Background: In 2024, an increase in colorectal surgical site infections (SSI) was identified at two AdventHealth Central Florida Division campuses. Control charts revealed this as a special cause variation, prompting an in-depth investigation into potential contributing factors and modifiable risks. Methods: A detailed review of 14 SSI cases (five at Campus A and nine at Campus B) was conducted. The analysis focused on key perioperative practices, including chlorhexidine gluconate (CHG) application, postoperative blood glucose control, perioperative antibiotic administration, hair clipping techniques, skin preparation protocols, and postoperative temperature monitoring. A secondary analysis was conducted by the surgical team on intraoperative factors and operative techniques. Results: The investigation revealed that for both campuses, over 80% of SSIs were linked to defects in perioperative antibiotic administration, postoperative glucose control, and CHG application. At Campus A, primary gaps were identified in postoperative glucose control, perioperative antibiotic administration, and CHG application, while at Campus B, issues stemmed from CHG application, postoperative glucose control, and hair removal practices. Conclusion: Corrective actions were recommended to address these gaps, including enhanced pharmacy involvement to ensure timely and appropriate antibiotic administration, standardized processes for glucose monitoring and CHG application, and standardization of adherence to WHO guidelines. A continuous audit system with regular feedback was proposed to monitor compliance and drive further improvements. This analysis also revealed the importance of creating a robust process metric dashboard to monitor and provide the ability to detect variation in perioperative processes that could lead to an increase in SSI. It also highlights how quality improvement science has great applicability in infection prevention and hospital epidemiology. These measures aim to significantly reduce SSI rates and improve patient care.

Surgical site infection (SSI) is one of the most common complications following cesarean section (CSEC) and adds significant burden to the healthcare system. We aimed to explore factors associated with increased risk of these infections and to compare disease severity based on tissue level.

Observational study of post-CSEC SSIs from Jan 2021-Dec 2023 at Henry Ford Hospital in Detroit. SSIs were defined according to National Healthcare Safety Network (NHSN) criteria. Cases were categorized as superficial incisional (SI), deep incisional (DI) and organ space (OS). Demographics, risk factors, clinical features and outcomes were evaluated. DI and OS were grouped together into non-superficial infections for comparative analysis. 70 (3%) of 2,230 CSECs performed during the study period met post-CSEC SSI criteria, of which 41 (60%) were SI, 4 (6%) DI, and 25 (34%) OS (Table 1). Majority of patients were black (51.5%) with BMI>30 (56%), had Medicaid insurance (66%) and underwent emergent CSEC (60%). Anemia (hemoglobin 3 manual exams prior to surgery (55% vs. 29%, p=0.017) were significantly more common among patients with non-superficial infections. Receipt of perioperative antibiotics was similar between the two groups, and most were administered within 1 hour of incision; cefazolin was frequently used. Incisional pain and drainage were the most prevalent symptoms (Table 2). Abdominal pain (69% vs. 10%, 3 manual exams and worse clinical outcomes compared to patients with superficial infections. Implementing evidence-based practices and recommendations are therefore critical to reduce the morbidity associated with non-superficial CSEC infections.

Background: Carbapenem-resistant Enterobacterales (CRE) have become an increasing public health challenge in the United States over the past two decades. Carbapenemase-producing CREs (CP-CREs) significantly contribute to the spread of antimicrobial-resistant pathogens in healthcare settings. Tennessee has been conducting surveillance of CRE since 2011. As part of the Emerging Infections Program (EIP), the state has participated in population-based surveillance in Davidson and seven surrounding counties, collaborating with the Centers for Disease Control and Prevention (CDC) since 2014. Methods: The data collected through the Muti-site Gram-negative Surveillance Initiative (MuGSI) project, a collaboration between Tennessee and CDC as part of EIP, was used for this study. The analysis was performed on a subset of CRE isolates tested for carbapenemase production (CP) among all incident CRE cases collected from 2016 to 2022. Incident CRE cases are defined as the identification of carbapenem-resistant E. coli, Enterobacter cloacae complex, and Klebsiella species (K. aerogenes, K. oxytoca, K. pneumoniae, and K. variicola) from urine or normally sterile specimens (e.g., blood) from the residents of the surveillance area in a 30-day period. The mortality data was obtained from the Tennessee Vital Registry and merged with the surveillance data. Cox regression analysis was performed to evaluate if there is a difference in the 90-day survival rate based on the CP status of the pathogen, gender, age group, and the Charlson comorbidity index (CCI) score. Data analysis was done using SAS version 9.4. Results: There were 570 CRE cases reported during the study period (2016-2022). Of these, 406 were tested for carbapenemase production and 87 (21.4%) were positive for CP. There were 269 (66.3%) females and 137 (33.7%) males. Patients with higher Charlson comorbidity index score (> = 5) have significantly higher hazard ratios compared to those with low scores (HR 4.17; p-value) Conclusion: This study indicates that patients infected with CP-CRE, females, and those with high Charlson comorbidity index score have a significantly higher probability of dying within 90 days. These factors are worth considering when conducting a risk assessment of patients infected with drug-resistant gram-negative bacilli. The significantly increased risk of death among patients infected with CP-CRE highlights the need for timely carbapenemase testing and use of the test result for appropriate antimicrobial therapy and infection prevention.

