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Background: Isolation gowns are one of the most used personal protective equipment worn by healthcare workers to prevent healthcare associated infections (HAIs) that can spread via direct- or indirect contact of contaminated objects. Isolation gowns are available as either reusable or disposable; however, urgent data are needed to determine whether these two gown types are associated with differences in HAI rates. Objective: To assess if respiratory and gastrointestinal viral HAI rates differ by using disposable versus reusable gowns. Methods/design: A retrospective observational analysis compared HAI rates per 1000 patient-days before and after phased implementation of reusable gowns across inpatient units from July 2020 through November 2025. to examine the significance of differences in HAI rates. Results/discussion: The analysis identified 513 HAIs, including 314 respiratory and 169 gastrointestinal viral infections. Statistically significant lower HAI rates were observed with reusable gowns compared with disposable gowns for all HAIs combined (0.75 vs. 1.07, p=0.002) and gastrointestinal HAIs (0.26 vs. 0.35, p=0.009). Lower but statistically insignificant rates were observed for respiratory viral HAIs (0.49 vs. 0.72, p=0.07). Rates were comparable or lower with reusable gown use for norovirus (0.16 vs. 0.16, p=0.98), respiratory syncytial virus (0.03 vs. 0.04, p=0.67), and influenza (0.03 vs. 0.02, p=0.72). Implementation of reusable gowns was not associated with increased respiratory HAI rates and was associated with lower overall HAI incidence. These findings suggest that reusable gowns provide effective protection against respiratory pathogen transmission while supporting sustainability initiatives. Reusable gowns may represent a viable strategy to balance infection prevention, environmental impact, and resource utilization in healthcare settings.
Background: Nontuberculous mycobacteria (NTM) have caused serious infections following cardiothoracic surgery. In 2015, the first reports of NTM infections attributed to heater-cooler devices used during cardiopulmonary bypass (CPB) led to a prolonged international response. Surveillance and clinical management of these infections is challenging due to the long period (approximately 13–26 months) between exposure and disease presentation. Our objective was to describe the frequency and clinical outcomes of NTM infections following surgery with CPB among U.S. Medicare beneficiaries. Methods: We used Centers for Medicare & Medicaid Services claims data for Medicare fee-for-service beneficiaries. The study included adults who had (a) an inpatient claim with a procedure code for surgery requiring CPB between 2009–2021, and (b) an inpatient claim with a non-pulmonary NTM diagnosis code within two years after the index surgery. For beneficiaries with multiple surgeries in 2009–2021, only the first was included. Beneficiaries with an NTM diagnosis code on a claim in the year before the surgery were excluded. Demographic and clinical characteristics among cases and clinical outcomes in the two years after the index surgery were described. Results: Overall, 349 NTM case-patients with an index cardiothoracic surgery between 2009-2021 were identified. Cases had a median age of 70 years (interquartile range [IQR]: 65–77) (Table). The number of cases peaked in 2014 (n=40) and was lowest in 2018 (n=16) (Figure). The largest proportion of index surgeries were coronary artery bypass graft surgeries (45.0%), followed by cardiac valve surgeries (33.8%) and ventricular assist device surgeries (19.5%). The median time from index surgery to the first hospitalization with an NTM diagnosis code was 195 days (IQR: 75–416), and 26.9% of cases (n=94) had a diagnosis code for a serious infection (sepsis, endocarditis, or other bloodstream infection) at the time of the NTM diagnosis. During the two years after the index surgery, cases had a median of 4 inpatient hospitalizations and the median cumulative length of inpatient stays was 41 days (IQR: 18–77); 129 cases (37.0%) died, including 51 deaths among cases with a serious infection (54.3%). Conclusions: NTM infections following cardiothoracic surgery involving CPB continue to be identified despite heater-cooler device-related interventions. Although this claims-based analysis was unable to assess detailed clinical manifestations or cause of infection, the results suggest a need for continued attention to NTM prevention strategies in patients requiring CPB surgery to prevent these severe infections that are associated with multiple subsequent hospitalizations and high mortality.
