Algorithms using electronic health record data to identify children with community-acquired pneumonia (CAP) and to evaluate the appropriateness of antibiotic use may facilitate antibiotic stewardship efforts, but validated measures of antibiotic choice and duration are unavailable.

We performed a cross-sectional study within a single hospital system, including hospitalized children ages 6 months to 17 years who were admitted between 1/1/2019 and 10/31/2022. CAP was defined electronically as an ICD-10 code for pneumonia, a chest x-ray or chest CT within 48 hours of admission, and at least two days of antibiotics starting within 48 hours of admission. Hospital transfers and those who died within 48 hours or had chronic conditions, intensive care unit stays ≥48 hours, or concurrent infections were excluded. We validated electronic measures of appropriate antibiotic choice and duration using a reference standard of manual chart review. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each metric.

The electronic algorithm identified 1058 CAP encounters, and 100 were randomly selected for validation. Inappropriate antibiotic choice and duration occurred in one and 75 encounters of the 100 encounters, respectively, based on manual chart review. The electronic algorithm had a sensitivity of 100%, specificity of 93%, PPV of 14%, and NPV of 100% for inappropriate antibiotic choice and a sensitivity of 97%, specificity of 88%, PPV of 96%, and NPV of 92% for inappropriate antibiotic duration.

Metrics of inappropriate antibiotic choice and duration had acceptable performance characteristics and may facilitate syndrome-based stewardship efforts.

To assess differences in SARS-CoV-2 infection rates between patients receiving hemodialysis in outpatient centers (in-center) and those receiving dialysis in their homes (hemodialysis and peritoneal dialysis) from December 29, 2020, through May 9, 2023.

Retrospective cohort study.

Outpatient dialysis facilities in the United States reporting to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

Maintenance dialysis patients that received hemodialysis treatment at or were affiliated with outpatient dialysis facilities.

SARS-CoV-2 infection rates were assessed by dialysis setting (in-center and home). Weeks were categorized as surge (rate of infection > median) and non-surge (rate of infection ≤ median) and by variant predominance. A negative binomial regression model with generalized estimating equations was constructed to examine differences in rates of infection among patients.

A total of 7,974 dialysis facilities reported 171,338 SARS-CoV-2 infections among patients. In-center hemodialysis patients had higher average rates of SARS-CoV-2 infection at 2.85 infections per 1000 patient-weeks than home patients at 1.69 infections per 1000 patient-weeks. During surge weeks, the differences in rates of infection between in-center and home patients were more pronounced than during non-surge weeks for all variant predominance categories: Delta (relative rate ratio (RRR) = 1.20, CI: 1.09–1.32), B.1 and Other (RRR = 1.11, CI: 1.02–1.22), and Omicron (RRR = 1.07, CI: 1.01–1.12).

Rates of SARS-CoV-2 infection among patients receiving outpatient hemodialysis were persistently higher than rates among patients receiving dialysis treatments at home; these differences were more pronounced during surge weeks.

Patients receiving maintenance hemodialysis are frequently exposed to antibiotics, a proportion of which may not be necessary thereby increasing the risk of antibiotic-associated adverse events. Antimicrobial stewardship programs remain underdeveloped in outpatient dialysis facilities. This study aimed to quantify antibiotic prescribing trends across in-center dialysis units and identify patient- and facility-level factors associated with decreased antibiotic use to inform the future stewardship strategies.

Retrospective observational cohort study among 16 in-center hemodialysis units

Antibiotic prescribing patterns and patient- and unit-level characteristics were analyzed among patients receiving maintenance hemodialysis from April 1, 2021, to March 31, 2024. Antibiotic prescribing trends were analyzed using general linear models. Generalized estimating equations were used to identify factors associated with decreased prescribing.

A total of 937 (26.4%) among 3,549 patients received ≥1 antibiotic dose, with an average of 15.36 doses per 100 patient-months, ranging from 4.82 to 30.87 doses/100 patient months. Types and frequency of antibiotics prescribed among units varied considerably. Trends in antibiotic prescribing did not decrease among 10 (62.5%) of the in-center hemodialysis units. Patient-level characteristics in units associated with a decrease in prescribing included Black race, Hispanic ethnicity, age 56–65, and diabetes as the cause of kidney failure.

There is substantial variability in antibiotic prescribing across dialysis units. Decreasing trends in prescribing were observed in a subset of units and were associated with patient-level factors. These findings support the need for developing and implementing antimicrobial stewardship programs targeting the outpatient dialysis setting.

