Infection Control and Hospital Epidemiology最新文献

{"title":"Modeling the impact of health care worker masking to reduce nosocomial SARS-CoV-2 transmission under varying adherence, prevalence, and transmission settings.","authors":"Timothy D Whiteley, James Stimson, Colin S Brown, Julie V Robotham, Stephanie Evans","doi":"10.1017/ice.2025.78","DOIUrl":"https://doi.org/10.1017/ice.2025.78","url":null,"abstract":"<p><strong>Objectives: </strong>To understand the scenarios where health care worker (HCW) masking is most impactful for preventing nosocomial transmission.</p><p><strong>Methods: </strong>A mathematical agent-based model of nosocomial spread with masking interventions. Masking adherence, community prevalence, disease transmissibility, masking effectiveness, and proportion of breakroom (unmasked) interactions were varied. The main outcome measure is the total number of nosocomial infections in patients and HCW populations over a simulated three-month period.</p><p><strong>Results: </strong>HCW masking around patients and universal HCW masking reduces median patient nosocomial infections by 15% and 18%, respectively. HCW-HCW interactions are the dominant source of HCW infections and universal HCW masking reduces HCW nosocomial infections by 55%. Increasing adherence shows a roughly linear reduction in infections. Even in scenarios where a high proportion of interactions are unmasked \"breakroom\" interactions, masking is still an effective tool assuming adherence is high outside of these areas. The optimal scenarios where masking is most impactful are those where community prevalence is at a medium level (around 2%) and transmissibility is high.</p><p><strong>Conclusions: </strong>Masking by HCWs is an effective way to reduce nosocomial transmission at all levels of mask effectiveness and adherence. Increases in adherence to a masking policy can provide a small but important impact. Universal HCW masking policies are most impactful should policymakers wish to target HCW infections. The more transmissible a variant in circulation is, the more impactful HCW masking is for reducing infections. Policymakers should consider implementing masking at the point when community prevalence is optimum for maximum impact.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Candida auris</i> outbreak in a cardiothoracic transplant intensive care unit: implications for infection prevention practices and keeping pace with an evolving landscape.","authors":"Shardul N Rathod, Grace Barajas, Brooks I Mitchell, Michael Malczynski, W Justin Moore, Erin Weslander, Christine Bulger, Andrea Stone, Abbas Al-Qamari, Christie M Bertram, Sarah H Sutton, Valentina Stosor, Chao Qi, Teresa R Zembower, Maureen K Bolon","doi":"10.1017/ice.2025.10217","DOIUrl":"https://doi.org/10.1017/ice.2025.10217","url":null,"abstract":"<p><strong>Objective: </strong>To describe the mitigation strategies for a <i>Candida auris</i> outbreak in a cardiothoracic transplant intensive care unit (CTICU) and its implications for infection prevention practices.</p><p><strong>Design: </strong>Retrospective cohort study from July 2023 to February 2024.</p><p><strong>Setting: </strong>A large academic medical center.</p><p><strong>Methods: </strong>A multidisciplinary team convened to conduct the outbreak investigation and develop mitigation strategies in the CTICU.</p><p><strong>Results: </strong>From July 2023 to February 2024, 34 possible hospital-onset cases of <i>C. auris</i> were identified in our CTICU. Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two distinct outbreak clusters. Of the 34 patients, 11 (32.3%) were solid organ transplant recipients and 12 (35.3%) had a mechanical circulatory support device. Of the cohort, only 11/34 (32.3%) had prior exposure to high-risk healthcare facilities within six months prior to admission, as follows: acute inpatient rehabilitation facilities (AIRs) (n = 5, 14.7%), skilled nursing facilities (SNFs) (n = 3, 8.8%), and long-term acute care hospitals (LTACHs) (n = 3, 8.8%). The cohort had a median of 22.0 antibiotic-days prior to their positive results. Five (14.7%) patients had <i>C. auris</i> candidemia, three of whom expired likely due to infection. Infection Prevention (IP) interventions addressed several modes of transmission, including healthcare personnel hands, shared patient equipment, and the environment.