Background Catheter associated bloodstream infections (CABSIs) remain a preventable healthcare-associated infection, with prolonged central venous catheterization posing a significant risk. Peripherally inserted central catheters (PICCs) are increasingly used in hospitalized patients due to convenience and a lower infection risk compared with nontunneled central venous catheters. Despite their benefits, PICCs are associated with complications, including thrombosis, phlebitis, infiltration and CABSI. Complications can delay treatment, prolong hospitalization and increase financial burden on healthcare facilities. Ensuring appropriate PICC use and considering less invasive alternatives can reduce patient harm and healthcare costs. Methods From May to October 2024, infection prevention team identified sustained high utilization of PICCs in the adult inpatient units. The infection prevention team organized and conducted a multidisciplinary meeting with the PICC team, Dietary, Pharmacy, and Nursing partners to identify opportunities to reduce unnecessary PICC use. Lack of a formal review for PICC insertion appropriateness and limited assessment of PICCs present on arrival were identified as main opportunities. In October 2024, the team implemented standardized review for all PICC indications and PICC line insertion request. The intervention included a multidisciplinary evaluation of all PICC lines. The review included daily assessment of PICC necessity, potential for device de-escalation and removal, and review of medication and parenteral nutrition orders for potential transition to formulations compatible with midlines or other lower risk access devices. Daily huddles facilitated communication regarding line necessity and escalation of barriers. Results Hospital-wide central venous catheter (CVC) utilization decreased 15.5% from a standard utilization ratio (SUR) of 0.653 in the baseline period, to 0.552 in the 6-month post-implementation period (p-value < 0 .001). Decreased CVC utilization was sustained with a SUR of 0.527 through November 2025. Furthermore, PICC Utilization decreased 52.5% from a utilization ratio of 0.016 to 0.0074. Conclusion PICC lines were frequently overutilized, contributing to unnecessary exposure to central venous access risks. Key opportunities included expanding midline use for short-duration therapies and peripheral administration of appropriate parenteral nutrition formulations. Implementation of a multidisciplinary PICC review process significantly reduced PICC utilization and decreased potential CABSI risk.
Introduction: Outpatient parenteral antimicrobial therapy (OPAT) allows patients to receive intravenous antibiotics safely outside the hospital and is an important strategy to reduce inpatient hospital stays, healthcare costs, and exposure to nosocomial pathogens. However, OPAT carries risks, including adverse drug events, repeat healthcare encounters, and treatment complications. Prior studies suggest certain populations such as Black/African American patients may be at higher risk for adverse outcomes, underscoring the need to evaluate OPAT program performance. We aimed to characterize clinical outcomes among patients enrolled in the Loyola University Medical Center (LUMC) OPAT program and identify factors associated with adverse events. Methods: We conducted a retrospective case-control study of adults enrolled in the LUMC OPAT program between 10/01/24 – 12/31/24. Patients were identified through OPAT flowsheets, a specialized Epic flowsheet created to follow patients enrolled in OPAT. Inclusion criteria were age ?18 years and completion of OPAT at LUMC. Patients who did not complete OPAT at LUMC, lacked documentation, or followed with non-LUMC ID were excluded. Cases were defined as those who suffered an OPAT complication, defined as any of the following: 30-day OPAT or infection related ER visit and hospital admissions, medication adverse events, and vascular access complications. Controls were patients who did not have an OPAT complication. Data collected encompassed patient demographics, comorbidities, and OPAT related clinical characteristics. Univariable and multivariable analysis was conducted using R, statistical significance set to p<0.05. Results: Of 97 patients identified, 74 met the inclusion criteria (Figure 1). 27 (36%) experienced an OPAT complication (Table 1). OPAT complications were more common in patients who were younger (median age 52 vs 64 years, p<0.01) and receiving OPAT at home (63% vs 32%, p=0.04). In multivariable analysis, younger age, and non-English speaking status were strongly associated with OPAT complications. Conclusion: Younger age and non-English speaking status were significantly associated with OPAT complications. Receiving OPAT at home demonstrated a trend toward increased risk. Race, ethnicity, zip code, insurance status, and underlying comorbidities were not associated with complications. Microorganism and vascular access type did not differ significantly between groups. A larger study is planned to confirm associations identified from this study, and to develop interventions to help improve outcomes for at-risk populations.