Background: Carbapenemase-producing Enterobacterales (CPE) poses a major infection control challenge in healthcare settings. Over the past decade, Klebsiella pneumonia carbapenemase (KPC)-CPE colonization at our hospital declined to under 10% of all CPE rectal screens, while New Delhi metallo-beta lactamase (NDM)-CPE and oxacillinase (OXA)-CPE colonization rates have tripled, Figure 1. Methods: A comparative historical study was conducted on adult patients colonized with OXA-CPE (2017-2023), NDM-CPE (2017-2023), or KPC-CPE (2017-2018). Patients were retrospectively identified through the microbiology laboratory, their files reviewed for demographics, clinical characteristics, and outcomes. Results: The study included all 341 patients who underwent a screening rectal swab for CPE on admission or during contact tracing: 115 tested positive for OXA-CPE, 136 for NDM-CPE, and 92 for KPC-CPE. Patients colonized with OXA-CPE or NDM-CPE were younger (61.7±20 and 60.7±19.56, respectively) compared to those colonized with KPC-CPE (67.2±18.78; P=0.043 and P=0.013). Clinical characteristics and outcomes for the three cohorts are summarized in Table 1. Patients colonized with OXA-CPE or NDM-CPE were more likely to be admitted to surgical wards, have fewer urinary catheters and decubitus ulcers, and were more often discharged home compared to KPC-CPE colonized patients. OXA-CPE and NDM-CPE genes were predominately associated with Escherichia coli, while KPC-CPE gene was mainly found with Klebsiella sp. Conclusions: OXA-CPE and NDM-CPE colonized patients are younger, less debilitated and primarily reside at home. These findings prompted a revised CPE admission strategy, resulting in higher detection of OXA-CPE and NDM-CPE colonization upon admission.

Background: The gold standard for surgical site infection (SSI) surveillance is 100% chart review, a practice neither efficient nor pragmatic for most large hospital systems.

Modern infection surveillance software uses indicators – specific data elements within the patient medical record - to report possible SSI for confirmation by infection preventionists (IPs). Using all available indicators has been shown to increase identification of SSIs and may approximate the gold standard but has been called “noisy” for including many patients with no SSI and costing precious surveillance time. Here, we describe our experience with evaluating the performance of our surveillance system. Methods: The setting for this study was the 21-hospital Cleveland Clinic health system with a uniform SSI surveillance plan and shared medical record. Our software, Bugsy (Epic Systems Corporation), employs six indicators for possible SSI: hospital readmission, return to surgery, positive microbiology tests, and chief complaint, physician diagnoses (billing codes), or administration of post-prophylaxis antibiotics suggestive of SSI. We extracted all possible SSIs, indicators, and confirmed infections for seven NHSN procedure code categories. We calculated the sensitivity and specificity of each indicator individually using OpenEpi v3.01 and estimated the cost associated with IP time spent on indicators that do not result in confirmed SSI. Results: From January to December 2023, 12,739 possible SSIs were reported with any indicator out of 26,276 inpatient procedures (48%). The frequency of procedures flagged for review ranged from 25% for CSEC to 78% for HYST. The number of procedures, possible SSI, and confirmed SSI with rates are shown in Table 1. The sensitivity and specificity of each indicator are shown in Table 2. Infection preventionists spent an average of 2 minutes reviewing each of 12,027 patient charts (401 hours) and determined there was no SSI, costing an estimated $18,602 annually. Conclusion: Nearly 50% of surgical patients were flagged for review for possible SSI with any indicator. Post-prophylaxis antibiotic was the most sensitive (97%) but least specific (65%) indicator. There was variability in indicator performance between procedure types. Readmission to the hospital was more sensitive in procedures with implants, e.g. KPRO and HPRO, than in procedures without, such as COLO and HYST. Evaluating the performance of possible SSI indicators enables IP programs to make data-driven and pragmatic decisions related SSI case finding practices. Tuning the indicator criteria within the software build may be necessary for optimization and presents an opportunity for IP time and cost savings.