Inadequate empiric therapy for sepsis has been correlated with heightened mortality; however, bloodstream infections do not uniformly manifest as severe presentations. Empiric administration of broad-spectrum antibiotics may result in adverse events and treatment failure. This study aimed to evaluate the impact of time to antibiotic optimization on outcomes of patients with bloodstream infections who received either inadequate or excessive empiric therapy.

This single-center retrospective study included patients aged ≥18 years with positive blood culture results and confirmed antimicrobial susceptibility between April 2018 and March 2024. The primary endpoint was a composite outcome of all-cause 30-day mortality, microbiological failure, and antibiotic modification due to insufficient efficacy. The secondary endpoints included adverse event–related discontinuation in the excessive group.

Of the 1943 patients screened, 405 met the inclusion criteria. In the inadequate group (n = 150), antimicrobial stewardship team intervention was associated with treatment success (OR, 0.38; 95% CI, 0.15–0.90; P = .028), whereas time to optimization was not associated with any of the outcomes. In the excessive group (n = 255), delayed optimization (≥64 h) was a risk factor for treatment failure (OR, 2.63; 95% CI, 1.14–6.07; P = .023). Later optimization (≥100 h) was also linked to higher antibiotic discontinuation due to adverse events.

Delayed optimization was independently associated with adverse outcomes in cohorts receiving excessive empiric therapy. These findings emphasize the importance of prompt de-escalation of broad-spectrum antibiotics to mitigate treatment failure and treatment discontinuation attributable to adverse events.

The COVID-19 pandemic caused unprecedented operational stress on hospital-based antimicrobial stewardship programs (ASP). We utilized a systems engineering framework to characterize multi-level systems challenges to and strategies for resilient, hospital-based antimicrobial stewardship (AMS) during the COVID-19 pandemic.

Using a national data set, we identified hospitals that had significant COVID-19 burden. We conducted semi-structured interviews with pharmacists, physicians and quality leaders involved in ASPs during the pandemic at those hospitals. Interview guides were developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Transcribed interviews were analyzed using deductive content analysis.

We interviewed 37 participants from 22 different healthcare systems across the country. Challenges to resilient ASP included physician employment model; limited AMS resources; staff shortages due to illness; shift in priorities; increased workload; remote work; and therapeutic momentum. Preexisting strategies to promote resilient AMS included system-wide AMS; decentralized AMS; excellent interprofessional relationships; strong culture of AMS and embracing incremental change. Real-time response strategies included ability to prioritize well; consistency with AMS work; being flexible and adopting change; intensifying infectious disease engagement; dedication to the profession; and reliance on automated tools and technology.

Using a systems engineering informed qualitative approach, participants identified many modifiable challenges to AMS resiliency. Given the unfortunate reality that infectious disease pandemics and periods of operational stress are likely to occur in the future, we recommend that healthcare system leadership utilize the preexisting and real-time response strategies identified in this manuscript as a roadmap to ASP preparedness and a more proactive future response.

To characterize institutional masking policies for healthcare personnel (HCP) and identify factors informing masking decisions in the post–COVID-19 pandemic era.

Cross-sectional, survey-based study.

Healthcare institutions participating in the Society for Healthcare Epidemiology of America (SHEA) and Association for Professionals in Infection Control and Epidemiology (APIC) Research Networks.

One representative per institution, including infection preventionists, hospital epidemiologists, or healthcare administrators, knowledgeable about organizational masking policies.

A structured, web-based survey was distributed through the SHEA/APIC Research Networks. Survey domains included institutional characteristics, masking strategies outside of transmission-based precautions, epidemiologic and operational factors influencing masking decisions, and mask types required. Responses were collected anonymously via REDCap over a six-week period and analyzed descriptively.

A total of 172 unique healthcare institutions completed the survey (41% response rate, n = 172/425). Most respondents were infection preventionists (65%) or hospital epidemiologists (25%). The most common masking approach was a seasonal or situational risk-based strategy (57%), while 7% of institutions reported no formal masking policy. Among institutions using seasonal or situational masking, decisions were most frequently informed by outbreaks or clusters (37%), public health guidance (33%), and HCP illness/absenteeism (27%). Most institutions reported no fixed epidemiologic thresholds for masking decisions. When masking was required, surgical masks were most commonly used (98%).

Masking policies and decision-making criteria vary widely across healthcare institutions, reflecting a lack of standardized operational guidance. These findings underscore the need for consensus-based, data-driven frameworks to support consistent, transparent, and evidence-informed masking policies in healthcare settings.

