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Importance  Methicillin-resistant Staphylococcus aureus (MRSA) infections are major contributors to morbidity and mortality among hospitalized patients. Despite evidence-based guidelines, opportunities remain to improve the implementation of MRSA infection prevention.Objective  To determine whether an educational quality improvement program is associated with improved evidence-based practices and prevention of MRSA infections among hospitalized patients.Design, Setting, and Participants  This quality improvement study evaluates the Agency for Healthcare Research and Quality’s Safety Program for MRSA Prevention, which was conducted and evaluated in volunteer intensive care units (ICUs) and non-ICUs in US acute care hospitals from April 2022 through September 2023. Data analysis, which was conducted between October 2024 and January 2025, compared data from the project period to the previous 12 months of baseline data.Exposures  The program provided 22 webinars and durable educational content and assisted units with implementing evidence-based MRSA infection prevention interventions. Webinars targeted nurses, infection preventionists, physicians, nursing assistants, and environmental services personnel. The major foci were chlorhexidine bathing, nasal MRSA decolonization, environmental disinfection, and interventions to prevent person-based MRSA transmission and device-related infections.Main Outcomes and Measures  The primary outcome was the rate of laboratory-identified, MRSA hospital-onset bacteremia (HOB) events. Secondary outcomes included hospital-onset clinical cultures growing MRSA, all-cause HOB, and central line–associated bloodstream infections. The χ2 test was used to compare binary outcomes.Results  One hundred ninety-three hospital units completed the program (106 ICUs and 87 non-ICUs from 94 hospitals), including units from 31 (33%) academic medical centers, 42 (45%) non–academic medical centers teaching hospitals, and 21 (22%) nonteaching community or other hospitals. Between baseline and the end of the program, laboratory-identified MRSA HOB events decreased by −2.3 events per 10 000 patient-days (95% CI, −2.8 to −1.9 events per 10 000 patient-days; P < .001), or −65% (95% CI, −73% to −58%; P < .001). Clinical cultures growing MRSA from hospital day 4 or later decreased by −5.6 events per 10 000 patient-days (95% CI, −7.8 to −3.3 events per 10 000 patient-days; P < .001), or −39% (95% CI, −50% to −29%; P < .001). All-cause HOB decreased by −10.5 events per 10 000 patient-days (95% CI, −13.8 to −7.1 events per 10 000 patient-days; P < .001), or −37% (95% CI, −45% to −30%; P < .001). Central line–associated bloodstream infections decreased by −3.5 events per 10 000 central-line days (95% CI, −5.5 to −1.5 events per 10 000 central-line days; P < .001), or −31% (95% CI, −45% to −17%; P < .001).Conclusions and Relevance  In this quality improvement study of MRSA prevention in ICU and non-ICU hospital settings, the program was associated with significantly reduced rates of laboratory-identified MRSA HOB events and other infections among participating hospital units. The program content is publicly available and may help ICUs and non-ICUs reduce MRSA infection among hospitalized patients.

View abstract Objectives:Pediatric patients undergoing hematopoietic transplant or cellular therapy (TCT) are at increased risk of developing central line-associated bloodstream infections (CLABSI). The role of language barriers in CLABSI risk has not been well-explored in this population. This study aimed to evaluate the risk for CLABSI in pediatric TCT patients with limited English proficiency (LEP).Design and patients:A retrospective cohort study of patients hospitalized in the TCT unit in a single pediatric oncology center between January 2021 and June 2024.Interventions:Clinical data was abstracted from the electronic health records and CLABSI events from the hospital infection prevention and control surveillance database. CLABSI rates were calculated as events per 1,000 inpatient central line days (CLD) and compared between patients with LEP and those English-proficient. Cox proportional hazard analysis was used to evaluate independent risk factors for CLABSI.Results:Two hundred and eighty patients contributed a total of 12,325 CLD and 93 CLABSIs; of which 57 patients were with LEP contributing 3,113 CLD and 29 CLABSIs. The unadjusted CLABSI rate in patients with LEP was significantly higher (9.32/1,000 CLD) than that in English-proficient patients (6.95/1,000 CLD, P < .001). Patients with LEP had twice the risk of developing CLABSI compared to English-proficient patients (Adjusted HR 2.03, 95% CI [1.23, 3.34]).Conclusions:This study identified a significantly increased risk of CLABSI in pediatric TCT patients with language barriers. Addressing these barriers through equitable strategies is crucial for improving clinical outcomes and promoting an inclusive healthcare for diverse patient groups.