Background: Candida auris is an emerging fungal pathogen with potential to cause outbreaks. To mitigate transmission, the California Department of Public Health (CDPH) recommends considering implementation of an active case detection process in acute care hospitals to identify high-risk patients who may be colonized on admission. Methods: From 1/5/2024 to 9/20/2024, Stanford Health Care piloted an active surveillance program to identify high-risk patients for C. auris – defined as patients coming from (1) long term acute care hospitals (LTACHs), (2) ventilator skilled nursing facilities (vSNFs), (3) outside institutions with known C. auris outbreaks, (4) hospitals in Nevada, (5) recent international hospitalizations, and (6) patients with carbapenemase-producing organism (CPO) colonization.

Patients were identified for screening via daily review of custom-designed lists from the electronic medical record (EMR). A list of patients admitted from skilled nursing facilities (SNFs) and a list of patients transferred to Stanford from an outside facility were cross-referenced with a published list of high-risk facilities provided by CDPH. A list of inpatients flagged for CPOs was reviewed daily. Infection prevention was also notified by the transfer center or the care team if a patient had a recent international hospitalization. Screening was via superficial skin specimens from the axilla and groin. Culture-based testing was performed with identification of any fungal growth via MALDI-TOF. Results: During the pilot period, 1159 patients were evaluated for high-risk criteria; 58 (5%) met criteria for C. auris testing. One of 58 patients (colonization (Figure 1). There were 5 clinical cases during the pilot period, including the patient identified via screening. Active surveillance required 5-7 hours per week of infection preventionist effort, plus an hour to educate nursing staff when screening tests were performed. Conclusions: Our experience with performing active surveillance for C. auris resulted in one positive case, suggesting that this approach may have a lower yield in regions with low prevalence. Since surveillance can often be a time-intensive task for infection preventionists and nursing staff, it is important we continue to improve our knowledge about when and what surveillance is the most effective.

Background: Targeted admission screening of high-risk patients for antimicrobial resistant organisms (AROs) is a key component of infection prevention and control. However, adherence with screening is suboptimal, risking a negligible impact on the prevention of ARO transmission. Clinical decision support tools in clinical information systems (CIS) may improve ARO screening adherence. This study evaluated the adherence of ARO admission screening using a tool in the provincial CIS in Alberta, Canada and the relationship between adherence and hospital ARO rates. Methods: A population-based, sequential cross-sectional study was completed on all admissions to acute care and acute rehabilitation facilities where ARO admission screening occurs on any unit, and where the CIS was implemented in Alberta between January 1, 2020 and March 31, 2024 (n=100). Mental health facilities/units, continuing care, newborns Results: There were 97 (97% of eligible facilities) facilities that implemented the CIS across seven launch periods included. Overall adherence ranged from 43% to 65%. After controlling for bed size and health zone, adherence decreased by the number of months each facility was active on the CIS (aIRR 0.987, 95%CI 0.986-0.987). There was no seasonality in trends. There was a negative relationship between adherence and overall MRSA infection rate (rs = -0.68) and after adjusting for bed size, health zone, and number of months active on the CIS (aIRR 0.99, 95% CI 0.986-0.994). Analysis could not be completed for CPO due to small numbers. Conclusions: While increased ARO admission screening adherence was associated with lower overall MRSA infection rates, the IRR was close to one and may not be clinically significant. With adherence decreasing over time, further work is needed to understand barriers to ARO admission screening and implement strategies to support healthcare providers in completing appropriate surveillance for AROs.

Background: Intact skin is a major barrier for colonization and infections. Burn-related Infections particularly central line associated bacteremia and pneumonia are the most frequent cause of death in burn patients. We aimed at prospectively studying colonization and infections in inpatient burn victims. Methods: This is a single center study between April 1st, 2022 – March 30th, 2023. The patients included in the study are patients with inhalational lung injury (IHI) and or patients with total burn surface area (TBSA) of ≥ 10%. All the patients had nasal MRSA swab as well as inguinal swab for MRSA, VRE, C diff, ESBL and CRO screening. These plates were incubated for 2 days at 36 °C. Additionally, fungal cultures were placed on selective fungal media and incubated for 7 days at 32°C. Electronic health records were reviewed for antibiotics used (local or systemic), hospital associated infections (HAI) and clinical and surveillance cultures. The patients were followed for their length of stay (LOS) in the hospital. Results: During the study periods, 99 patient encounters were included. There was male predominance (75%) with an average age of 60 years. The average TBSA was 19% and IHI was diagnosed in 41% of the patients with an average length of stay was 28 days. No patients had history of MDRO. MRSA was the most common MDRO identified in clinical and surveillance (routine and study cultures). Groin MRSA was slightly more likely to be positive than nasal MRSA (32% vs. 24% respectively). C diff was positive in 5 cultures and fungal cultures were positive in 4 patients (3 candida and one Aspergillus). Other MRDO (including CRO, ESBL and VRE) were rare (only 2 VRE cultures and no CRO). Local antibiotics were used in the first 10 days in 25% of cases and 35% of the cases after 10 days. Systemic antibiotics were used in 50% of the patients. HAI was diagnosed in 35% patients with pneumonia then urinary tract infections as the most common ones. Blood stream infection was reported in only 2 patients. Burn registry definition of infection included less than half of the patients reported by the National Health Safety Network (NHSN). Conclusion: MRSA remain the most important pathogen in burn victims. Strict infection prevention measures and antibiotics stewardship are likely the reason for low infection rate and antibiotic use. NHSN definition may be more sensitive than Burn registry in including HAI in burn victims.

