Despite the availability of straightforward and economic interventions to prevent HAIs, these unintentional adverse events still pose a significant challenge to public health globally. We aimed to evaluate the outcomes of a nationwide project designed to mitigate HAI incidence in intensive care units (ICUs) using the Model of Improvement framework.

A Quality Improvement (QI) study assessing the outcomes of a two-year initiative in Brazilian ICUs from September 2021. A customized Collaborative methodology was applied to mentor and enhance the capabilities of healthcare workers, equipping them with evidence-based, structured, systematic, and auditable QI strategies (prevention bundles) to improve patient care outcomes. A one-year preintervention baseline incidence was established for the three critical HAIs: central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI), to compare with the intervention period.

The initiative encompassed 188 ICUs (169 adults, 11 pediatric, and eight neonatal), recording substantial reductions in HAI incidence density: by 43% for CLABSI (from 5.5 to 3.2 per 1,000 catheter-day), by 51% for VAP (from 13.6 to 6.7 per 1,000 ventilator-day), and by 55% for CAUTI (from 3.2 to 1.4 per 1,000 catheter-day), irrespective of age. Implementing this QI strategy prevented an estimated 7,342 infections.

Our initiative has been demonstrated to be a feasible and valuable strategy for preventing HAIs in critical care settings. The success of this approach emphasizes the potential for its broader application and reinforces the need for systematic, evidence-based interventions in healthcare settings.

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.

Use the electronic health record (EHR) to prospectively validate a risk prediction tool identifying patients at high-risk for carbapenem-resistant Enterobacterales (CRE).

Prospective, cross-sectional analysis.

Adults admitted to two hospitals in Atlanta, Georgia.

An EHR report calculated a CRE risk score on all admissions from 6/2024–3/2025. The risk score was determined from a prior model incorporating data from current and prior hospitalizations. Stool or perianal samples were cultured from a convenience sample of patients with the highest risk scores. A receiver operating curve analysis calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of various risk scores that could be used as a “threshold” for CRE admission testing. Using the threshold with the greatest Youden’s index, we estimated the cost of implementing a CRE screening program.

Of the 853 patients approached, 342 (40%) consented. Eleven (3.2%) tested positive for CRE. Patients with CRE had a higher median CRE risk score (0.19% vs 0.04%) than those who tested negative. The AUC of the model was 0.66. Using a testing threshold of 0.16% yielded a 55% sensitivity, 84% specificity, 10% PPV, and 98% NPV. The number needed to screen to diagnose 1 patient with CRE was 12 patients, and the screening program approximately costs $8,015/month.

An EHR-based risk prediction tool can detect patients likely to be colonized with CRE. In facilities with a low CRE prevalence, identifying a high-risk subset of patients to test could be a cost-effective infection prevention initiative.

There is increasing evidence on the effectiveness of prevention bundles against non-ventilator hospital-acquired pneumonia (nvHAP), but detailed reports on their implementation are lacking. This study aims to describe and structure the implementation activities undertaken in a single-center multimodal intervention that achieved a 31% reduction in nvHAP incidence.

Longitudinal descriptive qualitative study.

Nine medical and surgical departments of a Swiss university hospital.

Healthcare professionals and implementation teams in study departments.

We collected longitudinal data on implementation activities using (1) implementation activity logs, (2) drop-in interviews and observations, (3) “action plan meetings,” (4) focus groups, and (5) unstructured recall sessions among the project team. Data were deductively coded using the “Expert Recommendations for Implementing Change” taxonomy, specified using Proctor et al.’s “Recommendations for specifying and reporting implementation strategies” and mapped to the “Exploration, Preparation, Implementation, Sustainment” framework phases.

A total of 174 activities were undertaken. Activities varied by implementation phase, most frequently involving “evaluative and iterative strategies,” “develop stakeholder interrelationship strategies” and “training and education of stakeholders” during Exploration, Preparation, and Implementation, respectively. During Implementation, 54% of activities were initiated by department nurses, and 27% were initiated by the institutional implementation team. Activities included interdisciplinary kick-off events, education in various formats, posters, informational stickers for patients, provision of new equipment (e.g., toothbrushes), and electronic medical records order sets.

This report offers valuable insights for future implementation efforts by providing a structured overview of the concrete implementation activities performed in a successful one-hospital multimodal nvHAP prevention project.

Racial and ethnic disparities in healthcare-associated infections (HAIs) could have significant implications for hospital-based incentive programs. We sought to quantify racial and ethnic disparities in HAIs across inpatients in the United States.

Systematic Review and Meta-Analysis.

Medline, Embase, and Scopus were searched 2008–2022 for English language studies describing reportable HAIs among inpatients and references to race or ethnicity. Studies were excluded if they used an aggregate outcome of “infection,” described a non-acute care setting, or measured a respiratory virus. Meta-analysis was performed using random-effects model on pooled continuous outcomes with 3 or more studies.

39 studies met criteria for inclusion; 23 evaluated surgical site infections (SSI), 6 evaluated hospital-onset Clostridioides difficile infection (HO-CDI), 5 evaluated central line-associated bloodstream infections (CLABSI), and 8 examined other HAIs. There was a high degree of heterogeneity across studies. Meta-analysis was performed for 10 distinct HAI/risk factor combinations. Race and ethnicity were not associated with SSIs (Black vs White OR 1.19, 95% CI 0.95–1.48; Hispanic vs White OR 1.01, 95% CI 0.78–1.31). Hispanic patients had lower risk of HO-CDI relative to White patients (OR 0.80, 95% CI 0.64–0.98). Black (OR 1.36, 95% CI 1.07–1.70) or Hispanic (OR 1.16, 95% CI 1.073–1.249) patients had increased risk of CLABSI compared with White patients.

Racial and ethnic disparities were observed in rates of HAIs, specifically for CLABSI and HO-CDI. However, conclusions are limited by the substantial heterogeneity present. Further research characterizing social determinants of health driving these disparities is needed.

To identify modifiable surgical practices associated with reduced sternal wound infection rates following isolated coronary artery bypass grafting (CABG) using positive deviancy methodology.

Retrospective cohort study with prospectively collected data (January 2021–June 2025).

Single tertiary referral cardiac surgery center.

3,087 consecutive patients undergoing isolated CABG.

Primary outcome was total sternal wound infection (deep and superficial combined) within 30 days. Risk-adjusted surgeon performance was evaluated using mixed-effects logistic regression with observed-to-expected (O/E) ratios. Positive deviants were defined as surgeons with O/E ratios <1.0 with 95% confidence intervals excluding unity. Surgical techniques were systematically reviewed through anonymized surveys, and volume-weighted analysis compared techniques of better and worse performers.

Total sternal wound infection occurred in 175 patients (5.7%). Nine surgeons were stratified: better performers (O/E <1.0, n = 5), worse performers (O/E ≥1.2, n = 3), and average performers (O/E 1.0–1.19, n = 1). One surgeon achieved statistically significant superior performance (O/E = 0.590, 95% CI: 0.39–0.91), representing 41% fewer infections than expected across 543 cases. Four protective techniques were identified: wound irrigation at closure (100% vs 0%), double skin preparation with chlorhexidine and povidone (100% vs 0%), superior Ioban adherence quality (5/5 vs 3.7/5 vs 3.2/5, P < .001), and minimal cautery usage (1.0/5 vs 3.2/5 vs 3.5/5, P < .001).

Positive deviancy methodology successfully identified four modifiable surgical practices associated with reduced total sternal wound infections. These techniques represent immediately implementable interventions for infection prevention in cardiac surgery. Further study is needed to validate these findings across multiple institutions and evaluate implementation outcomes.

Surgical site infections (SSIs) remain a significant source of morbidity in children. Elevated standardized infection ratios (SIRs) for pediatric gastrointestinal (GI) procedures persist nationally and at our institution. We assessed pediatric-specific risk factors and the applicability of the adult SIR model.

Case–control study of pediatric patients undergoing GI surgery (2019–2022) with 82 SSI cases matched 1:2 with 164 controls by prematurity, age, National Healthcare Safety Network (NHSN) procedure category and year. Data was collected via chart review; socioeconomic risk was assessed using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Bivariate and multivariate conditional logistic regression analyses used to estimate adjusted odds ratios (aOR) with 95% confidence interval (CI).

A tertiary pediatric referral center.

Ages 0–21; NHSN reportable GI SSI procedures (appendix, gastric, small bowel, colon, laparotomy).

Cases were more likely to speak a language other than English or Spanish aOR 4.26 (95% CI, 1.06–17.11; P = .041) compared to controls. Adult SIR risk factors such as diabetes mellitus, were not significant predictors. Cases had longer hospitalizations (median 17.5 vs 7 days) and higher 30-day readmission rates (26% vs 10%) compared to controls.

These findings highlight the importance of language-concordant care and consideration of other social vulnerabilities in pediatric GI surgical care. Adult-based SIR models may not be applicable to children, highlighting the need for pediatric-specific measures that ensure equitable access to preventive care.

A semi-automated surveillance system for surgical site infections (SSIs), SPICMI (Surveillance and Prevention Program for Infectious Risk in Surgery and Interventional Medicine), has been implemented in French hospitals, leveraging data from electronic health records (EHRs).

To evaluate the performance of the SPICMI algorithm in detecting SSIs in orthopedic and digestive surgery.

Surveillance data were collected annually from the EHRs. The algorithm identified suspected SSIs based on two criteria: (1) surgical revision during the index stay or readmission, (2) positive microbiological samples from the wound. Suspected SSIs identified were subsequently validated by surgeons.

A stochastic modeling approach was used to estimate probability intervals for performance indicators. Various detection scenarios were constructed based on SPICMI criteria. Logistic regression analysis was performed using surveillance data. Data unavailable in the database were estimated through a literature review and expert opinions.

The probability of surgical revision following an SSI varied significantly between surgical specialties, ranging from 92% in orthopedic surgery to 45.2% in gynecology. In orthopedic and digestive surgery, the SPICMI algorithm demonstrated good reliability for detecting SSIs in minimizing false-negative and false-positive cases (Youden index: 0.96 and 0.79, respectively). Sensitivity (Se) was lower in digestive surgery (0.7–0.9) compared to orthopedic surgery (0.9–1), while specificity (Sp) remained high (0.9–1) in both specialties.

The SPICMI algorithm shows potential to support efficient use of time and resources in SSIs surveillance management. Further evaluation is needed with a broader panel of surgery procedures.

Older adults (≥65) often receive antibiotics in emergency departments (ED), where guideline concordance is low with both overuse and underuse; whether community disadvantage drives these patterns is unknown.

We analyzed electronic health records from 1,318,281 ED encounters among 790,562 adults ≥65 (2015–2024). Outcomes were guideline concordance and components (overuse, underuse). To address omitted variables and reverse causality, we used two-stage instrumental-variable models with Social Vulnerability Index (SVI) and Social Deprivation Index (SDI) as exposures, instrumented by maximum state Earned Income Tax Credit, adjusting for patient, facility, state, and time covariates.

16.8% of encounters were non-concordant (overuse 9.5%; underuse 7.2%). Concordance improved to 83.8% in 2024. In IV models, each 10-point increase in SVI reduced concordance by 6.37 percentage points (pp) (SE 0.69) and each 10-point increase in SDI by 1.84 pp (SE .20; P < .0005). Declines reflected higher underuse (+0.43 pp per 10-point SVI; +0.12 pp per 10-point SDI) with less overuse (−0.10 and −0.30 pp). Concordance was higher for Black (+12.90 pp vs White) and Medicaid-insured patients (+5.40 pp vs commercial). Overuse was higher in rural (+7.90 pp vs metropolitan) and academic EDs (+5.00 pp vs non-academic), whereas underuse was more common in metropolitan (+42.50 pp) and non-academic EDs (+32.70 pp). Spatial analyses found high deprivation/low concordance in the South and low deprivation/high concordance in the Midwest.

Community disadvantage may causally predict lower guideline-concordant antibiotic prescribing for older adults, primarily via underuse. Stewardship should address underuse and overuse and prioritize disadvantaged regions where gaps are greatest.

As measles vaccination rates in the United States decline and incidence rises, healthcare facilities face an increased risk of measles transmission. Measles exposures in clinical settings lead to extensive contact tracing investigations, significant staffing disruptions, high costs, and potential infections in vulnerable patients. This study aimed to assess US hospitals’ readiness of to identify and manage measles exposures and to identify common infection prevention gaps.

In 2025, the Emerging Infections Network (EIN) conducted a 9-question electronic survey of its physician members. The questions addressed immunization policies, exposure identification capabilities, and management protocols.

Of 153 respondents whose scope of practice includes measles prevention, 139 (91%) reported that their institutions required evidence of measles immunity for some healthcare personnel; 20% applied this requirement to a subset. Only 36% of facilities stored immunity data for employed staff in accessible electronic format. Most facilities could determine when patients were in specific clinical areas but could not identify visitors or non-employed staff. Exposure definitions varied; 33% of respondents used criteria that potentially underestimate exposure risk (eg, >15 min of shared air). Others lacked access to air exchange data (33%). Furthermore, 12%–31% of respondents reported their institutions do not consistently recommend postexposure prophylaxis for non-immune individuals.

Despite the high transmissibility of measles, significant gaps in record-keeping, exposure definitions, and prophylaxis protocols persist in US hospitals. Standardized exposure criteria and improved accessibility to staff immunity records could help reduce measles transmission in health care and the associated clinical and financial adverse outcomes.

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.

Hospital sinks are reservoirs for epidemiologically important pathogens (EIPs), yet practical, effective strategies for sustained decontamination are lacking.

We conducted a randomized controlled trial of 30 in-room sinks (15 intervention, 15 control) in a newly renovated hospital unit to evaluate the efficacy of a hydrogen peroxide/peracetic acid foamed disinfectant in reducing sink contamination. Intervention sinks received foamed disinfectant to sink drains three times weekly; control sinks underwent standard daily surface cleaning. Weekly sampling was performed from three sink locations (top surface, tail pipe, P-trap) over 35 weeks. The primary outcome was sink conversion events (SCEs), defined as first detection of ≥1 EIP, defined as Pseudomonas aeruginosa, Stenotrophomonas spp., or Acinetobacter spp., and ESBL-producing or carbapenem-resistant Enterobacterales, in previously negative sinks.

A total of 2880 samples were collected. All sinks were negative at baseline for study pathogens. Nearly all sinks (29/30) experienced an SCE during the study period. However, only 44 (9%) intervention sink samples were positive for EIPs, compared to 270 (47%) in control sinks (p < 0.00001). EIPs were recovered from 4% versus 24% of P-traps and 4% versus 39% of tail pipes; sink top/handle contamination was rare and similar (3% vs 4%). The most frequent EIPs were Acinetobacter spp. and Stenotrophomonas spp. Intervention sinks experienced a delayed time to SCE (p = 0.0001). Items were stored on/in sinks in 93% of observations.

Regular application of a foamed disinfectant reduced and delayed EIP contamination in renovated hospital sinks. Foam-based protocols may help mitigate environmental reservoirs of multidrug-resistant organisms.

Cardiovascular surgeries can be lifesaving, but mediastinitis following these procedures results in increased morbidity and mortality. We sought to increase the number of days between cases of mediastinitis at our institution from an average of 58 to greater than 223 days, the upper control limit of our baseline data.

Quality improvement initiative.

Freestanding pediatric hospital.

We convened a multidisciplinary team to identify potential interventions. As many infections were not captured by the Solutions for Patient Safety definition, we monitored mediastinitis cases using the Society of Thoracic Surgeons definition. Our outcome measure was cases of mediastinitis. Plan-Do-Study-Act cycles were completed within our operating rooms (ORs) and cardiac care unit (CCU). We tracked measures on statistical process control charts and with descriptive statistics.

