Ture Z, Maraş Baydoğan G, Çetinkaya Fİ
… +3 more, Tarkan M, Eryılmaz Eren E, Ulu Kılıç A
Am J Infect Control
· 2026 Aug · PMID 41831485
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BACKGROUND: As patients increasingly turn to artificial intelligence (AI) chatbots for medical information, concerns remain regarding the accuracy, transparency, and readability of these tools. This study aimed to compar...BACKGROUND: As patients increasingly turn to artificial intelligence (AI) chatbots for medical information, concerns remain regarding the accuracy, transparency, and readability of these tools. This study aimed to comparatively assess the quality, reliability, understandability, actionability, and readability of Surgical site infection (SSI)-related responses produced by widely used AI chatbots. METHODS: A cross-sectional design was used to evaluate 6 AI chatbots (ChatGPT-5o, Gemini 2.5 Pro, Gemini 2.5 Flash, DeepSeek, Grok-1.5, Perplexity). Five patient-centered SSI questions were developed through a Delphi method and directed to each chatbot. A multidisciplinary panel of 5 blinded experts rated responses using DISCERN, QUEST, PEMAT-P, and the Web Resource Rating. Readability was assessed using the Simple Measure of Gobbledygook, Flesch Reading Ease, and Ateşman formulas. Inter-rater reliability was calculated using the intraclass correlation coefficient. RESULTS: No single chatbot excelled across all domains. ChatGPT-5o achieved the highest quality scores (DISCERN), while DeepSeek showed the highest accuracy (QUEST). Gemini 2.5 Pro demonstrated the best understandability; however, actionability was lower across all platforms. Transparency was a major weakness: all chatbots scored poorly on Web Resource Rating, with ChatGPT-5o performing best yet still considered a low-quality source. Readability was generally high-level, with most responses requiring high-school to university literacy (Simple Measure of Gobbledygook 11.8-13.9). CONCLUSIONS: Current AI chatbots are not sufficiently reliable as primary educational tools for SSI prevention. Despite strengths in quality and clarity, shortcomings in transparency and readability limit safe patient use.
Mosleh T, Weil A, Beard D
… +7 more, Clements A, Radloff C, Nolen LD, Khader K, Stevenson E, Cheever S, Rigby S
Am J Infect Control
· 2026 Aug · PMID 41831484
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BACKGROUND: Inappropriate antibiotic use can accelerate the evolution and spread of antimicrobial resistance and increase Clostridioides difficile infection and adverse drug events. Utah typically reports lower overall o...BACKGROUND: Inappropriate antibiotic use can accelerate the evolution and spread of antimicrobial resistance and increase Clostridioides difficile infection and adverse drug events. Utah typically reports lower overall outpatient antibiotic prescribing than the average across the US, but Medicaid-specific trends are less well described. METHODS: We conducted a retrospective analysis of Utah Medicaid outpatient pharmacy claims (January 2019-July 2023). Prescription rates were calculated per 1,000 enrollees and compared with all Utah and US rates. Demographics, provider types, age distribution, and antibiotic classes were summarized. RESULTS: Among 256,602 unique Medicaid patients, 1,812,796 antibiotic claims were identified; 93% were oral agents; mean age at fill was 29.6 years; 57% male. Crude rates fell 55% over the study period (2019 peak 137/1,000; 2020 78/1,000) but remained higher than Utah overall and US comparators. Pediatric and young-adult groups accounted for the largest proportion of prescriptions. Salt Lake County accounted for the majority of prescribing providers, and physicians, nurse practitioners, and physician assistants (NPs/PAs) represented the dominant prescriber types. The most commonly prescribed antibiotic classes were penicillins, cephalosporins, sulfonamides, and tetracyclines. CONCLUSIONS: Outpatient antibiotic prescribing among Utah Medicaid beneficiaries decreased substantially during 2019-2023 but remained elevated compared with statewide and national prescribing rates. Targeted stewardship efforts focused on pediatric and young populations, high-volume prescribers, and geographic areas with higher prescribing rates may help reduce unnecessary antibiotic use in Medicaid populations.