Background: Multi-drug resistant organisms (MDROs) are highly transmissible in hospital environments. Understanding the onward transmission of Methicillin-resistant Staphylococcus aurous (MRSA), Carbapenemase Producing Enterobacterales (CPE) and Vancomycin-resistant Enterococcus (VRE) is an important part of infection prevention. Patient-staff interactions can sometimes lead to MDRO acquisition. We aimed to investigate if patient-staff interactions were associated with MDRO acquisition in patients over 1 month in an inpatient tertiary hospital setting. Methods: During routine clinical care, staff will document in a patient’s electronic health records (EHR) upon interaction. Data regarding nursing and patient interactions were obtained extracting from “documents authored” and “vital signs” sections of the EHR. Hospital-Onset MDRO acquisition is defined as a positive detection of MDRO from a specimen collected on or after the third day of admission. The MDRO cohort was categorized by pathogen into two groups: before MDRO acquisition (cohort 1) and after MDRO acquisition (cohort 2). Patients with no known MDRO acquisition were selected as a control group. Average number of patient-staff interactions per day were calculated for each cohort. Descriptive statistics were employed and the appropriate post-hoc tests performed. Data analysis was performed using R (version 4.4.2) and RStudio IDE (version 2024.12.0). R package dunn.test (version 1.3.6) was used. Results: 8451 unique patients were included in the control group. Twenty-three MRSA and 35 VRE cases were included in cohort 1 and 2. For CRE, 41 cases were included in cohort 1 and 39 in cohort 2. Room type and location showed statistically significant relationship with (p < 0 .001) per-patient-daily average staff-inpatient interactions. The [MA3] average number of interactions per cohort can be seen in Table 1. Across all MDROs, the difference in patient-staff interactions between the cohort 2 and control group is significant (p < 0 .002). For VRE, the difference in patient-staff interactions between cohort 1 and control is significant (p=0.0015). Conclusion: Increased patient-staff interaction shows a correlation with VRE acquisition, but not for MRSA and CPCRE. [MA4] Further analysis is warranted to better understand the factors influencing the correlation between HCW interactions and MDRO acquisition.

Background: Vancomycin-resistant Enterococcus (VRE) is a pathogen that can cause nosocomial infection leading to increased morbidity and mortality. Healthcare provider interactions have been reported to cause nosocomial infection acquisition. Here we aim to understand patient-staff interactions by mapping their interactions together with the movement of VRE colonised patients in an acute inpatient setting in a tertiary hospital for one month to create a dynamic visualisation map. Methods: Staff-patient interactions were obtained through documentation in the electronic health records (EHR). Hospital-onset VRE Hospital-Onset acquisition is defined as a positive screen/culture on or after the third day of admission. The cohort was categorised by their VRE statuses such as Hospital-onset (HO), Community-onset (CO) defined occurring before the 3rd day of admission, Infectious period (XO) and Negative (NO). XO is estimated to be the two days before a positive test HO acquisition. NO patients in this cohort eventually turn positive during their admission. A network was generated where patients and staff were represented as nodes, with edges weighted by number of interactions with the specific staff. Node colours were assigned based on VRE status. An interactive patient-staff interaction network map was developed using Python 3.12.8, using PyVis library version 0.3.2 for network visualization and Dash version 2.18.2 for web-based interactivity. Results: There are a total of 207 patients who tested positive for VRE in SGH in July 2024. 54 (26.1%) were HO. A snapshot of the map filtered for 10/07/24 to 11/07/24 can be seen in Figure 1. 14 (11.8%) were HO, 58 (48.7%) were CO, 44 (37.0%) were NO and 3 (2.5%) were XO. As seen in figure 1, there are 7 (5.9%) are in isolated singular clusters, 6 (5.0%) are in pair clusters and 3 (2.5%) are in a triple cluster. In total, the largest cluster consists of 103 (86.6%) patients. This cluster consists of HO,NO,CO and XO patients. This intermingling highlights potential routes for cross-transmission of VRE. Conclusion: The network map reveals notable intermingling of CO, HO, XO and NO contacts within the dominant cluster and suggests potential routes of transmission. This underscores the need for better understanding of transmission dynamics to allow enhancement of existing infection prevention policies to prevent this spread.

