Candida auris is a globally emerging, multidrug-resistant pathogen characterized by extreme environmental persistence and resistance to standard hospital disinfectants. Our ICU faced an endemic outbreak that lasted for 30 months, which was resistant to standard infection prevention and control (IPC) bundles.

To evaluate the efficacy of a radical, multi-sectoral “Unit Reset” protocol involving total operational decanting, mechanical disassembly, and inventory disposal after incremental IPC strategies were exhausted.

We executed a 120-hour “Unit Reset” in February 2026. The intervention comprised: (1) transferring all patients to a temporary satellite site; (2) total disposal of all pharmaceutical and disposable inventories; (3) structural remediation; and (4) dual-team mechanical disinfection with 5,000 ppm hypochlorite supplemented by 18% automated hydrogen peroxide vapor (HPV).

Over the 30-month endemic period, C. auris acquisition rates escalated despite high compliance with standard IPC bundles. Environmental surveillance rounds identified persistent reservoirs on high-touch surfaces that the routine cleaning protocols missed. Following the 120-hour Unit Reset, the ICU was reopened to admissions. During the subsequent 16-week active surveillance window, zero new clinical acquisitions or screening-positive cases were detected, representing the first sustained interruption of transmission since August 2023.

When C. auris achieves deep environmental sequestration within deteriorated medical infrastructure or complex equipment housings, incremental “enhanced cleaning” protocols may fail due to biofilm shielding. A radical, coordinated institutional reset can terminate entrenched nosocomial transmission when standard IPC bundles reach their limits.

To evaluate the impact of daily chlorhexidine gluconate (CHG) bathing on healthcare-associated infections (HAIs) in patients in a large health system serving a predominantly rural population.

Multi-center, quasi-experimental, before-after study.

21 hospitals (including academic, community, and critical access) in a decentralized Appalachian healthcare system.

During August and September of 2023, we implemented daily CHG bathing for all patients (of at least two months of age) who had central lines and/or were admitted to an intensive care unit (ICU).

We compared the hospital-level monthly incidences of two HAIs, central line-associated bloodstream infections (CLABSI) and laboratory-identified methicillin-resistant Staphylococcus aureus bloodstream infection (MRSA-BSI), in the 18 months before and after the intervention, excluding a 2-month rollout period. We modeled the standardized infection ratio (SIR) using negative binomial generalized linear mixed effects models, incorporating each hospital’s risk-adjusted predicted number of infections (from NHSN).

After implementation of daily CHG bathing, we observed significant reductions in bloodstream infections, with a 35% reduction in CLABSIs (incidence rate ratio [IRR] 0.650; 95% CI: 0.502–0.841) and a 40% reduction in MRSA bacteremia (IRR 0.599; 95% CI 0.408–0.880).

Implementation of daily CHG bathing for high-risk patients across a decentralized, Appalachian healthcare system was associated with reductions in CLABSI as well as MRSA bacteremia.

Carbapenem-resistant Enterobacterales (CRE) infections are an urgent public health threat in the United States. Despite infection prevention and control measures, hospital CRE rates have not declined in the past decade. Novel drug-based pathogen reduction approaches may decrease CRE incidence, and mathematical models can assess implementation strategies.

We used agent-based modeling to evaluate a hypothetical drug with pathogen reduction properties for reducing CRE transmission in an example acute-care hospital. We compared a strategy that treated only clinically detected CRE-colonized patients—using three drug effectiveness (DE) levels (25%, 50%, 75%)—with strategies that treated patients identified through surveillance screening in addition to clinical cultures. Surveillance screenings (intensive care unit (ICU) or all-admission screenings) were implemented at 50% and 100% patient participation (PP). Model parameters were informed by administrative healthcare data and published literature.

The baseline mean CRE colonization incidence was 27.4 per 10,000 patient-days (interquartile range [IQR]: 11.7–39.9). Compared to baseline, at DE = 25% the reduction in mean colonization incidence was 1.2% (−0.8%–3.2%) for the treatment-only strategy. At DE = 50%, treatment + ICU screening reduced incidence by 9.0% (7.1%–11.0%) at PP = 50% and 13.2% (11.4%–15.1%) at PP = 100%. The reduction reached 38.5% (37.1%–40.0%) for treatment + all-admission screening at DE = 75% and PP = 100%.

This study underscores the potential of novel drugs as pathogen reduction measures to reduce CRE incidence in US hospitals if deployed strategically. Findings highlight the value of developing pathogen reduction strategies for colonized patients to prevent CRE transmission and infections.