Tan D, Huang X, Deng L
… +3 more, Wen L, Liang Z, Ke L
Am J Infect Control
· 2026 Aug · PMID 41831483
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BACKGROUND: The structure of lumened instruments is precise, complex, and frequently used in clinical settings. Traditional cleaning devices exhibit cleaning blind spots, resulting in suboptimal disinfection and an incre...BACKGROUND: The structure of lumened instruments is precise, complex, and frequently used in clinical settings. Traditional cleaning devices exhibit cleaning blind spots, resulting in suboptimal disinfection and an increased risk of hospital-acquired infections. This study aims to evaluate the clinical effectiveness of a novel cleaning device for lumened instruments. METHODS: A total of 240 used suction lumened instruments recovered from the sterilization supply center were selected and randomly divided into a control group (standard cleaning basket) and an experimental group（novel cleaning device for lumened instruments）, each consisting of 120 instruments. Cleaning quality was assessed using visual inspection, cotton swab testing, and ATP bioluminescence detection methods. Additionally, cleaning and drying times were recorded, and the cleaning pass rate was calculated. Data analysis was performed using SPSS version 22.0. RESULTS: All 3 detection methods indicated that the cleaning pass rate in the experimental group was significantly higher than that in the control group (P < .05). Furthermore, the drying time in the experimental group was significantly shorter than that in the control group (P < .05). CONCLUSIONS: The novel cleaning device for lumened instruments effectively improves cleaning quality and drying efficiency, thereby reducing the risk of hospital-acquired infections.
Morton J, Neelakanta A, Kester S
… +1 more, Passaretti C
Am J Infect Control
· 2026 Jun · PMID 41825533
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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 patients was associat...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 patients was associated with longer catheter duration and line type, even after adjusting for confounders. These findings highlight modifiable risk factors for CLABSI prevention.
Yassine I, Fayad S, Tajani AG
… +8 more, Hassan JW, Eltai NO, Ericson JE, Schiff SJ, Naas T, Bisha B, Osman M, Kassem II
Am J Infect Control
· 2026 Jun · PMID 41825532
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The mobile colistin resistance gene, mcr-1, encodes resistance to colistin, a critically important antibiotic. Resistance to colistin can jeopardize antimicrobial chemotherapy. Here, we report the detection and genomic c...The mobile colistin resistance gene, mcr-1, encodes resistance to colistin, a critically important antibiotic. Resistance to colistin can jeopardize antimicrobial chemotherapy. Here, we report the detection and genomic characterization of mcr-1-carrying Escherichia coli isolated from otherwise healthy children in community daycares. The mcr-1 was located on transferable plasmids. Additionally, the mcr-1 occurred in E coli that mainly belonged to a clonal ST10 lineage, indicating that these mcr-1-carrying strains were spreading across daycares in geographically distant cities.
Doran B, Stoltzfus H, Shackelford A
… +5 more, Baghagho E, Merrill K, Nicholson F, Crapanzano-Sigafoos R, Reese SM
Am J Infect Control
· 2026 Mar · PMID 41785916
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BACKGROUND: Infection preventionists (IPs) operate in dynamic health care environments addressing evolving infectious and organizational challenges. This study investigates how career stages are associated with perceptio...BACKGROUND: Infection preventionists (IPs) operate in dynamic health care environments addressing evolving infectious and organizational challenges. This study investigates how career stages are associated with perceptions of leadership, support, and clinical relationships, and their impact on job satisfaction and mental health. METHODS: A cross-sectional survey of US-based IPs evaluated leadership and organizational factors across experience levels (<3 to >20 years). Perceptions of support, satisfaction, and mental health were analyzed using χ² tests, linear-by-linear associations, Kendall's Tau-b, and ordinal logistic regression. RESULTS: Significant associations emerged between years of experience and perceptions of leadership and organizational support, especially in work-life balance, career advancement, new training, and the strength of clinical staff relationships. Most mental health outcomes showed no significant association with experience. Notably, late-career IPs (>20 years) reported the highest job satisfaction despite increased stress. CONCLUSIONS: Leadership, organizational, and job-related perceptions evolve across an IP's career, revealing critical points for strategic intervention. Though late-career IPs (> 20 years) report high job satisfaction and positive perceptions of workload/resources, they concurrently report challenges with weakened clinical staff relationships and the perceived challenges with new IP training.