From a baseline of 58 days, our hospital has gone over 450 days without a case of mediastinitis. No special causes were noted in our balancing measures. All process measures showed improvement.

A series of OR- and CCU-based interventions significantly increased the amount of time between our cases of mediastinitis. This work highlights the importance of engaging both OR and postoperative stakeholders in proactive mediastinitis prevention work.

Hospital sink drains are recognized reservoirs for gram-negative bacteria (GNB). This study evaluates the efficacy of a sink drain disinfection strategy using hydrogen peroxide-based foam, mechanical cleaning, and drain cover replacement in reducing GNB bioburden in a neonatal intensive care unit (NICU).

We conducted a prospective cohort study of 30 NICU room sinks comparing three interventions: (1) foam disinfection alone (n = 5), (2) foam with mechanical cleaning (n = 5), and (3) foam with drain cover replacement (n = 5), and (4) foam, mechanical cleaning, and drain cover replacement (n = 5), to controls (no intervention, n = 10). Samples from sink drains, faucets, counters, basins, and drain covers were collected at baseline (Day 0) and post-intervention (Days 1, 3, 5, and 7). Bacterial colony counts were analyzed using linear regression models.

At baseline, sink drains and drain covers had the highest bioburden (total GNB mean ln-CFU: 15.4 and 16.4), with Pseudomonas aeruginosa (33%) and Stenotrophomonas maltophilia (39%) as predominant isolates. The intervention combining foam, mechanical cleaning, and drain cover replacement achieved the greatest bioburden reduction on Day 1 in drains (mean ln-CFU reduction = 11.0, 95% CI: 6.4, 16.0, p < 0.001) and covers (mean reduction = 14.0, 95% CI: 8.7, 19.0, p < 0.001), with sustained effects through Day 7. Recolonization to ∼50% of baseline was evident by Day 5 in both sites.

Physical bioburden removal improved the effect of a foaming disinfectant in reducing GNB. However, recolonization occurred by day 5.

While infection is a leading cause of mortality among patients on hemodialysis, there are limited data on patients’ infection prevention knowledge and attitudes. We aimed to assess hemodialysis patients’ knowledge of their elevated infection risk, their willingness to actively prevent infections, and the acceptability of a long-term intranasal decolonization intervention.

We surveyed patients as part of a stepped wedge cluster randomized trial evaluating intranasal povidone-iodine (PVI) decolonization.

Sixteen outpatient hemodialysis centers affiliated with 5 academic medical centers.

Patients undergoing outpatient hemodialysis.

Patients were asked to complete a pre-intervention survey (9 questions) and two intervention surveys (13 questions; only patients interested in PVI) at 1 month and 6 months after starting PVI. We used the chi-squared test to compare responses over time.

469 (∼25%) participants completed at least one survey. Most (55%) participants underestimated their infection risk compared with an average person in the United States. The percentage of participants willing to expend “a lot of effort” to prevent an infection decreased from 79% (pre-intervention) to 63% (final survey) (p < 0.01). Among the 102 participants using PVI at 6 months, 87% said PVI felt neutral or pleasant and 75% used PVI for the past 3 dialysis sessions. Only 9.4% reported side effects.

Patients on hemodialysis underestimate their infection risk. Most patients found intranasal PVI to be acceptable. Future research should aim to improve patient education on their infection risk and remove barriers to adherence with infection prevention interventions.

Clinical trial information: NCT04210505, https://clinicaltrials.gov/

To evaluate the pathogen-specific diagnostic yield of rectal and groin screening sites in a hospital-based multidrug-resistant organism (MDRO) surveillance program.

Prospective observational surveillance study.

Tertiary academic hospital in Northern Greece.

Hospitalized patients undergoing active MDRO screening based on predefined infection prevention and control criteria.