Background: The Centers for Medicare & Medicaid Services (CMS) Hospital-Acquired Condition Reduction Program (HACRP) assigns penalties to the worst-performing quartile of U.S. hospitals based on the Patient Safety and Adverse Events Composite (PSI-90) and five standardized infection ratios (SIRs). Although these measures are weighted equally in program scoring, the extent to which each metric contributes to penalty risk is unclear. Understanding the relative influence of these measures is essential for infection preventionists (IPs) and quality leaders working to anticipate penalties and prioritize improvement efforts. Methods: We conducted a retrospective cross-sectional analysis of 3,082 acute care hospitals included in the CMS Fiscal Year (FY) 2025 HACRP dataset. Predictors included PSI-90 and SIRs for central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI), Clostridioides difficile infection (CDI), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. All measures were analyzed as continuous variables and standardized using z-scores. Multivariable logistic regression estimated associations with penalty status. Model discrimination was assessed using area under the curve (AUC). Results: All six measures were strongly associated with HACRP penalties. PSI-90 demonstrated the largest effect size (OR 10.87; 95% CI: 7.76–15.7). Among infection-specific measures, CAUTI (OR 8.60; 95% CI: 6.27–12.1) and CDI (OR 8.48; 95% CI: 6.25–11.8) showed the strongest associations. The primary model exhibited excellent discrimination (AUC = 0.99). Distribution plots revealed that penalized hospitals consistently had higher PSI-90 and SIR values; for CAUTI and CDI, even small shifts toward or above an SIR of 1.0 increased penalty likelihood. Conclusions: In FY2025, PSI-90 demonstrated the strongest association with HACRP penalty assignment, despite equal weighting with infection-specific SIRs. Among infection measures, CAUTI and CDI showed the greatest influence on penalty risk. These findings provide actionable benchmarks for IPs and quality leaders to interpret performance and anticipate penalty risk within HACRP.
Background: The indications for the use of cardiac and endovascular implants have expanded worldwide. With increased utilization, there has been a proportional increase in implant-related complications, including infections. Epidemiological factors influencing patient outcomes in cardiac and endovascular implant infections (CEVII) are poorly characterized. We aimed to evaluate the epidemiology of CEVII and further, how healthcare utilization (HCU) patterns and the timing of infectious disease (ID) consultation influence hospital length of stay, a known surrogate of patient morbidity and quality of care. Methods: This retrospective study included patients admitted between 2010 and May 2025 with a CEVII encounter ICD-10 diagnosis of T82.7XXA, excluding deaths. For patients with multiple admissions, only the first encounter was analyzed. Descriptive statistics summarized patient characteristics, and we evaluated associations with the timing of ID consultation, HCU, and LOS. LOS modeling used generalized linear mixed models with a negative binomial distribution and log link, including categorical predictors and their interactions; significant interactions indicated effect modification. Model-adjusted mean LOS and 95% confidence intervals were obtained by exponentiating model coefficients. Analyses were performed in SAS 9.4, with p? Results: Among 763 patients with CEVII (1,168 admissions from 2013–May 2025), most were male (62%), White (76%), and Medicare beneficiaries (63%), with a median age of 61 years, median LOS of 8 days, and median Charlson Comorbidity Index (CCI) of 5.5. Early ID consult (<48 hrs.) occurred in 58.1% of cases, while 24% had no ID consult. Age and CCI were independent predictors of LOS, with no significant interaction with HCU. After adjustment, insurance type and the timing of ID consult significantly influenced LOS (p=0.0067), with late ID consults being associated with longer stays among Medicare and private insurance beneficiaries. Timing of ID consultation also interacted with admission period (pre-COVID, COVID, and post-COVID), with early ID consultationconsistently reducing LOS, while late consults resulted in the longest LOS, a difference amplified during the pandemic. Conclusion: Older patients with suspected CEVII who have high HCU and severe CCI experience longer LOS, underscoring the need for proactive care bundles to reduce excess stay and associated burden. Early ID consultation is critical, especially for Medicare and privately insured patients, where delays can lead to LOS penalties. Strengthening coordinated workflows to prevent delayed ID consultations during system strains, such as pandemics, can help avoid unnecessary prolonged hospitalizations and their impacts.
