Objectives: Management of outbreaks of the newly emerging pathogen Candida auris may include use of antimicrobial wash-mitts for decolonization. In the absence of large-scale clinical trials, the immediate assessment of the efficacy claims for these products can be based on in vitro experimental data that follows the standard protocols established by CEN (European committee for Standardization). In this study, the chemical tolerance of C. auris was compared with the surrogate test organism Candida albicans as established in the European standards (EN). Methods: The study was conducted following the protocol for the quantitative suspension test EN 13624 using C. albicans ATCC 10231 in comparison to C. auris DSMZ 21092 and C. auris DSMZ 105986. Two commercially available wash-mitts containing chlorhexidine digluconate (CHG) or octenidine dihydrochloride (OCT) were used. Experiments were conducted using the impregnation liquid squeezed from the wash-mitts at different dilution concentrations between 0.5% to 97% at a contact time of 30 sec in the presence of 0.03% bovine serum. Results: Yeasticidal efficacy according to EN 13624 was found for the OCT wash-mitts at 30 sec at ≥ 10% concentration with C. albicans (≥ 4 log RF). In comparison, for both C. auris strains ≥ 4 log RF was found at a much lower concentration of ≥ 1%. For the CHG wash-mitts efficacy against C. albicans was below 2 log RF at 97% concentration within 30 sec. In contrast efficacy against the two C. auris strains was around 3 log RF. Conclusion: In conclusion, both C. auris strains were found to be significantly more susceptible when compared to C. albicans in this study. Moreover, our data also demonstrates that not all antiseptic-impregnated body wipes is equally effective against C. auris with OCT having a higher efficacy compared to CHG.

Background: Empiric antibiotic therapy choices and de-escalation practices for the management of febrile neutropenia (FN) can vary. Facility-specific antimicrobial guidelines have an important role in influencing prescription practices for FN and is a foundation of antimicrobial stewardship activities. Methods: This pre-post quality improvement study at the University of Maryland Medical Center (UMMC) Greenebaum Comprehensive Cancer Center evaluated the impact of the implementation of updated institutional FN guidelines. The changes primarily included: 1) removal of meropenem as first-line agent for patients receiving levofloxacin prophylaxis without other risk factors (e.g. history of resistant organism) and 2) de-escalation protocol for low-risk patients (e.g. afebrile, hemodynamically stable). Education of oncology attendings, residents and pharmacists were carried out. We included patients receiving antipseudomonal antibiotics for FN or sepsis as indicated by prescriber (~70% concordance with antimicrobial stewardship review). Sepsis was included because of high rates of observed misclassification for patients with FN. Stem cell transplant patients were excluded. Pre-intervention (04/2021 – 12/2022) and post-intervention (01/2023 – 09/2024) groups were compared for total anti-pseudomonal antibiotic and meropenem-specific days of therapy (DOT) per 1000 days present (DP) and count of unique antibiotic order per 1000 DP. In addition, a sample of antibiotics reviewed by the UMMC antimicrobial stewardship team was assessed for guideline compliance. Means were calculated across quarters for each period and Willcoxon rank sum was used for comparisons (p Results: A total of 3,311 antibiotics were ordered for FN (79%) or sepsis (21%) during the study period. Longitudinal trends and antibiotic type distribution are illustrated in Figures 1 and 2, respectively. DOT per 1000 DP for all antipseudomonal antibiotics was 213 in the pre-intervention group compared to 191 in the post-intervention group (p=0.06). Meropenem DOT per 1000 DP decreased from 105 in the pre-intervention group to 87 in the post-intervention group (p=0.004). Unique antibiotic order per 1000 DP of all antipseudomonal antibiotics remained constant (62 vs. 56, p=0.1), while unique antibiotic order per 1000 DP for meropenem decreased (16 vs. 8, p =0.01). Of the 317 antibiotics reviewed, 130/169 (77%) were guideline compliant in the pre-intervention group and 113/148 (76%) in the post-intervention group. Conclusion: Changes in FN guidelines at the UMMC cancer center led to decreased meropenem use with a nonsignificant decline in all antipseudomonal antibiotics. Additional work is needed to identify barriers to guideline adherence.

Ambulatory antibiotic stewardship has traditionally focused on acute respiratory infections with few studies evaluating metrics for other commonly encountered ambulatory conditions, including urinary tract infections (UTI). We describe the development and validation of an electronically captured appropriate antibiotic use metric for ambulatory UTIs using coding data.

