Background: Since January 2025, critical structural and funding changes have altered the global healthcare landscape. To respond effectively, we performed a situation premortem. Premortem methods are commonly used within the field of implementation science to identify risk factors and early warning signs for failure of complex systems. Recognizing the systems-oriented nature of participant responses, we applied the socioecological model (SEM) to organize emergent themes. Methods In April 2025, a cross-sectional electronic premortem survey was distributed to IPC thought leaders. Participants were asked to imagine the year 2029 in which IPC research and practice had collapsed and to identify contributing factors, early warning signs, barriers, populations most affected, and missed opportunities for prevention or mitigation. Responses were analyzed using thematic content analysis. Themes were organized using the socioecological model to map findings across policy, community/professional, organizational, interpersonal, and individual levels. Results Nineteen of twenty-nine people agreed to participate (66.83% response rate) from the U.S., Australia, and Singapore. The majority (n = 13) were researchers with representation from clinical practice (n = 3), policy and regulation (n = 1), or in public health or professional capacity building (n = 2). Participants anticipated widespread consequences across all SEM levels (Figure 1). At the policy level, they described diminished IPC advocacy, global reversal of progress in infectious disease control, and increased economic burden. At the community and professional level, anticipated impacts included loss of public accountability, closure of training programs, reduced surveillance capacity, and fewer scholarly outputs to inform practice. Organizational consequences included inadequate funding of infection prevention/antimicrobial stewardship programs in healthcare facilities, workforce attrition, and increased legal risk. Interpersonally, participants anticipated inconsistent guidance and confusion, reduced support for frontline clinicians, decreased vaccine uptake, and diminished capacity to serve underserved populations. At the individual level, consequences included increased multidrug-resistant and healthcare-associated infections, fewer treatment options, lower vaccination rates, and increased morbidity and mortality among vulnerable, low-income, and immunocompromised individuals. Conclusion This premortem exercise highlights the potential impacts of a collapse of IPC research and practice. Participants anticipated cascading harms across multiple levels. These results identify areas for proactive, creative strategies tailored to specific socioecological domains of impact. Reliance on traditional federal funding models and the expectation for national data collection and reporting standards may be insufficient. The field must collaborate and develop alternative approaches to sustain IPC research, training, and practice to prevent negative downstream consequences and uphold professional values.

Background: central line–associated bloodstream infections (clabsis) remain a leading cause of preventable morbidity and mortality in hospitalized patients. although evidence-based guidelines for central venous catheter (cvc) insertion and maintenance are well established, variability in knowledge, procedural practice, and access to essential equipment persists across hospitals and clinical settings. Methods: between january 2019 and march 2020, a mobile classroom simulation-based training (sbt) program was implemented in 26 of 30 public acute-care hospitals in israel, representing a nationwide large-scale initiative. the program combined standardized curricula, hands-on simulation, and structured feedback for cvc insertion (physicians and nurses) and maintenance (nurses). for physicians undergoing cvc insertion training, the program also included a dedicated hands-on workshop focused on ultrasound-guided central venous catheter insertion. training sessions were video-recorded using a closed internal system, allowing participants to review their performance. each trainee completed two standardized simulation scenarios, enabling real-time feedback, iterative improvement, and experiential learning. of approximately 1,700 healthcare workers who participated in the program, 1,551 (91.2%) completed both pre- and post-training questionnaires. questionnaires assessed procedural knowledge, satisfaction, and availability of cvc-related equipment. knowledge outcomes were compared using paired t-tests, and associations between hospital characteristics, equipment availability, and knowledge improvement were evaluated using chi-square analyses. Result: knowledge scores improved significantly across all participant groups (p<0.001). mean knowledge gains were 18.6% for physician cvc insertion, 26.5% for nurse insertion, and 16.4% for nurse maintenance. the largest improvements were observed in sterile technique, minimal barrier precautions, and maintenance-related clinical decision-making. higher baseline knowledge was associated with icu settings, larger hospitals, and availability of full personal protective equipment (ppe) kits and disinfectant wipes (p<0.05). knowledge improvement was independently associated with refresher training, structured feedback during simulation, and access to full ppe kits, whereas hospital size and professional seniority were not consistently associated with learning gains. substantial variability in availability of essential cvc equipment was observed across departments. Conclusion: a nationally coordinated simulation-based training program significantly improved cvc insertion and maintenance knowledge among physicians and nurses across diverse hospital settings. structured feedback and reliable access to essential equipment emerged as key drivers of learning gains. these findings support simulation-based training as a scalable, policy-relevant strategy for strengthening clabsi prevention and standardizing practice at the national level, particularly in smaller hospitals and non-icu settings. background: central line–associated bloodstream infections (clabsis) remain a leading cause of preventable morbidity and mortality in hospitalized patients. although evidence-based guidelines for central venous catheter (cvc) insertion

