Infection prevention and control (IPC) is essential to reduce healthcare-associated infections in long-term care facilities (LTCFs). Its implementation faces unique challenges and is less studied than in acute care. This scoping review mapped barriers and facilitators to IPC implementation in LTCFs.

Standardized procedures for scoping reviews were followed (eg, PRISMA-ScR). PubMed, Web of Science, CINAHL and PsycINFO were searched (2008–2025). Out of 965 articles, 21 studies were included. Data were charted and mapped to the (sub)domains of the Consolidated Framework for Implementation Research (CFIR).

Studies covered nursing homes, pediatric care, and disability care facilities in North America (n = 11), Europe (n = 8), Australia (n = 2) and Asia (n = 1). Most focused on hand hygiene and healthcare staff. Barriers and facilitators were identified across five CFIR domains. Intervention characteristics: Complex, untailored guidelines hindered use, while concise, context-specific protocols and adequate supplies enhanced adherence. Individual characteristics: Knowledge gaps, low risk perception, and competing priorities reduced adherence, whereas motivation, outbreak experience, and professional responsibility supported compliance. Inner setting: Staff shortages, high workload, and limited leadership were major barriers, while managerial engagement, supportive culture, and IPC champions promoted success of IPC. Outer setting: Limited policy support constrained implementation, whereas collaboration with public health agencies and peer networks facilitated it. Implementation process: limitations were lack of structured approaches; but ongoing training, peer feedback, and evaluation were key facilitators.

Many barriers and facilitators towards IPC in LTCFs were identified that can inform future implementation strategies. Implementation processes were rarely considered and need attention in research and practice.

Ralstonia spp. are opportunistic gram-negative bacilli that persist in aqueous environments and may cause nosocomial outbreaks. We describe an outbreak of bloodstream infections by Ralstonia pickettii associated with contaminated dexmedetomidine.

Outbreak investigation, including a case–control study, was conducted in a tertiary pediatric hospital (July 19–August 23, 2025), affecting the Cardiovascular, Pediatric, and Burn Intensive Care Units. Species identification was performed using MALDI-TOF MS. Whole-genome sequencing evaluated clonality and phylogenetic relationships with previously reported outbreaks. Environmental sampling and traceability of medical products identified the outbreak source.

Eleven R. pickettii bloodstream infections were identified, with 72.73% occurring in the Cardiovascular ICU. The median patient age was 6 months (IQR: 2 mo–7 yr), and fever was the predominant symptom (72.73%). The attack rate was 29.73%, and the case fatality rate was 27.27%. Significant risk factors included exposure to the implicated dexmedetomidine batch (OR 18.75, 95% CI 2.02–173.00, P = .01) and higher dispensed quantity of dexmedetomidine (OR 1.33, 95% CI 1.07–1.67, P = .01). Genomic analysis confirmed clonal R. pickettii (rST-37,889) with close phylogenetic relatedness to outbreaks in Germany and Australia in 2023. All isolates harbored blaOXA-60, blaOXA-22, adeF, and vanH resistance genes. Identical R. pickettii was isolated from the implicated imported dexmedetomidine batch. The outbreak was controlled following withdrawal of the contaminated batch.

This first reported outbreak of R. pickettii bloodstream infections linked to intrinsically contaminated dexmedetomidine highlights risks from manufacturing failures in global pharmaceutical supply chains and emphasizes the essential role of genomic surveillance in outbreak investigation.

To evaluate the association between neighborhood-level social vulnerability and risk of surgical site infection.

Retrospective cohort study from January 1, 2019-December 31, 2024

Large academic hospital in the Deep South

Patients undergoing NHSN-defined procedures by CPT coding (coronary artery bypass graft, colon surgery, craniotomy, spinal fusion, hip prosthesis, knee prosthesis, or abdominal hysterectomy) were included. Social vulnerability index (SVI) percentile and themes were defined by the Centers for Disease Control and Prevention criteria and assigned based on residential ZIP code.

The primary outcome was development of SSI. Cox proportional hazards models stratified by SSI surveillance duration (30 or 90 days) were used to estimate hazard ratios (HRs) and 95% confidence intervals, adjusting for demographic, clinical, and procedural characteristics.

Among 40,954 surgeries, 26,067 patients (63.7%) resided in high SVI ZIP codes. The risk of SSI increased across SVI tertiles (low 1.5%, medium 2.2%, high 2.4%). Compared with those in low SVI tertile, SSI risk was higher for patients in the medium-SVI (aHR 1.40, 95% CI 1.03–1.92) and high-SVI tertile (aHR 1.49, 95% CI 1.10–2.01). Higher SVI socioeconomic status was associated with increased SSI risk (aHR 1.33, 95% CI 1.07–1.64) and higher housing and transportation vulnerability was associated with increased deep incisional and organ space SSI.