Background: Clostridioides difficile infection (CDI) disproportionately impacts hematology-oncology patients. In June 2022, our hospital implemented screening of asymptomatic patients admitted to the hematology-oncology unit to reduce CDI rates by early identification and isolation of C. difficile carriers. We evaluated the impact of admission screening on rates of CDI and compared incidence of diarrhea and subsequent symptomatic testing stratified by asymptomatic admission testing result. Method: During the intervention period (July 2022 – July 2024), asymptomatic patients admitted to the hematology-oncology unit were tested for C. difficile (perirectal swab, Cepheid GeneXpert®, Sunnyvale, CA). Guidelines for C. difficile symptomatic testing (unformed stool, Cepheid GeneXpert®) and treatment did not change between the baseline (May 2020 – May 2022) and intervention periods. Monthly CDI rates were calculated using CDC definitions based on clinical symptoms and positive C. difficile testing (community onset [CO] if positive in the first three hospital days, hospital-onset [HO] if day 4 or later). We performed an interrupted time-series analysis adjusted for repeated measures to compare CO-CDI and HO-CDI rates per 10,000 patient-days between baseline and intervention periods. The risk of developing diarrhea through hospital day 14 or being tested for symptomatic CDI during the intervention’s first year (July 2022 – June 2023) was analyzed using a cohort of asymptomatic C. difficile carriers and non-carriers in a 1:2 ratio, matched on hospital length of stay and date of admission. Result: The incidence rate ratio was 0.45 (P=0.10) for HO-CDI (Figure 1) and 0.15 (P=0.049) for CO-CDI (Figure 2) after screening implementation. During the first year of the intervention, 25 individuals were identified as asymptomatic C. difficile carriers by positive admission screen and were matched to a cohort of 50 asymptomatic non-carriers. There were no significant differences in development of diarrhea during hospital days 1-3 or days 4-14 between carriers and non-carriers (Table). None of the carriers received symptomatic C. difficile testing during hospitalization, compared to 20% of matched non-carriers (P=0.03). Conclusion: There was no significant change in HO-CDI rates and a statistically significant reduction in CO-CDI rates after implementation of C. difficile admission screening. Patients identified as carriers at time of admission were less likely to be tested for CDI during hospitalization than non-carriers, despite similar rates of diarrhea. Admission screening for C. difficile may reduce CDI rates through a variety of mechanisms; changes in provider testing behavior for patients previously screened for C. difficile may play a role.

Objectives: The recent experience of the COVID-19 pandemic emphasized the critical need for a surveillance system to alert healthcare facilities about the admission of patients with emerging infectious diseases (EID), thereby preventing nosocomial transmissions. Methods: Tan Tock Seng Hospital, an 1800-bed acute tertiary-care hospital in Singapore, transitioned to a new- generation electronic medical record system, Epic, in August 2022. Leveraging the system’s capabilities, we developed an algorithm to generate the line-list of suspected Middle East Respiratory Syndrome (MERS) patients, in alignment with the screening guidelines provided by Singapore’s Ministry of Health. The algorithm first identifies patients who presented within 14 days (maximum incubation period) of their travel to Arabic peninsular countries. This information is documented by the emergency department’s triage nurses. Additionally, patients with suspected MERS indicated in the problem list or diagnosis by attending clinicians, particularly emergency-medicine physicians or infectious-disease physicians, are included. Furthermore, patients who are ordered for a MERS- Coronavirus polymerase chain reaction test, are identified. The algorithm can also be further modified as and when the case definition of the EID changes. Results: The surveillance report constructed with Epic algorithm can be scheduled for daily generation or generated on demand within a few minutes. This newer approach is more time- and resource-efficient compared to the manual surveillance process, which necessitates at least three staff members to engage in a series of prolonged manual processes. The report, by extracting information directly from Epic in near real-time, also minimizes the likelihood of errors that may occur during the manual process. Subsequently, the team of epidemiologists identifies the suspected MERS patients form the generated report and efficiently follow up them until a diagnosis of MERS is excluded. Conclusions: Harnessing Epic’s capabilities, we constructed an algorithm to efficiently and swiftly identify suspected MERS patients, enabling the timely implementation of infection prevention strategies to prevent nosocomial transmission.

