To evaluate the hospital-reported cost of care, clinical burden, and incidence of hospital-onset bacteremia and fungemia (HOB) for hospital admissions with surgical site infections (SSI).

A cross-sectional study of 38 acute-care hospital admissions with a procedure under the National Healthcare Safety Network (NHSN) surveillance for SSI was conducted. SSI admissions were identified through NHSN reporting by the hospital. Clinical outcomes were estimated for SSI compared to no SSI controls using propensity matching and multivariable adjusted models that controlled for patient and hospital demographics; these endpoints were also compared for SSI admissions with and without HOB co-occurrence.

The rate of hospital-reported SSI was 0.15 per 100 admissions with a procedure under surveillance for SSI. Admissions with SSI compared to no SSI had significantly higher incremental hospital-reported cost of $30,689 and length of stay (LOS) was 11.6 days higher. The incidence of HOB was 6-fold higher in admissions with SSI compared to no SSI. For SSI admissions with HOB vs. no HOB, HOB added $28,049 to cost of care and 6.5 days to the LOS.

Hospital-reported SSIs were associated with higher clinical and economic burden. Patients with SSI and HOB had even more deleterious outcomes. These data may inform programs to augment infection prevention bundles targeting SSIs and downstream complications or comorbidities like HOB.

Bloodstream infections (BSI) are associated with high mortality rates, particularly when caused by resistant pathogens. Reducing the delay in diagnosis and initiation of appropriate treatment is crucial for improving clinical outcomes. The implementation of polymerase chain reaction (PCR) tests in the diagnostic process offers a promising approach to achieving quicker identification of pathogens, thereby potentially reducing mortality associated with BSI.

A difference-in-differences analysis was performed within a New York City hospital system, comparing mortality risk between patients with enterococcal BSI before and after the adoption of BCID2 PCR testing, using as control those with methicillin-sensitive S. aureus BSI, for which diagnostic protocol has been unchanged.

The study included 548 inpatients; 164 diagnosed with vancomycin-resistant enterococci (VRE) BSI and 384 with MSSA BSI. The mean 30-day mortality risk difference in the period post-intervention estimated in our difference-in-differences model was -6.03 per 100 (95% CI: -10.35 to -1.7), with event study plots suggesting minimal deviation from parallel trends in the pre-treatment period.

Findings suggest that introduction of BCID2 PCR testing for enterococcal bloodstream infections (BSI) may be associated with a reduction in mortality, however, interpretation of the effects must be approached with caution given the relative imprecision of estimates. Further research with larger samples is essential to establish a definitive conclusion on the impact of rapid PCR testing on mortality in BSI. This is an innovative approach using causal methods to evaluate interventions aimed at the improvement of infection control and antimicrobial treatment strategies.

To determine whether differences exist in antibiotic prescribing for respiratory infections in pediatric urgent cares (PUCs) by patient race/ethnicity, insurance, and language.

Multi-center cohort study.

Nine organizations (92 locations) from 22 states and Washington, DC.

Patients ages 6 months–18 years evaluated April 2022–April 2023, with acute viral respiratory infections, otitis media with effusion (OME), acute otitis media (AOM), pharyngitis, community-acquired pneumonia (CAP), and sinusitis.

We compared the use of first-line (FL) therapy as defined by published guidelines. We used race/ethnicity, insurance, and language as exposures. Multivariable logistic regression models estimated the odds of FL therapy by group.

We evaluated 396,340 ARI encounters. Among all encounters, 351,930 (88.8%) received FL therapy (98% for viral respiratory infections, 85.4% for AOM, 96.0% for streptococcal pharyngitis, 83.6% for sinusitis). OME and CAP had the lowest rates of FL therapy (49.9% and 60.7%, respectively). Adjusted odds of receiving FL therapy were higher in Black Non-Hispanic (NH) (adjusted odds ratio [aOR] 1.53 [1.47, 1.59]), Asian NH (aOR 1.46 [1.40, 1.53], and Hispanic children (aOR 1.37 [1.33, 1.41]), compared to White NH. Additionally, odds of receiving FL therapy were higher in children with Medicaid/Medicare (aOR 1.21 [1.18–1.24]) and self-pay (aOR 1.18 [1.1–1.27]) compared to those with commercial insurance.

This multicenter collaborative showed lower rates of FL therapy for children of the White NH race and those with commercial insurance compared to other groups. Exploring these differences through a health equity lens is important for developing mitigating strategies.

