Introduction: Acinetobacter infections are commonly viewed as hospital-onset events linked to critical illness and invasive devices. We evaluated whether this paradigm holds true at our institution by examining a decade of Acinetobacter infections at an urban safety-net trauma center. Methods: We conducted a retrospective analysis of patients with Acinetobacter spp. isolated from culture at a 500-bed urban academic safety-net Level I trauma center from January 2015 through December 2025. Clinical and epidemiologic variables were abstracted from the electronic health record. Hospital-onset infection was defined as culture collection on or after hospital day 4 (admission day = day 1). Infections not meeting criteria for hospital onset were classified as community-onset and subsequently assessed for healthcare-associated exposures. Healthcare-associated infection was defined by hospitalization, antibiotic exposure, dialysis, or residence in a skilled nursing facility within 60 days prior to diagnosis. Additional covariates included age, sex, birth place, race/ethnicity, intensive care unit (ICU) admission, active chemotherapy or chronic steroid use, chronic lung disease (e.g., chronic obstructive pulmonary disease or COPD), chronic liver disease (cirrhosis or hepatitis B/C), diabetes, substance use disorder (alcohol or illicit drugs), trauma within 90 days, presence of an invasive airway (endotracheal tube or tracheostomy), indwelling urinary or renal catheters, organism identification (A. baumannii vs non-baumannii species), and final antibiotic used for treatment. To identify factors associated with hospital-onset infection, we used multivariable logistic regression with generalized estimating equations (GEE) to account for within-patient clustering from repeated cultures, reporting adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: A total of 157 cultures with growth of Acinetobacter spp. were identified during the study period. Acinetobacter baumannii accounted for 69% of isolates. Most cases occurred among inpatients (79%). Hospital-onset infection accounted for 39%, while 61% were community-onset; among community-onset cases, 56% met criteria for healthcare-associated infection. The cohort was predominantly White (45%) or Hispanic (36%). The most common clinical syndromes were ventilator-associated pneumonia (26%), bacteremia (26%), and urinary tract infection (19%). Treatment was administered in 83% of cases, most commonly with levofloxacin (30%) or cefepime (25%). Carbapenem resistance was uncommon (3%). In multivariable GEE analysis accounting for repeated cultures, hospital-onset infection was independently associated with chronic lung disease, recent trauma, and presence of an invasive airway (Figure 2). Conclusions: In this safety-net health system, most Acinetobacter infections were community-onset rather than hospital-onset. Hospital-onset infection was strongly associated with markers of critical illness and lung injury rather than demographic factors.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) infections present treatment challenges due to host-related factors, infection source, and complex resistance mechanisms. Attribution of poor clinical outcomes to suboptimal therapy versus underlying host factors remains unclear. Evidence supporting an optimal treatment strategy is limited. Current Infectious Diseases Society of America (IDSA) guidance recommends high-dose ampicillin-sulbactam in combination with an additional agent, including minocycline, as a treatment option. In 2025, the Clinical & Laboratory Standards Institute (CLSI) lowered the A. baumannii minocycline susceptibility breakpoint from ?4 to ?1 mcg/mL. Despite this change, our health system’s standard practice includes high-dose ampicillin-sulbactam plus minocycline for invasive CRAB infections. Given the updated CLSI breakpoint, this study evaluated clinical outcomes among patients with CRAB infections treated with minocycline. Methods: This was a retrospective cohort study of hospitalized adult patients with CRAB isolates who received minocycline within a large integrated health system from June 1, 2024, to June 1, 2025. Patients were excluded if isolates were deemed colonization by provider documentation or cultures were obtained in the outpatient setting. The primary outcome was clinical failure defined as need for antibiotic escalation, lack of microbiologic cure, 90-day readmission requiring retreatment, or 90-day all-cause mortality. Result: We identified 137 CRAB isolates from 128 patients; majority were male (84, 61.3%) with a mean age of 63 ± 14.5 years. ICU admission occurred in 57 patients (39.4%) and the mean Charlson Comorbidity Index was 6.1 ± 2.5. The most common infection sources were respiratory (75, 54.7%), skin and soft tissue/osteomyelitis (34, 24.8%), and bloodstream (19, 13.9%). Most infections were polymicrobial (95, 69.3%). Combination therapy was used in 102 cases (74.5%). Based on updated CLSI breakpoints, only 35% of isolates were minocycline susceptible versus 84% susceptibility to previous breakpoints. Clinical failure was similar regardless of minocycline susceptibility (52.1% with MIC ?1 mcg/mL vs 51.7% with MIC <1 mcg/mL, p=0.964). In contrast, clinical failure was more frequent among patients with CRAB bacteremia (14/19, 73.7%; p=0.04), 18 of which had isolates with a minocycline MIC Conclusion: Following the 2025 CLSI breakpoint revision, most CRAB isolates were identified as minocycline resistant. Clinical outcomes did not differ between groups based on minocycline susceptibility. Outcomes were poor however for sterile-site infections despite documented in-vitro susceptibility. These findings highlight the need for careful differentiation between colonization and true infection at non-sterile sites and emphasize the limitation of MIC-based susceptibility in predicting clinical outcomes of CRAB infections.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a critical multidrug-resistant pathogen. The Emergency Intensive Care Unit (EICU) is particularly vulnerable to transmission due to the high-pressure environment and need for immediate clinical decisions, often made with incomplete microbiological data. While patient-related factors are traditionally prioritized, the relative contribution of invasive procedures and environmental colonization pressure in this specialized setting remains under-quantified. This study aimed to identify the determinants of CRAB acquisition through a comprehensive, hierarchical analysis of patient, treatment, and environmental factors. Methods: A retrospective case–control study was conducted at a tertiary hospital from April 2020 to December 2023. Monthly indicators of CRAB acquisition were examined in relation to environmental characteristics using Spearman correlation. A four-block multivariable hierarchical logistic regression analysis, consisting of patient demographics, clinical characteristics, treatment factors, and environmental characteristics, was performed (48 cases, 144 controls) to identify independent risk factors for CRAB acquisition and to evaluate the model’s explanatory power. Result: During the study period, the monthly CRAB acquisition rate showed a median of 1.69 (range, 0.00–14.59) per 1,000 patient-days. This rate correlated positively with colonization pressure (daily mean number of CRAB-positive inpatients; r = .399, p = .007). Although hand hygiene compliance was high (median 93.8%; range 70.0–100.0%), it showed no correlation with CRAB acquisition rate (p = .753). In the hierarchical analysis, the model’s explanatory power improved significantly as treatment and environmental blocks were added (Nagelkerke R from .043 to .609). In the final model, carbapenem use was the strongest independent predictor (OR 8.58; 95% CI, 2.62–28.09; p p = .004), enteral nutrition (OR 6.36; p = .002), and mechanical ventilation (OR 4.79; p = .037). Colonization pressure also remained a significant independent risk factor (OR 3.56; p Conclusion: CRAB acquisition in the EICU is primarily driven by carbapenem-associated selection pressure, invasive procedures involving fluid exposure, and colonization pressure. Notably, the lack of correlation between high hand hygiene compliance and acquisition rates suggests that individual-level efforts alone are insufficient to mitigate risk in high-pressure environments. Consequently, effective prevention requires a paradigm shift from individual compliance toward organizational strategies. This includes strengthening treatment-related infection prevention bundles for high-risk invasive procedures and implementing dynamic environmental controls based on real-time colonization pressure.