Background: Many laboratories have shifted from traditional culture-based to molecular panel diagnosis of gastrointestinal (GI) pathogens for a broad array of reasons including simplicity and rapidity. The Portland VA Health Care System (VAPORHCS) implemented the Biofire® Film array® GI pathogen panel (Biofire GI panel) 05/2024. In 04/2024, a recall alert was issued regarding increased risk of false positive norovirus results alongside a recommendation to confirm positive results by another method. The aim of this quality improvement project was to evaluate the false positive rate for norovirus of this assay. Methods: We used microbiology laboratory records to identify all norovirus positive results on the Biofire GI panel from 05/2024-09/2025. Chart review was performed to determine confirmatory norovirus test results, testing location (outpatient, inpatient, or emergency department), compatible clinical symptoms (acute nausea/vomiting/diarrhea), and the presence of other positive stool testing results. False positive was defined as discrepant Biofire GI panel (positive) and dedicated norovirus PCR (negative) results on the same sample. Result: We identified 39 initial positive tests on the Biofire GI panel from 38 unique patients. One test was excluded due to specimen processing error on the confirmatory test, leaving 38 tests for analysis. Of these, 13 (34%) were confirmed as positive by single-plex PCR corresponding to a false positive rate of 66%. False positive rate stratified by test location are shown in Figure 1. Compatible symptoms stratified by test results are shown in Figure 2. Of the true positive group, 11/13 (85%) had diarrhea < 5 days compared to 6/25 (24%) in the false positive group (p<0.001). Similarly, in the true positive group, 11/13 (85%) of patients had nausea/vomiting compared to 5/25 (20/%) in the false positive group (p<0.001). An alternative enteric pathogen was identified in 8/38 (21%) cases. Conclusion: We found an alarmingly high rate of false positive norovirus results on the Biofire GI panel at our center, which is higher than previously reported. True positive tests were more likely to be accompanied by those that fit with typical symptoms. Positive norovirus results from the Biofire GI panel should be interpreted with caution as is recommended by the manufacturer, particularly in absence of a compatible clinical syndrome.
Background: Seasonal viral respiratory pathogens increase isolation needs in pediatric care, creating workflow challenges. A survey found variation in isolation guidelines, particularly regarding duration. In Phase 1, we focused on aligning isolation orders, signage, and infection prevention auditing time. In Phase 2, we sought to implement a nurse-led de-isolation process, empowering nurses to evaluate symptoms and determine readiness to discontinue isolation precautions. Methods: An interdisciplinary quality improvement team mapped isolation work processes, identifying 7 decision points for initiating or discontinuing isolation. Using a prioritization matrix, we developed an EMR-integrated, nurse-driven de-isolation tool (figure 1) that generated a nursing task every 7-28 days based on patient status due to protracted illness (e.g., immunocompromised, severely immunocompromised, or neonates). Predefined clinical criteria guided assessments, triggering discontinuation when met, and eliminating clinician intervention. Patients on Extracorporeal Membrane Oxygenation (ECMO) were excluded. We used iterative cycles of testing and refinement to continuously improve the automation process and clarify response options. Outcome measures included successful discontinuation of isolation precautions; process measures surveyed for nursing satisfaction and assessed appropriateness of decisions based on IPC audits; and balancing measures monitored hospital-acquired viral respiratory infections. Data from a 6-month period were analyzed using descriptive statistics. Results: Before implementation, 39 nurses tested the tool. The majority reported satisfaction with its ease of use, clarity of clinical definitions, and appropriateness of assessment outcomes. Completion time ranged from 20 seconds to 5 minutes. 310 nursing assessments were analyzed; 34% discontinued isolation precautions, 50% maintained precautions with discussion during rounds, and the remainder involved patients automatically retained in isolation due to their special status (neonates, immunocompromised) (Table 1). We identified that 72 assessments during the refinement process misfired without an active isolation order. Then, among the 238 assessments with order and assessment dates, the median time between order placement and nursing assessment was 7 days, with an average of 10 days. Most assessments occurred within 14 days for patients without protracted illness status. Over time, the proportion of patients with protracted illness status increased (Figure 2). No clusters of hospital-acquired viral infections were observed, and IP audits confirmed agreement with the nurses’ assessment in most cases. Conclusion: In this phase, we revealed that a nurse-driven, patient-tailored de-isolation process created a systematic approach to remove isolation without increasing exposure risk. Future opportunities entail strengthening congruency between IP and nursing assessment and de-isolation decisions for patients with underlying clinical conditions who may have a more protracted illness.