Background: Admission screening for CRO carriage may prevent transmission, but there is a lack of consensus on the best targeted approach. Using a well-characterized cohort of medical intensive care unit (MICU) patients prospectively screened for CRO carriage at time of admission (MAriMbA cohort), we compared the effectiveness of common targeted strategies (singly and in combination) available to hospitals in Illinois to identify MICU patients at risk for CRO carriage, including: (a) screening patients transferred from external facilities (e.g., short- and long-term acute care hospitals); (b) screening patients with a tracheostomy or pressure ulcer; or (c) querying the Illinois XDRO registry for prior CRO history. Methods: Results of rectal swab samples collected within 48 hours of MICU admission during 1/2017-1/2018 and cultured for CROs (carbapenem-resistant Enterobacterales [CRE], CR Pseudomonas aeruginosa [CRPA], and CR Acinetobacter baumannii [CRAB]) were used as the reference standard. Patients’ status as direct transfer from an external healthcare facility and presence of tracheostomy or pressure ulcer were collected prospectively during the MAriMbA study. History of CRO colonization before MICU admission was queried retrospectively from the Illinois XDRO Registry (xdro.org), with the limitation that most reports available during the study period were restricted to CRE. We evaluated each predictors’ independent association with admission CRO status and combined variables in a planned logistic regression modeling approach. Results: CRO colonization was detected in 37 (2.6%; including 26 CRE, 10 CRPA, and 1 patient co-colonized with CRE and CRAB) of 1,423 unique MICU admissions. For univariate analyses, presence of a tracheostomy (OR 9.32, 95% CI 4.29-20.27), presence of pressure ulcer (OR 3.07, 95% CI 1.42-6.64), transfer from an external healthcare facility (OR 1.97, 95% CI 1.02-3.82), and prior CRO history reported to the Illinois XDRO Registry (OR 72.96, 95% CI 25.83-206.07) were associated with higher odds of CRO colonization. A model combining these variables improved the predictive capability (AUC 0.73) (Table). Prior CRO history reported to the Illinois XDRO Registry identified 27% of CRO cases, with number needed to screen (NNS) of only 2 patients. Adding tracheostomy, pressure ulcer, and external facility transfer together improved detection of admission CRO cases to 68%, with NNS of 20 patients (Figure). Conclusion: In a region with well-established inter-facility communication of CRO history via the Illinois XDRO Registry, the addition of screening patients with a tracheostomy, transfer from an external facility, or pressure ulcer may improve early identification of CRO carriage at time of MICU admission.

Background: According to the Centers for Disease Control and Prevention (CDC), carbapenem-resistant Enterobacterales (CRE) are an urgent public health threat. The CDC states the most common or ‘Big Three’ CRE are Escherichia coli, Enterobacter species, and Klebsiella species. States look at the ‘Big Three’ for guidance when setting reportable condition criteria for CRE. Evaluating trends of the non-‘Big Three’ genera is critical to ensure surveillance efforts are focused on priority targets. Thus, CRE genera trends were evaluated to verify the fitness of CRE surveillance reporting recommendations. Method: The Antimicrobial Resistance Laboratory Network (ARLN) Southeast region (SER) includes Alabama, Florida, Georgia, Louisiana, Mississippi, Tennessee, and Puerto Rico. All CRE is reportable in Tennessee (TN) and isolate submission is required to ARLN. Other jurisdictions submit CRE to the TN regional lab. Submitted CRE cases to ARLN from 2018 – 2023 were analyzed. CRE cases were defined as an Enterobacterales organism resistant to one or more carbapenem, excluding imipenem for Proteus sp., Providencia sp., or Morganella sp. due to intrinsic resistance. Data was cleaned in SAS v9.4 to provide descriptive CRE statistics. Result: The top three genera for TN fluctuate between Enterobacter sp., Klebsiella sp., Proteus sp., and Escherichia sp. In 2022, Proteus sp. (n=132) had twice the incidence of Escherichia sp. (n=65) in TN. There was an overall increasing trend of Proteus sp. from 2018 – 2023. The largest increase of Proteus sp. in TN was seen between 2018 (n=23) and 2021 (n=183). However, the prevalence sharply decreased between 2021 (n=183) and 2023 (n=12). Proteus sp. was 17% (n=627) of all CRE cases (n=3625) in TN from 2018 – 2023, while the “Big Three” was 72% (n=2628). In contrast, Proteus sp. was only 3% (n=35) of all CRE cases (n=1400) in the SER excluding TN from 2018 – 2023, compared to 89% (n=1250) for the “Big Three”. Conclusion: CRE surveillance identified an increased overall prevalence of Proteus sp. in TN between 2018 and 2022 despite not being included in the ‘Big Three’. While there was a large increase of Proteus sp. observed in 2021, the increase was limited to TN, and the subsequent decline suggests this is an outlier. Jurisdictions outside of TN often only submit Carbapenemase-producing CRE to ARLN as not all jurisdictions have CRE as a reportable condition. Results of this analysis suggest the SER should continue to monitor CRE and Proteus sp. to note if there is an increasing overall trend to better inform isolate submission strategies.