Background: Due to concern for ongoing colonization and substantial risks posed by horizontal transmission of RGN in acute care settings, it is common practice in many institutions to employ indefinite CP once a patient tests positive for resistant bacteria. However, it is important to recognize the adverse environmental and patient care costs of CP which has led institutions to consider structured CP discontinuation policies. Emerging evidence supports implementation of practices to safely discontinue CP in select patients following a defined period without subsequent positive cultures. Despite this, standardized methods to identify eligible patients remain unexplored. Objective: As a part of a larger study to evaluate our institution’s adopted policy of contact precaution (CP) discontinuation for resistant gram negative organisms (RGNs) after one year of no subsequent positive cultures, we aimed to assess the utility of a retrospective audit of medical records as a strategy to identify patients eligible for CP discontinuation. Methods: A retrospective chart review of patients with identified RGNs in the Children’s Hospital of Philadelphia (CHOP) electronic medical record (EMR) system from May 2021 to November. In concordance with the internal policy established November 202 recommending removal of contact precautions after one year without subsequent RGN culture positivity, each chart was assessed for the date and organism of the initial infection as well as last positive culture to determine eligibility for CP removal. Patients with carbapenem resistant organisms or those with cystic fibrosis were excluded from the review. Results: Of the/of the identified patients were determined to be eligible for de-labeling. The time required to determine eligibility status in the EMR was approximately 1 minute per patient totaling around 2.5 hours of review. Conclusion: This review identified a significant proportion of RGN-positive patients for whom standing CP were not removed in real time, allowing for an efficient update of CP status to align with hospital policy. Removal of CP not only alleviates a significant environmental and financial burden but also could contribute to a more positive patient/family experience during the hospital stay. The results of this study suggest that employing prospective plans for chart audits as CP discontinuation policies are modified would improve resource utilization.

Background: Active surveillance for carbapenem-resistant Acinetobacter baumannii (CRAB) is essential for infection prevention in endemic settings. Skin screening using pre-moistened sponges with enrichment has demonstrated the highest sensitivity for CRAB detection and is considered the reference standard. However, sponge-based sampling is labor-intensive and less feasible for routine use. Prior studies reported limited sensitivity of swab-based screening. We evaluated whether an optimized swab-based protocol, incorporating expanded skin sampling sites, could improve sensitivity compared with sponge sampling among known CRAB carriers. Methods: This paired-method study included hospitalized patients with documented prior CRAB carriage withing prior 3 months. On the day of screening, skin samples were collected before bathing simultaneously using Polywipe sponges and dry E-Swabs (Copan Italia S.P.A., Brescia, Italy), from opposite sides of the body. Swabs were used to sample multiple skin sites, including palm, interdigital spaces, antecubital fossa, axilla, groin, knee crease, sole of the foot, and toe webs, encompassing moist skin folds known to favor Acinetobacter colonization. Skin samples were collected from patients’ arms and legs (groin and downward), Sponge samples were incubated overnight in brain–heart infusion (BHI) broth at 37 °C, vortexed, and plated onto CHROMagar MDR Acinetobacter. Swabs were broken directly into 3 mL BHI broth, incubated overnight, vortexed, and plated identically. Sponge sampling was defined as the gold standard. Sensitivity of swab screening was calculated among sponge-positive samples. Results: Among 134 paired screening samples from known CRAB carriers, 95 (70.9%) were positive by sponge sampling. Of these, 78 were also positive by swab screening, yielding a swab sensitivity of 82.1% (95% CI, 73.2–88.5). Thirty-nine patients (29.1% of the cohort) screened negative by both methods on the day of sampling, despite prior documented carriage. Discordant results were predominantly sponge-positive/swab-negative. Conclusions: Among patients with known CRAB carriage, an optimized swab-based skin screening protocol achieved substantially higher sensitivity than previously reported swab methods, though sensitivity remained lower than sponge-based screening. The inclusion of moist skin folds (such as the knee creases and toe webs), which are known to harbor Acinetobacter spp. but are not routinely sampled in previous studies, may explain the improved detection observed. The high proportion of negative screeing among known carriers highlights the dynamic and intermittent nature of CRAB skin colonization and the limitations of single time-point screening.