Background: Timely conversion of intravenous (IV) antibiotics to oral (PO) therapy remains a core principle of antimicrobial stewardship. Appropriate transition from IV to PO medications reduces the potential for adverse events such as line infections and thrombophlebitis but may also reduce healthcare costs by potentially facilitating a timelier discharge. In addition, IV to PO supports sustainability initiatives by reducing the environmental impact of single-use IV bags and tubing, and PO antibiotics are prepared more quickly by pharmacy and administered easier by nursing, lessening staffing requirements. Methods: Emory Healthcare developed a fully automated dashboard to monitor IV to PO transitions and assess adherence to institutional protocols. The dashboard details antibiotic utilization and documented indication for select IV and PO agents among inpatients at Emory Healthcare from January 2024 to the current year-to-date. Selected antibiotics were chosen based on their inclusion in the Emory Healthcare IV to PO Medication Conversion by Pharmacist Protocol. The dashboard integrates data from the electronic health record including antibiotic selection, infection type, and days of therapy. The data is organized into sections and graphs for streamlined viewing and clear interpretation. Results: A dashboard was successfully created to monitor IV to PO therapy conversions. The first section (Figure A) shows days of therapy (DOT), which can be filtered by operating unit and indication. The second section (Figure B) displays DOT filtered by route and indication for the specific antibiotics included in the Emory Healthcare IV to PO conversion protocol. The third section (Figure C) displays DOT filtered by route and antibiotic for all indications. The antibiotic and indication charts can additionally be filtered to include any combination of antibiotics, indications, facility, unit type, and units. The dashboard also includes tables with antibiotic route of administration data stratified by facility, unit type (ie. oncology, emergency, operating room, acute care), and individual unit. Conclusion: The dashboard provides a novel tool for ASPs to continuously assess utilization and adherence to the Emory Healthcare IV to PO conversion protocol. The dashboard is interactive, customizable, and data is readily available, making it a key tool for optimizing stewardship practices. The data can also be used to identify stewardship opportunities, set quality improvement targets, and quickly display information to key stakeholders.
Background: Blood culture contamination leads to increased healthcare costs and patient harm. Routine practice at our institution oftentimes involves placement of a new peripheral intravenous catheter (IV) followed by immediate blood culture collection from the catheter. Published guidelines discourage routine blood culture collection from central venous catheters, but do not address collection from new IV starts. We hypothesized higher contamination rates in cultures collected from new IV starts. To evaluate, mandatory documentation of blood culture collection site was implemented and contamination rates were analyzed. Methods: A prospective observational study was conducted from September to December 2025 at a large quaternary medical center. Peripheral blood culture contamination rates were measured using the CLSI definition. Mandatory documentation of collection site was implemented September 2025 and included an option for “new IV start”. Contamination rates by collection site were compared using chi-squared tests. An estimated cost of $4,538 for each contamination event was based on pooled published cost analyses data. Results: During the study period, 15,926 peripheral blood culture sets were collected and 234 (1.47%) met contamination criteria. Table 1 shows the new IV start contamination rate was significantly higher than all other sites combined (p-value <0.001 with an odds ratio of 1.86 [1.34-2.54]). The difference remained when comparing new IV start to individual anatomic sites. Per year, an estimated 89 contaminations would be avoided if cultures are not obtained from new IV starts with an estimated savings of $403,882 and 267 antimicrobial days. Conclusions: At our institution, it is common practice to collect blood cultures immediately after inserting a peripheral IV. The contamination rate of new IV starts was nearly double the contamination rate of dedicated upper extremity venipuncture leading to increased costs and unnecessary antimicrobial use. The large sample size provides robust data that collecting blood cultures from a new IV start should be avoided and this compelling data should be used to update published guidelines.
Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) moves specialized, technically demanding care from hospitals to homes, where patients and caregivers take on tasks performed traditionally by trained nurses. However, infection prevention research rarely examines the home environment where OPAT administration and intravenous (IV) line management increasingly occur. Standard quantitative and qualitative approaches (e.g., surveys, interviews) may miss subtle medication administration deviations, environmental constraints, and other challenges that influence IV catheter- and medication-related risks. Video Reflexive Ethnography (VRE) and Photo Elicitation Interviews (PEI) offer a way to observe medication administration processes directly and to incorporate patient and caregiver perspectives to improve infection prevention education and practices. Methods: Using a VRE approach, we videorecorded discharge teaching and in-home OPAT routines, then conducted reflexive sessions in which patients and caregivers reviewed their own discharge teaching videos and discussed aspects of the process they found helpful, unclear, or challenging within their home environments. PEI added a participant-driven perspective by inviting patients and caregivers to photograph features of their home care setup that facilitated or hindered antibiotic administration and IV handling. Figure 1 demonstrates the steps in data collection. The Systems Engineering Initiative for Patient Safety Results: Observations of four patients, both in hospital and at home, revealed that visual methods captured behavioral details (e.g., using teeth to open syringe packaging) not typically discussed in interviews. Reflexive sessions and photo elicitation interviews highlighted uncertainties (e.g., doubts about correct processes), challenges with medication or IV-line maintenance (e.g., difficulty with IV clamps), and practical strategies for managing complex care tasks at home (e.g., hanging IV bag from wall hook rather than IV pole). These methods provided deeper insights into patients' experiences with care. Conclusions: This study demonstrates how VRE and PEI used together can strengthen infection prevention research. Both methodologies in concert provide new insight into how real-world patient and caregiver behaviors, constraints, and teaching gaps shape IV-line care, medication administration, and overall safety outside the hospital. By providing a clearer view of OPAT-related care as it occurs in home settings, this work shows promise for informing future refinement of education and IV medication administration guidance. This work is especially relevant given the growing complexity of infection-related care, including care delivered outside the hospital setting, requiring new approaches to understand and support patient safety.