To retrospectively observe procalcitonin (PCT) and antibiotic ordering practices in patients hospitalized with community-acquired pneumonia (CAP).

Retrospective, exact matched, multicenter cohort study from October 1, 2018 – March 31, 2023.

All hospitals across the Mayo Clinic Enterprise.

Adult patients with CAP, identified using pneumonia diagnosis codes and receipt of systemic antibiotics with an indication of “respiratory tract infection” within 48 hours of hospitalization.

PCT testing within the first 7 days of hospitalization was compared to non-PCT care (nPCT). The primary outcomes were treatment duration, antibiotic days of therapy (DOT), and length of stay (LOS).

15364 patients met inclusion criteria. PCT testing occurred in 42.4% (6515/15364) of encounters, totaling 8214 PCT results. 12880 unique patient encounters were matched 1:1, 6440 in each group. Treatment duration was longer in the PCT group compared to the nPCT group (5.1 vs 4.6 days, respectively, P < 0.001). Patients in the PCT group also received more DOT (8.6 vs 7.6 DOT, P < 0.001) and had a longer LOS (6.8 vs 5.9 days, P < 0.001), respectively. There was no difference in 30-day all-cause mortality or C. difficile infection between groups. In a sensitivity analysis of nPCT patients compared to those with a peak value <0.25 ng/mL (i.e. normal result) there was no difference in treatment duration (4.6 days nPCT vs 4.7 days normal PCT, P = 0.104) or LOS (5.9 days nPCT vs 6.0 days normal PCT, P = 0.134).

PCT testing in patients hospitalized with CAP was not associated with reduced antimicrobial utilization, LOS, or 30-day all-cause mortality.

Clostridioides difficile (C. difficile) is one of the most common causes of healthcare-associated infections (HAIs). Elimination of C. difficile spores is difficult as they are resistant to common hospital-grade disinfectants. Copper-impregnated surfaces provide continuous reduction of multiple pathogens, potentially lowering the risk of infections. This manuscript aims to evaluate the efficacy of copper-impregnated surfaces on C. difficile spores.

Control (no copper) coupons and copper coupons containing 20% copper-oxide were inoculated with C. difficile spore loads ranging from 105 to 107 spores, with or without 5% fetal bovine serum soil load. After 4 hours of contact time, the C. difficile spores were recovered, plated on C. difficile growth media, and colony forming units were counted. The efficacy of copper (log10 kill) was estimated using a Bayesian latent variables model.

After 4 hours, unsoiled copper bedrail and copper table coupons at mean spore inoculation resulted in a 97.3% and 96.8% reduction in spore count (1.57 and 1.50 log10 kill, respectively). That of soiled bedrail and table coupons showed a 91.8% and 91.7% reduction (1.10 and 1.10 log10 kill, respectively).

Copper coupons can substantially reduce C. difficile spores after 4 hours, but results vary depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent spores from contact with copper surfaces, thus decreasing kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces may decrease spore burden and help prevent transmission of spores.

Validate a public health model identifying patients at high risk for carbapenem-resistant Enterobacterales (CRE) on admission and evaluate performance across a healthcare network.

Retrospective case-control studies

Adults hospitalized with a clinical CRE culture within 3 days of admission (cases) and those hospitalized without a CRE culture (controls).

Using public health data from Atlanta, GA (1/1/2016–9/1/2019), we validated a CRE prediction model created in Chicago. We then closely replicated this model using clinical data from a healthcare network in Atlanta (1/1/2015–12/31/2021) (“Public Health Model”) and optimized performance by adding variables from the healthcare system (“Healthcare System Model”). We frequency-matched cases and controls based on year and facility. We evaluated model performance in validation datasets using area under the curve (AUC).

Using public health data, we matched 181 cases to 764,408 controls, and the Chicago model performed well (AUC 0.85). Using clinical data, we matched 91 cases to 384,013 controls. The Public Health Model included age, prior infection diagnosis, number of and mean length of stays in acute care hospitalizations (ACH) in the prior year. The final Healthcare System Model added Elixhauser score, antibiotic days of therapy in prior year, diabetes, admission to the intensive care unit in prior year and removed prior number of ACH. The AUC increased from 0.68 to 0.73.

A CRE risk prediction model using prior healthcare exposures performed well in a geographically distinct area and in an academic healthcare network. Adding variables from healthcare networks improved model performance.

We aimed to determine whether benchmarking antimicrobial use (AU) to antimicrobial resistance (AR) using select AU/AR ratios is more informative than AU metrics in isolation.