Objectives: A multi-center study aimed to determine the outcome of using oral care sets for cleaning the oral cavity of the patients admitted to the Intensive Care Units (ICU). Methods: Oral care sets which are single-use sets consisting of two toothbrushes with toothpaste, six 0.12% chlorhexidine swabs, and an oral moisturizer swab were developed. The ICUs of fourteen tertiary care hospitals participated in the study. All ICU nurses were asked to brush the patient’s teeth twice and clean the patient’s oral cavity with antiseptic six times daily. One thousand four hundred and two patients were recruited. The oral care sets were used with each patient on the first day they received mechanical ventilation until weaning. VAP surveillance was conducted to compare the VAP rate before and after the ICU used the oral care set. Results: Two hundred and sixty-six VAPs developed with an overall 34,731 ventilator days in the participating ICUs in 2022, before ICUs used oral care sets. The VAP rate was 7.66 per 1,000 ventilator days. The cost of antibiotic treatment was 5,134,621.74 Thai Bath. In 2023, after the ICUs used the oral care sets, 182 VAPs were developed. The overall ventilator day was 34,309. The VAP rate was reduced to 5.30 per 1,000 ventilator days. The cost of antibiotic treatment was reduced to 2,101,939.70 Thai Bath. One hundred and eighty-seven ICU nurses evaluated the benefit of the oral care set. Ninety-six-point eight percent of them agreed and strongly agreed that the single-use oral care set could prevent hospital- associated infections. Ninety-two-point five percent agreed and strongly agreed that only one nurse could clean the patient’s oral cavity, the oral care set helped reduce VAP occurrence (92%), the patient’s teeth and oral cavity were clean (92%), and ICU nurses could work conveniently (91.4%). Conclusion: The single-use oral care set can help reduce the VAP occurrence among patients admitted to the ICU.

Background: Catheter-associated urinary tract infections (CAUTIs) are a challenge for hospitalized patients accounting for approximately 40% of all healthcare-associated infections. CAUTI surveillance remains underdeveloped in many Sub-Saharan countries, even though identifying infections is critical to prevention and management. Standardized CAUTI surveillance among 45 LMICs conducted in intensive care units (ICUs) has demonstrated high CAUTI incidence compared to high-income countries. However, few studies have examined CAUTI in non-ICU settings in LMIC, where catheter use is common. We aimed to identify challenges in CAUTI surveillance related to documentation and antibiotic use patterns among adult inpatients in non-ICU wards in a Kenyan public hospital. Methods: Using a cross-sectional design, we retrospectively abstracted data on non-ICU adult inpatients from clinical and laboratory records. We identified patients with suspected UTI through urine culture requests from 1/1/2023-12/31/2023, whom we linked to clinical records. We abstracted data on diagnosis on admission, socio-demographics, urinary catheter indication and duration, UTI symptoms, urine culture results, and antibiotic use. This descriptive analysis summarizes characteristics of patients with suspected UTI to identify factors hindering CAUTI surveillance in non-ICU settings. Results: 293 non-ICU adult inpatients admitted to Mombasa Regional Referral Hospital had at least one urine culture request in 2023. Of these 193 (65.9%) had indwelling urinary catheters (IUC) inserted. Among those with IUC, 49.7% were female, with an average age of 51.5 years, with majority (64.8%) admitted to the medical wards; 5.2% had no recorded indication for catheterization and 82.9% had no UTI symptoms documented in the 2 days before the urine culture request. There were 124 negative cultures, 4 were determined to be contaminated, 6 did not have results on file, and 59 were positive; pathogens identified in the positive cultures included Escherichia Coli (51.8%), Klebsiella Pneumoniae (28.6%), Pseudomonas aeruginosa (10.7%), and others (8.9%) including Klebsiella Oxytoca, Acinetobacter baumanii, and Protein Mirabilis. 38.3% were prescribed intravenous antibiotics in the 7 days before the urine culture was obtained. 66.3% had no documentation of IUC removal, and 10.9% had incomplete documentation on file with missing pages. Conclusion: Myriad challenges to accurate CAUTI surveillance were identified among non-ICU patients at a Kenyan regional referral hospital. Lack of documentation of clinical symptoms makes application of standard case definitions challenging, and non-documentation of catheter removal dates hinders calculation of incidence using a catheter-day denominator. Further, the administration of antibiotics prior to urine culture hinders identification of potential source pathogens. Documentation and antibiotic administration practices are major hurdles for CAUTI surveillance.