Am J Infect Control
· 2026 Jun · PMID 41780753
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In intensive care units, unreliable hand hygiene performance can be difficult to detect using routine surveillance metrics. In a 12-month observational study, inappropriate glove use was consistently associated with lowe...In intensive care units, unreliable hand hygiene performance can be difficult to detect using routine surveillance metrics. In a 12-month observational study, inappropriate glove use was consistently associated with lower and more variable hand hygiene compliance. These findings suggest that glove substitution behavior may serve as a simple behavioral indicator of declining infection-prevention reliability.
Williams MD, Bridges A, Coppin JD
… +8 more, Chatterjee P, Choi H, Navarathna T, Bennett M, Nelson RE, Brackens E, Mayo L, Jinadatha C
Am J Infect Control
· 2026 Aug · PMID 41771379
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BACKGROUND: Health care-associated infections are a major cause of morbidity and mortality among hospitalized patients. Our Copper for Reducing Environmental Healthcare-Associated Infections (CuRE HAI) study evaluated th...BACKGROUND: Health care-associated infections are a major cause of morbidity and mortality among hospitalized patients. Our Copper for Reducing Environmental Healthcare-Associated Infections (CuRE HAI) study evaluated the effectiveness of introducing a novel copper-oxide infused polymer resin surface in the immediate environment surrounding a hospitalized patient. METHODS: The study was conducted between January 2014 and December 2023. Several high-touch surfaces were replaced with 16-20% copper-oxide-infused surfaces. All hospital admissions each month were monitored for onset of HAIs using predefined criteria. A Bayesian hierarchical Poisson model was used to estimate the effect of the intervention on monthly HAI rates. RESULTS: There were 543 HAIs and 231,752 bed days of care (BDOC) in the 120-month study period, a mean of 27.6 HAIs per 10,000 BDOC and 20.8 HAIs per 10,000 BDOC in the pre- and post-copper installation periods, respectively. The estimated incidence rate ratio for copper across all infections was 0.51 (0.25, 0.95). CONCLUSIONS: The CuRE HAI study suggests that implementation of novel copper components in a patient care environment may prevent HAIs. The continuous antimicrobial and antisporicidal activity provided by the copper surfaces likely explains at least some of the observed decline in HAI rates.
Am J Infect Control
· 2026 Aug · PMID 41763611
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BACKGROUND: Antimicrobial resistance poses a growing global threat. In real-world practice, antimicrobial prescribing is shaped by clinicians' cognitive biases and perceptions of resistance risk, potentially driving unne...BACKGROUND: Antimicrobial resistance poses a growing global threat. In real-world practice, antimicrobial prescribing is shaped by clinicians' cognitive biases and perceptions of resistance risk, potentially driving unnecessary broad-spectrum antibiotic use and increased antimicrobial pressure. METHODS: We conducted a questionnaire-based study among physicians to assess perceptions on antimicrobial resistance magnitude, determinants of prescription, and barriers to de-escalation. Clinician-estimated resistance rates were compared with observed data, and the main factors influencing antimicrobial prescription were analyzed. RESULTS: 82 physicians were surveyed; 76% were attendings; 37% internal medicine, 30% pediatrics, and 11% infectious diseases (adult and pediatric). Clinicians consistently overestimated carbapenem-resistant (CR) Klebsiella pneumoniae and Escherichia coli, methicillin-resistant Staphylococcus aureus, and VRE (Holm-adjusted P < .001). Non-ID clinicians overestimated resistance rates compared with ID physicians (CR E coli 26.7% vs 8.8%, CR K pneumoniae 23.4% vs 10.0%, MRSA 35.6% vs 16.6%, and vancomycin-resistant Enterococcus spp 28.3% vs 12.2%, all P < .05). CONCLUSIONS: This study reveals a gap between perceived and observed resistance rates, indicating cognitive biases that favor broad empirical therapy and delayed de-escalation. Differences by specialty underscore the role of specialized training, while fear- and severity-driven decision-making reflects a defensive prescribing approach that may undermine antimicrobial stewardship efforts.