We retrospectively measured AU (antimicrobial therapy days per 1,000 days present) and AU/AR ratios (specific antimicrobial therapy days per corresponding AR event) in two hospitals during 2020 through 2022. We then had antimicrobial stewardship committee members evaluate each AU and corresponding AU/AR value and indicate whether they believed it represented potential overuse, appropriate use, or potential underuse of the antimicrobials, or whether they could not provide an assessment.

Two acute-care hospitals.

Hospitalized patients.

In semi-annual facility-wide analyses, echinocandins had a median AU/AR ratio of 658.5 therapy days per fluconazole-resistant Candida event in Hospital A, IV vancomycin had a median AU/AR ratio of 114.9 and 108.2 therapy days per methicillin-resistant Staphylococcus aureus event in Hospital A and B, respectively, and linezolid had a median AU/AR ratio of 33.8 and 88.0 therapy days per vancomycin-resistant Enterococcus event in Hospital A and B, respectively. When AU and AU/AR values were evaluated by stewardship committees, more respondents were able to assess antimicrobial use based on AU/AR values compared to AU values. Based on AU/AR ratios, most respondents identified potential overuse of echinocandins and IV vancomycin in Hospital A, and potential overuse of linezolid and IV vancomycin in Hospital B.

Select AU/AR ratios provided informative metrics to antimicrobial stewardship personnel, which can be used to motivate audits of antimicrobial administration to determine appropriateness.

To better delineate multiplexed gastrointestinal polymerase chain reaction (PCR) panel (MGPP) diagnostic and therapeutic stewardship for patients undergoing treatment for acute leukemia including indications and benefits of testing, optimal timing, and interpretation of results.

We retrieved all MGPP ordered on 662 consecutive patients admitted with newly diagnosed acute leukemia between June 2015 and May 2024.

Regional referral center for acute leukemia.

Fifty-one (17%) of 305 MGPP obtained on the 198 patients who underwent testing identified at least one and 4 (1%) more than one diarrheagenic pathogen. The probability of a positive result was greater if obtained as an outpatient [20/52(38%)], but was not related to type of leukemia, sex, or age. Among the positive results, the pathogens identified included Clostridioides difficile (78% of tests), norovirus (16%), diarrheagenic Escherichia coli (6%), adenovirus 40/41 (4%), and Giardia lamblia (4%). The results of 30 of the 305 tests resulted in a change in treatment (28 C. difficile, 2 G. lamblia). For the MGPP C. difficile results with an accompanying toxin determination, this included treatment following 16/19 tests with a positive toxin result and 11/19 with a negative. Actionable results other than C. difficile were rarely seen in the inpatient population.

MGPP testing is most useful when administered as an outpatient and of little benefit for inpatients with hospital-onset diarrhea. Since MGPP is sensitive and does not distinguish between colonization and causes of diarrhea, caution is needed in interpretation of results, especially for toxin-negative C. difficile.

An association between weekend/off-hour care and unfavorable clinical outcomes has been observed, commonly called the “weekend effect.” In the present study, we examined whether there was a weekend effect associated with blood culture (BC) contamination, which can lead to inappropriate medical resource consumption.

We conducted a single-center retrospective observational study using data from BC tests performed on adult patients. The primary outcome was the incidence of BC contamination, which was compared between weekend and weekday sampling groups. In a multivariable logistic analysis, we evaluated the association between weekend sampling and the incidence of BC contamination.

The analysis included 7,597 weekend and 50,655 weekday BC sets from 1 January 2013 to 31 December 2019. The proportion of BC contamination during the study period was 1.15% (87/7,597) and 0.80% (405/50,655) in the weekend and weekday groups, respectively. In the logistic regression analysis adjusted for blood sampling settings, weekend sampling was significantly associated with increased BC contamination (odds ratio, 1.36; 95% confidence interval, 1.06–1.71).

This study highlighted a significant association between weekend blood sampling for BC and an increased incidence of contamination. To provide better-quality care, further studies evaluating the differences in staffing and blood collection processes on weekends and weekdays are warranted.

Hand hygiene is effective to prevent transmission of pathogens and healthcare-associated infections. Despite efforts by hospitals to improve hand hygiene adherence among healthcare practitioners (HCP), adherence in neonatology wards is often limited.

Identifying determinants, i.e., facilitators and barriers, to hand hygiene adherence among frontline HCP in neonatology.

Qualitative implementation research study.

Department of Neonatology of the University Hospital Zurich, Switzerland.