Introduction: According to the recommendation of the United States Environmental Protection Agency, the bacteria count of airborne microbe must be under 1500 cfu/ m3. And as we know, the environment is the key factor of the airborne microbe. Traditional, we used air-conditioning to let the air circulate, but this method may be useful in other environments but is not suitable in hospitals. So, there were many new technologies to improve the quality of airborne microbe, just as UVC, plasma, and filtration. In this study, we used the UVC LED to examine the quality of airborne microbes in our meeting room of the emergency room. Material and method: We used the impaction method to collect the air for 10 minutes then gathered 1000L air to impact the Tryptone Soy Agar. After collection, we incubated at 37oC for 48 hours the check the bacteria count. So, we used this method to test the quality of airborne microbe before and after adding the UVC-LED (NKFG, Taiwan) to our air conditioner vent in the meeting room of the emergency room. Result: Before adding the UVC-LED, the average bacteria count in difference time was from 361 to 443, and after adding the UVC-LED, the average bacteria count in difference time was from 214 to 300, and the percentage of reducing count was from 24% to 40%. Conclusion: Due to this study, we though the UVC-LED could improve the quality of the airborne microbe. Otherwise, this technology would not use too much space because of the limitations of the environment.

Background: The diagnostic approach for Clostridioides difficile infection (CDI) significantly influences treatment and resource utilization. This study compares clinical characteristics and treatment choices based on three testing algorithms combining antigen and toxin enzyme immunoassay (EIA) tests and nucleic acid amplification tests (NAAT). Methods: We performed a retrospective study of patients tested for CDI between August 2022 and November 2024 in a large health system where multiple CDI testing algorithms are utilized: (arm 1) antigen and toxin EIA with automatic reflex to NAAT if discrepant results; (arm 2) NAAT with automatic reflex to toxin EIA if NAAT positive; and (arm 3) antigen and toxin EIA with NAAT at provider request with approval by Antimicrobial Stewardship. The last step in the testing algorithms determined whether the result was considered positive. We determined positivity rate by algorithm results and compared clinical variables including fever (temperature > 38.0° C) or abnormal white blood cell (WBC) count (12,000) within 48 hours prior to test order, laxative use within 24 hours prior to test order and treatment rates between those who tested toxin positive by EIA and those who tested toxin positive by NAAT only. Treatment was defined as receiving oral vancomycin or fidaxomicin for more than 5 days OR receiving those medications on the day prior to or day of discharge. Results: A total of 16,555 patients were tested. Overall algorithm positivity rate was highest in the EIA with reflex to NAAT (arm 1) at 13.7% compared to 5.7% for arm 2 (NAAT with reflex to toxin EIA) and 5.1% for arm 3 (EIA with NAAT at Provider Request). Toxin EIA positive patients were 1.2 times more likely than NAAT positive patients to display fever or abnormal WBC in the 48 hours prior to test order (p < 0 .001). Toxin EIA positive patients were less likely to receive laxatives compared to NAAT only positive patients. (p=0.11). Among toxin EIA positive cases, 89% received treatment compared to 57% in toxin NAAT only positive cases (p < 0 .001). 46% of patients who tested NAAT positive with a subsequently negative toxin EIA were treated. Conclusion: Patients with toxin EIA positive tests were more likely to exhibit systemic signs of infection and were treated at higher rates compared to NAAT-positive cases. While NAAT-based testing identified additional cases, many may reflect colonization. Treatment of toxin NAAT positive/toxin EIA negative patients was common highlighting opportunities for diagnostic stewardship.

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious in humans, and in May 2021, an outbreak occurred in the Wanhua district of Taiwan. During the Coronavirus disease 2019 (COVID-19) pandemic, we implemented various rules to prevent the spread of SARS-CoV-2- alpha in the hospital. This included establishing four special wards (dedicated care wards) specifically for patients infected with SARS-CoV-2-alpha. When patients were discharged, we conducted real-time polymerase chain reaction (RT-PCR) testing on the terminal environment to ensure that SARS-CoV-2- alpha was not present. Maintaining a negative test result was crucial for preventing cross-infection and further outbreaks. The goal of this study was to identify effective intervention measures to improve the quality of terminal cleaning and achieving overall infection control in the hospital. Methods: After cleaning and disinfection of the dedicated care wards by the cleaning staff as per the recommendations of the Centers for Disease Control (CDC), we collected three swabs from different areas in one ward. We used Roche and GeneXpert instruments for COVID-19 RT-PCR testing. However, because the test results were not ideal, we introduced ultraviolet-C (UV-C) machines and a disinfectant solution containing hydrogen peroxide (H2O2) into our current cleaning and disinfection procedures. Results: The negative test result ratios for RT-PCR testing were 80.13% when cleaning was done with bleach- only method as a disinfectant (without intervening with other methods); 92.81% when intervening with UV-cC machine disinfection for 5 minutes was done before bleach disinfection; 96.19% when bleach was replaced with a disinfectant solution containing H2O2 and intervening with UV-C disinfection. Conclusion: The quality of terminal cleaning and disinfection was a key factor in reducing nosocomial outbreaks. We could consider using UV-C machine and H2O2 disinfectant to intervene in the current bleach disinfection method to enhance the quality of terminal cleaning and disinfection in the hospital.