</p><p><strong>Conclusion: </strong>Our experience suggests that the epidemiology of <i>C. auris</i> may be changing, pointing towards a rising prevalence in acute care settings. IP interventions targeting hand hygiene behavior and promoting centralizing cleaning and disinfection of shared patient equipment may have contributed to outbreak resolution.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the antibiotic spectrum index in a stewardship-focused clinical trial for childhood pneumonia.","authors":"Sabrina E Carro, Nicolas Gargurevich, Mert Sekmen, Srinivasan Suresh, Judith M Martin, Derek J Williams","doi":"10.1017/ice.2025.10208","DOIUrl":"https://doi.org/10.1017/ice.2025.10208","url":null,"abstract":"<p><strong>Objective: </strong>The antibiotic spectrum index (ASI) outcome quantifies antibiotic exposure based on spectrum of activity. Our objective was to examine ASI as an exploratory outcome in the context of a recent stewardship-focused, clinical trial in childhood pneumonia that originally used a binary guideline-concordant outcome.</p><p><strong>Design: </strong>Secondary analysis of a randomized clinical trial.</p><p><strong>Setting: </strong>Two tertiary pediatric hospitals.</p><p><strong>Methods: </strong>Encounters were randomly assigned to clinical decision support (CDS) or usual care treatment arm. The ASI was calculated by summing daily ASI scores for each unique antibiotic administered. It was evaluated as a continuous and ordinal measure: No Antibiotics (ASI = 0), Narrow (1-2), Intermediate (3-4), Broad (5-7), and Very Broad (≥8). Proportional odds regression modeled the ordinal ASI outcome in the first 24 hours by treatment arm and compared to the guideline-concordance outcome. Results were stratified by emergency department (ED) disposition. We also conducted a longitudinal, descriptive analysis of day-to-day ASI for those with in-hospital dispositions.</p><p><strong>Results: </strong>We included 1027 encounters, 549 (53%) were randomized to CDS and 478 (47%) usual care respectively. ASI Category did not differ by treatment arm overall (Odds Ratio: 0.88[95% Confidence Interval: 0.70,1.09]), which mirrored binary guideline-concordance. Mean ASI was lower for concordant encounters (2.1 vs 8.4, <i>P</i> < 0.001) and across all ED dispositions. In the longitudinal analysis, there were 1137 day-to-day ASI comparisons, with only 7% representing spectrum escalations.</p><p><strong>Conclusions: </strong>The ASI outcome yielded similar results to a dichotomous concordance outcome. However, ASI provided more granular insights into antibiotic prescribing, suggesting ASI may be a useful outcome measure in future stewardship-focused trials.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving containment and prevention strategies using a patient transfer network representative of patients with multidrug-resistant organisms.","authors":"Rany Octaria, Stephen Deppen, Allison Chan, James C Slaughter, Pamela Talley, Rachel B Slayton, Peter F Rebeiro, Marion A Kainer","doi":"10.1017/ice.2025.86","DOIUrl":"https://doi.org/10.1017/ice.2025.86","url":null,"abstract":"<p><strong>Objectives: </strong>Interfacility patient transfers contribute to the regional spread of multidrug-resistant organisms (MDROs). We evaluated whether transfer patterns of inpatients with similar characteristics to carbapenem-resistant Enterobacterales (CRE) case-patients (CRE surrogates) better reflect hospital-level CRE burden than traditionally used populations.</p><p><strong>Design: </strong>We determined the risk factors for subsequent hospital admission using demographic and clinical information from Tennessee Department of Health tracked CRE case-patients from July 2015 to September 2019. Risk factors were used to identify CRE surrogates among inpatients in the 2018 Tennessee Hospital Discharge Data System (HDDS). Transfer networks of CRE surrogates, Medicare/TennCare beneficiaries, and all-inpatients with ≤365 days of intervening community stays were compared with the transfer networks of CRE case-patients in 2019. The associations between hospital-level CRE prevalence and hospitals' incoming transfer volumes from each network were assessed using negative binomial regression models.