A pathogen-focused analysis was conducted using data from a prospective MDRO surveillance program between October 2024 and January 2025. Screening swabs were obtained from the rectum and groin. Target organisms included multidrug-resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa, vancomycin-resistant enterococci (VRE), Candida auris, and Acinetobacter spp. Pathogen-specific detection yields were calculated for each anatomical site.

Among 1,206 screening swabs, 308 (25.5%) were positive for at least one MDRO. Rectal swabs detected 95.8% of Klebsiella pneumoniae (K. pneumoniae) (92/96), 100% of VRE (59/59), and 66.7% of Pseudomonas aeruginosa (46/69). In contrast, 88.9% of Candida auris cases (24/27) were identified exclusively from groin swabs. Reliance on rectal screening alone would have missed nearly 90% of Candida auris carriers, whereas groin-only screening would have failed to detect most K. pneumoniae and all VRE carriers.

Anatomical site selection critically influences MDRO surveillance sensitivity. Rectal screening is optimal for MDROs colonizing the gastrointestinal tract, whereas groin sampling is essential for detecting Candida auris. Pathogen-targeted, site-specific surveillance strategies may substantially improve detection efficiency and optimize infection prevention efforts in high-prevalence hospital settings.

Large language models (LLMs) are increasingly explored for healthcare-associated infection (HAI) surveillance, but their reliability in applying formal National Healthcare Safety Network (NHSN) definitions is not well characterized. This study evaluates GPT-5.1 Thinking’s accuracy and rationales in classifying NHSN-defined infections.

Seventy synthesized case vignettes containing complete, organized clinical data representing five NHSN infection types, including complex edge cases, were assessed using 2025 NHSN surveillance definitions. GPT-5.1 Thinking classified cases under three prompting strategies: standard, structured, and constrained. Quantitative accuracy metrics and qualitative inductive content analysis of rationales and failure modes were performed.

Overall accuracy across 210 classifications improved from 78.6% (standard prompt) to 88.6% (structured) and 95.7% (constrained). Performance was highest for infections with clear anatomical or radiographic criteria (surgical site infections [SSI], ventilator-associated pneumonia [VAP]) and lowest for infections involving complex exclusion rules (central line-associated bloodstream infection [CLABSI], Clostridioides difficile infection [CDI]). Constrained prompting enhanced adherence to NHSN rules but did not eliminate errors in hierarchical exclusions. Content analysis identified three recurrent failure categories: prioritization of clinical plausibility over surveillance logic, failure to apply quantitative and temporal thresholds, and errors in hierarchical source attribution.

GPT-5.1 Thinking shows potential to support infection surveillance under strict constraints but exhibits systematic limitations, including overreliance on clinical intuition and difficulty with complex exclusion pathways. Currently, LLMs are unsuitable for autonomous NHSN classification but may serve as supervised decision-support tools with robust human oversight. Further development is needed to enhance LLMs’ ability to synthesize surveillance definitions and complex situational characteristics critical for effective HAI surveillance, though fully autonomous deployment would require further validation. These findings are based on synthetic data that may differ from real-world clinical data in ways likely to overestimate the accuracy of these tools.

The purpose of surgical hand antisepsis before surgical or invasive procedures is to suppress microbial flora on the hands. This study aimed to evaluate the effect of a modified surgical hand antisepsis technique on recolonization of microbial flora on surgeons’ hands over time.

Participating surgeons were randomly assigned to one of two study groups. In both groups, surgical hand antisepsis was performed using 10% povidone-iodine followed by rinsing of the hands and forearms. In Group 1, surgeons dried their hands after rinsing according to the conventional method. In Group 2, surgeons applied an additional layer of 10% povidone-iodine to the still-wet hands and forearms after rinsing and then allowed the solution to dry without further rinsing. Hand cultures were obtained immediately after antisepsis (0 hour) and at 1 and 2 hours thereafter. Colony-forming units (CFUs) were counted and compared between groups and sampling periods.