Background: Residents living in post-acute and long-term care settings (PALTC) settings are particularly vulnerable to severe infections caused by common respiratory viruses, including COVID-19, influenza, and respiratory syncytial virus (RSV). The Perceived Vulnerability to Disease (PVD) scale has been used to understand general public perceptions of vulnerability to infectious diseases. We adapted the PVD for administration to PALTC residents and their care partners. Here, we describe the perceptions of infectious disease risk among Veterans and their care partners at a large Veterans Affairs (VA) PALTC setting, termed Community Living Centers (CLCs). Methods: From November 2024 to July 2025, we surveyed residents at a 152-bed CLC. Inclusion criteria were CLC residents aged > Results: Out of 81 eligible residents and LARs, 40% (N=32; 6 residents and 26 LARs) completed the survey. Regarding previous infections, 27 (84%), 9 (28%), and 0 (0%) respondents indicated that Veterans had tested positive for COVID-19, influenza, or RSV, respectively, during their CLC stay. No more than 9 (28%) perceived a moderate to high risk of infection with any of the pathogens during the next month (Figure 1). At least 12 (38%) of respondents agreed or strongly agreed with 6 of the 7 items for the Perceived Infectivity subscale of the PVD; at least 15 agreed or strongly agreed with 6 of 8 items for Germ Aversion (Figure 2). Conclusions: Participant responses to the Perceived Infectability and especially Germ Aversion indicated concerns with personal susceptibility to illness and general contamination. The perceived risk specifically to COVID-19, influenza, and RSV was comparatively lower, despite most Veterans having viral respiratory infections during their CLC stay. Although based on a small sample, our findings provide valuable insight about resident and LAR perspectives that can help inform and support infection prevention efforts in PALTC settings.
Title: Hospital-onset influenza and RSV: Impact of Infection Prevention Efforts During the COVID-19 Pandemic Authors: Emily Schmitz, MD, MPHa Laura Anderson, RN, MPH, CICb Daniel Shirley, MD, MSa,b,c Affiliations: University of Wisconsin School of Medicine and Public Health, Madison, WI UW Health, Madison, WI Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI Objective: To quantify and characterize hospital-onset influenza and respiratory syncytial virus (RSV) cases, pre- and post- COVID-19 pandemic. Design: Retrospective cohort study from January 1, 2018 - December 31, 2024. Setting: This study was conducted at a large urban Midwestern tertiary-care hospital system. Participants and Interventions: The Infection Prevention team reviewed the electronic medical records (EMR) of patients who were admitted > 48 hours and subsequently tested positive for influenza and/or respiratory syncytial virus (RSV). Incubation periods for each virus were determined based on Centers for Disease Control and Prevention (CDC) guidance and literature review. Hospital-onset was defined as a positive test three or more days after admission for influenza and six or more days after admission for RSV. Patients were excluded if a positive test did not meet these criteria or was completed at least 1-week prior to admission. Clinical data including medical comorbidities, anti-viral administration, vaccination and immunocompromised status were collected from the EMR. Hospital-associated influenza and RSV data were taken from the Wisconsin Communicable Disease Surveillance Data. Results Forty-nine patients met criteria for hospital-onset influenza infection, and 44 (89%) were symptomatic. Twenty-one (43%) patients required the intensive care unit (ICU) and mechanical ventilation during their hospitalization. The majority of patients (92%) received anti-viral therapy (oseltamivir). Nineteen patients (39%) were immunocompromised. A total of 30 (61%) were vaccinated against influenza for the season. Three patients died during their hospitalization, for an in-hospital mortality rate of 0.06%. Nineteen patients met criteria for hospital-onset RSV infection and 18 (95%) were symptomatic. In patients with RSV, 6 (32%) required the ICU and mechanical ventilation during their hospitalization. Only 5 patients (26%) received antiviral therapy for their RSV infection. Compared to influenza, hospital-onset RSV was associated with a higher in-hospital mortality rate (n=3, 16%). There were no hospital-onset influenza or RSV cases from April 2020 through March 2022, which coincides with the COVID-19 pandemic. Cases increased with 12 cases of hospital-onset influenza and 6 cases of hospital-onset RSV in 2024, which were similar to pre-pandemic rates. Discussion Hospital-onset influenza and RSV lead to significant morbidity and mortality. These preventable infections also put healthcare workers and other patients at risk. Data suggest that enhanced infection prevention efforts during the COVID-19 pandemic mitigated the number of hospital-onset cases of influenza and RSV. During periods when influenza and RSV rates are high, enhanced infection prevention efforts are likely warranted to prevent hospital-onset cases.