Background: Patients infected or colonized with Candida auris or Carbapenemase-Producing Organisms (CPO) can serve as a transmission source for other patients. Screening select patients for these organisms allows facilities to implement infection prevention measures to minimize the risk of transmission.

Following a two-year period of ongoing transmission of Candida auris occurring in a community served by a large multi-state healthcare system, and the passing of a board of health rule requiring admission screening of select patients in another community served by the health system, an admission screening program was implemented across all acute care facilities in the system in 2024. Methods: Beginning in March of 2024, all patient admissions were screened for history of an overnight stay in either a long-term acute care (LTAC), skilled nursing (SNF), or non-US healthcare facility, or having had an invasive medial or surgical procedure outside of the US in the past 12 months. Patients who screened positive were placed in transmission-based precautions and consented for screening for Candida auris and CPO. Screening tests were performed utilizing a two-step method of HardyCHROM agar followed by UV fluorescence, MALDI-TOF MS or CARBA5. Potentially exposed patients who had been discharged were not screened. Results: 4249 patients in the acute care facilities were identified for admission screening, with 2553 consented and screened for Candida auris and 3346 for CPO respectively. Admission screening positivity rates are in table 1. No Risk Factors With Risk Factors Overall Candida auris 2.3% 2.3% 2.3% CPO 6.5% 7.25% 7.11%. Table 1: Admission screening positivity rates by pathogen and risk factors Conclusion: Candida auris colonization rates were the same in patients with and without risk factors. CPO colonization rates were 11% higher in patients with a risk factor present. 96.4% of the CPO positive screens had a LTAC/SNF stay as their risk factor. More robust surveillance and prevention strategies are needed in these care settings to prevent CPOs endemicity. Limitations of this study include the lack of screening completion in discharged patients and those patients who did not consent.

Background: Candida auris (C. auris) is a resistant fungal pathogen that persists in the hospital environment and poses a significant infection risk, particularly to immunocompromised patients. Early detection and infection control are vital for patient safety as C. auris may spread between patients in healthcare settings through contact with contaminated surfaces. The Centers for Disease Control and Prevention (CDC) and Texas Department of State Health Services (Texas DSHS) recommend screening high-risk patients, including those previously hospitalized abroad, in rehabilitation or long-term care facilities, or those with indwelling medical devices, mechanical ventilation, immunocompromised conditions, or colonization by other multidrug-resistant organisms. We developed a C. auris screening program based on these guidelines, local epidemiology, patient risk factors, and facility characteristics. Methods: An initial point prevalence survey was conducted to identify our high-risk patient population, but no positive screening results were found during our pilot study. However, a retrospective review of patients with clinical C. auris infection revealed 53% (8/15) had transferred into our center from other healthcare facilities. A targeted screening program of transfer patients was developed, and a needs assessment identified gaps in infection prevention practices, staff knowledge, and laboratory capabilities. Patients meeting screening criteria had composite swabs collected from axilla and groin creases, which were sent to an external lab for C. auris PCR testing. A tracking system was established for patients, results, and newly identified infections. Newly identified colonization cases received targeted infection control measures and were placed on isolation. Results: During the first four months of the screening protocol, 588 transfer patients have been screened, reflecting 5.47% of all admissions. We identified ten positive colonization cases, yielding a 1.82% positivity rate. In addition, two C. auris infections were identified. Conclusion: Overall, our C. auris colonization rates are low. This may reflect differences in patient population or screening practices. Identifying ten colonized patients through our screening protocol enabled timely isolation and targeted infection control measures, preventing possible horizontal transmission in a high-risk patient population. Ongoing monitoring and evaluation will inform our screening practices and enhance our ability to respond to outbreaks. As the prevalence of C. auris continues to grow, our screening program will continue to provide a proactive approach to managing this growing threat to our highly vulnerable patient population.

