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Political Black Girl Magic  explores black women's experiences as mayors in American cities.The editor and contributors to this comprehensive volume examine black female mayoral campaigns and elections where race and gender are a factor--and where deracialized campaigns have garnered candidate support from white as well as Hispanic and Asian.

Together, we create educational materials, develop practice and policy recommendations, and honor the careers of our members with the APIC-SHEA Award for Lifetime Contribution to the Field of Infection Prevention and Epidemiology, which is jointly selected and presented at both societies’ national meetings. Together, we have efforts planned for the coming year to develop expert guidance related to staffing and resources necessary for infection prevention and antimicrobial stewardship programs to assist you in advocating for support from institutional leadership. For now, you can help to recruit the next generation of professionals who will enter this field as physicians, nurses, pharmacists, and public health professionals by introducing students to infection prevention and epidemiology roles, by inspiring them with stories of your own career path, and by involving them in this work.

Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, “asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.

Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection with high associated cost and poor patient outcomes. Many strategies for VAP reduction have been evaluated. However, the combination of strategies with the optimal cost-benefit ratio remains unknown. To determine the preferred VAP prevention strategy, both from the hospital and societal perspectives. A cost-benefit decision model with a Markov model was constructed. Baseline probability of VAP, death, reintubation, and discharge from the intensive care unit (ICU) alive were ascertained from clinical trial data. Model inputs were obtained from the medical literature and the U.S. Department of Labor; a device cost was obtained from the manufacturer. Sensitivity analyses were completed to test the robustness of model results. Overall least expensive strategy and the strategy with the best cost-benefit ratio, up to a willingness to pay threshold of $50,000-100,000 per case of VAP averted was sought. We examined a total of 120 unique combinations of VAP prevention strategies. The preferred strategy from the hospital perspective included subglottic suction endotracheal tubes, probiotics, and the Institute for Healthcare Improvement VAP Prevention Bundle. The preferred strategy from the point of view of society also included additional prevention measures (oral care with chlorhexidine and selective oral decontamination). No preferred strategies included silver endotracheal tubes or selective gut decontamination. Despite their infrequent use, current data suggest that the use of prophylactic probiotics and subglottic endotracheal tubes are cost-effective for preventing VAP from the societal and hospital perspectives.

The importance of infection prevention and control and healthcare epidemiology (IPC/HE) in healthcare facilities was highlighted during the COVID-19 pandemic. Infectious disease (ID) clinicians often hold leadership positions in IPC/HE teams; however, there is no standard for training or certification of ID physicians specializing in IPC/HE. We evaluated the current state of IPC/HE training in ID fellowship programs. A national survey of ID fellowship program directors was conducted to assess current IPC/HE training components in programs and plans for expanded offerings. All ID fellowship program directors in the United States and Puerto Rico. Surveys were distributed using Research Electronic Data Capture (REDCap) to program directors in March 2023, with 2 reminder emails; the survey closed after 4 weeks. Of 166 program directors, 54 (32.5%) responded to the survey. Among respondent programs, 49 (90.7%) of 54 programs reported didactic training in IPC/HE averaging 4.4 hours over the course of the fellowship. Also, 18 (33.3%) of 54 reported a dedicated IPC/HE training track. Furthermore, 23 programs (42.6%) reported barriers to expanding training. There was support (n = 47, 87.0%) for formal IPC/HE certification from a professional society within the standard fellowship. