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Background: Candida auris (CA) is an urgent threat per Centers for Disease Control and Prevention with rapidly increasing cases across the US. Patient rooms recontaminate with CA within hours after daily cleaning due to skin shedding, persistence on environmental surfaces and resistance to commonly used disinfectants. Continuous dry hydrogen peroxide (cDHP) is a novel environmental technology augmenting daily room disinfection. cDHP reduces CA organism counts based on environmental cultures. Adenosine triphosphatase (ATPase) testing offers rapid results to monitor surface cleanliness. ATPase Testing Protocol: Upon identification of CA, cDHP was activated in the patient’s room. ATPase surface testing was performed in rooms of CA infected inpatients and nearby control rooms of inpatients without CA and thus no cDHP. Group A surfaces near the patient were nurse call handheld devices and/or bed rail. Group B surfaces were horizontal counter and/or computer keyboard, located >3 feet away from the patient. ATPase testing was to occur within one hour of daily room disinfection for CA patient Day0 (day of cDHP activation), Day1, Day7 and Day14 and controls. Daily room disinfection using quaternary disinfectants was replaced with EPA Class P chemicals upon CA identification. Nursing spot disinfects with Class P ready to use disinfectant wipes in all rooms. Results: Testing occurred among 13 CA and 22 control patients in 5 hospitals. In Table 1, pass rates are displayed by cumulative (Day0+1+7+14) test days for surfaces and patient room groups. Analysis applied Pearson’s Chi-squared test with Yates’ continuity correction. Conclusions: Surfaces further from the patient in rooms of CA patients exposed to cDHP had higher ATPase pass rates than controls. Surfaces close to the patient have a high ATPase failure rate, regardless of CA or cDHP. Strategies are needed to ensure disinfection occurs on high touch surfaces near patients. cDHP may have value in supplementing room disinfection. Contributing failure factors include surfaces missed for disinfection, delays in timely testing and known limitations with ATPase methods.

Background: Candida auris (CA) is an urgent threat per CDC with rapidly increasing cases across the US. Patient rooms quickly recontaminate after daily cleaning due to skin shedding, CA persistence on environmental surfaces and resistance to surface disinfectants. Burn services experienced a sharp increase in 2023-2024 CA cases concurrently with statewide reported increases. Dry hydrogen peroxide (cDHP) is an environmental air technology augmenting daily room disinfection with activity against CA. Investigation: The 113 bed hospital treats complex burns and wounds as a Level 2 trauma center serving a large geographic region. Room design is single patient rooms with one semi-private ward. A total of 236 patient encounters were coded by quarter based on CA identification from clinical or surveillance cultures. cDHP was deployed in Burn ICU as of 3/2023 and nonICU as of 6/2024, with prioritization for cDHP in patients with an expected LOS of > 14 days. Surface disinfectants with CA label claim were implemented upon CA case identification. Patient skin surveillance cultures were taken upon admission burn/wound intake process and tested by the state department of health (DOH) starting in 3/2023. ATPase testing occurred as an indirect measure of cleaning and disinfection. Findings: Figure 1 displays the occurrence of CA burn service patients. The majority of initial positive culture sources were wound/tissue (43%) and skin surveillance (35%). Figure 2 displays when CA specific prevention actions were initiated and 63% CA cases were identified after admission. Six CA patients were in semi-private rooms. However, transmission was absent based on surveillance cultures. No statistical difference in ATPase pass/fails was found between cDHP and control room surfaces after daily cleans. In CA cases detected post discharge, all tested negative upon admission, were in single patient rooms and were more frequent within months of high CA case burdens. Conclusions: Surveillance testing is important for assessing burden of CA colonization, which fluctuated over this 2 year period. Despite increase in CA burden on admit, new hospital acquisition remained relatively constant Infection prevention resources shifted to observations of compliant practices. Next steps are to increase cDHP use as supplemental room disinfection, regardless of anticipated length of stay and investigate potential risks associated with silent CA acquisition identified post discharge.