</p><p><strong>Results: </strong>Eight risk factors for subsequent hospital admission were identified from 2,518 CRE case-patients, which were used to match CRE case-patients with HDDS inpatients, resulting in 10,069 surrogate patients. CRE surrogate network showed more structural similarities with the CRE case-patient network than with the all-inpatient and Medicare/TennCare networks. A 33% increase in hospitals' CRE prevalence in 2019 was associated with each doubling of incoming transfer of CRE surrogates in 2018 (adjusted Risk Ratio [aRR] 1.33, 95%CI: 1.1, 1.59), higher than all-inpatient (aRR 1.27, 95% CI: 1.08, 1.51) and Medicare/TennCare networks (aRR 1.21, 95% CI: 1.02, 1.44).</p><p><strong>Conclusions: </strong>Surrogate transfer patterns were associated with hospital-level CRE prevalence, highlighting their value in MDRO containment and prevention.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do far ultraviolet-C light technologies increase ozone concentrations in healthcare facility patient rooms?","authors":"Samir Memic, Claire E Kaple, Jennifer L Cadnum, Curtis J Donskey","doi":"10.1017/ice.2025.10207","DOIUrl":"https://doi.org/10.1017/ice.2025.10207","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting real <i>clean</i>: a virtual reality training pilot study for cleaning and low-level disinfection of portable medical equipment.","authors":"Esteban A Barreto, Michelle S Jerry, Vianelly García, Chloe V Green, Andrea S Greenfield, Eileen F Searle, Erica S Shenoy","doi":"10.1017/ice.2025.89","DOIUrl":"https://doi.org/10.1017/ice.2025.89","url":null,"abstract":"<p><p>Portable medical equipment (PME) is inconsistently cleaned and disinfected, resulting in contamination that increases the risk of healthcare-associated infections. A virtual reality PME cleaning and disinfection training module was designed and tested at multiple healthcare facilities. Barriers identified during an initial phase led to improvements in the second phase.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society for Healthcare Epidemiology of America (SHEA) infectious diseases fellow infection prevention and control and healthcare epidemiology curriculum.","authors":"Elise M Martin, Catherine Cichon, Rebecca Choudhury, Shandra R Day, Yasaman Fatemi, Vera P Luther, Terri Stillwell, Abby Sung","doi":"10.1017/ice.2025.85","DOIUrl":"https://doi.org/10.1017/ice.2025.85","url":null,"abstract":"<p><p>With the rapid expansion of the Infection Prevention Control/Healthcare Epidemiology (IPC/HE) fields over recent decades, the pivotal roles of IPC/HE in hospital regulation, quality improvement, patient safety, and healthcare finances have become increasingly apparent. Consequently, the demand for effective IPC/HE leaders has surged.^1,2 Training in IPC/HE is essential for all infectious diseases (ID) fellows (both adult and pediatric), including those planning a career in hospital epidemiology as well as those planning to focus on general ID, transplant, HIV, etc. ID fellows, however, have historically felt ill-prepared in IPC/HE. Joiner et al's survey highlighted this gap, revealing that only half of respondents felt adequately trained in infection control, despite half of them participating in infection control in their practice.³ IPC/HE fellow education is not currently standardized, and most IPC/HE training is led by individual mentors and healthcare facilities.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-10"},"PeriodicalIF":3.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visitation and universal masking impact to healthcare-associated respiratory viral infection rates in a freestanding children's hospital.","authors":"Kellie Rusin, Samuel R Dominguez, Kelly Pearce, Lori Silveira, Ann-Christine Nyquist, Sara R Saporta-Keating","doi":"10.1017/ice.2025.95","DOIUrl":"https://doi.org/10.1017/ice.2025.95","url":null,"abstract":"<p><p>Pediatric healthcare-associated respiratory viral infections (HA-RVI) were evaluated during four intervention periods using different visitation models. Allowing two visitors and requiring universal masking significantly decreased HA-RVI rates (<i>P</i> < .001). There was no significant difference in HA-RVI rates between periods restricting younger siblings versus periods allowing all siblings without seasonal/age restriction.