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.

Although preterm infants are prone to healthcare-associated infections (HAI), HAI surveillance in neonates is still not widely practiced. In this paper, we present the HAI rates subsequent to nationwide implementation of NEO-KISS, the German national surveillance system for HAI in high-risk neonates. We also report on risk factors for the development of HAI in this population.

Observational study.

German National Reference Centre for Surveillance of Nosocomial Infections, responsible for the maintenance of NEO-KISS.

Infants with a birth weight of less than 1500 g.

NEO-KISS data from the years 2008–2022 was analyzed retrospectively and incidence densities were calculated (in five-year reference periods) for different types of healthcare-associated sepsis (HAS), healthcare-associated pneumonia (HAP), and necrotizing enterocolitis (NEC). Rates were analyzed with Cox-proportional hazard regression models.

A total of 118,214 infants with a birth weight of less than 1500 g from 251 neonatology departments were included. They comprised 15,254 HAS, 1,657 HAP, and 2,786 NEC. The incidence densities of HAS and HAP were 33.3% and 46.7% lower in the admission period 2018-2022 compared to 2008–2012 (2.98 vs. 4.47 HAS, 0.3 vs. 0.56 HAP, per 1,000 patient days). In the multivariable regression analysis, the period of admission remained significant after adjustment for independent risk factors for HAS, HAP, and NEC.

In Germany, the surveillance data for neonates in NEO-KISS between 2008 and 2022 showed a nationwide decrease in incidence densities of HAS, HAP, and NEC. The continuous engagement with NEO-KISS surveillance data may have contributed to this reduction.

Shorter antibiotic courses and transition to oral therapy for uncomplicated gram-negative bloodstream infections (GN-BSI) are evidence-supported yet remain challenging to implement. Here we report our experience with a GN-BSI antimicrobial stewardship (AS) quality improvement initiative in a large health system.

We implemented two sequential AS interventions in adult patients hospitalized with uncomplicated GN-BSI: (1) mandatory AS review of patients discharging on intravenous (IV) antibiotics (“OPAT review”) and (2) a clinical guideline informing oral antibiotic transition and duration, in our 22-hospital system. We evaluated the initiative from January 2018 to September 2024. Pre- and postimplementation rates of (1) IV antibiotics at discharge and (2) total length of antibiotic therapy were calculated across the following periods: preintervention, after OPAT review, and after guideline implementation. Secondary outcomes included duration <10 days, oral antibiotic prescribing, and guideline-recommended dosing.

3,231 patients (preintervention: 666, postOPAT review: 1,357, postguideline: 1,208) were included. We observed decreases in IV antibiotics at discharge (22.7% preintervention, 10.7% postOPAT review, and 9.2% postguideline, p < 0.001) and median length of treatment (13.5 days preintervention to 10.7 days postguideline, p < 0.001). We also observed improvement in durations <10 days (19.1% vs 45%, p < 0.001), oral antibiotic prescriptions, and appropriate dosing (2.8% vs 33.5%, p < 0.001), but no difference in rates of BSI recurrence, mortality, or C. difficile infection.

After implementing GN-BSI-focused AS initiatives in our large health system, we observed a shift toward more frequent oral rather than IV antibiotics at discharge, and shorter overall antibiotic durations, without obvious changes in adverse outcomes.

To determine if hospital characteristics were associated with rates of healthcare-associated (HA) viral respiratory infections (VRIs) in a large Canadian acute care hospital network.

Survey of hospital characteristics and prospective surveillance of HA-VRI.

The Canadian Nosocomial Infection Surveillance Program is a sentinel surveillance system with 89 hospitals participating in adult and pediatric VRI surveillance.

Patients with laboratory confirmed infection from SARS-CoV-2, Influenza A/B or RSV associated with their hospitalization from participating hospitals between January 1-December 31, 2024.

A 15-item survey was distributed to hospitals to collect information on hospital infrastructure, infection prevention and control practices, and occupational health measures for healthcare workers. HA-VRI rates/10,000 patient-days were analyzed alongside survey responses using univariable and multivariable negative binomial regression models in R to determine associations. Hospitals without case data were excluded.

Of 89 hospitals, 93% (n = 83) responded to the survey, with 79 included in the analysis. The national HA-VRI rate was 8.15/10,000 patient-days. Pediatric hospitals had a 56% lower HA-VRI rate than adult/mixed hospitals (P < .001) that increased with the exclusion of SARS-CoV-2. Each 10% increase in the percentage of single-bed rooms corresponded to a 12% reduction in infection rate (P < .001). Teaching vs. Non-teaching hospitals were associated with a 32% lower HA-VRI rate. Universal masking was not associated with a statistically significant reduction in HA-VRI rates (RR 0.82, 95% CI: 0.56–1.19).