Background. Clinical identification of measles prompts post-exposure prophylaxis (PEP) and surveillance. This report informs on implementation, results, facilitators and challenges associated with two measles post-exposure investigations (MPEI). Methods. Two MPEI were conducted in 2025 at a 545-bed public NYC Health+Hospitals. Measles case evaluations utilized the Identify-Isolate-Inform (I3) tool and the MPEI employed Identify-Inform-Initiate PEP-Isolate process (I4). Measles exposure was defined as a person in the Emergency Department (ED) within two hours of the index case. PEP for non-immune exposures was MMR vaccination within 72 hours (immunocompetent), measles intravenous immunoglobulin (IVIG) within six days (pregnant, immunocompromised), or notification to self-isolate for a 21- to 28-day surveillance period for non-immune persons who did not receive PEP. The exposure window was defined after security tape reviews of ED index-case entries. Epic (Verona, WI) facilitated exposure recalls; a ‘Measles rule out’ banner was uploaded to each chart. Internal and external stakeholders were informed after suspected case isolation. Recalls were conducted using standardized scripts tailored to initial responses and identified accompanying persons. MMR vaccination status was screened for in Epic and NYC vaccine registry. Descriptive analyses were calculated for MPEI. Results. Case 1 presented in Spring 2025 with airborne infection isolation room (AIIR) placement within 16 minutes. Case 2 presented in Summer 2025 with AIIR placement within 10 minutes. Each case had measles serology and nasopharyngeal swab for PCR obtained; the NYC Public Health Laboratory confirmed measles for Case 1 and Case 2 at 28- and 11-hours post-presentation, respectively. There were 145 adults and one child identified in the two MPEI. Spring MPEI identified 70 patients, 11 accompanied persons, 34 staff; Summer MPEI identified 22 patients, three accompanied persons, six staff. Fifty-nine of 146 (40%) exposures were measles immune, 30 received MMR, 3 non-immune pregnant women and one immunocompromised host received measles IVIG; 53 persons were notified to self-isolate through the surveillance period. No secondary cases of measles were identified. Discussion. Each MPEI was initiated after astute identification of a measles case. Key MPEI facilitators were an existing I3 preparedness plan and prior trainings, rapidly defined epidemiological exposure windows, leveraged use of Epic, and a structured post-exposure I4 process. Major challenges were related to uncertainty of a potential surge of cases requiring internal communications for patient flow during the recall process and for streamlined bidirectional communication with public health agencies. We acknowledge limitations of a single-site study and inherent biases of retrospective study design.

Background: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infection in the United States. Diagnostic stewardship is a core element of reducing inappropriate CDI testing. Methods: In response to rising rates of hospital onset CDI (HO-CDI), our institution implemented a “hard-stop” clinical practice alert (OPA) in the Electronic Medical Record (EMR) in July 2024, shown in Figure 1. The OPA fired when a CDI test was ordered on patients hospitalized greater than 48 hours who had received laxatives within the previous 48 hours or who had a positive test within the previous 7 days and was active from 7AM-5PM Monday through Friday. OPA completion to order CDI testing required approval from either the Infection Prevention & Control Medical Directors (IPCMD) or a consulting Infectious Disease (ID) physician if patient was followed by ID. To facilitate communication, a dedicated “chat group” was created in the EMR instant messaging to specifically respond to a request for testing by the IPCMDs and a link to the chat was included in the OPA. EMR documentation of the approving IPCMD was required, and logs were regularly reviewed for compliance. Every HO-CDI case at our institution undergoes a multidisciplinary review with the staff and primary providers involved in the care of the patient at time of diagnosis to identify a “driver” for the case. Testing Stewardship, defined as inappropriate testing due to noncompliance with institutional CDI testing guidance, is one of the 5 drivers that can be assigned during this review process. Results: Over the 12.5 months following implementation the OPA was triggered 432 times on 214 unique patients with testing performed 79 times (0.18 tests per trigger). Twenty of 79 tests (25%) were positive for toxigenic C. difficile. In the 12 months prior to the OPA, there were 17 of 88 HO-CDI cases attributed to Testing Stewardship compared to 4 of 58 in the 12 months after the OPA (18/80 vs 4/58 by fiscal year). In the context of multiple interventions, NHSN-defined HO-CDI declined from 68 in FY 2023, 80 in FY 2024 to 58 in FY2025, corresponding to rates of 2.22, 3.13 and 1.7 per 10,000 patient days, respectively. Conclusion: A multicomponent OPA requiring approval for CDI testing for specific parameters was successfully implemented. This intervention contributed to improved diagnostic stewardship and reduction on HO-CDC cases Figure 1: C. difficile Hard Stop OPA example for patient with recent laxative administration

Background: Effective implementation of infection prevention and control (IPC) reduces the risk of healthcare-associated infections (HAIs), thereby protecting patients and healthcare workers. Tanzania has experienced ongoing outbreaks demonstrating a need for stronger IPC. Amref Health Tanzania, in collaboration with the Ministry of Health and U.S. Centers for Disease Control and Prevention, implemented a multimodal project in Kigoma, a high HAI-risk region, aimed at improving IPC practices in 20 healthcare facilities (HCF). It involved activating Quality Improvement Teams (QIT), supportive supervisions and mentorships, quarterly standardized assessments using the national Standard Based Management and Recognition (SBMR) tool, and virtual and in-person trainings. We evaluated progress and effectiveness of the project. Methods: We conducted a mixed methods evaluation of the project in March 2024. Ten HCFs were selected purposively to have variation on location, IPC performance, and level and convenience sampling was used to select staff. A comparative cross-sectional design was utilized to collect data through focus group discussions (FGDs), key informant interviews (KIIs), and quantitative knowledge assessments and practice observations. A comparison of SBMR results at baseline (September 2021) and endline (October 2023) was completed to assess effectiveness of the project. Quantitative data were analyzed using STATA 14 software and thematic analysis was conducted for qualitative data. Results: Ten FGDs, 8 KIIs, 150 knowledge assessments, and 6-11 observations per HCF were conducted. The SBMR baseline to endline comparison showed IPC performance increased for 95% of HCFs, from 49.9% to 70.7%, on average. During knowledge assessments participants verbally described accurate knowledge of IPC practices 28.0% of the time, with a higher proportion of participants from rural districts (40.8%) and medical doctors (55.6%) describing practices accurately. Based on observations, adherence to injection safety and high-level disinfection was high; weaknesses were observed for hand hygiene, waste management and spillage cleaning. Thematic analysis of qualitative data revealed strengths in the frequency of supervisions and SBMR assessments. Remaining challenges include insufficient infrastructure, supplies, and HCW IPC knowledge on implementation of IPC practices, such as hand hygiene. Conclusion: Although the comparison of baseline and endline SBMR results show progress, IPC knowledge and adherence to evidence-based practices remain low three years into the IPC project, further hindered by insufficient infrastructure and resources. Addressing the root cause of the identified gaps, such as ensuring sufficient IPC supplies and practical training, is critical for sustained IPC progress. These results will be used to improve the delivery of this multimodal IPC project.