Higher neighborhood-level SVI was independently associated with increased risk of SSI across a broad surgical population in the South. Incorporating SVI into preoperative risk assessment may allow targeted infection prevention strategies for hospitals to address barriers to care.

Leukemic and hematopoietic cell transplant patients have one of the highest incidences of Clostridioides difficile infection (CDI). Although CDI patients are considered the primary source of transmission, asymptomatic colonized (AC) patients can progress to CDI or contribute to in-unit transmission. We aim to quantify the roles of CDI and AC patients in C. difficile importation and transmission within oncological units.

Prospective cohort study

Two leukemia and hematopoietic cell transplant units in a large tertiary care hospital in the United States for a 6-month period.

We developed a stochastic, individual-based network model to simulate C. difficile acquisition and transmission. Data from cultures and nucleic acid amplification testing obtained at admission and weekly, and toxin enzyme immunoassay tests used for CDI diagnosis were used to calibrate the model. Healthcare worker room assignments informed the network structure. Key parameters were estimated via particle filtering.

The model reproduced observed weekly test counts and transmission pairs. Only 23% of new colonization events were observed via testing. AC patients were the primary source of new colonizations: 51% (range: 38%–70%) were due to importation (of those, 87% were admitted as AC), and 49% (30%–62%) were due to transmission (AC was the source in 92% of transmissions that resulted in new colonizations).

These findings reinforce the role of AC, particularly via admission importation, in sustaining C. difficile transmission in high-risk hospital settings. Infection control focused on CDI effectively reduced onward transmission, as indicated by CDI’s low contribution to new colonizations.

Understand current prevention practices used for Candidozyma auris and identify target areas for improvement.

Electronic survey.

Long-term acute care hospitals (LTACHs).

National Association of Long-Term Hospitals (NALTH) network facilities located in the United States.

REDCap survey distributed by email to 56 facilities in the NALTH network exploring knowledge and perceptions related to C. auris screening methods, prevention practices, barriers to prevention, and tools needed to improve containment.

Among 33 responses from 56 LTACHs, 23 (70%) had ever identified at least one case of C. auris infection or colonization. Eighteen (54%) reported identifying cases of C. auris within the past three months and nine (27%) had experienced suspected within-facility transmission. All facilities employed multimodal approaches for C. auris infection prevention. The most frequently reported barriers to effective C. auris prevention included lack of communication between healthcare facilities, inadequate training and education for frontline staff, and lack of compliance with personal protective equipment. The most impactful interventions anticipated to support future C. auris containment included improved communication between facilities at the time of patient transfer and standardized protocols for C. auris decolonization and surveillance.

Most LTACHs within the NALTH network reported firsthand experience with C. auris. Universally, facilities employed multimodal evidence-based infection prevention and control strategies targeted against C. auris. Future strategies anticipated to improve containment included improving interfacility communication of C. auris colonization status, development of effective decolonization protocols, and standardization of surveillance practices.

To assess the surveillance characteristics of respiratory syndromic surveillance criteria and their usefulness for monitoring infection trends in long-term care (LTC) facilities.

Retrospective observational study.

Two wards caring for children and adults with severe motor and intellectual disabilities in an LTC facility with 110 beds.

Inpatients who underwent respiratory pathogen testing during febrile episodes between November 2022 and December 2025 were included. Episodes were defined as testing events associated with febrile periods and surveillance characteristics were assessed among tested episodes.

Surveillance criteria, derived from the patient-based component of the CARES strategy, were defined as fever ≥38.0°C lasting for ≥2 consecutive days accompanied by at least one respiratory symptom. Associations between surveillance-positive episodes and microbiologically confirmed respiratory infections were examined, and temporal trends were assessed. Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios were calculated as descriptive surveillance characteristics.

Overall, 1,467 episodes from 124 patients were analyzed, including 375 microbiologically confirmed episodes. Surveillance criteria identified 140 (9.5%) episodes, of which 87 (62.1%) were microbiologically confirmed, with 23.2% sensitivity (95% confidence interval, 19.0–27.8) and 95.1% specificity (95% confidence interval, 93.7–96.3). Surveillance-positive episodes demonstrated temporal patterns consistent with confirmed infections.