In a large surveillance network, lower HA-VRI rates were seen in pediatric hospitals, teaching hospitals, and in hospitals with higher proportions of single-bed rooms.

Automated hand hygiene monitoring systems (AHHMSs) can monitor a large number of hand hygiene opportunities, and some provide real-time feedback; however, the impact of these systems is unclear. We sought to better understand how one of these systems improves hand hygiene adherence.

The AHHMS was installed in seven units of an urban teaching hospital, and healthcare workers, primarily nurses and nurse technicians, were enrolled. We used a prospective observational cohort design with multiple interventions, including providing individual adherence rates and real-time voice reminders, to understand how these interventions improve hand hygiene adherence.

Over the 40-week study period, 744,769 hand hygiene observations were observed among the 346 participants. The overall hand hygiene adherence rate increased from 37.0% (95% CI: 34.3% to 39.9%) at the start of the study to 55.5% (95% CI: 51.6% to 59.6%). This increase of 18.5% was statistically significant. However, adherence varied widely among different units and between individual participants. Voice reminders (58.7% (95% CI: 55.9% to 61.6%)) led to a significantly higher hand hygiene adherence rate than weekly individual feedback (46.4% (95%: 42.2% to 51.0%)) after adjusting for work shift and the seven individual participating clinical units. With the combination of interventions, improved adjusted adherence rates were sustained until the end of the study period.

After the introduction of the AHHMS, real-time voice reminders improved short-term hand hygiene adherence more than feedback of individual adherence rates. Multiple interventions and cultural changes are required to sustain improved adherence.

To quantify antibiotic-related misinformation across major social networking platforms and examine its potential relevance to antimicrobial stewardship(AMS) and healthcare epidemiology.

A retrospective, Cross-platform infodemiology study (2015–2025).

Public data from Twitter/X, Reddit, and Facebook were analyzed, and a temporal association with global antimicrobial-resistance measures from the World Health Organization’s Global Antimicrobial Resistance(AMR) Surveillance System.

We extracted 1.8 million posts containing antibiotic-related key terms. Natural-language processing and transformer-based classification identified misinformation themes, sentiment polarity, and diffusion dynamics. Topic modeling and network analysis (Gephi) characterized echo-chamber structures. Temporal associations between misinformation intensity and antimicrobial-resistance indicators were examined using cross-correlation and Granger lead–lag analysis.

Misinformation comprised 19.3% of posts, spreading 2.4 times faster than factual content (p <.001). Four dominant themes were identified: self-medication advocacy, natural-remedy promotion, misinformation alleging hidden motives or suppressed evidence, and anti-medical discourse. Misinformation intensity correlated strongly with antibiotic search intent (ρ = .74; p <.001) and preceded resistance trends by 6–9 months for Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus.

Antibiotic misinformation may function as a measurable behavioral exposure with potential relevance to AMS and infection prevention goals. The inclusion of digital-behavioral surveillance in AMS reporting platforms would offer warning signs for potential risks associated with antibiotic resistance.

We aimed to evaluate the impact of transitioning from a conventional antimicrobial stewardship team (AST) to an interdisciplinary infectious disease support team (IDST) on patient mortality.

Single-center retrospective cohort study.

Yamanashi Prefectural Central Hospital.

We included patients with bacteremia during the AST and IDST periods.

We implemented an interdisciplinary IDST that provided comprehensive support beyond antimicrobial selection and treatment. We compared 28-day mortality outcomes in hospitalized patients with bacteremia during the AST-only period (April 2021–March 2022) and the IDST-intervention period (April 2022–March 2023). Cox proportional hazards modeling was used to assess 28-day mortality; multivariable logistic regression served as a prespecified sensitivity analysis. Between-group differences were tested using two-sided tests (P < .05), and 95% confidence intervals (CIs) were reported.

Among the 854 patients (413 in the AST group and 441 in the IDST group), AST interventions did not significantly decrease 28-day mortality compared with no-intervention cases (20.8% vs 23.3%, P = .630). However, intervention by the IDST significantly reduced 28-day mortality compared with the no-IDST group (16.1% vs 25.2%, P = .019). In the multivariate Cox proportional hazards model, IDST interventions remained independently associated with a reduced 28-day mortality (hazard ratio, 0.518; 95% CI, 0.325–0.826; P = .006).

