Despite the availability of straightforward and economic interventions to prevent HAIs, these unintentional adverse events still pose a significant challenge to public health globally. We aimed to evaluate the outcomes of a nationwide project designed to mitigate HAI incidence in intensive care units (ICUs) using the Model of Improvement framework. A Quality Improvement (QI) study assessing the outcomes of a two-year initiative in Brazilian ICUs from September 2021. A customized Collaborative methodology was applied to mentor and enhance the capabilities of healthcare workers, equipping them with evidence-based, structured, systematic, and auditable QI strategies (prevention bundles) to improve patient care outcomes. A one-year preintervention baseline incidence was established for the three critical HAIs: central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI), to compare with the intervention period. The initiative encompassed 188 ICUs (169 adults, 11 pediatric, and eight neonatal), recording substantial reductions in HAI incidence density: by 43% for CLABSI (from 5.5 to 3.2 per 1,000 catheter-day), by 51% for VAP (from 13.6 to 6.7 per 1,000 ventilator-day), and by 55% for CAUTI (from 3.2 to 1.4 per 1,000 catheter-day), irrespective of age. Implementing this QI strategy prevented an estimated 7,342 infections. Our initiative has been demonstrated to be a feasible and valuable strategy for preventing HAIs in critical care settings. The success of this approach emphasizes the potential for its broader application and reinforces the need for systematic, evidence-based interventions in healthcare settings.

Expanded multiplex PCR gastrointestinal panels (GIPs) are routinely ordered to diagnose infectious diarrhea. However, recommendations for repeat GIP testing are limited, resulting in variable testing practices. We evaluated the diagnostic yield of repeat GIP testing within 14 days. We conducted a retrospective cohort study of adults (age ≥ 18 years) tested with GIPs across 12 hospitals and outpatient centers (2019-2024). We analyzed the first diarrheal episode per patient, excluding cases with invalid/missing results and C. difficile results. Repeat testing was defined as a GIP completed within 14 days of an index GIP, excluding confirmatory testing using the same stool sample. The primary outcome was diagnostic yield (new pathogen detection), and the secondary outcome was pathogen persistence (same pathogen detection). Among 16,502 patients, 507 (3.1%) underwent repeat GIP testing within 14 days (median interval: 6.3 days; IQR: 2.7-9.8). Only 4.6% [19/415] index-negative patients and 2.2% [2/92] index-positive patients detected new pathogens on repeat testing, with 51% [47/92] index-positive patients demonstrating persistence of at least one pathogen from their initial test. The number needed to test (NNT) to identify one new pathogen was 24 (95% CI: 16-39) tests overall, and 127 (95% CI: 50-455) tests to identify one new pathogen warranting antimicrobial treatment. Most repeat testing (86% [436/507]) was ordered by a different clinician. Repeat GIP testing within 14 days rarely provided new diagnostic information, highlighting the limited utility of early repeat testing. Institutional policies discouraging repeat GIPs within 14 days may improve diagnostic stewardship.

Our study evaluated a large language model (gpt-4o-mini) for surgical site infection (SSI) adjudication, achieving 100% sensitivity but 69.4% specificity. While reducing the manual screening workload by 66%, the agent generated many false positives, underscoring the need for refined models to improve specificity without compromising accuracy.

There is increasing evidence on the effectiveness of prevention bundles against non-ventilator hospital-acquired pneumonia (nvHAP), but detailed reports on their implementation are lacking. This study aims to describe and structure the implementation activities undertaken in a single-center multimodal intervention that achieved a 31% reduction in nvHAP incidence. Longitudinal descriptive qualitative study. Nine medical and surgical departments of a Swiss university hospital. Healthcare professionals and implementation teams in study departments. We collected longitudinal data on implementation activities using (1) implementation activity logs, (2) drop-in interviews and observations, (3) "action plan meetings," (4) focus groups, and (5) unstructured recall sessions among the project team. Data were deductively coded using the "Expert Recommendations for Implementing Change" taxonomy, specified using Proctor et al.'s "Recommendations for specifying and reporting implementation strategies" and mapped to the "Exploration, Preparation, Implementation, Sustainment" framework phases. A total of 174 activities were undertaken. Activities varied by implementation phase, most frequently involving "evaluative and iterative strategies," "develop stakeholder interrelationship strategies" and "training and education of stakeholders" during Exploration, Preparation, and Implementation, respectively. During Implementation, 54% of activities were initiated by department nurses, and 27% were initiated by the institutional implementation team. Activities included interdisciplinary kick-off events, education in various formats, posters, informational stickers for patients, provision of new equipment (e.g., toothbrushes), and electronic medical records order sets. This report offers valuable insights for future implementation efforts by providing a structured overview of the concrete implementation activities performed in a successful one-hospital multimodal nvHAP prevention project.

To report on the investigation of a pseudo-outbreak of Mycobacterium mucogenicum and examine its clinical and operational impact. Outbreak investigation, retrospective cohort study. Academic medical center in Los Angeles, California. Patients whose bronchoalveolar lavage (BAL) cultures grew M. mucogenicum from 2020-2024. We performed an institutional outbreak investigation of M. mucogenicum, reviewed electronic medical records of a subset of affected patients (2023-2024), and assessed the operational impact. The incidence of M. mucogenicum in BAL cultures at Hospital A increased from 6.1% (29/473) in 2020 to 18.6% (29/156) in the first quarter of 2024. Epidemiologic investigation revealed non-sterile ice baths used to cool uncapped sterile syringes during bronchoscopy procedures as the contamination source. Next generation sequencing linked clinical isolates to M. mucogenicum recovered from a perioperative ice machine. Nearly all (157/160) clinical isolates grew from nocardia media rather than acid-fast bacilli media. Among 154 patients, including 51 (33.1%) who were highly immunocompromised, no true infections were identified. Thirty-nine (25.3%) patients were referred to infectious diseases for consultation, seven (4.5%) underwent additional workup, and only one received targeted treatment. The pseudo-outbreak incurred 458 hours of microbiology technologist and infection preventionist time and cost the laboratory $88,426. A four-year pseudo-outbreak of M. mucogenicum traced to contaminated ice baths used during bronchoscopy resulted in unnecessary infectious disease referrals and substantial operational and financial burden to the institution. Avoidance of non-sterile ice use in procedures prevents costly and burdensome pseudo-outbreaks of environmental mycobacteria in healthcare settings.

Healthcare personnel (HCP) are at risk for occupational exposure to tuberculosis. Current guidelines for managing exposed HCP are broad and resource intensive. Based on review of our internal data, we propose a risk-based stratification approach to streamline exposure follow-up testing and optimize resource utilization.

In this prospective cohort study, trimethoprim-sulfamethoxazole direct oral challenge (DOC) for hospitalized adults reporting a low-risk sulfa antibiotic allergy was safe with 75/76 (99%) inpatients delabeled. Within 90-days of DOC, immunocompromised patients were more likely to receive trimethoprim-sulfamethoxazole, compared with non-immunocompromised patients (adjusted OR 5.6 95% CI 1.3, 23.0).