Background: Within-hospital transmission has been reported with carbapenem-resistant Enterobacterales (CRE) infections. At our medical center, much of the CRE submitted for carbapenemase surveillance is non-carbapenemase producing (non-CP-CRE). We explored risk factors for CP-CRE vs non-CP-CRE infections in a cohort in our center in which both CP-CRE and CRE overall are rare to explore the hypothesis that horizontal transmission is more likely with CP-CRE. Methods: All patients with meropenem-resistant Enterobacterales isolated at MUSC March 2022 through February 2025 that were submitted to the state public health lab for modified carbapenem inactivation method (mCIM) testing and reflex metallobetalactamase gene PCR (CARBA-R, Cepheid) were included. Patients with positive mCIM were defined as carbapenemase-producing CRE (CP-CRE). A subset of CP-CRE patients from January 2024-February 2025 was compared to patients with non-carbapenemase-producing CRE over the same period and underwent chart review regarding antimicrobial exposures, past infection with other MDROs, past healthcare facility exposure, and other clinical features. Results: Over the study period 170 total CRE isolates were forwarded, of which 83 (48%) were confirmed CP-CRE, of which KPC (68, 82%) and NDM (15, 18%), and oxa-48-like (1, 1%) were the mechanisms detected. Klebsiella pneumoniae (54/83, 65%) and Enterobacter spp. (35/87, 40%) were the most prevalent CP-CRE and non-CP-CRE species, respectively. From January 2024 – February 2025, 35 CP-CRE and 31 non-CP-CRE-infected patients were reviewed. CP-CRE was associated with resistance to several non-beta-lactam antibiotics whereas non-CP-CRE was significantly associated with prior exposure to carbapenem-class antibiotics in the prior 90 days (23% vs 3%, P = 0.021). No other significant differences in the two groups were noted apart from prior MRSA infection and solid organ transplant status associated with non-CP-CRE (Table). Conclusion: CP-CRE is associated with more significant multi-class resistance and much less associated than non-CP-CRE with prior carbapenem exposure, suggesting that horizontal transmission may play a more important role in CP-CRE infections whereas in-patient evolution of CRE may play a larger role in non-CP-CRE infections.

Background: Wastewater surveillance has emerged as a powerful tool for monitoring community pathogen burden. However, its role in hospital infection prevention remains unclear. We evaluated hospital wastewater for detectable multidrug-resistant organisms (MDRO) at an academic tertiary-care center (AH) and a community hospital (CH). Methods: From April-September 2024, wastewater was collected longitudinally from an AH and a CH. Samples were collected from selective plumbing draining intensive care beds at both facilities. After a 24-hour collection, samples were processed using digital droplet PCR to detect and quantify resistance genes and pathogens, including blaCTX-M, blaTEM, blaCMY-2, blaSHV, IMP, VIM, OXA-48, KPC, NDM, and Candida auris. Results were reported as gene copies per swab. Concurrent hospital isolation logs were reviewed to identify unit isolation with corresponding MDROs at the time of sampling. Results: Wastewater from both hospitals consistently contained multiple MDRO genetic markers across all sampling periods (Figures 1-4). Extended-spectrum beta-lactamase (ESBL) genes blaCTX-M, blaTEM, and blaSHV were detected in every sample, often at high copy number. Carbapenemase (CRE) genes IMP, KPC, and VIM were frequently detected, whereas NDM and OXA-48 were present at low and variable levels. C. auris was rarely detected. Across both sites, quantitative gene copy numbers varied over time. AH demonstrated persistently high ESBL and CRE gene burdens with temporal surges (Figure 1-2), while CH showed lower and more episodic detection patterns (Figure 3-4). Isolation needs for ESBL and CRE at both hospitals are reported in Figures 1-4. Conclusion: Hospital wastewater harbors diverse MDRO genetic signatures that do not reliably track with isolation practices, reflecting contributions from both silent patient shedding and environmental sources. ESBL genes often remained high even when no patients required isolation, whereas carbapenemase surges frequently preceded increases in CRE isolation, suggesting wastewater may provide early warning of rising resistance pressure. Differences between hospitals likely reflect both patient populations and environmental persistence. Wastewater surveillance may complement infection prevention efforts but should not be interpreted as a direct surrogate for patient colonization. Figure 1. Temporal trends in ESBL-producing resistance genes in wastewater and isolation needs at an academic center Figure 2. Temporal trends in CRE-producing resistance genes in wastewater and isolation needs at an academic center Figure 3. Temporal trends in ESBL-producing resistance genes in wastewater and isolation needs at a community hospital Figure 4. Temporal trends in CRE-producing resistance genes in wastewater and isolation needs at a community hospital