Shoemaker H, Li H, Zhang Y
… +10 more, Mayer J, Stevens V, Fagerlin A, Rubin M, Haroldsen C, Millar MM, Pavia AT, Gesteland PH, Keegan LT, Samore M
Am J Infect Control
· 2026 Mar · PMID 41761746
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BACKGROUND: Risk perceptions and social activities shaped SARS-CoV-2 transmission. However, most related studies are cross-sectional, often neglecting correlated outcomes and dropout bias. We assessed relationships betwe...BACKGROUND: Risk perceptions and social activities shaped SARS-CoV-2 transmission. However, most related studies are cross-sectional, often neglecting correlated outcomes and dropout bias. We assessed relationships between local COVID-19 incidence levels and health care personnel (HCP) risk perceptions and social activity count. METHODS: We conducted a prospective cohort study using monthly surveys (December 2021-May 2022) at an academic health care system (n = 1,590 HCP). COVID-19 incidence was categorized into 4 levels, from low to high. Five risk perception measures (scaled 1-4) and activity count were modeled simultaneously using a Bayesian joint model to estimate the impact of incidence on risk perception and behavior. RESULTS: COVID-19 incidence was associated with various risk perception measures and activity count. Strongest risk perception associations were perceived risk of infection and risk while unmasked indoors in public, with score increases of 0.60 (95% credible interval [CI]: 0.51, 0.69) and 0.62 (95% CI: 0.52, 0.71), respectively, during high incidence. Individuals reported 0.68 (95% CI: -0.88, -0.47) fewer social activities during high incidence levels. CONCLUSIONS: During the Omicron surge, HCP adjusted their risk perceptions and behaviors in response to changing risk and placed high value on the protective effects of masking. These findings can inform communication strategies during future outbreaks.
Am J Infect Control
· 2026 Mar · PMID 41761745
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BACKGROUND: Toys, while integral to children's development and well-being, can serve as significant vectors of infection, especially in hospital settings. This study aimed to assess the effectiveness of toy hygiene educa...BACKGROUND: Toys, while integral to children's development and well-being, can serve as significant vectors of infection, especially in hospital settings. This study aimed to assess the effectiveness of toy hygiene education for mothers of hospitalized children on toy contamination and maternal knowledge. METHODS: A randomized controlled trial was conducted in a public hospital's pediatric units in Türkiye with 48 mothers and their 1-6-year-old children's favorite toys. The intervention group (n = 24) received two structured toy hygiene education sessions during hospitalization. Toy surface contamination was measured using an ATP device via swab samples collected from the same toy area on days 1 and 3. Data collection tools included the Personal Information Form, Toy Hygiene Information Form (THIF), and Toy Surface Hygiene Level Record Form (TSHLRF). CLINICALTRIALS: gov registration: NCT06199804. RESULTS: The intervention group demonstrated a significantly higher post-test mean THIF score compared to the control group (F = 227.77, P < .001, η² = 0.835). In addition, toys in the intervention group showed significantly lower ATP contamination levels on day 3 (F = 4.093, P = .048, η² = 0.098). CONCLUSIONS: Toy hygiene education for mothers significantly improved their knowledge and effectively reduced toy contamination in pediatric hospital settings. These findings highlight the importance of parent-focused hygiene interventions in infection prevention efforts.