Background: Carbapenem-resistant (CR) organisms (CROs) pose a serious public health threat. We examined the burden of CRO colonization, the proportion of CROs among clinical isolates, and infection prevention and control (IPC) practices in three hospitals in India. Methods: This study was conducted December 2023 to December 2024 in medical intensive care units (ICUs) at three hospitals in western India. CRO colonization was assessed by direct MacConkey method in rectal/stool specimens collected ≤24 hours after admission and weekly until colonization detection or ICU discharge, colonies < 25mm from carbapenem disks were processed for bacterial identification and carbapenem susceptibility. Proportion of CROs in clinical isolates was assessed by screening Gram-negative bacilli (GNB) identified for carbapenem susceptibility. CRO was defined as GNB resistant to any carbapenem. Carbapenemase production among Enterobacterales was detected by modified carbapenem inactivation method (mCIM). Fifty day shift hand hygiene (HH) observations were collected weekly to measure adherence. Fluorescent gel markers (FGM) were placed on high-touch surfaces (HTS) to assess environmental cleaning (EC); effectiveness was assessed by proportion of FGM removed the following day. Nine key EC indicators were observed weekly to monitor cleaning technique. HH and EC data included were from June 2024 to November 2024.

The epidemiological triad model (Population-Environment-Agent) is used to describe results. Results: Population: Over half (476 [55%]) of 869 patients screened at ICU admission were colonized with CROs. An equal proportion of colonization was observed among patients without prior healthcare exposure in last 90 days (55% [217/396]). Of the 660 GNBs isolated from clinical specimens, 60% were CROs. Environment: CRO colonization was acquired by 65% (20/31) of the patients who remained in ICU for ≥ 7 days. Average HH adherence was 50% (30%-69%). HTS cleaning effectiveness averaged 65% (50%-77%). Adherence with correct EC technique was 77% (53%-86%). Agent: Among clinical isolates, 92% Acinetobacter-baumannii-complex, 70% Klebsiella pneumoniae, and 47% Escherichia coli were CRO. K. pneumoniae (35%) was the most frequently isolated CRO followed by A.baumannii-complex (33%) and E.coli (16%). Among colonization screening swabs, E.coli (57%) was the most frequently isolated CRO followed by K. pneumoniae (23%) and A.baumannii-complex (10%). 96% of CR Enterobacterales among clinical isolates and colonization screening were carbapenemase producers. Conclusions: The high prevalence of CRO colonization, acquisition rate, and carbapenem resistance indicate a high level of CRO threat in these Indian ICU settings with suboptimal IPC measures. There is an urgent need to strengthen IPC practices to interrupt transmission in healthcare settings.

Background: Irrational use of antibiotics will trigger anti-microbial resistance which is a threat to health problems now and in the future. The use of meropenem is often the last choice in using antibiotics without undergoing microbiological examination (culture). The rational use of meropenem is expected to reduce resistant microbes as well as reducing hospital costs. Anti-microbial stewardship at Prof Ngoerah General Hospital began to be implemented at the end of 2020, and evaluation of the implementation of antimicrobial stewardship is required. Objective: The aim of this study was to determine the effect of meropenem stewardship on the prevalence of Carbapenem-resistant Acinetobacter Baumannii, Carbapenem-resistant Pseudomonas Aeruginosa and evaluate meropenem cost of purcashing. Retrospective cohort study from medical records, pharmacy records and microbiology data from microbiology from 2020 to 2023 was taken. Data is presented in the form of tables and graphs. Results: Before antimicrobial stewardship was implemented, in 2020 the prevalence of Carbapenem-resistant Acinetobacter Baumannii reached 69.1% and began to decline in 2021 by 52.35%, in 2022 it became 43.8% and 44.3% in 2023, respectively. The prevalence of Carbapenem-resistant Pseudomonas Aeruginosa also decreased, in 2020 was 31.6% to 27.3% in 2021, in 2022 it fell again to 24.8% and in 2023 only 18.4%. The cost of purchasing meropenem at Prof Ngoerah hospital before implementing antimicobial stewardship in 2020 was IDR 229,905,300,- decreasing to IDR 94,156,920,- in 2021, IDR 98,025,255 in 2022 and in 2023 IDR. 97,147,335,-, respectively. Conclusions: Meropenem stewardship at Prof. Ngoerah Hospital reduces the prevalence of Carbapenem-resistant Acinetobacter Baumannii and Carbapenem-resistant Pseudomonas Aeruginosa. Meropenem stewardship also reduces hospital costs in purchasing antibiotics.