Background Ethiopia’s Ministry of Health (MoH), in collaboration with ICAP at Columbia University and the U.S. Centers for Disease Control and Prevention, sought to establish five infection prevention and control (IPC) Centers of Excellence (CoEs) with the ultimate goal of promoting effective and sustained implementation of IPC interventions. The CoEs are based on MoH IPC CoE guidance and leverage capacity gained through previous initiatives including implementation of a national IPC Advanced Training Program and a national monitoring and evaluation system. CoEs are encouraged to develop innovative solutions to challenges and serve as a reference for other healthcare facilities. We describe the initial phase of establishing IPC CoEs. Methods In 2023, five hospitals were selected based on the following criteria: experience implementing IPC interventions, hospital size and location, supportive leadership, and willingness to disseminate findings. Selected hospitals used the WHO multimodal improvement strategy to strengthen IPC over nine months, starting with environmental cleaning programs in maternity units. Facility-level baseline assessments and unit-level environmental cleaning needs assessments were created and conducted, followed by the development of operational plans to address identified gaps. The implementation team provided training, mentorship, and resources (e.g., CDC’s Best Practices for Environmental Cleaning in Healthcare Facilities) to each facility. Initial and follow-up audits assessing visual cleanliness and availability of appropriate cleaning materials were conducted after <3 months to assess progress. Results Baseline assessment demonstrated that all hospitals outsourced environmental cleaning services. None of the hospitals provided regular training upon employment or had job-aids for environmental cleaning staff. One hospital had an environmental cleaning policy. The maternity unit needs assessment identified gaps in IPC standard operating procedures (SOPs) at four hospitals. During implementation, all facilities developed operational plans to guide improvements, subsequently creating or updating environmental cleaning policies and SOPs. Hospitals worked with environmental cleaning companies to train cleaning staff and monitor cleaning. Mean audit scores across four hospitals increased from 51% at baseline (range 22-90%) to 83% (range 71-94%); a follow-up audit was not conducted at one hospital. Conclusion Initial efforts to establish IPC CoEs demonstrated that hospitals with existing IPC capacity built from national programs successfully led interventions to address identified gaps in environmental cleaning programs. Further work is needed to determine whether the interventions are sustainable long-term and whether interventions can be applied to other wards and healthcare facilities in the country.

Background: Candida growth in organ preservation fluid (OPF) is uncommon, with reported incidence ranging up to 4% of OPF. Its clinical significance is unclear, as many recipients remain asymptomatic, while on rare occasions, transmission can lead to severe donor-derived infections, most notably mycotic aneurysms, graft loss, and fatal hemorrhage. The current American Society of Transplantation (AST) guidance recommends prompt antifungal therapy when Candida is identified; however, real-world practice patterns and outcomes are not well described. Methods: We conducted a retrospective cohort study of adult solid organ transplant recipients at a tertiary academic center from January 2020 through October 2025. Patients with Candida-positive OPF cultures were identified through the medical record. We collected recipients' and donors' demographics, microbiological profiles, antifungal management, and clinical outcomes. Invasive candidiasis was defined as Candida isolated from blood or deep tissue/fluid within 90 days of transplant. Results: We identified 55 solid organ transplant recipients with Candida-positive OPF cultures (34 Kidney, 9 Liver, 12 Kidney-Pancreas). The most common isolates (37 patients) were C. albicans and C. glabrata. Treatment patterns and outcomes varied by organ type. Among Kidney recipients, 20.5% (7/34) received no antifungal therapy; notably, none of these untreated patients developed invasive candidiasis, graft loss, or vascular complications. All Liver recipients (n=9) received antifungal therapy, predominantly for <7 days (n=8). Despite treatment, Liver recipients had high morbidity: 22% (2/9) progressed to invasive candidiasis (peritonitis and vascular arteritis), and 67% (6/9) demonstrated vascular Doppler abnormalities. Median length of hospital stay was similar across treatment durations (p < 0.05) and similarly no increased readmission rate among all transplant groups. Conclusion: Our findings suggest that the risk of Candida-positive OPF is not uniform across organ types, indicating that current universal treatment recommendations may lead to over-treatment in some populations. Kidney recipients demonstrated favorable outcomes even without antifungal therapy. In contrast, liver recipients remained at risk for significant vascular morbidity and invasive infection regardless of treatment. Shifting to an organ-specific, risk-stratified management strategy can improve antifungal stewardship while ensuring safety for higher-risk recipients.