Am J Infect Control
· 2026 Aug · PMID 41730337
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BACKGROUND: Given limited data on ventilator-associated pneumonia (VAP) in emergency intensive care units (EICUs), we investigated VAP incidence, compliance with VAP prevention practices, risk factors, and effectiveness...BACKGROUND: Given limited data on ventilator-associated pneumonia (VAP) in emergency intensive care units (EICUs), we investigated VAP incidence, compliance with VAP prevention practices, risk factors, and effectiveness of VAP bundle compliance in our EICU. METHODS: A retrospective cohort study was conducted at the EICU of a tertiary hospital from September 1, 2020, to February 28, 2021. We investigated VAP incidence and bundle compliance, then compared patient-/treatment-related factors and bundle compliance between VAP and non-VAP patients using univariate analysis. Variables found statistically significant were analyzed with logistic regression to assess association with VAP. RESULTS: Among 131 patients, the VAP incidence was 7.46 per 1,000 ventilator days. Compliance rates were spontaneous breathing trials 48.9%; head-of-bed elevation 16.1%; use of endotracheal tubes with subglottic secretion drainage 35.4%; maintaining cuff pressure ≥ 20 cmHO 98.2%; oral care with chlorhexidine 93.2%; and deep vein thrombosis prophylaxis 79.7%. Overall, VAP bundle compliance was 2.3% (6.7% excluding contraindications). Independent risk factors for VAP included sepsis at admission (adjusted odds ratio [aOR] = 5.99, P = .042), reintubation (aOR = 8.56, P = .028), and aspiration (aOR = 9.58, P = .006). Compliance with spontaneous breathing trials was protective (aOR = 0.96, P = .015). CONCLUSIONS: Our findings highlight the need for targeted VAP prevention strategies to improve bundle compliance in the EICU.
Ghavidel-Sardsahra A, Fattahpour Marandi M, Seifi A
… +3 more, Afhami S, Montazeri M, Yekaninejad MS
Am J Infect Control
· 2026 Aug · PMID 41730336
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BACKGROUND: Adherence to prevention guidelines for device-associated infections in intensive care units (ICUs) is critical but often suboptimal. This study assessed awareness, adherence, and barriers to implementing prev...BACKGROUND: Adherence to prevention guidelines for device-associated infections in intensive care units (ICUs) is critical but often suboptimal. This study assessed awareness, adherence, and barriers to implementing preventive measures for ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI) in Iranian ICUs. METHODS: In a multi-center, cross-sectional study using census sampling, a structured questionnaire was administered to the head nurse and attending physician in all 20 eligible medical, surgical, and general ICUs in Iranian teaching hospitals. The survey assessed awareness, self-reported adherence to core preventive practices, and perceived implementation barriers. Adherence rates were compared by ICU type. RESULTS: Mean overall adherence was 77.9%; rates were highest for CAUTI (82.0%) and lowest for VAP (73.5%). Surgical ICUs demonstrated significantly higher adherence for CLABSI (P = .008) and CAUTI (P = .015) prevention compared to general ICUs. The most frequently cited barrier was a lack of periodic staff training (reported by 50% for CLABSI). CONCLUSIONS: Adherence to device-associated infection prevention protocols was moderate, with VAP prevention a key challenge. The primary barriers were organizational, including insufficient training and staff shortages, not a lack of guidelines. Improving adherence requires systemic solutions that address institutional infrastructure, provide sustained training, and ensure adequate staffing.
Thampi N, Darbha A, Zumbansen A
… +3 more, Comeau G, Tsampalieros A, Longtin Y
Am J Infect Control
· 2026 Jul · PMID 41707914
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BACKGROUND: A musical mnemonic may help children learn and recall the recommended six-step handwashing technique. METHODS: This proof-of-concept study was conducted in two toddler-aged (1-2 years) and two preschool-aged...BACKGROUND: A musical mnemonic may help children learn and recall the recommended six-step handwashing technique. METHODS: This proof-of-concept study was conducted in two toddler-aged (1-2 years) and two preschool-aged (3-5 years) classrooms. On Days 1 and 8, students were presented the handwashing technique in prose through demonstration and poster. One toddler and preschool classroom received additional musical mnemonic instruction. Students were observed pre-instruction and Days 1, 2, 8, 9, 22 and 29 for handwashing step completion. The primary outcome was number of steps completed (9-point score); the secondary outcome was handwashing duration. RESULTS: Over 4 weeks, 378 observations were recorded among 47 students. All groups initially had comparable median [interquartile range] technique scores and durations. Scores significantly increased in classrooms with lyrical compared to prose instruction alone at Day 1 (2.0 [1.0 to 7.0] vs 1.0 [0.3 to 3.5], P=0.046, and Day 29 (2.0 [1.0 to 4.0] vs. 1.0 [0 to 1.0], P = .01). Only lyrical classrooms saw significant improvement in scores from baseline to Day 29 (P = .002). At Day 29, duration was significantly longer in lyrical versus prose classrooms (22s [18 to 32] vs. 5s [3 to 11], P<.001). CONCLUSIONS: A musical mnemonic can improve handwashing quality in preschool classrooms.