Background: Between October 2023 and July 2024, Methodist Hospital Specialty Transplant (MHST, San Antonio TX) experienced a cluster of five infections with Salmonella enterica serotype uganda among hospitalized kidney and liver transplant patients. All patients were symptomatic and specimens included blood, stool and urine. Salmonella enterica serotype uganda is rare with only a few reported outbreaks in the literature with none from healthcare settings. Methods: Investigation focused on two hypotheses: 1) a source within the facility was causing broad exposure but only severely immunocompromised patients were becoming symptomatic or 2) The clinical management of certain transplant patients is creating a risk of reactivation of Salmonella sp. The case definition was any solid organ transplant patient with a positive culture result (any specimen source) for Salmonella enterica serotype uganda post-transplant (no defined time) with or without symptoms who had a hospitalization at MHST after October 2023. The response focused on horizontal control measures (foundational infection prevention practices, water management), vertical control measures (food and nutrition services, patient screening) and epidemiologic descriptive analysis. Findings: Whole genome sequencing identified the five cases to be from an identical species. Cases occurred among kidney and liver transplant patients in roughly the proportion to the underlying census of these patients. No clinical or nutritional product or service was identified that would expose risk to transplant patients exclusively. There were no commonalities among the cases in relation to clinical care, procedures, or type of immunosuppression. Screening was performed for twenty-eight patients (either pre-liver transplant, post liver transplant or post kidney transplant) hospitalized between September and October 2024 with either chronic diarrhea or acute loose stools, none of which were positive for any species of Salmonella. Inspections of the kitchen showed opportunities around staff attire, food handling, food storage and the physical environment. Compliance to infection prevention assessments was 71% initially but improved to above 90% by early October 2024. Hand hygiene by food handlers after the handling of raw meat was low in July and August 2024 at 25% and 37%, respectively. After targeted interventions, compliance increased to 80% by September 2024. Conclusion: Following interventions, no additional healthcare-associated Salmonella sp cases in transplant patients were noted after July 2024. While a common source for these cases was suspected, none was definitely identified. While it was not possible to make a definitive conclusion, evidence suggests that the transplant population had a unique vulnerability to this species of Salmonella.

Although \"respect\" and \"dignity\" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating \"failures of respect\" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.

The quality of communication with patients and family members in intensive care units (ICUs) is a focus of current interest for clinical care improvement. Electronic communication portals are commonly used in other healthcare settings to improve communication. We do not know whether patients and family members desire such portals in ICUs, and if so, what functionality they should provide. To define interest in and desired elements of an electronic communication portal among current and potential ICU patients and their family members. We surveyed, via an Internet panel, 1,050 English-speaking adults residing in the United States with a personal or family history of an ICU admission within 10 years (cohort A) and 1,050 individuals without a history of such admission (cohort B). We also administered a survey instrument in person to 105 family members of patients currently admitted to ICUs at an academic medical center in Boston (cohort C). Respondents, especially current ICU family members, supported an electronic communication portal, including access via an electronic tablet. They wanted at least daily updates, one-paragraph summaries of family meetings including a list of key decisions made, and knowledge of the role and experience of treating clinicians. Overall, they preferred detailed rather than \"big picture\" information. Respondents were generally comfortable sharing information with their family members. Preferences regarding a communication portal varied significantly by age, sex, ethnicity, and prior experience with ICU hospitalization. Electronic communication portals appear welcome in contemporary ICUs. Frequent updates, knowledge about the professional qualifications of clinicians, detailed medical information, and documentation of family meetings are particularly desired.

The Northern Gateway pipeline and the four new natural gas lines proposed to run through the Prince George region are extremely important for Canada, similar in many ways to the historical push to build the Canadian Pacific Railway 150 years ago.

Gary Hesse of Leavenworth, Wash., said the coverage has helped him to clarify which direction he already was leaning but wishes the coverage focused on more than just a few key issues. Readers around the country were sent e-mail by their local newspapers asking them to respond to the survey questions. Nine out of 10 who responded said media coverage either affirmed their choice or had no impact. The remaining readers said coverage left them: confused and unsure of their choice; caused them to doubt their choice; or caused them to change their choice. The survey also asked readers to list their primary source of news about the presidential election. There was no clear favorite among traditional media. And while 20 percent of readers indicated in a different question they have read online Web logs for political insight, few readers listed the Internet as a primary source of news.