American journal of infection control最新文献

A Carbapenem-Resistant Acinetobacter baumannii Outbreak in an Intensive Care Unit: Detection Before Recognition and Persistence After Containment. 重症监护病房耐碳青霉烯鲍曼不动杆菌爆发：识别前的检测和遏制后的持续。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-19 DOI: 10.1016/j.ajic.2026.10.010

Funda Memisoglu, Elif Seren Tanriverdi, Yusuf Yakupogullari, Zeynep Celik, Sibel Altunisik Toplu, Ayse Belin Ozer, Baris Otlu

{"title":"A Carbapenem-Resistant Acinetobacter baumannii Outbreak in an Intensive Care Unit: Detection Before Recognition and Persistence After Containment.","authors":"Funda Memisoglu, Elif Seren Tanriverdi, Yusuf Yakupogullari, Zeynep Celik, Sibel Altunisik Toplu, Ayse Belin Ozer, Baris Otlu","doi":"10.1016/j.ajic.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.010","url":null,"abstract":"Background: We analyzed a carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak in an intensive care unit (ICU) to improve insight into how this pathogen spreads within health care facilities and to inform the development of targeted control procedures.Methods: A CRAB outbreak in a tertiary referral center was investigated over a 5-month window with clinical data, molecular typing (AP-PCR, PFGE), and one month of environmental sampling. All ICU patients (n=31) were compared-epidemic-clone-positive (n=7) versus -negative (n=24)-using Mann-Whitney/Fisher tests and Firth penalized logistic regression.Results: Although the outbreak spanned 6 days clinically, index patients had been colonized up to 41 days earlier. CRAB was recovered from high-touch surfaces; 6/7 patients developed pneumonia/VAP and 6/7 died (4 CRAB-attributable). Prior A. baumannii isolation (57% vs 0%) was the only independent risk factor (Firth odds ratio 34.7; P=.004). Despite treatment, infected patients redeveloped epidemic-clone infection up to 3.5 months later.Conclusions: In CRAB outbreaks, spread may begin weeks before clinical recognition, and-even months after the outbreak is contained-the epidemic clone can cause reinfection in previously treated patients; only high-resolution analyses spanning an extended period can document this. Multidisciplinary and administrative collaboration, extended and effective environmental disinfection, and effective isolation of positive patients are important for containing CRAB outbreaks.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Environmental hygiene programs in public hospitals: a pilot study of pre-implementation assessment. 公立医院环境卫生方案：实施前评估的试点研究。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-16 DOI: 10.1016/j.ajic.2026.10.007

Nicholi Di Mari Silva Santos, Caroline Lopes Ciofi Silva, Maria Clara Padoveze

{"title":"Environmental hygiene programs in public hospitals: a pilot study of pre-implementation assessment.","authors":"Nicholi Di Mari Silva Santos, Caroline Lopes Ciofi Silva, Maria Clara Padoveze","doi":"10.1016/j.ajic.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.007","url":null,"abstract":"Background: Environmental contamination contributes to the transmission of healthcare-associated pathogens, particularly multidrug-resistant microorganisms.Objective: To perform a baseline assessment of environmental hygiene programs in public hospitals from the perspective of housekeeping personnel.Methods: A cross-sectional, descriptive, and exploratory mixed-methods study was conducted in three public tertiary hospitals in São Paulo State, Brazil. Quantitative data were collected from environmental hygiene staff using the translated and adapted CDC Environmental Hygiene Program Improvement Toolkit, specifically the \"B2 Baseline Assessment - Part 2 (Advanced Program)\" instrument. Qualitative data were obtained through semi-structured interviews with direct supervisors of environmental hygiene teams from each participating hospital.Results: Forty-five housekeeping professionals participated. High frequencies were observed for infection prevention and control training, including hand hygiene and personal protective equipment use (100%), and supervisor availability during shifts (97.8%). Gaps were identified in structured monitoring of environmental hygiene quality (55.5%), continuous supply availability throughout shifts (51.1%), and performance feedback, with 46.7% reporting no feedback.Conclusions: The main gaps were related to monitoring practices, feedback processes, and budget planning rather than task execution. The baseline assessment tool was successfully applied without operational difficulties, supporting its feasibility in Brazil and highlighting areas for strengthening environmental hygiene programs.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Silent bronchoscopy-associated outbreak of Stenotrophomonas maltophilia and pseudo-outbreak of Mycobacterium gordonae linked to contaminated rinse water and a damaged bronchoscope. 与受污染的冲洗水和受损的支气管镜有关的嗜麦芽窄养单胞菌和假戈登分枝杆菌的沉默性支气管镜相关暴发。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-16 DOI: 10.1016/j.ajic.2026.10.008

