based study utilizes stochastic compartmental mathematical modeling to explore the impact of staffing ratios and workload conceptualization on MRSA acquisitions in ICUs. Derived from a previously published model, the analysis involves running year-long stochastic simulations for each scenario 1000 times, varying nurse-to-patient ratios and intensivist staffing levels under infinite and finite workload conceptualizations. Our baseline model was a 3:1 nurse ratio with one intensivist. Main OutcomeMRSA acquisitions in ICUs, measured as median acquisitions per 1000 person-years. ResultsUnder baseline conditions, our model had a median of 8.2 MRSA acquisitions per 1000 person-years. Varying patient-to-nurse ratios and intensivist numbers showed substantial impacts. For infinite models, a 2:1 nurse ratio resulted in a 21% decrease, while a 1:1 nurse ratio led to a 65% reduction. Finite models demonstrated even larger effects, with a 48% decrease when having a 2:1 ratio, and an 83% reduction with a 1:1 nurse ratio. Reducing patient-to-nurse ratios in finite models increased acquisitions exponentially with a 348% increase for a 6:1 ratio. Intensivist variations had modest impacts. Conclusions and RelevanceOur study highlights the crucial role of optimizing staffing levels in ICUs for effective MRSA infection control. While intensivist variations have modest effects, bolstering nursing ratios significantly reduces MRSA acquisitions, underscoring the need for tailored staffing strategies, and recognizing the nuanced impact of workload conceptualization. Our findings offer practical insights for refining staffing protocols, emphasizing the dynamic nature of healthcare-associated infection outcomes. Key PointsO_ST_ABSQuestionC_ST_ABSHow does the conceptualization of ICU healthcare worker tasks in models--whether infinite or finite-- impact the results of changes in staffing ratios affecting methicillin-resistant Staphylococcus aureus (MRSA) acquisition? FindingsIn this compartmental mathematical model approach that included 15 different models, the trends of the impact of staffing ratios were consistent between the Infinite and Finite tasks models. However, both the absolute and relative values were markedly different, with the infinite task models having a much more linear effect on MRSA acquisitions while the number of MRSA cases in the finite model continued to rise exponentially as the number of nurses decreased. MeaningIt is essential when considering model generalizability, to state the assumptions made about how workload and contact patterns within a hospital work, and to ensure these are appropriately tailored for the specific setting being modeled.

SARS-CoV-2 spread has proven to be especially difficult to mitigate in high risk settings, including nursing homes, cruises, prisons and various industrial settings. Among industrial settings, meat processing facilities in the United States have experienced particularly challenging outbreaks. We have sequenced SARS-CoV-2 whole viral genomes from individuals testing positive in an integrated regional healthcare system serving 21 counties in southwestern Wisconsin, northeastern Iowa and southeastern Minnesota, providing an overview of SARS-CoV-2 introduction and spread in a region spanning multiple jurisdictions with differing mitigation policies. While most viral introductions we detected were contained with only minor transmission chains, a striking exception was an outbreak associated with a meatpacking plant in Postville, IA. In this case, a single viral introduction led to unrestrained spread within the facility, affecting many staff and members of their households. Importantly, by surveilling viral sequences from the surrounding counties, we have documented the spread of this SARS-CoV-2 substrain from this epicenter to individuals in 13 cities in 7 counties in Iowa, Wisconsin and Minnesota, a region spanning 185 square miles. This study highlights the regional public health consequences of failures to rapidly act to mitigate viral spread in a single industrial setting.

BackgroundCurrent methods are insufficient alone for outbreak detection in hospitals. Real-time genomic surveillance using offers the potential to detect otherwise unidentified outbreaks. We initiated and evaluated the Enhanced Detection System for Healthcare-associated Transmission (EDS-HAT), a real-time genomic surveillance program for outbreak detection and mitigation. MethodsThis study was conducted at UPMC Presbyterian Hospital from November 2021 to October 2023. Whole genome sequencing (WGS) was performed weekly on healthcare-associated clinical bacterial isolates to identify otherwise undetected outbreaks. Interventions were implemented in real-time based on identified transmission. A clinical and economic impact analysis was conducted to estimate infections averted and net cost savings. ResultsThere were 3,921 bacterial isolates from patient healthcare-associated infections that underwent WGS, of which 476 (12.1%) clustered into 172 outbreaks (size range 2-16 patients). Of the outbreak isolates, 292 (61.3%) had an identified epidemiological link. Among the outbreaks with interventions, 95.6% showed no further transmission on the intervened transmission route. The impact analysis estimated that, over the two-year period, 62 infections were averted, with gross cost savings of $1,011,146, and net savings of $695,706, which translates to a 3.2-fold return on investment. Probabilistic sensitivity analysis showed EDS-HAT was cost-saving and more effective in 98% of simulations. ConclusionReal-time genomic surveillance enabled the rapid detection and control of outbreaks in our hospital and resulted in economic benefits and improvement in patient safety. This study demonstrates the feasibility and effectiveness of integrating genomic surveillance into routine infection prevention practice, offering a paradigm shift in healthcare outbreak detection and control.