Background: A foundational daily activity for infection preventionists (IP) is reconciling nursing isolation documentation to surveillance system current and historical isolation markers. Inefficiencies and isolation delays occur when: (i) electronic healthcare records [EHR] and IP surveillance tools are separate applications requiring manual person dependent resolution; (ii) EHR has logic limited isolation alerts or lack patient isolation history markers to activate on readmission; and (iii) IP staffing when limited to weekdays. Outcomes result in potential communicable disease exposures and added resources for bed reassignment and room cleaning of semi-private rooms. Surveys identified up to 25% of patients require a change in patient isolation status in an average 250-300 bed acute care hospital. Methods: EHR nursing isolation was aggregated to isolation alerts from IP third party surveillance software into a technology enabling advanced analytics platform in use for daily device rounds. Real time data overlays updated for admitted patients including pending ER hold admissions. Nursing and IP developed rules defining match agreement and review isolation conditions, visual displays and patient specific information. A pilot proof of concept was tested in 11 acute care hospitals ranging in size from 100 to 740 beds displaying both full facility and unit specific views. High performing nursing units operationalized the tool at the beginning of each shift during daily patient safety rounds including weekends and holidays. Results: Tool visuals displayed a patient list to prioritize review of isolation status (Figure 1), patient specific details of mismatch (Figure 2) and reconciled isolation (Figure 3). The average resolution within 24h was 86% (range 79-95%). Charge nurse adoption improved time to isolation, reduced reliance on IP manual processes, improved first time bed assignments and guided nursing patient care assignments. The tool solved for lab “new results” alert gaps to caregivers for MRSA, Candida auris, etc. and provided timely information to care team members unable to access EHR isolation status. Feedback was overwhelmingly positive from users. Short term limitations to reconciliation occurred for patients with clinical conditions warranting isolation pending diagnostic test results (i.e. C. difficile). Conclusion: The technology enabler tool brings together various data streams into a single view for patient care teams and leadership to prioritize activities. The tool enabled shared responsibility between nursing and IP for reconciling isolation status, improved communications, driving operational efficiencies and improving safety.

Background Bacterial resistance to frequently used antimicrobial therapies is a significant threat to human health. Chlorhexidine digluconate (CHG) is a topical antiseptic used to reduce healthcare-associated infections, including those caused by multidrug-resistant organisms. There is concern that exposure to CHG may lead to elevated bacterial CHG minimum inhibitory concentrations (MICs) in healthcare environments where the antiseptic is used. We investigated whether skin bacteria of CHG-exposed patients had elevated CHG MICs compared to patients without CHG exposure. Additionally, we evaluated whether bacteria isolated from environmental surfaces of CHG-exposed patients and from surfaces with detectable concentrations of CHG had higher CHG MICs compared to bacteria isolated from room surfaces without CHG exposure or from surfaces without detectable CHG. Methods We recruited a prospective observational cohort including two patient groups: 15 patients without CHG exposure during hospitalization, and 15 patients with daily CHG bathing for ?14 days prior to enrollment. Informed consent was obtained, and clinical data were recorded. Skin and environmental swab samples were collected using E-swabs and sponge sticks respectively and cultivated on non-selective media (Figure 1). A subset of isolates underwent CHG and antibiotic MIC determination by microbroth dilution. Swab samples of the same locations were collected using pre-moistened sterile water swabs and processed via colorimetric assay. Data were analyzed using multilevel models. Results No significant clinical differences between groups were noted, including in antimicrobial exposure or infection history. 360 unique bacterial isolates were identified, with Staphylococcus epidermidis and Staphylococcus hominis being the most common organisms isolated from all skin and environmental sites (Table 1). CHG MICs were not significantly different across all organisms detected at all sites in exposed versus non-exposed groups (p=0.4) (Table 2). No residual CHG was found on skin or environmental surfaces of the CHG non-exposed group. Residual CHG in the exposed group was most frequently detected on the anterior chest (n=13/15) and bed handle (n=8/15), and levels of residual CHG on body sites were significantly elevated compared to environmental sites (p=<0.0001). Bacteria found where residual CHG was detected on both skin and environmental sites did not have significantly elevated CHG MICs (p=0.21). Conclusion We found no evidence that CHG exposure correlates with elevated CHG MICs of skin or environmental bacteria, suggesting routine CHG use to prevent infections does not contribute to resistance. This study is the first to correlate bacterial CHG MICs with residual environmental CHG, and to perform colorimetric CHG testing on environmental surfaces.

Background:? Legionella poses a significant threat to immunocompromised oncology patients. To mitigate nosocomial legionellosis, healthcare systems often implement environmental surveillance. At MD Anderson Cancer Center, we combined a shared analytics platform with long-read whole genome sequencing (WGS) to enable detection of genetically related isolates from facility ice machines.? Methods:? A centralized dashboard (Power BI, Microsoft) was developed to monitor environmental Legionella surveillance across the institution and highlight areas with elevated positivity rates. Targeted environmental sampling was conducted to identify potential reservoirs. Given repeated isolation of L. anisa strains, a subset of isolates underwent WGS using the MinION platform (Oxford Nanopore Technologies). Genetic relatedness was assessed using MINTyper for single-nucleotide polymorphism (SNP) calling and Prokka with Roary for pan-genome analysis.? Results:? Environmental sampling of facility water sources revealed five positive Legionella samples from five separate ice machines, three of which grew L. anisa. No shared feeder lines or water sources tested positive. WGS performed by an infection control practitioner and revealed that two L. anisa isolates shared 99.9% genome similarity, differing by fewer than five SNPs, suggesting a common origin or transmission route (Figure 1). No clinical cases were associated with these findings during the investigation.? Conclusion:? A WGS based investigation powered by infection control practitioners without the use of a core genome sequencing facility uncovered potential transmission between geographically separated reservoirs that would have gone unrecognized through conventional methods. WGS also helped exclude a third ice machine from the suspected cluster. These findings led to the development of an updated institutional standard operating procedure (SOP), integrating data visualization and genomic analysis to enable earlier identification of related environmental sources and guide proactive interventions before clinical cases occur. This provides a framework for real-time implementation of WGS for Infection Control that can be deployed with minimal investment in nearly any clinical setting.