Regev Cohen, Yelena Losev, Mor Rubinstein, Maya Brodsky, Milena Pitashny, Orna Ben-Natan, Aliza Vaknin, Mohammed Ganayem, Michael Kuchuk

{"title":"Silent bronchoscopy-associated outbreak of Stenotrophomonas maltophilia and pseudo-outbreak of Mycobacterium gordonae linked to contaminated rinse water and a damaged bronchoscope.","authors":"Regev Cohen, Yelena Losev, Mor Rubinstein, Maya Brodsky, Milena Pitashny, Orna Ben-Natan, Aliza Vaknin, Mohammed Ganayem, Michael Kuchuk","doi":"10.1016/j.ajic.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.008","url":null,"abstract":"Background: Bronchoscopy-associated outbreaks may remain unrecognized when contamination is difficult to distinguish from infection.Methods: Following increased Mycobacterium gordonae isolation from bronchoalveolar lavage (BAL), we performed environmental sampling, bronchoscope assessment, a reprocessing audit, and whole-genome sequencing. Recovery of Stenotrophomonas maltophilia from automated endoscope reprocessor (AER) water prompted retrospective review of S. maltophilia-positive BAL cultures.Results: Six BAL-associated M. gordonae isolates were identified during 2024-2025. Three available isolates were genomically indistinguishable (0 single-nucleotide polymorphisms), consistent with a common source or contamination process. Other nontuberculous mycobacteria and water-associated organisms were recovered from the AER water supply, although M. gordonae was not. A concurrent outbreak of S. maltophilia-positive BAL cultures was identified; positivity increased from 0.6% during 2017-2023 to 12.9% during January-June 2025. Use of damaged bronchoscope RC41 was associated with S. maltophilia cases (94% vs 46%; OR 17.73, 95% CI 2.01-156.46; p=0.002). Following RC41 removal, water-system remediation, and reprocessing changes, no further BAL-associated M. gordonae or S. maltophilia isolates were detected.Conclusions: Investigation of an apparent M. gordonae pseudo-outbreak revealed a concurrent S. maltophilia outbreak in the setting of contaminated AER water and a damaged bronchoscope. These findings highlight point-of-use water quality, device integrity, traceability, and surveillance.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Wound care and infection prevention among war-injured civilians and their caregivers in the Gaza Strip: knowledge, attitudes, practices, and barriers. 加沙地带战争受伤平民及其护理人员的伤口护理和感染预防：知识、态度、做法和障碍

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-16 DOI: 10.1016/j.ajic.2026.10.009

Belal Aldabbour, Ruba Musallam, Samah Harara, Hadeel Alareer, Seham Oda, Mariam Eltalmas, Rula Mesmeh, Sajeda Alshreehy, Rozan Abu Amona, Zinat Alagha, Yqeen Albatta, Almaza Abu Zarqa, Sarah El Omari

{"title":"Wound care and infection prevention among war-injured civilians and their caregivers in the Gaza Strip: knowledge, attitudes, practices, and barriers.","authors":"Belal Aldabbour, Ruba Musallam, Samah Harara, Hadeel Alareer, Seham Oda, Mariam Eltalmas, Rula Mesmeh, Sajeda Alshreehy, Rozan Abu Amona, Zinat Alagha, Yqeen Albatta, Almaza Abu Zarqa, Sarah El Omari","doi":"10.1016/j.ajic.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.009","url":null,"abstract":"Background: When war moves wound care into homes and shelters, infection prevention depends on injured civilians and their caregivers. Their infection-prevention knowledge, attitudes, and practices (KAP) in Gaza remain poorly documented.Methods: We surveyed 528 respondents (191 war-injured patients, 337 caregivers) at three referral hospitals in the Gaza Strip (July-September 2025) using a structured, self-administered questionnaire covering wound-care and infection-prevention KAP. Knowledge and Attitude scores were modeled with multivariable linear regression, cross-validated against overdispersion-corrected binomial models.Results: Knowledge was moderate (median 11/19). Recognition of individual signs of infection ranged from 43.9% to 62.1%, and only 28.8% agreed that tetanus vaccination is necessary after injury. Handwashing was endorsed by 98.1%, yet 31.8% would change dressings bare-handed when gloves were unavailable, 23.7% accepted reusing clean-looking dressings, and 47.3% considered herbal remedies an effective antibiotic substitute. Personal dressing-change experience was most strongly associated with Knowledge (β = 1.65, p < 0.001); education and age were associated with both scores. Displacement (58.4%), supply uncertainty (53.4%), and unsuitable shelter (52.4%) were the leading barriers.Conclusions: Gaps in infection recognition, glove use, dressing reuse, and antibiotic beliefs coexisted with structural barriers, suggesting a need for infection-prevention education paired with hygiene and dressing supplies.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation and Outcomes of Obstetric and Surgical Healthcare-associated Brucella Exposures. 评估和结果的产科和外科保健相关的布鲁氏菌暴露。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-12 DOI: 10.1016/j.ajic.2026.10.001