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-genome sequencing surveillance of vancomycin-resistant <i>Enterococcus faecium</i> (VRE) detects hospital outbreaks and identifies the postanesthesia care unit as a transmission locus.","authors":"Sarah M Schrader, Meghan A Baker, Chanu Rhee, Michael Klompas, Samantha Taffner, Zachary Pearson, Jay Worley, Lynn Bry, Sanjat Kanjilal, Manfred Brigl, Nicole D Pecora","doi":"10.1017/ice.2025.68","DOIUrl":"https://doi.org/10.1017/ice.2025.68","url":null,"abstract":"<p><strong>Objective: </strong>Vancomycin-resistant enterococci (VRE) can cause serious healthcare-associated infections. Patients can become colonized and infected through contact with healthcare workers, hospital surfaces, equipment, and other patients. We evaluated the utility of broadly applied whole-genome sequencing (WGS) surveillance of vancomycin-resistant <i>Enterococcus faecium</i> (VREfm) for detection of hospital-based transmission.</p><p><strong>Design: </strong>Retrospective genomic and epidemiologic analysis of clinical VREfm isolates.</p><p><strong>Setting: </strong>Brigham and Women's Hospital, an 800-bed tertiary care center in Boston, MA, USA.</p><p><strong>Methods: </strong>VREfm was isolated from patient screening and diagnostic specimens. We sequenced the genomes of 156 VREfm isolates, 12 at the request of infection control and 144 as a convenience sample, and used single nucleotide polymorphism (SNP) differences to assess relatedness. For isolate pairs separated by 15 or fewer SNPs by two orthogonal comparison methods, we mapped epidemiologic connections to identify putative transmission clusters.</p><p><strong>Results: </strong>We found evidence for 16 putative transmission clusters comprising between two and four isolates each and involving 41/156 isolates (26.3%). Our analysis discovered 14 clusters that were missed by traditional surveillance methods and additional members of two clusters that were detected by traditional methods. Patients in four transmission clusters were linked only by exposure to the postanesthesia care unit.</p><p><strong>Conclusions: </strong>We show that WGS surveillance for VREfm can support infection control investigations and detect transmission events missed by routine surveillance methods. We identify the postanesthesia care unit as a locus for VREfm transmission, which demonstrates how WGS surveillance could inform targeted interventions to prevent the spread of VREfm.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative performance of sponge versus flocked swabs for culture-based and metagenomic detection of microbial contamination in the healthcare environment.","authors":"Matthew J Ziegler, Sean Loughrey, Selamawit Bekele, Elizabeth Huang, Pam Tolomeo, Michael Z David, Ebbing Lautenbach, Laurel J Glaser, Brendan J Kelly","doi":"10.1017/ice.2025.87","DOIUrl":"https://doi.org/10.1017/ice.2025.87","url":null,"abstract":"<p><strong>Background: </strong>Identifying optimal methods for sampling surfaces in the healthcare environment is critical for future research requiring the identification of multidrug-resistant organisms (MDROs) on surfaces.</p><p><strong>Methods: </strong>We compared 2 swabbing methods, use of a flocked swab versus a sponge-stick, for recovery of MDROs by both culture and recovery of bacterial DNA via quantitative 16S polymerase chain reaction (PCR). This comparison was conducted by assessing swab performance in a longitudinal survey of MDRO contamination in hospital rooms. Additionally, a laboratory-prepared surface was also used to compare the recovery of each swab type with a matching surface area.</p><p><strong>Results: </strong>Sponge-sticks were superior to flocked swabs for culture-based recovery of MDROs, with a sensitivity of 80% compared to 58%. Similarly, sponge-sticks demonstrated greater recovery of <i>Staphylococcus aureus</i> from laboratory-prepared surfaces, although the performance of flocked swabs improved when premoistened. In contrast, recovery of bacterial DNA via quantitative 16S PCR was greater with flocked swabs by an average of 3 log copies per specimen.</p><p><strong>Conclusions: </strong>The optimal swabbing method of environmental surfaces differs by method of analysis. Sponge-sticks were superior to flocked swabs for culture-based detection of bacteria but inferior for recovery of bacterial DNA.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}