Background: Candida kefyr, a non-albicans-yeast species, is recognized as a potential emerging pathogen among immunocompromised patients. Previous epidemiological studies have indicated that hematologic malignancy is a key risk factor for invasive infection among patients with cancer and those with neutropenia; however, the clinical impact is not well defined. Methods: As part of a clinical inquiry, we conducted a retrospective review of laboratory-confirmed cases of C. kefyr to understand its occurrence and distribution at an NCI-designated comprehensive cancer center from January 2024 through September 2025. Demographic, laboratory, and clinical outcome data were extracted from the electronic medical record. Epidemiologic data were reviewed to evaluate for potential trends or characteristics of patients with C. kefyr infection or colonization Results: Overall, 24 isolates were identified from 21 distinct patients. The majority were from urinary sources (71.4%). The majority of cases were considered colonizers (61.9%), but eight (38.1%) patients had clinical infections, including two (25%) bloodstream infections. The majority of patients were female (15, 71.4%) with a median age of 70 years old and an Eastern Cooperative Oncology Group (ECOG) score of 3 or greater (13, 62%). In contrast to published literature, a majority (17, 81.0%) of patients had solid tumors, and hematologic malignancy was less common, with only one patient having severe neutropenia at the time of culture. The majority (16, 76.2%) of patients had some form of central venous catheter. Only two (9.5%) patients were receiving antifungal therapy at the time of culture, with one additional patient having received antifungal therapy within the preceding 90 days. Overall, the 90-day mortality in patients with C. kefyr isolated was high (14/21; 66.7%), though not necessarily related to the organism. Conclusions: C. kefyr is a potential emerging pathogen, and patients with colonization or infection were noted to have substantial 90-day mortality. In contrast to prior studies, we observed several cases in non-neutropenic patients with solid tumors. Additional comparative studies with other organisms or Candida species are needed to better characterize risk factors, clinical impact, and the role of this organism in cancer patients.

Background: Recently, the Society for Healthcare Epidemiologists of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) have released full time equivalent (FTE) staffing recommendations for hospital epidemiologists (HE) (at least 0.3 FTE for 0-50 beds, 0.5 FTE for 51-300 beds, 1.0 FTE for <300 beds) and infection preventionists (IP)(between 1 IP: 69 beds and 1 IP: 100 beds depending on size and patient acuity) for acute care hospitals. As these important roles become more complex for a variety of reasons, the necessity for appropriate staffing is becoming more apparent. The purpose of this project was to utilize data from the 2025 APIC MegaSurvey to describe current staffing for HEs and IPs. Methods: The 2025 APIC MegaSurvey was distributed to over 13,000 members and shared through email, QR codes at the APIC national conference and social media campaigns from June 6 through July 31, 2025. The respondents provided the number of FTEs for HE and IPs in acute care hospitals along with hospital characteristics including bed size, physical setting, academic affiliation, ownership status, and hospital type. The average FTEs for HE (more FTEs = more HE support) and the 1 FTE: per number of beds ratio (lower the ratio = more IP support) for IPs were calculated and stratified by the hospital characteristics. Results: There were 1,471 respondents who reported the FTEs for HE with an average of 0.97 FTE. The FTE IP: number of beds reported for the 1,533 respondents was 1 FTE:103.3 beds. Rural hospitals reported the lowest FTE for HE (0.3, n=418) and yet had the lowest 1 FTE: number of beds ratio (1:67.7, n=453). Smaller hospitals (<50 beds) reported the lowest FTE for HE (0.5, n=380) with the lowest 1 FTE: number of beds ratio (1:34.1, n=319). As the hospitals increased in size, the FTE for HE increased with 1.7 FTE for hospitals <500 beds (n=307) but also reported the highest 1 FTE: number of beds ratio of 1:132.8 (n=336). Conclusions: The data suggest that staffing for HE and IPs are impacted by numerous factors including bed size, ownership, academic affiliation and physical location. The dyad model that includes the HE and IP leaders improves communication, collaboration, and successful attainment of institutional goals. Future efforts should focus on determining the positive impacts of appropriate staffing utilizing the dyad model.

Background: The Society for Healthcare Epidemiology of America (SHEA) International Ambassadors Program (IAP) aims to strengthen global infection prevention and healthcare epidemiology through engagement of emerging international leaders. Although program reach and activities have been described, factors associated with sustained engagement and post-program impact have not been quantitatively assessed. We conducted the first survey of current and former IAP participants to evaluate motivations, activities, barriers and factors associated with continued involvement. Methods: We administered an anonymous, cross-sectional online survey during 2023 to all identifiable current and former IAP members. The survey included 35 items capturing demographics, geographic region, areas of expertise, sources of program awareness, post-IAP activities, and ongoing engagement with SHEA. Descriptive statistics were calculated, followed by inferential analyses. Chi-square tests were used to assess associations between categorical variables, including geographic region and continued engagement with SHEA, as well as source of program awareness and participation in specific activities (training organization and conference presentations). One-way ANOVA was used to compare the mean number of reported activities across sources of program awareness. Statistical significance was set at p<0.05 (two-tailed). Results: Of 191 contacted ambassadors, 54 responded (27% response rate). Respondents were primarily based in Asia (50.9%), Latin America and the Caribbean (22.6%), and Africa (18.9%). Infection prevention and antimicrobial stewardship were the most common areas of expertise (51%), and nearly half learned about the program through former ambassadors. Over half (55.6%) reported ongoing engagement with SHEA through committees or other activities. No statistically significant associations were observed between geographic regions and continued SHEA engagement (p=0.065); also, no significant associations were observed between source of program awareness and organizing training programs (p=0.885) or conference presentation (p=0.897). Similarly, there was no significant difference in the mean number of reported activities by source of program awareness (ANOVA, p=0.621). Our findings indicate that post-program engagement and productivity were not dependent on recruitment pathway. Thematic analysis identified cost, time zone constraints, and language barriers as the most frequently reported obstacles to sustained participation. Conclusion: The SHEA IAP demonstrates meaningful global reach and impact on infection prevention activities. Ambassadors remain highly motivated and active, particularly in resource-limited settings, yet financial and logistical barriers limit long-term engagement. Addressing these challenges may enhance the program’s sustainability and global impact.