Background: Carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB) is a highly-transmissible multidrug-resistant organism. In November 2024, the Georgia Department of Public Health (DPH) identified a multi-facility CP-CRAB outbreak in central Georgia and applied whole-genome sequencing (WGS) to guide containment. Methods: During November 2024–May 2025, Georgia and Tennessee Public Health Laboratories confirmed 31 CP-CRAB cases. 24 isolates underwent WGS on Illumina MiSeq; sequences were processed with CDC’s PHoeNIx pipeline, and single-nucleotide polymorphism (SNP) heatmaps were generated with Snippy and Python. Epidemiologic data were abstracted from medical records; risk factors and network analyses were conducted using Excel, with case pairs ?10 SNPs prioritized for analysis. Results: WGS identified 18 cases in three sub-clusters, plus 2 related and 4 unrelated cases; SNP distances ranged 0–34, with 16/49 (33%) case pairs ?10 SNPs. Facilities included four acute-care hospitals (ACH-1–ACH-4, primary ACH-1), with prior exposures to 3 skilled-nursing facilities (SNFs), 1 ventilated-SNF (vSNF), and 1 long-term ACH (LTACH). Sub-cluster 1 (n = 8; 0–26 SNPs; 12/29 pairs ?10 SNPs) specimen sources included 3 respiratory, 2 urinary, 2 wound, and 1 blood specimens from ACH-1–ACH-4. 6 cases formed 12 ?10-SNP pairs, with collection dates 3–52 days apart; 3/6 cases were admitted to ACH-1 from vSNF with direct overlap, 4/6 had prior exposure to ACH-1, and 2/6 had no epidemiologic links. Prior healthcare exposure and intra-facility (ACH-1) movement were observed among all 6 cases. Sub-cluster 2 (n = 5; 2–22 SNPs; 3/10 ?10) involved 5 ventilated respiratory cases, 4 from ACH-1 and 1 from ACH-2. Conclusions: Integrating WGS with epidemiologic data revealed sub-clusters—multiple introductions, distinct transmission pathways, and related cases with wide ranges between collection dates—enabling sub-cluster-specific containment recommendations. These findings informed Georgia’s first multi-facility CP-CRAB outbreak investigation, contributing to the development of a multi-facility engagement model that improved interfacility communication and provider awareness of transmission. Routine WGS–epidemiologic integration is critical for targeted containment and coordinated regional response.

Background: Genomic surveillance detects healthcare-associated outbreaks that are often missed by traditional methods, offering substantial benefits for infection prevention. However, its use introduces complex ethical dilemmas regarding patient notification and disparities in outbreak detection between institutions with and without genomic capabilities. Methods: We applied the Centers for Disease Control and Prevention's 2020 ethical considerations regarding patient notification and the Ethical Infection Prevention and Control (EIPAC) framework to two hypothetical scenarios involving genomic surveillance programs. Our analysis was informed by qualitative research reporting the types of harm experienced by patients across detected and undetected outbreaks. Results: We identified ethical justifications for patient notification when both genomic and epidemiologic evidence suggest transmission, as well as considerations militating for and against notification when epidemiologic evidence supporting genomic findings is absent (Figure). We also demonstrated ethical concerns arising from institutional disparities in genomic capability such that patients in hospitals without genomic surveillance may suffer preventable harm and remain uninformed due to lack of detection. A harms matrix illustrates physical, psychological, and ethical harms depending on detection and disclosure status. Conclusion: Hospitals adopting genomic surveillance face new ethical duties to disclose transmission events, while those that do not engage in such surveillance risk perpetuating inequities in patient safety and transparency. National guidance is urgently needed to ensure consistency in notification and promote ethical adoption of genomics. Coordinated frameworks from professional societies should define genetic thresholds warranting disclosure, address disparities in pathogen genomic detection methods, and uphold patient trust in the genomic era.

Background: Hospital onset bacteremia (HOB) due to Methicillin Resistant Staphylococcus aureus (MRSA), defined as a positive blood culture obtained on admission day 4 or later, is associated with increased patient morbidity and mortality as well as excess healthcare utilization and costs. Determining patient risk factors as well as the most common sources of MRSA HOB can help identify patients at increased risk and guide infection prevention opportunities. Methods: A retrospective descriptive cohort study of patients with MRSA HOB was conducted at a quaternary care hospital from July 1, 2023 to June 30, 2025. Demographic and clinical data collected included comorbidities, hospital length of stay (LOS), chlorhexidine gluconate (CHG) treatment, presence of central venous catheter, and MRSA colonization/infection or hospitalization in prior 12 months. Clinical outcome data collected included infectious complications, need for intravenous (IV) antibiotics, IV treatment duration, 30 day mortality, 30 day readmission and discharge location. The primary source of MRSA bacteremia was determined by review of clinical chart documentation. Results: During the study period, 98 cases of MRSA HOB were identified. Demographics, clinical data and co-morbidities are detailed in Table 1. Primary sources of the MRSA bacteremia are detailed in Table 2 with the most common being vascular catheters, skin and soft tissue and pneumonia. Patient outcomes including infectious complications, 30 day mortality and 30 day readmission are detailed in Table 3. Overall healthcare worker hand hygiene compliance, measured via electronic hand hygiene monitoring system, was 83.3%. Discussion: Patients with MRSA HOB had several pre-existing co-morbidities with high exposure to the healthcare system. Less than half were found to have prior MRSA colonization/infection, but this is likely an underestimate since our institution does not perform active screening surveillance for MRSA. A majority of patients had a preventable source of bacteremia (vascular catheters and pneumonia) indicating opportunities for improvement with daily CHG treatment, hand hygiene and vascular access maintenance bundles. Proposed strategies to reduce hospital acquired pneumonia include improving oral care compliance and increasing patient mobility although further studies are needed. Patients with MRSA HOB had high rates infectious complications and over half required care in a facility post-discharge. More than a third of patients expired within 30 days of discharge. Targeted prevention strategies for MRSA HOB are needed and have the potential for significant impact in morbidity and mortality.