Background: Respiratory viral infections cause substantial acute morbidity among older adults; however, their impact on short-term health-related quality of life (HRQoL) and functional recovery remains incompletely characterized. Methods: We conducted a prospective observational analysis among adults aged ?65 years enrolled in the U.S. Flu Vaccine Effectiveness Network. Multivariable linear regression was used to examine associations between respiratory virus test positivity (influenza, COVID-19, and respiratory syncytial virus [RSV]) and follow-up HRQoL. Outcomes included EQ-5D utility scores and self-rated health measured using a visual analog scale (VAS). Models adjusted for baseline HRQoL, demographics, household characteristics, and comorbidities. Bias-reduced CR2 cluster-robust standard errors were used to account for heteroskedasticity and within-site clustering. Multicollinearity was assessed using variance inflation factors, all of which were <2. EQ-5D coefficients were rescaled to a 0–100 metric to improve interpretability. Results: After multivariable adjustment, respiratory virus test positivity was not consistently associated with worse follow-up HRQoL. Influenza test positivity was not associated with follow-up EQ-5D scores (? = ?0.4 points on a 100-point EQ-5D scale, 95% CI ?12.5 to 11.6) and showed a positive but non-significant association with follow-up VAS scores (? = 5.9, 95% CI ?2.0 to 13.8). COVID-19 test positivity was associated with higher follow-up EQ-5D scores (? = 21.6, 95% CI 6.0–37.2), but not with follow-up VAS scores. RSV test positivity was not associated with follow-up EQ-5D (? = ?2.1, 95% CI ?16.6 to 12.4) or VAS scores (? = 13.6, 95% CI ?23.4 to 50.6). Across all EQ-5D models, baseline EQ-5D was the strongest predictor of follow-up EQ-5D. In contrast, baseline self-rated health demonstrated weaker and less consistent associations with follow-up VAS scores. Household and social factors showed stronger and more consistent associations with VAS outcomes than infection status, including a significant association between comorbidities and lower follow-up VAS scores in the COVID-19 model. Conclusions: Among adults aged ?65 years with acute respiratory illness, respiratory virus test positivity was not associated with worse short-term HRQoL after adjustment for baseline health and social factors. Baseline health status and social context were more strongly associated with subsequent HRQoL and functional recovery than viral etiology.
Background: During a measles outbreak in the United States in 2025, health care settings were on high alert for patients who may have been exposed to or infected with this disease. When an infection is found, contact tracing investigations are extensive and require significant labor. Identify, Isolate, Inform (III) has become a standard tool for special pathogen preparedness. Our facility implemented an electronic medical record (EMR) alert for patients reporting fever and rash. The objective of this work is to compare and contrast our experience in drill vs clinical practice. Methods: Setting. Denver Health is an acute-care safety net hospital with both adult and pediatric emergency departments, sharing a common security checkpoint for entrance, and a check in and arrival space before patients are triaged into individual waiting rooms. Drill. In March 2025, Denver Health conducted a drill to test the III process in the pediatric emergency department and urgent care center (PEDUC) where care was provided for a mock patient with fever, rash, and cough. Time to masking and time to isolation were collected by a drill observer. Clinical practice. In April 2025, an infant with recent international travel presented to the PEDUC with cough, fever, and rash and was subsequently diagnosed with measles by PCR. Time to isolation was collected via time stamps in the EMR. Results: During the drill, fever and rash were documented, and the alert fired appropriately. The mock patient was masked within six minutes of entry and roomed in a negative pressure room within nine minutes of entry. During clinical practice, rash was documented, but the patient was afebrile at triage, and the EMR alert did not fire. The patient spent 62 minutes in the waiting room before being roomed. Contact tracing involved individuals in both the adult and pediatric emergency departments due to the shared airspaces. In total, 149 patients were identified as contacts and were notified of the exposure by public health. No transmission was identified. Conclusions: Despite a recent successful drill in the PEDUC, when a patient presented with measles, there were challenges with identification and isolation, as well as structural limitations within the facility and gaps with technology aiding the early identification of patients at risk. Having a real-life situation resulted in an extremely large contact investigation and juxtaposed the recent successful drill, highlighting the need to continue performing “no notice drills” and work on improving each facet of preparedness.