Rita Wilson Dib, Andrea Harding, Brian Scott, Heather Carlson, Kendra Dougherty, Mike Mannell, Aaron D Kofman, David T Kuhar, Aaron Wendleboe, Nelson Iván Agudelo Higuita, Dale Bratzler, María E Negrón Sureda, Caroline A Schrodt, Dawn Blackburn

{"title":"Evaluation and Outcomes of Obstetric and Surgical Healthcare-associated Brucella Exposures.","authors":"Rita Wilson Dib, Andrea Harding, Brian Scott, Heather Carlson, Kendra Dougherty, Mike Mannell, Aaron D Kofman, David T Kuhar, Aaron Wendleboe, Nelson Iván Agudelo Higuita, Dale Bratzler, María E Negrón Sureda, Caroline A Schrodt, Dawn Blackburn","doi":"10.1016/j.ajic.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.001","url":null,"abstract":"Background: Exposure to Brucella spp. in healthcare settings is rarely reported, and optimal exposure assessment and management remain poorly defined. We describe Brucella melitensis exposure in obstetric/surgical and laboratory settings and our exposure management approach.Methods: Seventy-four potentially exposed employees were identified; exposure risk was assessed using four categories adapted from the CDC Brucellosis Reference Guide for laboratory exposures.Results: Twenty (27%) were minimal risk requiring no intervention, 17 (23%) minimal risk requiring 24-week symptom monitoring, 2 (3%) low risk also requiring 24-week serologic monitoring, and 20 (27%) high risk also offered postexposure prophylaxis; 16 (80%) initiated it. Fifteen (20%) were lost to follow-up. Among those ultimately recommended monitoring, 11/22 (50%) underwent serologic testing (one completed 24-week serologic testing) and 29/39 (74%) accepted symptom monitoring (completion was 65% for daily and 83% for weekly). No secondary cases were identified.Conclusions: A tiered approach incorporating contact type, aerosol-generating events, and personal protective equipment can guide Brucella clinical exposure assessment and management. Early recognition, appropriate precautions, and public health consultation are important. Infection prevention programs and occupational health services should have coordinated processes for timely exposure identification, risk stratification, and postexposure follow-up. We also propose a broader risk assessment framework for future clinical exposures. Further research is needed to refine the management of Brucella clinical exposures.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Performance of hydrogen peroxide gas plasma and vaporized hydrogen peroxide sterilizers under long narrow lumen challenge conditions. 过氧化氢气体等离子体和汽化过氧化氢灭菌器在长窄腔挑战条件下的性能。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-12 DOI: 10.1016/j.ajic.2026.10.003

Lei Gao, Rui Mao, Qing Zhao, Jin Li, Ruixue Qin, Xuan Xiong, Lin Wen

{"title":"Performance of hydrogen peroxide gas plasma and vaporized hydrogen peroxide sterilizers under long narrow lumen challenge conditions.","authors":"Lei Gao, Rui Mao, Qing Zhao, Jin Li, Ruixue Qin, Xuan Xiong, Lin Wen","doi":"10.1016/j.ajic.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.003","url":null,"abstract":"Background: Long narrow lumens remain challenging for low-temperature sterilization because sterilant must reach the distal lumen endpoint. We compared hydrogen peroxide gas plasma and vaporized hydrogen peroxide systems under matched lumen challenge conditions.Methods: Polytetrafluoroethylene process challenge devices combined lumen lengths of 2, 4, and 8 m with internal diameters of 0.8, 1.0, and 1.5 mm. Each condition was tested in 5 standard cycles per system, yielding 90 biological indicator observations. Success proportions and between-system percentage-point differences are reported with 95% confidence intervals (CIs).Results: Overall success was 33/45 (73.3%; 95% CI 59.0-84.0) for ASP/STERRAD 100NX and 36/45 (80.0%; 95% CI 66.2-89.1) for STERIS V-PRO Max; the difference was 6.7 percentage points (95% CI -10.8 to 23.7). At 8 m, success was 6/15 (40.0%) and 8/15 (53.3%), respectively; the difference was 13.3 points (95% CI -20.2 to 43.1). The 8 m × 0.8 mm condition was most challenging. Chemical and biological indicator results diverged in the vaporized hydrogen peroxide system.Discussion: Distal biological indicator results varied mainly with lumen geometry.Conclusions: Local validation should consider combined lumen length and diameter and include distal biological monitoring for challenging lumen configurations.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Skin and Soft Tissue Infections Clinical Pathway Concordance in Pediatric Emergency and Urgent Care Sites. 儿科急诊和紧急护理场所皮肤和软组织感染临床途径的一致性。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-10 DOI: 10.1016/j.ajic.2026.10.005