Background: Contact precautions are often utilized by hospital systems to prevent the spread of Methicillin-Resistant Staphylococcus aureus (MRSA). Increasingly, however, the effectiveness of these measures is being debated. While MRSA colonization rates have been studied in various patient populations, published healthcare worker (HCW) colonization rates vary. We therefore sought to quantify the rate of MRSA colonization among HCWs at our institution while surveying HCWs about their use of contact precautions. Methods: HCWs with direct patient care responsibilities were recruited to complete an anonymous survey about contact precaution adherence, followed by a swab of the bilateral anterior nares. Swabs were performed using an ESwab sample collection system and plated on MRSA selective media (HardyCHROM MRSA chromogenic). Cultures were interpreted within 48 hours of incubation. Results: A total of 139 HCWs completed the survey, and 132 swabs were collected. The majority of participants were physician trainees or advanced practice providers (43.2%), followed by nurses (34.1%) and attending physicians (11.4 %). The remainder were collected from a combination of nursing assistants and patient therapists. MRSA was detected in 17 HCWs (12.2%). Nurses represented the majority of positive cases (9/17). Compared with MRSA negative HCWs, MRSA-colonized HCWs had higher average years of work experience (10.2 [IQR 2.5–16.0] vs 8.7 [IQR 1.5–12.0]; p = 0.56) though it was not statistically significant. Most HCWs (87%) reported performing recommended hand hygiene more than 90% of the time. Among HCWs who tested positive for MRSA colonization, 9/17 (52.9%) predicted they would test positive MRSA, while 52/115 (45.2%) of HCWs who ultimately tested negative predicted they were colonized. Discussion: Our results showed that MRSA colonization rates among HCWs at our facility were similar to published rates at other North American institutions. Although further statistical evaluation is needed, it is noteworthy that MRSA-positive HCWs had worked in hospitals longer than MRSA-negative HCWs and that nurses had a disproportionate colonization rate. This suggests that time at the bedside may be a strong risk factor for MRSA colonization among HCWs. While the data supporting the use of contact precautions to prevent MRSA transmission are debated, the importance of hand hygiene is not. Reassuringly, 87% of HCWs reported on this anonymous survey that they performed hand hygiene more than 90% of the time. We aim to further analyze our data and evaluate how HCW colonization rates change as our MRSA contact isolation policies are updated in the future.

Background: Parvovirus B19 causes a spectrum of illness in children, from asymptomatic infection to severe organ-invasive disease, particularly in immunocompromised hosts. Current infection prevention guidelines recommend prolonged isolation for patients with chronic infection, yet no validated quantitative PCR threshold exists to guide discontinuation of precautions. This uncertainty may lead to extended isolation and resource utilization. Objective: To evaluate the association between quantitative parvovirus B19 PCR levels and clinical manifestations in pediatric patients and explore implications for infection control practices. Methods: We conducted a retrospective observational study of patients aged 0–18 years who underwent quantitative parvovirus B19 PCR testing in a quaternary care hospital system from January–December 2024. Demographics, clinical features, and treatment were abstracted from the electronic medical record. Encounter-level and patient-level characteristics were summarized using Fisher’s exact and Kruskal-Wallis tests. Multivariable generalized estimating equation (GEE) models assessed factors associated with symptomatic infection. Optimal viral load cut-off associated with symptomatology was determined using Youden’s index. A patient with symptomatic infection was defined as having one or more signs/symptoms associated with clinical parvovirus B19 infection (fever, rash, arthropathy, cytopenias, carditis, hepatitis, etc.) that was not explained by a pre-existing underlying condition. Results: Among 103 patients (median age 7 years [IQR 4–11]), 224 encounters were analyzed; 57% were symptomatic (Table 1). Median viral load was 647,500 IU/mL (IQR 6,800–15,500,000) in symptomatic encounters versus 2,000 IU/mL (IQR 900–8,400) in asymptomatic (p<0.001). An optimal threshold of ?25,000 IU/mL (log10 ?4.4) was strongly associated with symptoms (adjusted OR [aOR] 6.54, 95% CI 1.98–21.64; p=0.002). Additional predictors associated with symptoms included hemoglobinopathy (aOR <700; p<0.001) and diagnostic testing indication (aOR 155.01, p<0.001). Viral load was not associated with organ-invasive disease or treatment response. Conclusions: Higher parvovirus B19 viral loads are associated with symptomatic infection, but not with organ invasion or treatment initiation. A threshold of ?25,000 IU/mL may inform future infection prevention guidance, potentially helping to modify isolation practices and improving resource utilization.