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View abstract Objective:To determine whether split septum needleless connector prevent central line-associated bloodstream infection (CLABSI) better than mechanical valve in very preterm or very low-birth-weight (VLBW) neonates.Design:This is an open-label, parallel, randomized controlled trial. Participants were followed up to 48 hours after central line removal for the primary outcome.Setting:This is a single-center study conducted at level III neonatal intensive care unit in public tertiary hospital.Participants:Very premature or VLBW neonates requiring central access.Intervention:Participants were randomized to receive either a split septum or mechanical valve needleless connector.Primary Outcome:The primary outcomes were CLABSI incidence rate and the estimated hazard ratio of CLABSI between the two groups.Results:A total of 60 neonates were included in the analysis, in which 30 neonates were allocated to each intervention (split septum) (mean±SD gestational age, 27.37 ± 7.7 weeks; 15 [50%] male) and control (mechanical valve) group (mean±SD gestational age, 30.27 ± 2.7 weeks; 17 [56.7%] male). The CLABSI incidence rate was lower in the intervention group (3.0 vs 16.2 per 1,000 catheter days). The adjusted hazard ratio for the intervention compared to control group was 0.153 (95% CI 0.02–1.52; P = .109). Although not statistically significant, the control group demonstrated higher CLABSI-related mortality (7% vs 0%), length of stay (49.8 ± 24.2 vs 42.3 ± 23.8), and hospital cost (130.5 (79.4–215.9) vs 104.1 (86.4–152.7).Conclusions:Split septum demonstrated a trend in lower incidence of CLABSI. This result should be weighed carefully in determining the needleless connector type best suited for very preterm or VLBW neonates.

A July 2026 CDC/NEJM study found hospital infection rates fell 27% from 2015 to 2023, with major drops in CLABSI, C. diff, and MRSA. But 518,000 HAIs still occurred in 2023.

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View abstract Background: Hospital onset bacteremia and fungemia (HOB) is under development as a Center for Disease Control and Prevention (CDC) automated digital quality measure. We evaluated the use of generative artificial intelligence (GenAI) in assessing attribution and preventability of HOB. Methods This is a retrospective cohort study of hospitalized patients with positive blood cultures at 11 US Veterans Affairs (VA) hospitals. We included a random sample of positive blood cultures collected after day 3 of admission where admission date is day 1. GenAI (OpenAI GPT-4o) was prompted to provide the most likely source and adjudicate the preventability of HOB using standardized prompts and clinical data (GenAI). IP experts used GenAI output to provide GenAI-assisted determinations of source and preventability of HOB (IP-AI). HOB event preventability was rated by IP expert using a 6-point Likert scale, responses were combined to 3 categories for analysis. We compared initial GenAI with IP-AI determinations of source and preventability. A separate human-only review by a different IP expert was performed (IP-alone) on a random subset to compare time required for review. Results We included 52 HOB events for IP-AI and a subset of 21 for IP-alone. Enterobacterales were the most common organisms (22/52, 42%) followed by Staphylococcus aureus (9/52, 17%). Median duration to HOB event was 12 (IQR 5 – 31) days. GenAI most commonly attributed bacteremia to gastrointestinal (GI) (14/52, 26.9%), followed by genitourinary (GU) (12/52, 23%), central line (CLABSI) (8/52, 15%), and skin and soft tissue infections (SSTI) (7/52, 14%) sources (Figure 1). IP-AI determination of source agreed with GenAI source in 67% (35/52) of cases. Most agreement between IP-AI and GenAI occurred when HOB was attributed to a bone and joint infection (2/2, 100%), followed by GI source (13/14, 93%), SSTI (5/7, 71%), and GU source (7/12, 58%). Most disagreements (17/52, 33%) occurred when IP-AI attribution was to an unknown source (5/17, 29%) or blood culture contamination (3/17, 18%). GenAI adjudication of preventability matched IP-AI adjudication in 20/52 (39%). The median time to complete an IP-AI review was 11.5 (IQR 6 – 20.5) minutes compared to a median of 25 (IQR 13 – 33) minutes for IP-alone. Conclusion IP experts often agreed with GenAI for source of HOB but disagreed with its preventability. GenAI rarely acknowledged unknown source. Using GenAI for HOB detection is faster than human review but must account for differences in preventability.