Harshini Kumaresan, Amanda Nedved, Frances Turcotte-Benedict, Brian R Lee, Rana E El Feghaly

{"title":"Skin and Soft Tissue Infections Clinical Pathway Concordance in Pediatric Emergency and Urgent Care Sites.","authors":"Harshini Kumaresan, Amanda Nedved, Frances Turcotte-Benedict, Brian R Lee, Rana E El Feghaly","doi":"10.1016/j.ajic.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.005","url":null,"abstract":"Introduction: Skin and soft tissue infections (SSTIs) are major drivers of antibiotic prescribing in pediatric emergency departments (EDs) and urgent care clinics (UCCs). Although guidelines recommend limited diagnostics and antibiotics, practice variation persists, and the influence of sociodemographic factors remains underexplored. We evaluated concordance with a pediatric SSTI clinical pathway (CP) and examined variation across sociodemographic factors.Methods: This retrospective cohort study included children aged 6 months to 18 years evaluated for SSTIs at 2 EDs and 3 UCCs in a Midwestern academic health system from July 2022 through June 2024. We defined concordance per national guidelines and institutional CP, including appropriate diagnostic, antibiotic selection, and antibiotic treatment duration. Generalized linear mixed model examined associations between concordance and patient/visit characteristics.Results: Among 4190 encounters, overall CP concordance was 59.0%. Diagnostic concordance was high (86.0%), as was treatment duration concordance (87.8% when antibiotics were indicated). Antibiotic selection showed the lowest concordance (72.6%), largely driven by unnecessary prescribing for diagnoses not requiring antibiotics, such as paronychia. Overall concordance was highest in the younger age group (6 months-2 years) and UCC visits. Black non-Hispanic children had higher odds of concordant care compared with White Non-Hispanic children (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.28-1.88). Return visits were uncommon (2.1% concordant vs 3.3% non-concordant).Conclusion: Standardized SSTI pathways support consistent diagnostics and appropriate treatment duration, but reducing unnecessary antibiotic prescribing remains a key stewardship opportunity.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of Active Surveillance Testing for Candidozyma (Candida) auris and Impact on Infection Control Behaviors in an Acute Healthcare System. 急性医疗系统中耳念珠菌主动监测检测评价及对感染控制行为的影响。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-09 DOI: 10.1016/j.ajic.2026.10.004

Rachel Guran, Donna Haiduven, Carol McLay, Jill Roberts, Christine McGuire-Wolfe

{"title":"Evaluation of Active Surveillance Testing for Candidozyma (Candida) auris and Impact on Infection Control Behaviors in an Acute Healthcare System.","authors":"Rachel Guran, Donna Haiduven, Carol McLay, Jill Roberts, Christine McGuire-Wolfe","doi":"10.1016/j.ajic.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.004","url":null,"abstract":"Objective: To evaluate the impact of active surveillance testing (AST) for Candidozyma auris on healthcare system epidemiologic trends and infection prevention and control (IPC) behaviors.Design: Explanatory sequential mixed methods study using retrospective electronic medical record review, hand hygiene observations, and healthcare personnel focus groups.Setting and patients: Five acute care hospitals within a suburban healthcare system. Chart reviews included 3,688 patients who underwent AST for C. auris or had positive clinical cultures for C. auris from 2020-2023.Methods: Incidence and prevalence were calculated by year and location. Logistic regression examined associations with C. auris events. Observations and focus groups explored barriers and facilitators to IPC behaviors.Results: AST volume increased from 66 tests in 2020 to 1,619 in 2023, while positivity decreased from 7.58% to 2.47%. Concurrent increases in community-onset and hospital-onset prevalence were observed over time. Focus groups identified barriers including fatigue and accountability, and facilitators including role modeling and supply accessibility.Conclusions: AST facilitated early identification of colonized or infected patients and supported systemic surveillance of C. auris, while behavioral assessment identified opportunities to strengthen adherence to core IPC practices. These findings demonstrate the value of integrating epidemiologic and behavioral evaluation when assessing IPC programs.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antibiotic Prescribing for Acute Respiratory Infections in Kentucky Medicaid: Opportunities for Stewardship. 肯塔基州医疗补助中急性呼吸道感染的抗生素处方：管理的机会。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-08 DOI: 10.1016/j.ajic.2026.09.019