The relative contributions of antibiotic duration (days of therapy, DOT) and spectrum intensity (days of antibiotic spectrum coverage, DASC) to Clostridioides difficile infection (CDI) risk remain unclear. This multicenter study aimed to identify independent risk factors for CDI, differentiate the impact of length of therapy (LOT) from combination therapy intensity (DOT/LOT ratio), and characterize continuous risk profiles to inform actionable antimicrobial stewardship.

Retrospective cohort study.

The study was conducted at two Japanese tertiary hospitals from 2016 to 2024.

Hospitalized patients undergoing CDI testing after receiving systemic antibiotics were classified into CDI and non-CDI groups. Independent risk factors were identified using multivariable logistic regression and restricted cubic spline (RCS) models. Internal validity was evaluated using bootstrap resampling. Propensity score matching (PSM) was performed to achieve balance in baseline CDI risk factors.

Among 3,073 patients, 186 developed CDI. Prolonged DOT was independently associated with an increased risk of CDI; RCS analysis demonstrated progressive increase in CDI risk beyond the median DOT of 16 days. Bootstrap validation showed minimal optimism. In the PSM cohort (n = 186 pairs), prolonged DOT remained significantly associated with CDI, and lower DASC emerged as a significant risk factor, reflecting the disproportionate use of specific high-risk, narrow-spectrum antibiotics. Furthermore, supplementary models revealed that both prolonged LOT and higher DOT/LOT ratio were independent risk factors for CDI.

Prolonged DOT was a primary factor associated with CDI. Antimicrobial stewardship interventions could benefit from incorporating duration reduction measures alongside careful evaluation of individual antibiotic CDI risks.

Although measles was declared eliminated in the United States in 2000, cases have increased in recent years. Our goal was to estimate the incidence and duration of diagnostic delays for measles and identify factors associated with delays.

Case-crossover.

We used the Merative MarketScan Research Databases (2001–2023).

We identified measles cases and evaluated prior healthcare encounters for potential missed diagnostic opportunities.

Using a bootstrapping approach, we estimated the number of healthcare visits representing possible missed opportunities to diagnose measles during a two-week period preceding the index diagnosis. We utilized Firth logistic regression to assess factors associated with delays.

We identified 4,651 measles cases. During the two-week period prior to diagnosis, 426 (9.2%) patients had healthcare visits with signs or symptoms commonly associated with measles. We estimated 381 (95%CI: 330–440) missed opportunities to diagnose measles. Delays occurred most frequently in outpatient settings (81.0%). Approximately 6.9% (95%CI: 6.1–8.0%) of patients experienced at least one missed opportunity, with a mean delay of 4.05 days (95%CI: 3.48–4.51) (median delay = 2.94 days [95%CI: 2.00–3.00]). An estimated 1.7% (95%CI: 1.1–2.2%) of patients experienced a diagnostic delay lasting a week or longer. Factors associated with an increased likelihood of delays included age <2 years and receiving antibiotic prescriptions.

Diagnostic delays for measles are not uncommon and may facilitate transmission, especially in outpatient settings.

Respiratory infections that transmit through air contribute substantially to global morbidity and mortality. Although preclinical data on germicidal ultraviolet (GUV) for air treatment are promising, its real-world effectiveness remains incompletely understood.

Review effectiveness and safety of GUV for preventing respiratory infection transmission.

Medline, Embase, Global Health, Cochrane Library, CINAHL, Engineering Village, Epistemonikos, Scopus, and Environmental Science Collection from inception through December 2025.

Studies of GUV with a comparator, measuring human outcomes including respiratory infections, absenteeism, or adverse events.

At least two investigators extracted data.

We identified 57 reports describing 40 studies published between 1940 and 2025: 30 non-randomized controlled trials, 4 randomized controlled trials (RCTs), 4 case series, 1 cohort study, and 1 cross-sectional study. Non-randomized studies indicated GUV reduces infections with high transmissibility through air (measles and chickenpox), although results were mixed for undifferentiated respiratory illnesses and absenteeism. Two RCTs were inconclusive or showed only modest effects. Safety monitoring in 16 studies identified no increased eye or skin irritation from properly installed GUV. All studies had at least one threat to validity; 89% were non-randomized, and 83% lacked statistical power calculations.

Heterogeneous study designs, interventions, and outcomes precluded meta-analysis.

Several older clinical studies indicated that GUV reduces infections with high transmissibility through air, but its broader effectiveness against respiratory infection remains uncertain. Inconclusive results may reflect methodological and epidemiological limitations rather than true ineffectiveness. Adequately powered RCTs with robust clinical endpoints are needed.

https://osf.io/fg6qx

To examine how physician workroom size affects healthcare professional contact networks and the risk of respiratory virus transmission.