View abstract Background: Vascular access devices (VAD), including central venous catheters (CVC) and peripheral intravenous catheters (PIVC), are among the most common medical intervention for hospitalized patients, yet they are also a major source of infectious and noninfectious complications. The Centers for Disease Control and Prevention (CDC) recommends prompt removal of CVC that are no longer indicated as a cornerstone of CLABSI prevention, although cessation of CVC indication is ill-defined. Our hospital implemented a Device Stewardship program to identify VAD that were likely inappropriate and to nudge providers to remove them promptly. The objective of this study is to quantify the opportunities to decrease VAD utilization and to describe early Device Stewardship efforts. Methods Study design and population. This is a retrospective cohort study at a 500-bed academic safety net hospital in Denver, CO. All inpatients hospitalized between 10/1/2025 and 12/31/2025, were eligible for inclusion. CVC placed for ECMO or rapid rewarming were excluded. Definitions. The following VAD were generally considered unnecessary: Femoral triple lumen catheters (TLC) in place for <1 day TLC present in a patient on an acute care unit Duplicate VAD (peripherally-inserted central catheter [PICC] and PIVC) in a patient on an acute care unit Intervention. Infection preventionists (IPs) identified eligible patients through an Epic worklist. Standardized text messages were used to suggest de-escalation of VAD to nursing and provider teams on weekdays (Figure 1). Results There were 576 TLC device days and 871 PICC device days in hospitalized inpatients during the study period. VAD selection could be improved in 29.6% of these patients (Table 1). Duplicate VAD was identified as the most frequent opportunity for improvement whereas femoral TLC present for <1 day was the least frequent opportunity. IPs contacted the clinical teams of 64 unique patients with duplicate VAD to suggest removal of ≥1 PIVC; 36 PIVC in 25 patients (39%) were removed as a result of intervention. Additionally, 5 femoral TLC present for <1 day and 15 TLC on acute care units were intervened upon with 1 femoral line and 3 TLC (20% each) removed during the study period. Conclusion Despite national guidelines to remove unnecessary VAD, there is ample opportunity to deescalate VAD in clinical practice. Simple criteria can be developed to standardize the selection and to prompt earlier removal of VAD, particularly duplicate access. Work can be done to improve the acceptance rate of suggestions.

Hospital-acquired infections (HAIs) impose a global burden, with hand hygiene (HH) a key preventive measure. Sustaining HH compliance requires behavio…

View abstract Background: Central line-associated bloodstream infections (CLABSIs) remain a significant source of preventable harm in hospitalized patients, often resulting from missed dressing changes and mislabeled tubing. Research indicates that most CLABSIs occur more than five days after catheter insertion, highlighting the importance of maintenance practices. This project, conducted at Atrium Health Union/Union West, aimed to reduce CLABSI rates by improving adherence to central line care protocols through innovative use of secure chat photography. Methods: Using the Plan-Do-Study-Act (PDSA) framework, the team identified procedural gaps in dressing changes and tubing labeling. A novel intervention was implemented: frontline nurses sent secure chat photos of central line dressings and tubing labels to leadership at each shift change via the electronic medical record (EMR). This real-time visual verification system enhanced compliance monitoring and accountability. Stakeholder engagement was prioritized through shared governance, pilot testing, and feedback loops. Pre- and post-intervention audits measured compliance, and statistical analysis validated the impact. Results: Pre-intervention compliance with central line maintenance protocols was 83%. Post-intervention, compliance improved to a range of 92.4% to 100% across seven units, averaging 95.5% with sustained results for a year thus far. This improvement correlated with a reduction in CLABSI rates, contributing to better patient outcomes and potential cost savings, as each CLABSI can cost between $16,000 and $45,000. The project is on track to meet its goal of ≥99% compliance, supported by ongoing audits, leadership feedback, and integration of the secure photo process into standard workflows. Conclusion: This initiative successfully leveraged digital tools to address a persistent clinical challenge. Secure photo documentation via EMR messaging proved to be an effective, scalable, and low-cost strategy for improving central line care compliance. The intervention not only enhanced patient safety and reduced infection risk but also promoted health equity by standardizing care across units. Its replicability across other healthcare settings makes it a valuable model for broader dissemination. The project demonstrates how technology-driven solutions can transform infection prevention practices and support institutional goals of safety, quality, and equity in care delivery.