Semi-structured interviews with frontline HCP and Infection Prevention and Control (IPC) experts were conducted in November 2022. Interviews were coded deductively according to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behavior model (COM-B), and inductively to capture nuances in the data. Determinants whose addressing was perceived to likely improve hand hygiene adherence in the current setting were rated as “high priority”.

A total of 42 interviews were conducted, 27 (64%) with nurses, six (14%) with physicians, four (10%) with other professions, and five (12%) with IPC experts. Sixteen determinants were identified, twelve of which were high-priority, four in each COM-B domain. Knowledge, attention control, planning workflows, and habits & automatisms were found in “Capability,” workload & emergencies, invisibility of germs, role models, and being observed in “Opportunity,” and bad conscience, experience consequences of (non-) adherence, self-reflection, and intention to adhere to hand hygiene in “Motivation.”

Facilitators from all COM-B domains and barriers from “Capability” and “Opportunity” influence hand hygiene behavior in neonatology settings. Our findings can now inform interventions to improving hand hygiene adherence in neonatal settings.

Understanding healthcare personnel’s (HCP) contact patterns are important to mitigate healthcare-associated infectious disease transmission. Little is known about how HCP contact patterns change over time or during outbreaks such as the COVID-19 pandemic.

This study in a large United States healthcare system examined the social contact patterns of HCP via standardized social contact diaries. HCP were enrolled from October 2020 to June 2022. Participants completed monthly surveys of social contacts during a representative working day. In June 2022, participants completed a 2-day individual-level contact diary. Regression models estimated the association between contact rates and job type. We generated age-stratified contact matrices.

Three-hundred and sixty HCP enrolled, 157 completed one or more monthly contact diaries and 88 completed the intensive 2-day diary. In the monthly contact diaries, the median daily contacts were 15 (interquartile range (IQR) 8–20), this increased slightly during the study (slope-estimate 0.004, p-value 0.016). For individual-level contact diaries, 88 HCP reported 2,550 contacts over 2 days. HCP were 2.8 times more likely to contact other HCP (n = 1,592 contacts) than patients (n = 570 contacts). Rehabilitation/transport staff, diagnostic imaging technologists, doctors, nurses, mid-level, and laboratory personnel had higher contacts compared with the lowest contact group (Nursing aids). Contact matrices concentrated in working-age populations.

HCP contacts concentrate in their work environment, primarily with other HCP. Their contacts remained stable over time even during large changes to societal contact patterns during the COVID-19 pandemic. This stability is critical for designing outbreak and pandemic responses.

Broad-spectrum antibiotic use in febrile neutropenia is often driven by concerns for severe and drug-resistant infections. In select patients who do not have an active infection and improve, their prolonged and unnecessary use contributes to antimicrobial resistance, drug toxicity, and increased healthcare costs. We describe the implementation of an antibiotic de-escalation protocol to reduce inappropriate antibiotic use in febrile neutropenia among hematology patients.

We conducted baseline analysis (January–June 2024) of antibiotic use in febrile neutropenia cases admitted under hematology. Interventions included the (i) development of an antibiotic de-escalation protocol to guide clinical management, (ii) a roadshow to educate and improve uptake of this protocol, and (iii) regular feedback via “report cards” for hematology teams. The primary outcome was the proportion of febrile neutropenia cases with inappropriate antibiotic use, with secondary measures including adverse outcomes (in-hospital mortality, Clostridioides difficile infection, need for intensive care).

Baseline data indicated inappropriate antibiotic use rates of 45.5–66.7% per month from January to June 2024, with 13–28 days of inappropriate therapy. The protocol was developed in July 2024, with a subsequent roadshow to promote its uptake. Regular feedback was provided in the form of “report cards” every 2-monthly thereafter. Post-intervention, inappropriate antibiotic use decreased to a median of 23.35% from July to December 2024, with no observed increase in adverse outcomes.

The implementation of a structured de-escalation protocol, combined with frequent education and feedback, effectively reduced inappropriate antibiotic use in febrile neutropenia without compromising patient safety.

To compare the effectiveness of universal admission testing (UAT) and risk-based testing (RBT) in preventing nosocomial coronavirus disease 2019 (COVID-19) after the implementation of strict infection control measures.

Retrospective multicenter cohort study.

Five community hospitals in Japan.

14,028 adult patients admitted emergently from June 1, 2022, to January 31, 2023.