Prospective observational study with agent-based simulations.

Two physician workrooms of differing size (internal medicine, 208.7 sq ft; cardiology, 112.6 sq ft) in a large academic hospital.

We deployed wireless sensor networks over 18 days in internal medicine and 14 days in cardiology workrooms. Physicians, residents, and medical students wore proximity-sensing badges during work shifts. Contacts were defined as two healthcare professionals within six feet, based on calibrated received signal strength indicators. Contact networks were generated in one-minute intervals. We simulated respiratory disease spread using a Susceptible-Infected (SI) model across varying transmission probabilities and estimated infection risk at different room densities.

Average occupancy was 2.7 persons in internal medicine and 2.3 in cardiology. Despite lower occupancy, the smaller cardiology room exhibited greater contact density: healthcare professionals in the smaller room had higher mean and median numbers of contacts. SI simulations showed consistently higher risk of secondary infections in the cardiology room, even at lower transmission probabilities.

Workroom size significantly affects healthcare professional contact density and infection risk. Smaller rooms increased opportunities for transmission despite lower average occupancy. Designing larger workrooms, limiting occupancy, or reconfiguring shared spaces may reduce infection transmission in healthcare facilities.

To investigate late-onset Group B Streptococcus (GBS) transmission dynamics in a neonatal intensive care unit (NICU) using whole-genome sequencing (WGS).

A 57-bed level III NICU in Toronto, Canada.

Neonates with late-onset GBS (LOGBS) identified, July 2023–February 2024.

An outbreak management team oversaw the investigation, hygiene audits, and stakeholder communications. Canada’s National Microbiology Laboratory performed WGS (Illumina) on outbreak and prior isolates. Core single nucleotide variant (SNV) phylogeny used SNVPhyl. Clinical data included age, infection type, maternal GBS status and outcome were reviewed. Three consecutive weekly point-prevalence surveys (PPS) were conducted using rectal and throat swabs.

In August 2023, two LOGBS cases (bacteremia and meningitis) triggered the investigation. Two more LOGBS bacteremias occurred pending WGS results. Three of the 4 isolates matched a prior early-onset (day-1) case (0 SNVs; cluster 1, serotype Ia). The fourth was 1 SNV different from a conjunctivitis case detected a week later (cluster 2, serotype V). PPS revealed 5 asymptomatic cases genomically unrelated to either cluster. In February 2024, two further LOGBS cases (bacteremia; asymptomatic bacteruria) emerged. The first matched the mother’s antepartum isolate with transmission to the second infant (0 SNVs; cluster 3, serotype IV). Hygiene audits identified gaps in hand and environmental safety; room proximity was the primary commonality. Following reinforcement of infection prevention measures, no further nosocomial GBS infections occurred through October 2025.

This prolonged NICU outbreak involved multiple serotypes. WGS was critical in distinguishing horizontal transmission from independent introductions, directly guiding targeted infection control interventions.

Real-world evidence is limited regarding the use and impact of procalcitonin (PCT) on antibiotic duration in severe community-acquired pneumonia (SCAP) patients.

A retrospective cohort study of adult patients with SCAP (defined by modified American Thoracic Society [ATS] criteria) to 12 hospitals between November 2022 and June 2025. We analyzed clinical characteristics and estimated the association between PCT testing within 24 hours of hospital admission and antibiotic duration, and between low (<.5 µg/L) and high (≥.5 µg/L) PCT values and antibiotic duration. Clinical stability was determined based on ATS criteria (temperature <100 °F with ≤1 sign of instability within 24 hours of admission).

Among 1,553 SCAP admissions, 325 (21%) were clinically stable on admission and 924 patients (59.5%) had PCT testing within 24 hours; 452 (48.9%) of PCTs were low. Clinical stability was not associated with testing. PCT testing was associated with fewer antibiotic days (mean 6.9 vs 7.4 days adjusted mean difference, −.5 days, 95% CI: −.8, −.3), particularly in stable (mean 6.6 vs 7.3 days, adjusted mean difference, −.8 days, 95% CI: −1, −.1) versus unstable patients (mean 7.2 vs 7.5 days, adjusted mean difference, −.4 days, 95% CI: −.8, −.05). Low PCT values were associated with shorter antibiotic durations than high values (mean 6.5 vs 7.6 days, adjusted mean difference, −1.1 days, 95% CI: −1.9, −.3).

PCT testing was associated with shorter antibiotic duration, especially among stable patients, but was performed without regard to clinical stability. Reserving PCT testing for stable patients may improve efficiency.

Outline our process in creating an efficient surveillance system through increased automation of detecting hospital-associated Staphylococcus aureus bacteremia (HA-SAB). To describe the rate and attributable source of HA-SAB over time at our institutions.