Healthcare linens act as a vector of microbial transmission through use, storage and handling. In this retrospective multi-year, multi-site study, the impact of an infection prevention program, that included an automated silver ion-based antimicrobial laundry treatment, was studied. A composite reduction of 42% in healthcare associated infection (HAI) rates was observed, with the biggest reductions associated with CAUTI and CDI rates. Although further study is needed to better understand the exact contribution of such an intervention towards prevention of HAIs, ionic silver treatment of healthcare textiles may prove to be a useful tool in HAI reduction strategies.

Background Severe Clostridioides difficile infection (CDI) morbidity and mortality disproportionately affect Black and Hispanic patients in the United States. Antibiotic exposure is the primary modifiable risk factor for CDI, and clindamycin is among the agents most strongly associated with related harm. Characterizing inequities in prescribing is critical. Dentistry is a major source of clindamycin prescriptions. Academic dental clinics serve diverse patient populations and provide an ideal setting to evaluate prescribing across racial and ethnic groups. We therefore examined antibiotic use and cumulative clindamycin exposure as measures of CDI-associated risk. Methods We conducted a retrospective study of electronic health records from 5 US academic dental institutions from 2021 through 2023. We analyzed 552,428 encounters among 132,770 patients with documented race/ethnicity to estimate adjusted odds of receiving any oral antibiotic and clindamycin by race/ethnicity. Secondary outcomes evaluated total antibiotic exposure among dental provider-prescribed antibiotics, focusing on higher-than-standard cumulative dosing of clindamycin (>8400 mg) and amoxicillin (>10,500 mg). Results Oral antibiotic prescribing occurred in 1.9% of encounters. Compared with White patients, Black, Hispanic, and Other race patients had slightly lower adjusted odds of receiving any oral antibiotic, while Black patients had greater odds of receiving a higher-than-standard cumulative clindamycin dose when clindamycin was prescribed (adjusted odds ratio, 2.19; 95% confidence interval, 1.25-3.82). Conclusion Racial and ethnic inequities in dental antibiotic prescribing extended beyond antibiotic receipt to cumulative clindamycin exposure. Although CDI outcomes were not directly measured, these prescribing differences may have implications for disparities in CDI-associated harm and warrant further investigation.

IntroductionDental settings have been considered high risk setting s for COVID-19. A Dental Public Health Team in South East Scotland have worked to risk assess the situation timeously to break chains of transmission. AimTo present routine data produced from a contact tracing service for COVID-19 cases in the dental setting with a focus on transmission. DesignObservational retrospective analysis of a routine data set of COVID-19 cases associated with a dental setting reported via the national contact tracing system for two health board areas in the east of Scotland. MethodsCOVID-19 cases were confirmed by PCR testing. Descriptive statistics are used to summarise the data collected over a 13-month period (Oct 2020-Dec 2021). A narrative presents themes identified during contact tracing that led to transmission within a dental setting and includes a case study. ResultsA total of 811 incidents are included. No evidence of staff to patient transmission or vice versa was found in this study. Staff to staff transmission occurred in non-clinical areas contributing to 33% of total staff cases. ConclusionTransmission of COVID-19 in a dental setting in the context of this study appears to be confined to non-clinical areas. Future pandemic plans should include tools to aid with implementation of guidance in non-clinical areas. In brief pointsO_LIOutbreaks of COVID-19 in a dental setting appear to be confined to the non-clinical areas of dental practices. C_LIO_LIWe have found no evidence of staff to patient transmission or vice versa using our contact tracing methods. C_LIO_LIFuture pandemic preparedness would benefit from including current quality improvement tools to aid with implementation of new standard operating procedures and other regularly changing guidance. C_LI