Background: We queried long term acute care hospitals (LTACHs) within the NALTH network regarding facility characteristics, C. auris prevention practices, and perceived barriers to C. auris prevention. Methods: Participating facilities completed a REDCap survey of multiple choice, free response, and ranked choice questions. Quantitative and descriptive analyses were performed for completed surveys. Perceived barriers and important tools for C. auris prevention were assessed with ranked choice questions and analyzed by non-weighted counts. Results: Among 33 responses from 56 eligible LTACHs (Figure 1, Table 1), 23 (70%) had ever identified at least one case of C. auris infection or colonization. Eighteen of 33 (54%) reported identifying cases of C. auris within the past 3 months (Figure 2) and 9 of 33 (27%) had experienced suspected within-facility transmission. All facilities employed multimodal approaches for C. auris infection prevention (Table 2). More than half of LTACHs reported routine C. auris screening programs (21, 64%), including in response to a known C. auris case (n=15) and/or screening for asymptomatic colonization at the time of LTACH admission (n=12). The most frequently reported barriers to effective C. auris infection prevention included lack of communication between healthcare facilities at the time of patient transfer (n=16), lack of training and education for frontline staff (n=15), and lack of compliance with personal protective equipment (n=12). The most impactful methods anticipated to support future C. auris prevention included improved communication between facilities at the time of patient transfer (n=15), standardized protocols for C. auris decolonization (n=15), and standardized protocols for C. auris screening and isolation (n=14). Conclusion: Most participating LTACHs within the NALTH network reported firsthand experience with C. auris. Universally, responding facilities employed multimodal evidence-based infection prevention and control methods targeted against C. auris. Future research should focus on improving inter-facility communication of C. auris colonization or infection status, development of novel decolonization strategies, and standardization of surveillance practices.

Background: Post-acute and long-term care (PALTC) residents are disproportionately affected by viral infections such as influenza, COVID-19, and respiratory syncytial virus (RSV). While chemoprophylaxis is the standard of care for mitigating the spread of influenza in PALTC settings, there are no agents available for chemoprophylaxis against outbreaks of COVID-19 or RSV at present. However, as we advance in our knowledge of antivirals, agents for chemoprophylaxis against outbreaks of COVID-19 and RSV may be available in the future. Little is known about the perspectives of PALTC residents and their care partners regarding the use of chemoprophylaxis against respiratory viruses. Methods: From November 2024 to July 2025, we surveyed residents at a 152-bed community living center (CLC). Inclusion criteria were CLC residents age > Results: Out of 81 eligible residents and LARs, 40% (N=32; 6 residents and 26 LARs) completed the survey. Respondents indicated 9 (28%) and 27 (84%) of residents had an influenza or COVID-19 infection, respectively, during their PALTC stay (Table 1). None recalled an RSV infection though 29 (91%) respondents had previously heard of RSV. Most respondents reported that residents had been vaccinated against influenza (n=31, 97%) and COVID-19 (n=29, 91%), while only 10 (31%) reported that residents had been vaccinated against RSV. Most residents or LARs, on behalf of their resident, indicated they would accept chemoprophylaxis during an outbreak of influenza (n=23, 72%), COVID-19 (n=24, 75%), or RSV (n=25, 78%). Only one resident indicated he would decline chemoprophylaxis for all three viruses. Conclusions: The majority of Veterans, or their representatives, in the PALTC setting would consent to chemoprophylaxis for influenza, COVID-19, and RSV if it were available and recommended by a healthcare provider. Gaining a better understanding of how PALTC residents and their care partners perceive the use of chemoprophylaxis against respiratory viruses can support the effective implementation of these programs.

Background: Outbreaks of norovirus and other enteric diseases are common in long-term care facilities (LTCFs) such as nursing homes and assisted living facilities. During the COVID-19 pandemic, LTCFs enacted strict infection control measures which, combined with societal non-pharmaceutical interventions, may have limited the introduction of other infectious diseases, including norovirus, into these settings and reduced disease transmission temporarily. However, a newly predominant strain of norovirus was associated with abnormally high outbreak activity in the 2024-25 winter season. We describe changes to trends in norovirus outbreaks in LTCFs reported to the National Outbreak Reporting System (NORS) and CaliciNet, a strain surveillance platform, during the last decade. Methods: State and territorial health departments voluntarily report foodborne, waterborne, and other enteric outbreaks to the Centers for Disease Control (CDC) and Prevention through NORS. Public health laboratories report laboratory-confirmed norovirus outbreaks and genotypes to CDC through CaliciNet. Merged data from both systems were analyzed across four time periods: pre-pandemic, August 2015 – March 2020; pandemic, April 2020 – July 2021; post-pandemic, August 2021 – July 2024; and the 2024-25 season, August 2024 – July 2025. Both laboratory-confirmed (positive specimens from ≥2 case-patients or as defined by the reporting site) and suspected (<2 positive specimens) etiology outbreaks were included. Result: In total, 16,196 enteric LTCF outbreaks were reported to NORS and/or CaliciNet from August 2015 – July 2025, of which 12,905 (80%) outbreaks with 342,712 associated cases were attributed to norovirus. The average number of outbreaks reported over 12 months was 1,505 (7,022 total) during the pre-pandemic period, 256 (341 total) during the pandemic period, and 1,085 (3,256 total) during the post-pandemic period. The predominant genotype during these periods, GII.4 Sydney[P16], caused 42% of outbreaks with genotype data available. During the 2024-25 season, 2,286 LTCF norovirus outbreaks were reported (52% higher than the pre-pandemic period) and the predominant genotype (76%) was GII.17[P17]. Outbreak size (median [IQR]: 21 cases [11–35]) and duration (median [IQR]: 8 days [5–14]) were consistent across periods. Hospitalization rates were lowest during the pandemic period (1.8%) and highest during the 2024-25 season (3.2%). Conclusion: The low burden of LTCF norovirus outbreaks during the COVID-19 pandemic highlights the impact of non-pharmaceutical interventions in preventing outbreaks in this setting. The increased norovirus activity in the 2024-25 season associated with a new predominant strain suggests that more proactive laboratory testing in response to outbreaks is needed in this at-risk population to monitor trends in norovirus