Suleyman G, Shallal A, Ruby A
… +7 more, Chami E, Holsey T, McKay S, Callahan K, Samuel L, Dabaja AA, Tibbetts RJ
Am J Infect Control
· 2026 Jul · PMID 41679515
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BACKGROUND: We evaluated an electronic health record (EHR) "hard stop" intervention to reduce inappropriate urine culture (UC) orders in patients with indwelling urinary catheters (IUCs). METHODS: In this pre-post quasi-...BACKGROUND: We evaluated an electronic health record (EHR) "hard stop" intervention to reduce inappropriate urine culture (UC) orders in patients with indwelling urinary catheters (IUCs). METHODS: In this pre-post quasi-experimental retrospective study, outcomes were compared between a pre-intervention period (January 2019-December 2020) and an intervention period (April 2021-December 2024) across a five-hospital health system in Southeast Michigan. The intervention, implemented in March 2021, tiggered a UC ordering hard stop 24 hours after admission for patients with an IUC in place for more than one day and remained active until four days after catheter removal. Overrides required medical director approval following case review, with real-time clinician education provided. Outcomes included catheter-associated urinary tract infection (CAUTI) rates per 1,000 patient days, UC order rates per 1,000 catheter days, Standardized Utilization Ratio (SUR), and Standardized Infection Ratio (SIR). Safety outcomes assessed pyelonephritis or bacteremia within three days and sepsis readmission within 30 days when UC was deemed unnecessary. RESULTS: CAUTI rates declined from 0.523 to 0.071 (86%; P < .001). UC order rate decreased from 191.3 to 77.5 per 1,000 catheter days (59%; P < .001). SUR declined from 0.809 to 0.769 (5%; 95% CI, 0.943-0.956; P < .001). SIR decreased from 0.400 to 0.081 (81%; 95% CI, 0.124-0.32; P < .001). Of 67 override requests, 65 (94%) were denied without adverse outcomes. CONCLUSIONS: An EHR-based hard stop with real-time review and education significantly reduced inappropriate UC ordering and CAUTI rates without compromising patient safety.
Am J Infect Control
· 2026 May · PMID 41672148
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To decrease central line-associated bloodstream infection (CLABSI) rates at a quaternary care children's hospital, a house-wide CLABSI Nurse Champion role was implemented in January 2023. The CLABSI Nurse Champion coache...To decrease central line-associated bloodstream infection (CLABSI) rates at a quaternary care children's hospital, a house-wide CLABSI Nurse Champion role was implemented in January 2023. The CLABSI Nurse Champion coached clinical nurses to evidence-based bundle elements and performed assessments of high-risk patients. Mean CLABSI rates decreased after implementation of the role (1.74 to 0.87 per 1,000 central line days). This project demonstrated the benefit of utilizing a CLABSI nurse champion role within pediatrics.
Townsend S, Cermignano T, Karley P
… +2 more, Seon N, Coffin SE
Am J Infect Control
· 2026 Jul · PMID 41651075
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BACKGROUND: A clean patient care environment is critical for safety, yet medical technology, unclear cleaning ownership, and diverse teams complicate expectations. Reliable cleaning practices are essential. METHODS: A pa...BACKGROUND: A clean patient care environment is critical for safety, yet medical technology, unclear cleaning ownership, and diverse teams complicate expectations. Reliable cleaning practices are essential. METHODS: A partnership between Infection Prevention, Nursing, and Environmental Services was created to assess and improve cleaning in clinical care environments. The institutional improvement framework was used to guide this work. RESULTS: A partnership between Infection Prevention, Nursing, and Environmental Services led to sustained improvements in room cleanliness and staff understanding of cleaning roles. A toolkit was created and is provided, including monitoring tools, education, and staff talking points. CONCLUSION: Our toolkit establishes strategies to define cleaning responsibilities in highly technical clinical settings and support environmental service teams to maintain cleanliness in a complex patient-care environment.