We calculated crude incidence density rates of community-acquired COVID-19 (positive test ≤4 days postadmission), hospital-acquired COVID-19 (positive test ≥8 days postadmission), total postadmission COVID-19 (all cases of positive test postadmission), and primary cases (sporadic and index cases). A generalized estimating equation model was used to adjust for local incidence (new COVID-19 patients per 100,000 population), single-bed room proportion, and admission proportion of patients older than 65 years.

The weekly local incidence in the study areas was less than 1,800 per 100,000 population (1.8%). Two hospitals implemented RBT and 3 implemented UAT. The median admission testing rate was higher in the UAT group than in the RBT group (95% vs 55%; difference 45.2%, 95% CI, 40.3%–48.8%). Crude and adjusted analyses revealed no significant associations between incidence density rates (IRR; >1 indicates higher incidence with UAT) and admission strategies for any of the outcomes: community-acquired cases (adjusted IRR = 1.23; 95% CI, 0.46–3.31), hospital-acquired cases (1.46; 0.80–2.66), total postadmission COVID-19 (1.22; 0.79–1.87), and primary cases (0.81; 0.59–1.12).

Compared with risk-based testing, universal admission testing may have limited additional benefits in preventing nosocomial COVID-19 transmission during a period of low-moderate local incidence.

To enumerate and describe the effect of whole genome sequencing (WGS) on epidemiological investigations of healthcare-associated transmission of nontuberculous mycobacteria (NTM).

Systematic review.

We performed a literature search using targeted search terms to identify articles meeting inclusion criteria. Data extraction of study characteristics and outcomes was performed by two independent researchers. The primary outcome was the author interpretation of WGS utility in the investigation of suspected healthcare-associated transmission of NTM. The secondary outcome was whether a transmission route was identified through WGS.

Thirty-one studies were included in the final analysis with 28 (90%) concluding that WGS was helpful in transmission investigations and in 19 of these 28 (68%) WGS aided in identifying a transmission route. The most common identified transmission routes were water-borne point sources (10), heater-cooler units (6), patient-to-patient (4), and a healthcare worker (1).

WGS is an informative tool in investigating healthcare transmission of NTM.

A diagnostic flexible laryngoscopy using a flexible endoscope (FE) without a working channel can become contaminated when inserted through the nose to inspect the throat. Microbiological surveillance is necessary to ensure adequate reprocessing. A lack of knowledge exists about the most accurate way to assess microbiological contamination on the surface of FEs without a working channel. A scoping review of research on sampling techniques for FEs without a working channel was done to identify frequently used sampling techniques and to determine the best way to assess microbiological contamination.

PubMed, Embase, Cochrane Library, and CINAHL databases were searched. Data related to the sampling technique and bacterial contamination were extracted.

Twelve of the 378 studies met the inclusion criteria. None compared sampling techniques, most studies investigated the efficacy of several disinfection methods. Retrieved sampling techniques were immersion, swabbing, and wiping. Immersion and wiping could detect bacterial contamination on contaminated FEs without a working channel. Two out of six studies using a swabbing method found bacterial contamination on contaminated FEs without a working channel. Three studies using the swabbing method detected bacterial contamination after disinfection. One study did not retrieve microorganisms after disinfection using the swabbing method.

Three different sampling techniques were extracted: immersion, wiping, and swabbing, which could all detect microbiological contamination on contaminated FEs without a working channel. However, this scoping review identified significant gaps in literature. Additional research is needed to determine the best sampling technique(s) for FEs without a working channel to detect microbiological contamination.

Evaluate Department of Defense (DoD) antimicrobial stewardship programs (ASPs) by assessing the relationship between key clinical outcome metrics (antibiotic use, incidence of resistant pathogens, and incidence of Clostridioides difficile infections) and CDC Core Element (CE) adherence.

Retrospective, cross-sectional study of DoD hospitals in 2018 and 2021

National Healthcare Safety Network Standardized Antimicrobial Administration Ratios (SAARs) were used to measure antibiotic use and microbiology results to evaluate four types of pathogen incidence. A novel CE scoring approach used scores to quantitatively assess relationships with CE adherence and outcome metrics using correlation and regression models. Assessments were repeated with 2021 data for Priority CE adherence and to conduct adjusted regressions for CEs and Priority CEs controlling for categorical bed size.

Compared to 2022 national data, DoD hospitals in 2021 had a similar proportion of facilities with a SAAR statistically significantly > 1.0. Leadership, Action, and Tracking CEs followed a more normal score distribution, while Reporting and Education were somewhat left-skewed. Unadjusted models often showed a positive relationship with higher CE scores associated with worse outcomes for the SAAR and pathogen incidence. Adjusted models indicated that procedural CEs, particularly Priority Reporting, were associated with better ASP-related outcomes.