Dialysis patients are at increased odds for central line-associated bloodstream infections (CLABSIs). In this 2:1 matched case-control study of hospitalized hemodialysis patients, CLABSI in dialysis p...

Few studies describe quantitative thresholds for daily device review that attempt to drive a decrease in device utilization (DU) for central venous catheter devices. Increased DU in the period spannin...

Reducing home infusion CLABSI through a dashboard and toolkit implementation - Volume 47 Issue 5

View abstract Background: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.Methods: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.Results: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.Conclusion: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.

View abstract Objective:Chlorhexidine gluconate (CHG) skin treatments are an effective strategy to reduce patients’ risk of central line-associated bloodstream infection (CLABSI); however, compliance with this practice is suboptimal. One barrier is patient refusal of CHG skin treatments. To mitigate this barrier, the purpose of this study was to evaluate the feasibility and outcomes of implementing a patient-facing CHG skin treatment educational video on an inpatient adult bone marrow transplant (BMT) unit.Design:A quasi-experimental pre–post research study design was used.Setting:The study took place at a large academic hospital in the Southeastern U.S.Patients:Patients admitted to a 16-bed BMT unit were included.Interventions:A patient-facing CHG skin treatment educational video was developed with input from a multidisciplinary team, patients, and their family members. Patients accessed the video through a QR code or website link provided on a laminated document.Results:The video was viewed 173 times, with an average of 84% of the video watched. Of the 117 patients who completed a feedback survey, most felt the video was helpful and increased their likelihood of participating in CHG skin treatments. No improvements were shown in documented CHG compliance or patient refusals. A 27.2% reduction in the CLABSI rate was found, with a decreased rate of 2.54 to 1.85 post-intervention, although this reduction was not statistically significant, P = .58.Conclusions:While patients found the video beneficial, future research that includes more diverse patient populations is needed to better understand the long-term impact of a CHG skin treatment educational video.

BACKGROUND Accurate, fully automated systems may increase efficiency of healthcare-associated infections (HAI) surveillance. AIM We aimed to validate the performance of a fully automated surveillance system for central-line-associated bloodstream infections (CLABSI) in critically ill patients in Switzerland. METHODS We conducted a multicentre retrospective study across six secondary and tertiary care hospital networks’ intensive care units (ICU). A centrally hosted, fully automated algorithm was implemented to detect catheter-related bloodstream infections (CRBSI), CLABSI and ICU-onset bloodstream infections (ICU-BSI). Algorithm performance was validated against an anonymised manual review of random samples of positive blood cultures. Incidence data were computed for each hospital. RESULTS From January 2022 to December 2023, we analysed 131,166 patient days, 108,719 catheter days and 7,832 positive blood cultures from 1,931 ICU patients. Median age was 65 years (interquartile range (IQR): 53–73), 458 (23.7%) were female. For CLABSI and CRBSI, the algorithm demonstrated a specificity of 95.3% (95% confidence interval (CI): 92.7–97.0), sensitivity of 86.5% (95% CI: 79.8–91.2), positive predictive value of 87.0% (95% CI: 80.4–91.7) and negative predictive value of 95.1% (95% CI: 92.5–96.8). CRBSI/CLABSI and ICU-BSI incidence rates were 3.23/1,000 catheter days (95% CI: 2.91–3.57) and 2.42/1,000 patient days (95% CI: 2.17–2.70), respectively. Most identified microorganisms for CRBSI/CLABSI were Staphylococcus epidermidis (15.1%; 53/351), Enterococcus faecium (9.1%; 32/351) and E. faecalis (5.7%; 20/351). CONCLUSIONS We demonstrate feasibility and external validity of a fully automated system for CLABSI surveillance in critically ill patients, supporting its integration into national HAI prevention and control strategies.