Background: Candida auris(CA) first recognized in the US in 2013, can be resistant to all major antifungal agents limiting treatment options. To decrease its spread, guidelines indicate patients with CA, if admitted to hospital, should be placed in isolation and considered positive indefinitely. Screening around newly identified patients is recommended. Methods: We review CA history in our facility, including colonizations, infections and screening/isolation protocols from 2019-2024. Results: In late 2019,a patient with a CA infection was transferred to our hospital. It was late 2022, before two additional patients with CA were admitted to our faciility from a long-term acute care facility (LTAC) that had a newly recognized CA cluster of cases/colonizations. Screening in our facility did not identify additional cases/colonizations (n =49) at that time. Patients with known infection or colonization were placed in contact isolation. Additional LTAC/LTCFs were recognized from which patients with CA were routinely identified and admitted to our facility Patients from these facilities were deemed high risk (HRP) and were preemptively placed in isolation and screened for CA. From March, 2023 through August 2024,patients with CA or HRPs were placed on a cohorted ward in contact isolation. Cohorted isolation was continued on high risk but screening negative patients until three screening tests were negative and they were no longer at the high risk LTAC/LTCF. Providers were notified by email or through electronic record of patients status and reminded of infection control measures to follow. Any patient with CA had their electronic record flagged for contact isolation in the event of readmission. Screening specimens for colonization were sent to an outside laboratory until August, 2024 when in-house testing became available. With in-house testing, screening results became available in 1-2 days rather than 3-4 days. A new protocol was started and only placed patients with known positive cultures in the cohorted ward. (see image) HRPs are placed in isolation wherever in the hospital they are admitted until screening results are known. If results are positive for CA they are transferred to the cohorted ward. Additionally rooms are cleaned with appropriate disinfectants for surfaces and floors. From December, 2022, through August, 2024 we identified 22 unique patients with cultures from clinical isolates. Specimens included nine cultures from blood, including three of hospital onset. Three cultures were from wounds, one was hospital onset. Other cultures were 1 from bone, 1 from pleural fluid and 9 from urine. 106 patients were identified as colonized with screening. Conclusion: Screening, isolation and cohorting have all been tools for managing CA in our facility. Only three hospital onset CA bacteremias have been identified with those protocols.

Purpose: This study aimed to verify the effectiveness of a virtual reality (VR)-based multidrug-resistant organisms (MDROs) infection control education program for nursing students. Methods: This study is quasi-experimental with a nonequivalent control group pretest-posttest design. The subjects were 56 nursing students (28 in the experimental and 28 in the control group). A VR education program on infection control for MDROs was applied to the experimental group. The effectiveness of the education was assessed using a questionnaire. Results: The experimental and control groups had no statistically significant difference in the knowledge of MDROs infection control, performance confidence, and self-efficacy before and after the VR-based education. The difference in the knowledge of MDROs infection control between the experimental group before and after the VR education was 9.08±7.50, and the control group was 6.12±16.69. The difference value between the two groups was statistically significant (p = .036). The difference in performance confidence was 0.32±0.38 points in the experimental group and 0.27±0.52 points in the control group, and there was no statistically significant difference between the two groups (p = .073). The difference value of self-efficacy was 0.43±0.39 points in the experimental group and -0.23±0.71 points in the control group, and there was a statistically significant difference between the two groups Conclusion: This study found that This study found that VR-based infection control education can help acquire knowledge and self-efficacy in MDROs infection control.

Background: Increasing influenza vaccination rates can significantly reduce the onset of severe symptoms and the risk of complications, thereby alleviating the burden on hospitals during flu seasons. However, the overall vaccine uptake has been decreasing in the United States, which is expected to increase the burden of disease. This study aims to estimate the impact of low influenza vaccination rates on disease burden and U.S. hospital system resources. Methods: The impact of reduced flu immunization rates was estimated using a dynamic age-stratified transmission model. Two U.S. flu seasons (2011-2012 for low incidence and 2017-2018 for high incidence) were analyzed to simulate flu epidemic variations. This study assessed four different flu vaccination rates: 25%, 30%, 35%, and 40%. Outcome measures included the number of infections, outpatient visits, hospitalizations, intensive care unit (ICU) stays, and deaths. The flu vaccine effectiveness (VE) rate was taken from CDC reports, estimating an average VE of 42% for all ages over the last 10 seasons. Vaccination rates by age group were also estimated using CDC reports, assuming immunization with quadrivalent flu vaccines for all ages. The total number of acute hospital and ICU beds available for influenza in the U.S. was assumed to be 300,000 and 30,000, respectively. Results: Using the U.S. flu immunization rate from the 2023-2024 season (approximately 35%), a high flu incidence season is expected to result in 71 million symptomatic infections, 29 million office visits, 0.94 million hospitalizations, and 133,670 deaths. Any scenario with an immunization rate below 45% will generate significant pressure on the U.S. hospital system and saturate the number of ICU beds during high incidence seasons. Only increasing the flu immunization rate to 50% or higher may prevent the saturation of acute hospital or ICU beds, regardless of the flu season’s incidence. Conclusions: The analysis shows the critical need to increase U.S. flu immunization rates to at least 50% to improve health outcomes and avoid the saturation of hospital system resources, especially ICU beds.