Background: There is increasing awareness of the importance of antimicrobial stewardship in long-term care settings internationally. Despite this, there is little robust surveillance data on the quality of prescribing in this setting to help target interventions. In Australia, nursing homes are known as residential aged care homes (RACHs). The Aged Care National Antimicrobial Prescribing Survey (Aged Care NAPS) is a national, standardized audit program enabling Australian RACHs to monitor antimicrobial use and provide feedback on prescribing practices. Since 2016, the program has collected detailed prescribing data but has not made an explicit assessment on prescribing quality. With revision to Australian national prescribing guidelines, we now have the potential to use this data to assess concordance with guidelines. Methods: All Australian RACHs are eligible and invited annually to participate in the Aged Care NAPS. A single-day point prevalence audit is the primary methodology adopted. Antimicrobial prescribing data are collected by auditors at participating RACHs and entered into an online platform. All residents present on the survey day were included in the audit. Retrospective analysis of Aged Care NAPS data collected between 1 January 2020 and 31 December 2024 was undertaken. Guideline concordance was evaluated for the five most common indications (cystitis, tinea, non-surgical wound infection, pneumonia and cellulitis), using the Therapeutic Guidelines: Antibiotic 16th edition and Dermatology 4th and 5th editions. Results: A total of 41,786 prescriptions from 1,408 RACHs were audited during the study period. The five most common indications accounted for 37.4% of all prescriptions. Incorrect antimicrobial choices were common, such as cefalexin and roxithromycin for pneumonia, and amoxicillin-clavulanic acid and doxycycline for cellulitis. Prevalence of dosing errors ranged from 3.4% (trimethoprim for cystitis) to 78.0% (amoxicillin for pneumonia). Cefalexin was frequently prescribed and commonly incorrectly dosed (70.3% in cystitis, 72.8% in non-surgical wound infections, 68.2% in cellulitis). Over 40% of prescriptions for the top five antimicrobials for each indication exceeded recommended treatment durations, ranging from 41.7% (amoxicillin for cystitis) to 96.8% (ketoconazole for tinea). Prescribing for tinea often exceeded six months and included non-recommended pro re nata (PRN) prescriptions. Conclusion: The Aged Care NAPS shows promise as a tool to monitor the quality of antimicrobial prescribing in long-term care facilities. This analysis has identified targets for improving antimicrobial prescribing, focusing on choice, dosing and duration.

Background Enhanced Barrier Precautions (EBP) aim to reduce multidrug-resistant organism transmission in long-term care settings. Infection preventionists play a critical role in implementing EBP, yet their experiences navigating operational challenges, staff adherence, and resident safety remain underexplored. Understanding these perspectives informs strategies for effective infection control and policy development. Methods A 42-item electronic survey was distributed via Qualtrics to 578 Florida nursing homes between May and September 2024, addressed to “Infection Control.” Ninety valid responses were received. Thirty-seven respondents provided 58 comments across seven prompts—six linked to specific survey questions and one to an open-ended prompt to share questions or thoughts about EBP. Comments were coded into nine categories and analyzed using MAXQDA Analytics Pro. Results The coding categories were: 1) Citation or Feedback, 2) Clarity and Scope of Criteria, 3) Cost and Resource Burden, 4) Effect on Infection Control Practice, 5) Effectiveness of EBP, 6) Resident Experience, 7) Staff Confusion, 8) Staffing, Workload, and Compliance, and 9) Support for EBP. Fourteen coded comments fell under Citation or Feedback, mostly related to corrective feedback or citations during F880 survey experiences, including, “Facility interpreted an action to be low contact and therefore not needing EBP while surveyor considered action to be high contact requiring full EBP”. Staffing, Workload, and Compliance had 13 coded comments, including six responses to a survey prompt asking about challenges in implementing EBP. One respondent wrote, “Non compliance in donning. No one wants to take the time to don when they are strapped for time.” Clarity and Scope of Criteria had ten coded comments, with four specifically mentioning wounds. One wrote, “I think that small skin tears should not be included into the EBP, so there is such a gray area on who should be on EBH [sic] and who doesn’t need to be. So maybe clarify skin tears.” Seven comments addressed Resident Experience, with mixed views on resident reactions. Cost and Resource Burden, Support for EBP, and Effectiveness of EBP each had four comments; Staff Confusion had two, and Effect on Infection Control Practices had one. Conclusions Infection preventionists reported significant challenges in implementing EBP, particularly staffing limitations, unclear criteria, and resource constraints. While many supported EBP’s intent, concerns about feasibility and resident impact persist. Addressing these barriers through clearer guidance, staff education, and resource allocation is essential for successful adoption and sustained infection control in long-term care settings.