Background: Influenza infection has been temporally associated with acute cardiovascular events, including myocardial infarction (MI). We evaluated whether laboratory-confirmed influenza infection is disproportionately present among ED patients presenting with acute MI compared with patients presenting with other common acute diagnoses. Methods: We conducted a retrospective cohort study using TriNetX data from the 2024–2025 influenza season. Adult ED patients (<18yrs) presenting with acute MI were compared to patients presenting with mutually exclusive acute diagnoses, including gastroenteritis, urinary tract infection or urolithiasis, appendicitis, pancreatitis, cholecystitis, pulmonary embolism, aortic dissection, and myocarditis or pericarditis. Patients with COVID infection 30 days prior the ED visit were excluded. Influenza positivity during the ED encounter was defined as the outcome. All comparisons were adjusted using 1:1 propensity score matching for demographics, cardiovascular risk factors, chronic respiratory disease, and healthcare utilization indicators. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. Results: Across propensity score–matched comparisons, influenza infection was consistently more prevalent among ED patients presenting with acute MI than among most comparator diagnoses. Influenza positivity was significantly higher in MI compared with gastroenteritis (RR 1.97, 95% CI 1.76–2.20), urinary tract infection or urolithiasis (RR 2.29, 95% CI 2.08–2.52), pancreatitis (RR 3.84, 95% CI 2.90–5.08), cholecystitis or cholelithiasis (RR 3.38, 95% CI 2.92–3.91), and appendicitis (RR 5.58, 95% CI 3.62–8.61). Among high-acuity cardiovascular chest-pain presentations, influenza positivity remained higher in MI compared with pulmonary embolism (RR 1.46, 95% CI 1.27–1.68) and aortic dissection (RR 1.85, 95% CI 1.59–2.15). In contrast, no significant difference was observed between MI and myocarditis or pericarditis (RR 0.79, 95% CI 0.51–1.23). Conclusions: In this diagnosis-based, propensity score–matched ED analysis, laboratory-confirmed influenza infection was disproportionately prevalent among patients presenting with acute myocardial infarction compared with a broad range of other acute ED diagnoses. The persistence of this association across infectious, surgical, and high-acuity cardiovascular comparators, alongside the absence of association with myocarditis or pericarditis, suggests that the observed association is not simply due to patients being sicker or undergoing more intensive diagnostic evaluation. These findings are hypothesis-generating and support further investigation into temporal and mechanistic links between influenza infection and acute coronary events.
Background: Measles is a highly transmissible virus. A single case can result in significant exposures within a healthcare facility and prompt action is needed to prevent secondary cases. In October 2025, Infection Prevention and Control (IPAC) was notified of a patient being admitted to our facility with recent international travel and symptoms consistent with measles. The patient was unvaccinated and had five healthcare facility visits prior to measles being suspected and subsequently confirmed. Objective: To describe our facility’s effective identification, prioritization, and prophylaxis of individuals exposed to measles. Methods: IPAC leveraged the electronic medical record to identify potentially exposed patients. Patients were quickly assessed for age and immune status, then prioritized and assigned to primary care teams. These teams promptly contacted patients and coordinated PEP administration. Results: Across five encounters, the index patient exposed 539 other patients. Due to delayed notification, our teams had less than four days to administer PEP for those exposed and still within PEP window. PEP administration began within hours of the index case’s positive test and patients received PEP within three days (Table 1). No secondary measles cases occurred within our facility. Conclusion: Timely and coordinated multidisciplinary effort enabled us to rapidly respond to our first measles case and control secondary transmission. Although the index case resulted in a large exposure, patients that were exposed and eligible for PEP were quickly prioritized to prevent secondary transmission.