Background: Outbreaks of Zaire ebolavirus are an ongoing public health threat associated with high case fatality rates. The US Advisory Committee on Immunization Practices (ACIP) recommends preexposure vaccination with rVSV∆G-ZEBOV-GP Ebola vaccine (Brand name: Ervebo), which is effective in preventing disease caused by Zaire ebolavirus, to people at high risk for occupational exposure. We describe the perceptions and desire to be vaccinated with Ervebo among a subset of eligible US healthcare workers (HCWs). Methods: We conducted a cross-sectional online anonymous survey during March-October 2024, distributed to eligible HCWs at three Regional Emerging Special Pathogen Treatment Centers (RESPTCs): NYC Health + Hospitals/Bellevue, University of Texas Medical Branch, and Denver Health & Hospital Authority. Results: There were 66 responses (40% response rate), with the majority aged 30-49 years (63%), female (65%), and either a physician (42%) or nurse (27%). The majority (56%) had received some form of education on Ebola vaccines, most commonly through informational sheets or pamphlets (60%). Thirty-four (51%) were interested in (n=30) or already vaccinated with (n=4) Ervebo. Among those interested or already vaccinated, 44% would choose to receive the vaccine immediately, while 24% would get vaccinated if there were a case of Ebola virus disease (EVD) in the US. Among those not interested or unsure (n=32), most were concerned about risks of spreading the vaccine viral vector (44%), insufficient knowledge about the vaccine (31%), and unacceptable side effects (31%). Among all respondents, the most common concerns about adverse events included potential for a serious side effect (64%) and risk of arthritis (36%). Forty seven percent of respondents were concerned about the potential for spread of the vaccine virus vector. Respondents most frequently wanted more education on potential side effects (67%) and the risk of spreading the vaccine virus vector (59%). Among those not interested in vaccination or unsure (n=32), some may be convinced to accept vaccination if there were an EVD outbreak in the US (44%), if they better understood the risks and benefits of vaccination (34%), and if they better understood the vaccine safety (31%). Conclusion: During a period with no EVD outbreaks, a majority (51%) of eligible HCWs surveyed at three US RESPTCs were interested in or had received Ervebo. A significant proportion (24%) prefer to postpone vaccination until there is a case of EVD in the US. Deployment of Ervebo to eligible US HCWs may be optimized by addressing concerns identified in this study.

Background: Ventilator associated events (VAE) due to changes in positive end expiratory pressure (PEEP) or fraction of inspired oxygen (FiO2) are associated with adverse outcomes for patients in the intensive care unit (ICU). Accurately identifying VAEs is important to improve the quality of care and outcomes for ICU patients. However, we have identified “false-positive” VAEs that are triggered by stylistic manipulation in ventilator settings, or knobmanship, without “true” VAEs that are preceded by signs of hypoxia. This knobmanship creates an undue burden for Infection Preventionists to differentiate clinically relevant VAEs that impact patient outcomes from “false-positive” VAEs. Methods: We utilized the Center for Disease Control and Prevention’s National Healthcare Safety Network definition to retrospectively identify VAEs in the pre-pandemic and post-pandemic eras. Of the five ICUs monitored for VAEs, the Neurosciences ICU had the greatest number of events in 2022 and 2023. Working with the NSICU, a pilot study using an initial PEEP of 6 millimeters of mercury (mmHg) rather than 5 mmHg for all intubated patients was conducted. We hypothesized that this would reduce the incidence of “false-positive” VAE without causing adverse patient outcomes. Results: Out of 283 reported VAEs from the pre-pandemic period of January 1, 2019, to December 31, 2020, 59 (21%) were due to ventilator changes in PEEP or Fi02 without preceding hypoxia. Post-pandemic evaluation from January 1, 2022, to December 31, 2022, identified “false-positive” VAE in 56 (41%) out of 137 VAE cases. Eighty-two (59%) of the 137 VAE cases were due to changes in PEEP from 5 mmHg to 8 mmHg. After changing the starting PEEP in the NSICU to 6 mmHg from 5 mmHg, from October 1, 2024, to December 1, 2024, only 1 VAE was identified compared to an average of 10 for similar quarters in 2022 and 2023. Despite this change, no adverse events or concerns were noted by the primary ICU team or respiratory therapists. Discussion: With thoughtful changes in knobmanship we reduced the burden of “false-positive” VAE without leading to adverse patient outcomes. Conclusions: Alteration in starting PEEP can reduce the burden of VAE that are not clinically relevant and allow Infection Preventionists the opportunity to critically analyze clinically relevant VAEs to improve ICU patient outcomes.