Background RSV vaccine effectiveness (VE) has not been described among nursing home (NH) residents, despite their increased risk for severe disease related to age and chronic heart and lung disease. We assessed bivalent RSVpreF VE in Veterans Affairs (VA) NH residents, overall and stratified by age and comorbidities. Methods We conducted a retrospective cohort study of NH residents over two RSV seasons (October 2023–April 2024; October 2024–April 2025). Inclusion criteria were a confirmed RSVpreF vaccination status (received RSVpreF or no RSV vaccine; other formulations and unconfirmed status excluded) and residing in a NH with RSV testing during the study period. Vaccination status was a three-level time-varying exposure: unvaccinated, vaccinated in current season, or vaccinated in the prior season. Time-at-risk for RSV was limited to continuous stays in VA NH or acute care settings. The primary outcome was laboratory-confirmed RSV infection; severe infections were defined as those requiring transfer to acute care or escalation within acute care. VE was calculated as 1 minus the hazard ratio from Cox models stratified by age and cardiopulmonary disease defined by diagnoses of congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD), adjusted for demographics, calendar year, and conditional on calendar month. Results Among 15,078 unique residents, those aged 60-74 had similar VE when vaccinated in the prior season vs current season, while those aged ≥Figure 1). Similarly, current-season model-adjusted VE was similar for those with and without cardiopulmonary disease. VE for vaccination in the prior season declined modestly among those with cardiopulmonary disease (76% [51–89] to 54% [4–78]). Of 220 total laboratory-confirmed RSV infections, 15 were severe (Table 1). Of the infections, 29 occurred among vaccinated residents of which 1(3%) was severe. Among unvaccinated residents, 14/191 infections (7%) were severe. Residents with severe infections were more likely to be ? Conclusion In this first RSV Vaccine VE study among NH residents, a frail population at high risk for severe RSV disease, bivalent RSVpreF vaccination was associated with a meaningful reduction in laboratory-confirmed RSV infection risk that persisted across two seasons, but with some diminished second-season protection for those with advanced age or cardiopulmonary disease. These subgroups were also overrepresented among those with severe disease and remain an important target for disease prevention.

Background: Despite implementing standard infection prevention measures, our long-term care facility faced catastrophic outbreaks in units with cognitively impaired residents, where such interventions proved either ineffective or impractical due to staffing and resident-related challenges. Project Design: Confronted with constraints related to staff, residents, and resources common in long-term care facilities, we explored options for adjunctive measures to address these challenges, ultimately implementing dry hydrogen peroxide technology in these specialized areas. Outcomes and Lessons Learned: This intervention resulted in drastic reductions in microbial burden, the total number of outbreaks, outbreak attack rates, severity, and duration, while optimizing resident quality of life without placing additional strain on staff. Through this process, we learned that infection prevention interventions tailored to the characteristics of the population and facility yield maximum effectiveness.

Background: Long-term care facilities (LTCFs) are a leading setting of norovirus acute gastroenteritis (AGE) outbreaks in the United States. While illness from norovirus infection is typically considered mild and self-limiting, residents in LTCFs are especially vulnerable to more severe outcomes such as hospitalization and, in rare instances, death. Norovirus typically spreads rapidly through LTCFs due to the high infectivity of the virus and the congregate nature of these facilities. Despite the high burden of norovirus outbreaks in the U.S., limited data exist in these settings. Our objective was to characterize clusters of AGE likely associated with a norovirus outbreak among LTCF residents in a large cohort of U.S. LTCFs. Methods: We analyzed electronic health records from the PointClickCare (PCC) database of residents in 14,588 LTCFs across 50 states, D.C., and 1 US territory from 2016 through 2023. We identified AGE episodes using ICD-10-CM diagnosis codes and defined AGE clusters as three or more residents of the same facility with AGE episodes within seven days of one another; norovirus-associated AGE clusters were defined as clusters with at least one norovirus or unspecified viral intestinal infection ICD-10-CM code (A08.1, A08.4). Results: From January 1, 2016 through December 31, 2023, there were 306,683 AGE episodes from 10,653 LTCFs. Among these LTCFs, there were 17,852 AGE clusters of 86,687 (29%) episodes; 648 were norovirus-associated AGE clusters comprising 3,548 AGE episodes. The median norovirus-associated AGE cluster size was 4 residents (interquartile range [IQR]) 3-6; maximum=36). The number of norovirus-associated AGE clusters was lowest in June, July, August, September, and October (average of 3 clusters each month) and was highest in February and March (average of 13 clusters each month). The median (IQR) length of norovirus-associated AGE clusters was 9 (6-13) days from the AGE onset of the first resident to the AGE onset of the last resident in the cluster. Norovirus-associated clusters occurred in 492 facilities: 141 (29%) facilities of <100 residents, 288 (58%) facilities of 100-199 residents, and 63 (13%) facilities of 200+ residents. Conclusions: AGE episodes were commonly reported among LTCF residents in PCC, and approximately 30% were associated with an AGE cluster. Norovirus-associated AGE clusters ranged in size, occurred in all sizes of facilities, and were more common in winter months. Identifying individual-level and facility-level risk factors for norovirus-associated AGE is a next step to inform prevention efforts, including infection control measures and target populations for future norovirus vaccines.