Background: Skilled nursing facilities (SNFs) face many challenges implementing robust infection prevention and control (IPC) programs. The Philadelphia Department of Public Health (PDPH) partnered with APIC Consulting Services, a wholly owned subsidiary of The Association for Professionals in Infection Control and Epidemiology (APIC), to provide IPC mentoring to Philadelphia SNFs. The objective of the program was to strengthen IPC capacities by providing an in-depth IPC assessment followed by an action plan and longitudinal infection preventionist (IP) support to mitigate identified gaps. Methods: A health equity framework based on area deprivation index (ADI), percent of residents on Medicaid, and Centers for Medicare & Medicaid (CMS) star rating was developed to identify priority SNFs for recruitment into the voluntary program. Participating SNFs received a three-day onsite IPC assessment with an expert IP consultant using an expanded version of the Centers for Disease Control Infection Control Assessment and Response (ICAR) tool. Assigned consultants provided mentorship and education for the SNF IP for up to six months. Each facility identified 4-5 focus areas and co-developed an action plan with the consultant. SNF assessment data collected July 2023 -May 2024 were analyzed to assess IPC gaps across facilities. Results: Participants included 11/46 (24%) Philadelphia SNFs, including 8/18 (44%) priority facilities. Median facility size was 189 beds and median census was 164 residents. Program completion rate was 73%. Consultants performed 66 onsite visits and 26 remote visits, totaling over 1,752 hours of support. Median number of IPC gaps identified was 79 (IQR: 57-84), most frequently within the domains of environmental cleaning and disinfection (13%); water management (10%); and training, auditing, and feedback (9%). Common facility-chosen action plan focus areas included disease surveillance (24%), antibiotic stewardship (16%), and hand hygiene (13%). Main barriers to program completion included lack of leadership support (18%) and staff turnover (9%). Conclusions: Expert-driven longitudinal support can be an effective strategy for enhancing IPC capacity within low resourced SNFs and a data-based health equity framework can be used to prioritize facilities for support. Through targeted mentorship, this program identified and addressed gaps in IPC practices and fostered a culture of safety. Most common action plan focus areas selected by the facilities did not align with IPC topic areas where most recommendations were given, highlighting potential SNF IPC program areas that may be challenging for facilities to address and where further education and resources are needed.

Objectives: Hospital networks can significantly improve healthcare-associated infection (HAI) prevention and management through quality improvement and standardization. Since 2017, the Korea Disease Control and Prevention Agency (KDCA) has coordinated a network project involving a central hospital and participating community hospitals nationwide. This paper shares our experience as one of the central hospital operating the program for seven years (2017-2023). Methods: Our network comprised one central tertiary-care hospital and 12 community hospitals. Activities focused on education, consultation, and quality improvement (QI). QI activities analyzed hand hygiene (HH) practices, alcohol-based hand rub consumption, and the World Health Organization’s HH Self- Assessment Framework (HHSAF) results. We provided educational resources for personal protective equipment (PPE) training, particularly during the COVID-19 pandemic. Annual workshops facilitated the sharing of specialized infection control programs from each hospital. Results: The project conducted 19 training sessions on topics like multidrug-resistant organism (MDRO) infection control, with 1,435 participants. We offered consultations for 41 cases (paper, phone, and 8 on-site visits) and shared consultation details through regular meetings. QI activities resulted in most hospitals maintaining a HH practice rate above 90%. All eight hospitals that consistently participated in the program saw improvements in their HHSAF scores compared to baseline. Notably, two hospitals achieved an “Advanced” level, having previously been at an “Intermediate” level. PPE training for 12,762 healthcare workers across 13 hospitals strengthened their response capabilities during COVID- 19 and reduced occupational infection risks. Conclusions: Frequent patient transfers and rising HAI rates highlight the limitations of individual hospitals in preventing and managing HAIs. The community hospital network establishes a government-led infection prevention response system. This model fosters enhanced infection control capabilities across network hospitals by offering technical support to resource-constrained facilities and implementing effective infection prevention initiatives that address ongoing challenges.