Transitioning from an AST to an interdisciplinary IDST model was associated with lower 28-day mortality in bacteremia cases, possibly due to sustained diagnostic and therapeutic interventions. Our findings support stewardship as a team-based process and may significantly impact patient outcomes by maintaining involvement until treatment completion and clinical stabilization.

To explore the impact of an immersive virtual reality (VR) training module on infection prevention and control (IPC) knowledge and attitudes of healthcare personnel (HCP) and to demonstrate the use of VR for performance assessment in cleaning and disinfection of portable medical equipment (PME).

Quasi-experimental study.

Two academic medical centers and three long-term care facilities.

HCP in clinical roles were recruited.

Pilot sites trained participants on an immersive VR training module on PME cleaning and disinfection. Participants completed the VR module and pre- and post-knowledge and attitude assessment surveys, including a post-survey on the user experience of the VR module. Performance data were collected from the head-mounted displays (HMD) on the duration of the VR session, and participant performance including in-module task completion, hand hygiene compliance, PME disinfection percentage, and in-module quiz performance. Statistical significance and effect size were calculated using paired sample t-tests and Cohen’s D for pre- and post-survey results. HMD data were analyzed using descriptive statistics.

A total of 60 participants were recruited; 54 were included for analysis, with improvements in knowledge and attitudes post-training. Participant user experience was rated 50.19/55. HMD data demonstrated: 22-minute mean module duration, mean of 2.15/28 tasks not completed, mean of 2.56 missed hand hygiene opportunities, and 54% PME mean disinfection percentage, and varied performance on in-module quizzes.

Immersive VR training may be effective in improving HCP knowledge and attitudes in IPC concepts. Performance data collected through VR training can evaluate learner performance and be used to target training for improvement.

Inappropriate urine cultures (UCs) are common and lead to inappropriate antimicrobial use. Urinalyses (UAs) have been increasingly incorporated into diagnostic stewardship interventions, but the impact of these interventions nationally has not been assessed. We describe UA and UC utilization practices using a nationwide dataset of patients admitted to acute care hospitals.

Design, Setting and Participants: We performed a retrospective cohort study of index UCs and their associated UAs performed for adult patients (age ≥ 18 years) admitted in U.S. acute care hospitals, participating in the PINC AI™ Healthcare Database (PHD) from January 1, 2017, through December 31, 2020. A positive UA was defined as >10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite.

The overall rate of UCs in this study was 124.7 per 1000 discharges and annual UC rates decreased from 2017 (129.2) to 2020 (120.0). The proportion of UCs that had a positive UA increased from 60.5% in 2017 to 68.1% in 2020; UCs without a UA decreased from 19.3% to 10.5%, and UCs with a negative UA did not significantly change (20.2% to 21.5%). A multivariate multinomial logistic regression model identified male sex, age <65, and a diagnosis of cancer to be predictors of having a UC with a negative UA or no UA.

UC utilization decreased over the study period. The proportion of UCs with a positive UA increased. This may suggest a positive impact of diagnostic stewardship practices at the national level although further progress is needed.

Describe the workload associated with using telehealth to support Antimicrobial Stewardship efforts at Veterans Affairs Medical Centers (VAMCs) without local infectious diseases (ID) expertise.

A mixed-methods process assessment to evaluate workload and workflow associated with Videoconference Antimicrobial Stewardship Teams (VASTs).

Rural VAMC champions paired with ID consultants at geographically distant VAMCs to form VASTs.

Total workload estimates were based on time that champions and ID consultants allocated to VAST activities. Clinical Procedural Terminology (CPT) codes were used to estimate the workloads for clinical encounters. Role-based process maps were developed to understand variation in implementation by VAMC.

The average workload that champions and ID consultants allocated to VAST activities was 6.7% (range 1.0%–20.0%) and 8.4% (range 2.0%–12.5%) full-time equivalents (FTEs), respectively. Clinical encounters completed by ID consultants contributed an average of 1.4% (range < 0.01%–2.5%) FTEs to the workload. The average proportion of FTEs required to sustain VASTs was 13.0% (range 3.0%–31.6%). Process maps showed four phases common to each VAST’s workflow: case identification, meeting preparation, team meeting, and documentation. The tasks associated with each phase varied between VASTs. Champions carried out most tasks related to case finding and meeting preparation; the ID consultants completed most documentation tasks.