Background:?Residents of long-term care facilities (LTCFs) are particularly vulnerable to infection and colonization with multidrug-resistant organisms (MDROs) due to immunologic vulnerability and prolonged healthcare exposure. Interfacility transfers (IFT) of these residents between LTCFs and acute care hospitals are common. Understanding trends in MDRO admission prevalence among LTCF transfers is important for hospitals considering targeted screening and implementation of protocols to prevent transmission. While the COVID-19 pandemic stalled national progress in MDRO prevention, it is unclear how MDRO admission prevalence trends among LTCFs transfers shifted. We aimed to (1) identify longitudinal trends in MDRO admission prevalence and (2) analyze shifts in these trends relative to the pandemic onset. Methods:?Hospital discharge data from the Healthcare Cost and Utilization Project Arizona State Inpatient Databases were evaluated from Oct 2015–Dec 2023. Acute care admissions for patients over 18 years old with LTCF identified as the admission source were included in the study; 12 epidemiologically important MDROs were identified via ICD-10 codes for each admission. The annual frequency and proportion of patients transferred to hospitals from LTCFs with evidence of MDRO prevalence at admission were described. Longitudinal trends in MDRO admission prevalence among all LTCF-hospital transfers were evaluated using the Cochran-Armitage trend test. Multivariable logistic regression was used to model the odds of MDRO admission prevalence – defined as documented colonization, history, or infection POA – by year, adjusting for age, sex, race, ethnicity, and rurality of patient residence. Results:?Among 14,195 Arizona IFTs from LTCFs to acute care hospitals during the 8.25-year study period, the mean age was 62.6 years, 53.1% were female, and 12.3% contained an ICD-10 diagnosis code indicating MDRO admission prevalence. Of these (n=1,741), 1,341 were documented as MDRO-POA infections, and 256 were documented as carriers or individuals with a known history of an MDRO. From 2015–2023, MDRO admission prevalence among LTCF transfers increased significantly from 6.8% to 14.9% (z=9.3, p<0.0001). Compared to 2016, the odds of MDRO admission prevalence were statistically unchanged for 2017, 2018, and 2019. From 2020-2023 odds increased annually in a dose-response pattern, peaking in 2023 with 58% higher odds compared to 2016 (p<0.001). Conclusions: MDRO prevalence among Arizona LTCF-to-hospital transfers more than doubled from 2015–2023. While pre-pandemic rates remained relatively stable, during the post-2020 period, MDRO admission prevalence increased steadily and significantly. These findings underscore the importance of interfacility communication and health record flagging to accurately capture MDRO prevalence upon admission from LTCFs.

Background: Carbapenemase-producing (CP) organisms (CPOs), including Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA), harbor carbapenemase genes that confer resistance and cause transmissible, difficult-to-treat infections, particularly in healthcare settings. In September 2022, California expanded reporting from CP-CREs to all CPOs. Through 2023, the state noted rising cases, multiple gene mechanisms, and rare combinations like NDM CRAB spreading statewide. However, recent data on all reportable CPOs remain limited. This analysis examines organism and gene distribution and annual trends in San Francisco (SF) following reporting expansion. Methods: We reviewed CPO cases, defined as isolates with a specific organism-carbapenemase gene combination, reported by SF healthcare facilities from January 1, 2023 to September 30, 2025. Clinical isolates were genetically characterized by local/state public health laboratories. Demographics, clinical, and epidemiological characteristics were analyzed. Crude incidence rates (IR) were calculated using SF population estimates, and temporal trends assessed using Poisson regression. Result: A total of 126 cases from 101 patients were included. Among these patients, median age was 64 years; 59 (58%) were male, and 68 (67%) resided outside SF. Of 126 cases, most were identified in short-term (70%) and long-term (18%) acute care hospitals (STACH and LTACH); 93% were healthcare-associated. CPO cases included 79 (63%) CP-CRE, 32 (25%) CP-CRAB, 5 (4%) CP-CRPA, and 10 (7.9%) unknown/other. Among the CP-CREs, Klebsiella pneumoniae (33%), Escherichia coli (32%), and Enterobacter cloacae (11%) predominated. Common specimen sources included urine (25%), respiratory (25%), and rectal (screening, 19%). CP-CREs were mainly associated with KPC (41%) and NDM (35%), while CP-CRAB frequently harbored OXA-variants (31%) and multiple mechanisms (31%, all NDM plus OXA-variant). Crude IR increased in 2024 to 6.3 cases/100,000 persons, driven by CP-CRE (4.5 cases/100,000 persons). NDM predominated in 2024 (2.4 cases/100,000 persons) before declining below KPC in 2025 (NDM: 1.3; KPC: 1.5 cases/100,000 persons). Incidence was highest among males and adults aged 65-79 years. No significant monthly trend was observed (IRR = 1.00, p = 0.74). Conclusion: Cases in SF increased from 2023 to 2024, with monthly trends through partial 2025 data suggesting stabilization. Our data showing 7% of cases with no/unknown healthcare-association align with estimates of 6-10% community-association from previous studies, reinforcing healthcare settings as the primary context for transmission. CP-CRE were predominantly KPC and NDM, consistent with recent reports; however, CP-CRAB showed greater multi-mechanistic resistance, with NDM/OXA-variant combinations as common as OXA-variants alone. Ongoing local surveillance and healthcare collaboration is critical to monitor evolving organism–gene patterns.