Aravind Pillai, Amen Ajamu, Andrea Flinchum

{"title":"Antibiotic Prescribing for Acute Respiratory Infections in Kentucky Medicaid: Opportunities for Stewardship.","authors":"Aravind Pillai, Amen Ajamu, Andrea Flinchum","doi":"10.1016/j.ajic.2026.09.019","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.09.019","url":null,"abstract":"Background: Inappropriate antibiotic prescribing for acute respiratory infections (ARIs) is a major stewardship target. We examined antibiotic prescribing in Kentucky Medicaid from 2022 to 2024 and identified factors associated with inappropriate ARI prescribing to inform stewardship targeting.Methods: Retrospective analysis of linked pharmacy and medical claims in Kentucky Medicaid. Prescriptions for beneficiaries with an outpatient ARI diagnosis within seven days of dispensing were classified for appropriateness using a three-tiered diagnostic classification framework, with Tier 3 considered inappropriate. Multivariable logistic regression with prescriber-clustered standard errors assessed patient, provider, and contextual factors.Results: Of 2,386,291 ARI antibiotic prescriptions, 437,193 (18.3%) were inappropriate. Four conditions accounted for 87.0%: viral upper respiratory infection, bronchitis, non-suppurative otitis media, asthma and allergy. Azithromycin accounted for 38.3% of inappropriate prescriptions and was the most common antibiotic for both viral upper respiratory infection and bronchitis. Advanced practice providers accounted for 67% of antibiotic volume and 65% of inappropriate prescriptions despite lower adjusted odds than adult primary care physicians. Rural residence was associated with higher odds of inappropriate prescribing [Adjusted Odds Ratio (AOR): 1.25]. Inappropriate prescribing declined 21% overall, driven by a 26% reduction between 2022 and 2023 with a modest increase in 2024.Conclusions: Inappropriate ARI antibiotic prescribing in Kentucky Medicaid is concentrated in a small set of conditions and antibiotics. Distinguishing prescribing volume from appropriateness has direct implications for stewardship targeting, and the longitudinal surveillance infrastructure developed here is replicable by other state health departments.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of door openings, staff members and operation length on particle contamination and surgical site infections during acute and elective orthopedic implant surgery: an observational study. 在急性和择期骨科植入手术中，门开度、工作人员和手术时间对颗粒污染和手术部位感染的影响：一项观察性研究。

IF 2.6 3区医学

American journal of infection control Pub Date : 2026-10-06 DOI: 10.1016/j.ajic.2026.10.002

Frans Stålfelt, Josefin Seth Caous, Henrik Malchau, Karin Svensson Malchau

{"title":"Impact of door openings, staff members and operation length on particle contamination and surgical site infections during acute and elective orthopedic implant surgery: an observational study.","authors":"Frans Stålfelt, Josefin Seth Caous, Henrik Malchau, Karin Svensson Malchau","doi":"10.1016/j.ajic.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.ajic.2026.10.002","url":null,"abstract":"Background: Surgical site infection (SSI) is a complication associated with patient morbidity and increased healthcare costs. Its etiology is multifactorial, including intraoperative air contamination. This study aimed to evaluate how door openings and operating room (OR) staff presence, influence particle dispersion during orthopedic implant surgery, and to explore associations with SSI risk.Method: Particle counters, door sensors, and camera-based people counting was installed in orthopedic ORs at Sahlgrenska University Hospital, Sweden between 2021 and 2025. Data on reoperations due to SSI were obtained from the Swedish Arthroplasty Register, the Swedish Fracture Register, and a local surgical scheduling system.Results: Among 5,105 surgeries, 138 (2.7%) had reported SSI. Each additional person in the OR increased 1.0- and 5.0-µm particle concentrations by 1,503 particles/m³ (95% CI 545-2,462; p=0.002) and 99 particles/m³ (95% CI 34-163; p=0.003), respectively. Staff presence was similar between SSI and non-SSI cases (5.5 vs 5.0). SSI cases had 18-minute longer operative times, 1.5-fold more door openings, and 3.6% higher SSI odds per additional opening.Discussion and conclusion: Real-time monitoring provides important insights into intraoperative particle dynamics. Further data are needed to develop robust predictive models for SSI risk and to clarify causal relationships between OR behavior and infection outcomes.","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0