CEs should be more quantitatively assessed. Results provide initial evidence to prioritize procedural CE implementation within the DoD; however, additional investigation for structural CEs is needed. Patient outcome data should be collected as an important indicator of ASP performance.

To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).

Tertiary referral hospital.

Prospective, 3-component, before-and-after intervention study.

Phase 1 consisted of a 4-week baseline determination of ED patient-room cleanliness, using two means: (1) the fluorescence spray, applied before cleaning and assessed subsequently with an ultraviolet lamp. Results are expressed as % of removed spots/all spots (≥7/10 cleaned spots/room was considered clean; (2) ATP swabs obtained after cleaning, which test for presence of residual organic material; readings <45 were considered clean. Phase 2 consisted of revision and reorganization of established cleaning practices. Phase 3 consisted of adding one cleaning person in afternoon/evening shifts, for 4-weeks, during which room cleanliness was assessed as previously described.

Cleanliness of the 79 patient rooms, for which fluorescence tests were available from before and after cleaning for all three phases of the study, increased from a baseline of 50% ± 35 removed spots/all spots, to 61% ± 36 after the first intervention (CI95 -0.6 – 21, P = 0.54) and to 68% ± 35 after the second intervention (CI95 5 - 31, P = 0.004, as compared to the baseline). Subanalysis showed that evening shifts improved most remarkably, from 47% ± 32 (n = 45), to 60% ± 33 (n = 49) to 76%±29 (n = 29), respectively, from baseline through the second and third phase (P = 0.001). ATP testing appeared less sensitive for assessment of cleanliness but confirmed the assessment by fluorescence for overall cleanliness (CI95 1 - 14, P = 0.018).

Our data demonstrate that a two-step intervention significantly improves cleaning in a busy ED.

A Joint Commission national program, the surgical care improvement project (SCIP), supported the adoption of evidence-based peri-operative antimicrobial use practices, including administration of antimicrobials prior to incision and early discontinuation after skin closure. With high compliance, in 2015, the public reporting requirement that provided external pressure to support practice improvements was discontinued. Since discontinuation, few studies have assessed the sustainment of best antimicrobial use practices and what procedures were developed to maintain improvements within facilities.

The aim of this study was to measure perceptions among antimicrobial stewardship experts about which policies and practices have been important and effective for sustainment.

A 15-min survey was administered to the Society for Hhealthcare Epidemiology in America (SHEA) research network over the summer of 2023. The survey included questions about different SCIP measures such as prophylactic antibiotic use pre and post-surgery and about local policies and procedures that were implemented to support best practices. Simple descriptive statistics were utilized to analyze results.

The survey was distributed to 112 members of the SHEA research network, with a 41% response rate. Most respondents perceived high rates of ongoing compliance with both pre- and post-operative prophylaxis guidelines, although ongoing surveillance and measurement is limited. Respondents perceived that the most important internal factors associated with ongoing compliance were electronic order sets, facility policies, time outs, and automatic stop orders. Substantial spread of best practices (eg, to surgical procedures and specialties not covered until the SCIP program) was reported.

Despite discontinuation of mandated reporting, antimicrobial stewards perceived ongoing compliance with SCIP measures. Local policies and procedures implemented to support initial uptake of best practices have supported ongoing sustainment of practice improvements.

SARS-CoV-2 asymptomatic surveillance testing (AST) is a common strategy to minimize the risk of nosocomial infection in patients and healthcare personnel. In contrast to admission screening, post-admission AST was less widely adopted.

This study describes the diagnostic yield of post-admission serial SARS-COV-2 testing in hospitalized patients at a large cancer center with mostly double-occupancy rooms.

Retrospective cohort study design. Post-admission SARS-CoV-2 tests were examined over a 18 month study period. Positive results were reviewed to determine true hospital-onset infections using a combination criteria of screening all sample cycle threshold (Ct) values >30, results of non-concordant repeat testing, and clinical symptoms.

Post-admission serial testing of 15,048 hospitalized patients during an 18-month study period at a tertiary care cancer center detected hospital-onset infection in 1.6% (n = 245 patients). Among all hospital-onset positive SARS-CoV-2 RNA tests, 13% were clinically false positive. Most true infections were mild to moderate in severity.

In summary, post-admission serial testing in a high-risk setting is a low-yield strategy with several unfavorable effects and should no longer be routinely applied.