The distribution of tasks within and among the VASTs indicated opportunities to improve workflow efficiency. Investing <12.5% of the FTE allocated to VA Antimicrobial Stewardship programs to support the time of an ID consultant from another VAMC can help rural VAMCs achieve staffing sustainability.

To evaluate factors associated with positive LTBI screening among HCWs and predictors of treatment initiation and completion across hospital sites in Ireland.

Multicentre retrospective cohort study.

Five hospital sites in Ireland.

N = 755 healthcare workers (HCWs).

Evaluation of latent tuberculosis infection (LTBI) by interferon gamma release assay in HCWs from high-incidence countries during 2023, identified via occupational health records. IGRA positivity rates, linkage to treatment and treatment outcomes were recorded. Demographic and occupational factors associated with these outcomes were investigated.

There were n = 755 HCWs from high-incidence TB countries identified via occupational health records eligible for LTBI screening. 719 underwent IGRA testing, of whom 93 (13%) were positive. Age > 50 was associated with IGRA positivity (OR 5.71; 95% CI 1.79–18.17; P = .003). In addition to these n = 93 HCWs, two additional sites provided treatment outcomes for n = 164 HCWs, and a further n = 58 IGRA-positive HCWs were referred to Site 1. Among these 313 IGRA-positive HCWs, 50% initiated therapy, with substantial variation across sites (27%–88%). Multivariable analysis showed study site, but not demographic factors, predicted treatment initiation (P < .001). Common reasons for non-initiation included treatment refusal and non-attendance. Treatment completion was high (82%) and was not associated with study site.

LTBI prevalence among HCWs in Ireland was lower than international estimates. While treatment initiation was low, completion was high. Treatment initiation varied by site, driven by institutional rather than individual factors. A standardised national programmatic approach is needed for HCWs within the LTBI cascade of care.

Emergency departments in tertiary care are critical areas for decision-making regarding antimicrobial use,however, they are often underrepresented in antimicrobial stewardship (AMS) interventions. This study evaluates the impact of a nurse-driven antimicrobial stewardship intervention in a medical emergency unit of a tertiary care facility.

A quasi experimental pre–post study was conducted in the Emergency Medical Outpatient department in a tertiary care center. Following a baseline assessment of antimicrobial use patterns conducted by a team of trained stewardship nurses, salient intervention targets were identified and implemented. AMS nurses actively reviewed antimicrobial prescriptions, reinforced adherence to institutional guidelines, monitored device- related practices and diagnostic utilization, and participated in audit and feedback with clinical teams. Data on patient characteristics, infection type, culture practices, antibiotic use, and guideline adherence were collected and compared between pre-intervention and intervention phases.

Following the intervention, compliance with hospital antibiotic guidelines improved from 82.4% to 91.0%. The proportion of cultures collected before initiating antibiotics increased from 23% to 40.3%, with a corresponding rise in culture positivity from 8% to 22%. An increase in antibiotic de-escalation practices was also noted.

This nurse-driven antimicrobial stewardship intervention was associated with more rational antimicrobial use, improved diagnostic utilization, and strengthened infection control practices. Integrating stewardship activities into nursing workflows represents a feasible approach to strengthening AMS in high-volume acute care settings.

Transmission of respiratory illnesses in health care settings poses significant risks to patients and staff. Without clear, standardized masking thresholds, policies may vary, resulting in confusion. We developed statewide consensus thresholds to guide masking in Minnesota health care systems over three respiratory seasons.

A multidisciplinary workgroup consisting of infection preventionists, infectious disease providers, occupational health specialists, and representatives from the state health department reviewed available data, including hospitalization rates, influenza-like illness levels, test positivity, and wastewater data. Thresholds used for masking were evaluated and updated each year after analyzing performance and feedback from health care facilities.

Analysis of the first season thresholds revealed issues with data sources selected and resulted in the group changing threshold recommendations from illness levels to hospitalization rates. Analysis of the second season thresholds revealed issues with masking timing and threshold recommendations for COVID-19 hospitalization leading to changes in COVID-19 masking thresholds and the addition of a masking implementation date for season three. Nine of out ten health systems reporting implementing universal masking during the respiratory season. Those that implemented masking reporting strong staff and leadership support due to the aligned metrics.

Development of standardized thresholds improved staff support for masking and reduced staff and patient confusion. Use of basic epidemiology tools in threshold development allowed for replication across healthcare systems and easy communication of thresholds to staff and patients. Data reporting lags can delay masking during periods of rapidly increasing illness.