Respiratory syndromic surveillance criteria demonstrated high specificity and captured temporal changes in microbiologically confirmed respiratory infections in LTC wards. Although not designed to identify every infection, simple signals, such as ≥2 surveillance-positive episodes per week, may facilitate monitoring respiratory infection activity and support timely infection prevention and control responses.

To evaluate the association between department-level implementation of broad multiplex respiratory pathogen panels and antibacterial prescribing.

Retrospective repeated cross-sectional staggered-adoption study with cohort-stacked difference-in-differences models.

US emergency and urgent-care departments contributing deidentified electronic health record data to Epic Cosmos, 2016–2025.

Adults with acute respiratory illness without a concurrent clear nonrespiratory bacterial indication.

Incident implementation was the first sustained increase in strict panel use from below 2% to at least 10%, with complete 8-quarter preimplementation and postimplementation windows. Adopters were compared with contemporaneous nonadopters and not-yet-adopters. The primary outcome was a same-day systemic oral or enteral antibacterial order after emergency department discharge.

Among 55,059,432 eligible encounters, 32 adopting departments in 9 cohorts were compared with 1,075 departments, yielding 114,832 department-quarter observations. Implementation was associated with a 23.53-percentage-point increase in panel use (95% CI, 20.32 to 26.74) and a 1.21-percentage-point reduction in same-day antibacterial prescribing (95% CI, −2.37 to −0.05; P = .041), a 5.7% relative decrease. However, alternative 5, 15, and 20% thresholds were not statistically significant, unrestricted analyses were null, and several preimplementation diagnostics rejected flat trends.

Sustained panel implementation was associated with a small reduction in antibiotic prescribing. Threshold sensitivity and mixed preimplementation diagnostics limit causal interpretation and support integrating testing into broader diagnostic-stewardship workflows.

Some inpatient antibiotic use metrics have important limitations, including the absence of patient-level risk adjustment. To address this limitation, we previously developed two risk-standardized ratios (RSRs), one based on days of therapy (RSR-DOT) and the other on days of antibiotic spectrum coverage (RSR-DASC). Here, we evaluated the construct validity of these metrics by examining whether hospital performance was associated with the quality of antibiotic selection and duration in patients with either lower respiratory tract infections (LRIs) or urinary tract infections (UTIs).

Using Veterans Health Administration data from October 2020 through September 2021, we calculated RSR-DOT and RSR-DASC for 121 acute-care hospitals and selected 24 hospitals with relatively low or high values. At each hospital, a blinded infectious diseases physician reviewed 10 admissions each for LRI and UTI. Antibiotic selection at day 3 and total antibiotic duration were adjudicated and summarized as a 6-category ordinal composite outcome. Associations between RSR metrics and antibiotic-prescribing quality were evaluated using ordinal logistic regression; model-fit and bootstrap analyses compared RSR-DOT and RSR-DASC.

We reviewed 479 admissions (239 LRI and 240 UTI). In LRI, lower RSR-DASC tended to be associated with a higher quality of antibiotic use (coefficient, 2.906 [P = .053]), whereas RSR-DOT was not (1.418 [P = .374]). In UTI, neither metric was associated with the quality of antibiotic therapy. Model-fit and bootstrap analyses consistently favor RSR-DASC over RSR-DOT for LRI.

RSR-DASC may capture antibiotic-prescribing quality more closely than RSR-DOT for LRI, but not for UTI, potentially supporting the value of spectrum-informed benchmarking metrics.

Urine cultures have been ordered inappropriately among many asymptomatic hospitalized patients. This study aimed to assess how a new urine culture order note incorporated into an electronic health record system impacted the number and appropriateness of urine cultures performed.

A quasi-experimental before-and-after intervention.

The study was conducted at the Veterans Affairs Connecticut Healthcare System (VACTHS) in West Haven, Connecticut.

The study included hospitalized adult patients who had urine cultures performed from January 1st, 2023, to October 31st, 2024.

The intervention was the addition of a mandatory urine culture order note that linked to a urine culture order in the electronic health record. The note required providers to choose an indication for ordering a urine culture. The study outcomes were the percentage of appropriateness associated with urine cultures and the number of urine cultures per 100 admissions performed pre- and post-intervention.

Following the initiation of the mandatory urine culture order note, the percentage of appropriateness increased from 20.6% before the intervention to 59.6% after the intervention (P < .01). The average monthly number of urine cultures per 100 admissions performed decreased from 18.6 before the intervention to 10 after the intervention, a significant 46.3% reduction.

The implementation of a mandatory urine culture order note linked to the urine culture order resulted in increased urine culture order appropriateness and a significant decrease in number of orders for urine cultures.