We developed an algorithm for extracting cases that met the temporal case definition of hospital-onset Staphylococcus aureus bacteremia (HO-SAB) through our electronic medical record system. The expanded temporal definition included both instances of S. aureus bacteremia (SAB) if occurring>48 hours after admission (HO-SAB Current Admission) or if admitted ≤48 hours but had a previous admission within the past 4 weeks (HO-SAB Previous Admission). Following extraction, clinical review was performed to ascertain if the algorithm extracted HO-SAB cases were hospital-associated SAB (HA-SAB) versus community-associated SAB (CA-SAB) and source(s) of infection.

Over a 5-year period from 2020 to 2025, the rate of HA-SAB was 15.2–26.2 per 10,000 patient admissions and 1.5–2.7 per 10,000 patient days. Our automated process screened 5,146 total cases of SAB, and determined that 222 cases (4%) fit the temporal definition of HO-SAB. Of these 222 HO-SAB, we classified 189 (85%) cases as HA-SAB and 33 (15%) as CA-SAB. The most common sources of HA-SAB were central lines (23%) and peripheral IVs (22%).

An automated process is effective at screening cases of SAB. This can improve workflows to enable a sustainable HA-SAB surveillance program as a quality metric for institutions. Our expanded definition of HO-SAB allowed detection and evaluation of an additional 38 (20%) previous admission cases.

To evaluate whether COVID-19 exposure management in healthcare personnel (HCP) reduced presenteeism, occupational exposures and cases, comparing contact tracing and self-reporting exposure to standard illness management (i.e. calling out sick).

Retrospective cohort study.

Large academic medical center, ambulatory and acute care.

HCP COVID-19 exposure and case records (N = 30,102) collected at the University of North Carolina Medical Center, March 2020 through June 2021.

Among COVID-positive HCP, we measured hours worked while infectious and symptomatic, onward exposures, and secondary cases caused. Using negative binomial regression, we estimated mean count differences for each outcome comparing contact-tracing and self-reporting to standard illness management. We calculated the “number of encounters needed” to prevent one additional outcome (e.g., single onward exposure) by multiplying count differences by the proportion of exposure management encounters that identified a case.

Contact tracing and self-reporting exposures captured a higher proportion of asymptomatic cases (14 and 18%) than standard illness management (5%). Both strategies reduced infectious work time by ~8 hours and presenteeism by ~3.5 hours. We found large relative reductions in onward exposures (62% contact tracing, 66% self-report) and secondary cases (79%, 100%), but small absolute reductions. Preventing one secondary case required identifying >1,000 traced contacts or >350 self-reports.

Compared with standard illness management, COVID-19 exposure management reduced infectious work time, presenteeism and onward exposures, but preventing secondary cases was highly inefficient. Layered with comprehensive institutional mitigation strategies, exposure management provided limited case prevention benefits. Presenteeism was common and remains an important healthcare safety challenge.

To evaluate the impact of removing the “other” free text special indication from an inpatient urinalysis (UA)-driven reflex urine culture UTI panel on urine culture utilization and special indication designation.

Single-center interrupted time series analysis using segmented regression to assess changes in urine culture ordering before and after intervention.

Tertiary academic medical center inpatient units, July 1, 2022–October 31, 2025.

All hospitalized adults with UTI panels during the study period. Urine culture orders from emergency and ambulatory settings were excluded.

Removal of the “other” free text special indication from the UTI panel in February 2024. A new “deceased donor” special indication was added to maintain compliance with local organ procurement regulations.

Among 39,218 UTI panels, 11,923 cultures were performed. Postintervention urine cultures decreased by 2.09 per 1,000 patient days (PD) (P <.05), with a significant postintervention downward trend of 0.15 cultures per 1,000 PD per month (P <.05). Special indication designation decreased immediately by 2.17 special indications per 1,000 PD (P <.05) with a reversal of the preintervention upward trend (P <.05). Designation for neutropenia increased by 0.74 indications per 1,000 PD immediately postintervention (P <.05); renal/pancreas transplant and pregnancy indications remained stable or declined. No compensatory increase in total urine cultures was observed.

Removing the “other” free text option in a UTI panel led to a sustained reduction in overall urine culture ordering and low-value special indication designations. Modifying electronic order set architecture represents a feasible diagnostic stewardship strategy to reduce unnecessary testing and potential overtreatment of asymptomatic bacteriuria while preserving pathways for high-risk populations.

Nontuberculous mycobacteria (NTM) are commonly found in healthcare facility water systems and can lead to serious and difficult-to-treat infections. We analyzed Centers for Disease Control and Prevention (CDC) consultations of water-related healthcare-associated infections (HAI) investigations involving NTM.