Background: A resilient healthcare epidemiology workforce is essential to preventing healthcare-associated infections (HAIs), mitigating antimicrobial resistance, supporting antibiotic stewardship, and responding to emerging pathogens. To address statewide gaps in training and preparedness, the Texas Epidemic Public Health Institute (TEPHI) developed a virtual Infection Prevention and Control (IPC) education program. The IPC 300 Series—the third tier of this initiative—focuses on clinical and systems-level applications that strengthen surveillance, outbreak response, environmental risk assessment, and epidemiologic capacity. This evaluation assesses the reach, learning outcomes, and workforce impact of the 300 Series. Methods: The 10-module 300 Series (2025) was delivered via Zoom and Microsoft Teams, with recordings available on YouTube for asynchronous access. Registration, attendance, and CE participation were tracked across platforms. Knowledge checks (?80% required) and post-module surveys assessed comprehension and intended practice change using the Kirkpatrick Model (Levels 1–3). Mid- and end-of-series evaluations identified epidemiology training needs, barriers to implementation, and perceived impact on outbreak and stewardship readiness. Descriptive statistics and pairwise t-tests for 2023–2025 trends were conducted in Stata/BE 18.0. Results: The 300 Series registered 5,230 individuals, including 1,685 live attendees and 2,070 asynchronous learners—contributing to more than 13,000 learning encounters across three years. Participation represented 49 states and over 20 countries, with 61% from Texas. Continuing education engagement was high (n=325). Knowledge assessment scores (n=511) averaged 92%, exceeding competency thresholds. Modules addressing emerging pathogens, outbreak investigation, environmental risk management, and stewardship-related decision-making generated the highest engagement, reflecting healthcare epidemiology priorities. Post-module surveys demonstrated strong satisfaction (mean 4.7/5.0), with 88% reporting improved understanding and 91% planning to apply epidemiologic principles in surveillance, risk assessment, preparedness, and stewardship-related practices. End-of-series evaluations highlighted persistent gaps in epidemiology and stewardship capacity, including limited staffing, time, and analytic resources. Monthly networking forums (n=323) supported peer learning, case discussion, and practical application of epidemiologic methods. Across 2023–2025, registration doubled and live attendance increased by 55%, demonstrating rising demand for statewide epidemiology-focused IPC training. Conclusions: The TEPHI IPC 300 Series strengthens healthcare epidemiology capacity by delivering accessible, competency-based education aligned with surveillance, outbreak response, environmental risk management, and antimicrobial resistance prevention. Light integration of stewardship principles further supports comprehensive infection prevention practice. Strong participation, high learning outcomes, and widespread intent to apply concepts demonstrate the program’s value as a scalable workforce model that advances public health preparedness across healthcare systems.

Background Timely healthcare personnel (HCP) response during occupational exposure investigations is crucial for risk stratification, prophylaxis, and preventing secondary transmission. Non-response delays interventions, creates blind spots, and increases patient and workforce safety risks. Understanding pathogen-specific response patterns can inform targeted strategies to improve engagement and mitigate these risks. Objective To quantify pathogen-specific response and non-response rates among potentially exposed HCP and assess timeliness of engagement during occupational exposure investigations. Methods We conducted a retrospective review of occupational exposure investigations tracked in REDCap between November 2024 and October 2025 at an academic health system. Incidents involving Mycobacterium tuberculosis (TB), Neisseria meningitidis, Bordetella pertussis, and varicella-zoster virus (VZV) were included. HCP response was defined as reviewing exposure details and submitting required attestation online; non-response was failure to complete these steps. Data were extracted October 29, 2025. Descriptive statistics summarized response patterns. Comparisons and calculations of odds ratios (ORs) with 95% confidence intervals (CIs) were performed using chi-square analysis. Results Among 1,442 HCP notified of a potential occupational exposure, overall response was 90.5% (n=1,305) and non-response was 9.5% (n=137). Response within 5 days was 70% (n=1,003). Pathogen-specific response rates varied. HCP with a TB exposure (n=803) had 60% response within 5 days and 90% total response. Pertussis exposures (n=331) had 87% response within 5 days and 97.6% total response. VZV exposures (n=298) had the lowest engagement, with 77% response within 5 days and 83.6% total response. Meningitis exposures (n=10) demonstrated 90% response within 5 days and achieved 100% total response. When comparing response rates by pathogen, pertussis had significantly higher response rates compared to TB (OR 0.22, 95% CI 0.11–0.47, p < 0.001) and VZV (OR 7.95, 95% CI 3.70–17.08, p < 0.001). TB responses were significantly lower than VZV (OR 1.78, 95% CI 1.21–2.61, p = 0.004). Similar trends were observed for 5-day response rates. Conclusion Statistical comparisons underscore disproportionate engagement challenges concentrated in TB and VZV exposures. TB required significant additional outreach to achieve overall response, reflected in the gap between the 5-day response (60%) and final response (90%) values. VZV had the highest non-response rate (16.4%), though clinical impact may be mitigated by workforce immunity. HCP potentially exposed to pertussis and meningitis demonstrated outstanding response, 97.6% and 100% respectively, perhaps due to urgency for post-exposure prophylaxis when indicated. Pathogen-specific engagement strategies are warranted where delayed or absent responses pose safety risks.