Fourteen surgeons participated in the study, with seven surgeons allocated to each group. No significant difference in bacterial growth was observed between the groups at 0 hour (Group 1: mean CFU 41.59 ± 72.53 vs Group 2: 18.63 ± 24.27, P = .27). At 1 hour, bacterial growth was significantly lower in Group 2 compared with Group 1 (8.43 ± 20.65 vs 25.44 ± 53.62 CFU, P = .001). Similarly, at 2 hours, Group 2 demonstrated significantly lower bacterial growth than Group 1 (16.37 ± 34.25 vs 32.88 ± 52.55 CFU, P = .022).

Compared with the conventional surgical handwashing technique, reapplication of povidone-iodine without a final rinse resulted in significantly reduced bacterial recolonization on surgeons’ hands at 1 and 2 hours after hand antisepsis. These findings suggest that this modified technique may provide prolonged antimicrobial activity during surgical procedures. Further large-scale studies are warranted to confirm its clinical utility.

The implementation of the World Health Organization’s multimodal strategy is crucial for strengthening infection prevention and control (IPC) programs. This study aimed to evaluate and compare the perceptions of infection prevention and control professionals (IPCPs) and healthcare workers (HCWs) regarding the effectiveness of the multimodal strategy.

In this study, an online survey was designed that included five MM components: system change, education and training, monitoring and feedback, reminders and communication, and cultural change. The survey was completed by IPCPs and HCWs within the institutions.

A total of 102 IPCPs and 166 HCWs from 96 institutions participated in the survey. The mean career duration was 19.8 ± 9.5 years. An Infection Control Committee (ICC) was present in 98% of participants’ institutions, and 88% held meetings every three months. Only 10 (10.4%) institutions met the ratio of 1IPC nurse per 150 beds. Effective communication techniques training was provided annually to 55.9% of IPCPs and 59.6% of HCWs.

Eighty-one (79.4%) IPCPs reported using effective communication when explaining the five indications of hand hygiene, but only 77 (46.4%) HCWs agreed (P < .001). Ninety-one (89.2%) IPCPs confirmed that effective communication techniques were used in bundle training. But, only 25 (15.0%) HCWs agreed, while 112 (67.5%) HCWs reported being undecided (P < .001). Sixty-one (64.7%) IPCPs and 130 (78.3%) HCWs believed that their institutions effectively motivated HCWs towards IPC measures compliance. However, 44 (43.1%) IPCPs and 29 (17.5%) HCWs were undecided (P = .002).

The survey reveals significant inconsistencies among IPCPs and HCWs regarding communication effectiveness, and perceptions of compliance with infection-control measures. These findings highlight the need for more inclusive and transparent communication strategies, regular interdisciplinary training, and stronger organizational support to improve IPC practices.

Surveillance activities are emerging as exemplar use cases for large language models (LLMs) in health care. The aim of this study was to evaluate the potential for LLMs to support the expansion of surveillance activities to include cardiovascular implantable electronic device (CIED) procedures.

A validated machine learning-based infection flagging tool was applied to a cohort of VA CIED procedures from 7/1/2021 to 9/30/2023; cases with ≥10% probability of CIED infection underwent manual review. Then, a weighted random sample of 50 infected and 50 uninfected cases was reviewed with generative artificial intelligence (GenAI) assistance. GenAI prompts were iteratively refined to extract and classify all components of infection-related variables from clinical notes. Data extracted by GenAI were compared with manual chart reviews to assess infection status and extraction consistency.

Among 12,927 CIED procedures, 334 (2.58%) had ≥10% probability of CIED infection. Among 100 sampled cases, 50 of 50 uninfected cases were correctly categorized. Among 50 infection cases, GenAI identified all CIED infections, but the timing of events and the attribution to a preceding procedure were incorrect in 7 of 50 cases. The overall specificity of the GenAI-assisted process was 100% and the sensitivity for accurately classifying timing and attribution of CIED infection events was 82%. Errors in timing improved with iterative prompt updates. Manual chart reviews averaged 25 minutes per chart; the GenAI-assisted process averaged 5–7 minutes per chart.

LLMs can help streamline the review process for healthcare-associated infection surveillance, but manual adjudication of output is needed to ensure the correct timeline of events and attribution.