Retrospective observational study.

We searched CDC consultation records from January 1, 2018, through December 31, 2024, using water-related terms and organisms, excluding Legionella, to identify and review investigations involving potential or confirmed transmission of water-related organisms; we reviewed investigations that involved NTM.

Among 1,458 consultations, we identified 639 (43.8%) water-related investigations involving 4,685 patients and 60 different organisms. Investigations involving NTM accounted for 10.3% (n = 66) with 15 NTM species identified. Among NTM-related investigations, almost half involved M. abscessus (n = 31, 47.0%) and two-thirds (n = 44, 66.7%) involved extrapulmonary infections only. More than half of identified NTM investigations (n = 37, 56.1%) occurred in hospitals and over one-third (n = 23, 34.8%) in outpatient settings. Exposures to surgery (n = 27, 40.9%) and medical products (e.g., medical devices, medications, and biological products) (n = 35, 53.0%) were common.

Over this seven-year period, approximately one-tenth of CDC healthcare water-related consultations involved NTM. The majority involved extrapulmonary infections, with surgery and exposure to contaminated medical products representing the most common exposures of concern. These findings highlight the potential for NTM infections when water-related healthcare exposures occur. Healthcare facilities are encouraged to identify the potential for exposure to nonsterile water during surgery, during the use of medical devices, and during the preparation and administration of medications to reduce the risk from NTM.

Carbapenemase-producing Enterobacterales (CPE) are a major healthcare-associated threat due to multidrug resistance, gastrointestinal colonization, and hospital transmission. We evaluated the cost-effectiveness of CPE screening using real-world data from 2015 to 2024.

We conducted a healthcare provider-perspective economic evaluation at Queen Mary Hospital, using electronic health records and hospital data. Screening episodes, clinical outcomes, lengths of stay, and costs (laboratory testing, staffing, personal protective equipment, and disinfection) were analyzed. We calculated the number needed to screen (NNS), incremental cost-effectiveness ratio (ICER) for infection prevention, and cost per quality-adjusted life-year (QALY) gained.

Among 375,213 hospitalization episodes in which CPE testing was performed (447,745 tests), 10,046 (2.7%) were positive; 390 (3.9%) were clinical infections and 9,656 (96.1%) colonizations. After patient-level deduplication (149,965 individuals), 3,628 (2.4%) were CPE-positive, with 153 clinical infections. Mean cost per CPE infection was US＄35,290 and per colonization US＄7,721. Annual screening program cost was US＄1,487,969. An estimated 63.6 infections were averted and 47.8 QALYs gained annually (NNS = 590). Compared with no screening, it was cost-saving (annual saving US＄757,604). Sensitivity analyses showed NNS most sensitive to screening effectiveness (−40.9% to +59.2%); screening remained dominant except at lower limit of effectiveness (ICER = US＄1,958; cost/QALY = US＄2,048). Worst-case scenario ICER was US＄31,019 (cost/QALY = US＄29,831). All values were below the World Health Organization cost-effectiveness threshold of US＄54,301 (Hong Kong gross domestic product/capita).

CPE screening was cost-saving and highly cost-effective, remaining robust across sensitivity analyses. These findings support sustained screening in high-volume tertiary settings.

To characterize nursing home (NH) resident hand hygiene knowledge, hand hygiene habits, and bathing practices to inform intervention strategies.

Cross-sectional survey.

Twenty geographically diverse NHs between December 2023 and July 2024.

NH residents.

The survey was administered verbally to NH residents and consisted of 22 questions pertaining to residents’ hand hygiene knowledge, hand hygiene habits at their previous residence and at the NH, and bathing practices at the NH.

Among the 495 NH residents who completed the survey, 54% were short-stay/temporary residents, 65% were female, and 79% were aged 70 years or older. Less than a third (29%) of the residents answered all three hand hygiene knowledge-based questions correctly. Residents washed their hands less often at the NH compared to their previous residence. Residents also washed their hands with running water less frequently at the NH (81% vs. 98%). Thirty percent of residents reported facing challenges with hand hygiene at the NH with 53% of the responses mentioning mobility impairments as the main reason why. Additionally, residents facing challenges with hand hygiene had a lower frequency of hand hygiene at the NH. Half (51%) of the residents reported bathing less at the NH compared to their previous residence with NH policy being the most commonly reported reason encompassing 54% of the responses.

NH residents perform hand hygiene and bathe less frequently at the NH. Our multi-site study identified multiple barriers to resident hand hygiene and bathing that can be modifiable through practice or policy changes.