Background: After three decades of declining tuberculosis (TB) incidence in the United States, case counts have increased annually since 2020, including an 8% rise in 2024. Undiagnosed TB poses a risk in healthcare settings because its clinical overlap with other respiratory illnesses can delay diagnosis and expose unprotected healthcare workers (HCWs) to active TB during routine job duties. Despite this risk, there is no standardized CDC definition of TB exposure for HCWs, resulting in variability in exposure investigations, notification, and follow-up. Safety-net hospitals such as Cambridge Health Alliance (CHA), a 300-bed health system, are increasingly affected by complex exposure events. Over the past year, seven patients with active pulmonary TB potentially exposed nearly 250 staff across six clinical areas, requiring multiple notification rounds despite prompt protocols, highlighting gaps in follow-up and uncertainty about actionable exposure definitions. Objective: Using the definition of employee exposure as ?15 minutes within 6 feet of a source case without mask/respirator, this study aimed to evaluate the effectiveness of post-exposure investigation protocols, determine TB screening test conversion rates among exposed employees, and assess the incidence of active TB disease during the study period. Methods: We reviewed email outreach to HCWs, employee communications, and TB testing records, and compared institutional practices with CDC and National Tuberculosis Controllers Association (NTCA) guidance. Analysis focused on accurate identification of exposed employees and completion of recommended follow-up testing using IGRA or TST. Results: Key barriers included incomplete exposure lists, fragmented interdepartmental communication, and inconsistent documentation of TB history,necessitating additional outreach efforts and contributing to a more time intensive notification process. The audit identified 243 potentially exposed staff, of whom 238 were contacted. 189 (79.4%) responded; non-responders included former employees, staff on leave, and those who did not reply. Among respondents, 87 (46%) met exposure criteria. Twenty-five (28.7%) had prior positive TB tests and were excluded from retesting. Of the 62 eligible for follow-up testing, 48 (77.4%) completed testing. No new TB infections or active TB cases were identified. Conclusions: Despite logistical challenges, the investigation achieved a high response rate with no new TB cases detected. Our study identified opportunities for improvement in data management, communication, and exposure classification. Standardizing TB exposure definitions and implementing centralized tracking systems may improve efficiency, consistency, and HCW protection. These findings support the effectiveness of current infection prevention measures while underscoring the need for a standardized national or regional approach.

Background: Sharps injuries remain a major occupational and infection prevention concern in healthcare settings, yet underreporting and inconsistent use of protective equipment persist despite mandatory regulations. Evidence on institutional and behavioral factors associated with reporting and preventive practices is limited. This study examined institutional, educational and behavioral correlates of sharps injury reporting among nursing professionals in the Republic of Croatia. Methods: We conducted a national-level cross-sectional survey in May 2024 using an anonymous online questionnaire. Eligible participants were nursing professionals who experienced at least one sharps injury in the previous five years. Data included sociodemographic characteristics, sharps injury reporting behavior, as well as the use of protective equipment and safety devices. Descriptive statistics were used for sample characterization. Group differences were tested using Mann-Whitney U and chi-square tests. Associations between organizational climate and reporting behavior were assessed using point-biserial correlation. Statistical significance was set at p < 0.05 (two-tailed). Result: A total of 215 participants met inclusion criteria; 88.4% were female, with a mean age of 36.4 years and a mean of 15.4 years of professional experience. Sharps injury reporting differed significantly by healthcare level: nurses working in tertiary healthcare institutions reported injuries more frequently than those in secondary care, where partial or non-reporting was more common (p = 0.048). Moreover, the use of protective equipment differed significantly by educational level, with more regular use reported by nurses with undergraduate or graduate education compared with those with secondary-level education (p = 0.028). A strong association was observed between regular use of protective equipment and sharps injury reporting: irregular or non-use of protective equipment was markedly more common among nurses who partially reported or did not report injuries, whereas regular use predominated among those who reported injuries (p < 0.001). The most frequently cited reason for non-reporting was low perceived infection risk associated with the injury. Conclusion: Sharps injury reporting is closely linked to both institutional context and preventive behavior. Higher reporting in tertiary care settings and the strong association between protective equipment use and reporting underscore the importance of organizational and safety culture factors. Infection prevention strategies should integrate reporting systems with interventions that promote consistent use of protective equipment, most notably in secondary-level healthcare settings, to strengthen surveillance and reduce preventable occupational exposures.

Background: In 2026, demonstrating the value of healthcare epidemiology and infection prevention is critical amid vaccine and science denialism and federal funding cuts. As hospitals face increasing financial pressures, executives may question sustained investment in healthcare epidemiologists and infection preventionists. Clinicians and nurses may also disengage from pay-for-performance or value-based initiatives. This project aimed to present a practical method for quantifying program outcomes for senior leadership, expressed as lives saved and costs avoided. Methods: Twelve types of healthcare-associated infections (HAI), including device-associated, laboratory, and surgical site infections—were identified across an eight-hospital health system in upstate New York using standardized CDC National Healthcare Safety Network definitions. Attributable mortality estimates were derived from published evidence. In the absence of improvement, infection rates were assumed stable year to year. Rates (R) from 2024 were multiplied by corresponding 2025 denominators (device days, patient days, or surgeries) (PD2025) to calculate expected infections (EI). Infections prevented (IP) were calculated as IP2025 = EI2025 – OI2025, where OI represents observed infections. To estimate total lives saved (TS) in 2025 compared with 2024, infections prevented (IP2025) were multiplied by the attributable mortality (AM) of each infection type to obtain lives saved (LS), then summed: IP20251 ՠAM1 = LS1; TS = ?LS. One-way sensitivity analyses across reported mortality ranges were performed using R. Cost avoidance was determined using facility-specific HAI costs and nationally reported cost ranges. Results: In 2025, 67 HAIs were prevented, corresponding to about five additional lives saved compared with the previous year (Table). The method also allowed estimation of costs and bed days saved. In our health system, each central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) adds $97,588 and $61,939 in excess costs and 16.9 and 8.8 additional bed days, respectively. Using these and other adjusted HAI cost estimates for 2025, prevention of 67 infections yielded approximately $3.1 million in cost avoidance and 842 fewer inpatient bed days. Conclusion: Expressing outcomes as lives saved resonates more with executives and clinicians than abstract performance metrics. Because overuse of preventive measures (including unnecessary isolation) can cause collateral harm, prioritizing mortality outcomes is more relevant than pursuing reductions in rates or standardized infection ratios of all HAI types at any cost. This practical, generalizable method enables facilities, including those with limited research infrastructure, to quantify the impact of infection prevention and control and highlights the substantial effect of carbapenem-resistant Enterobacterales on overall mortality.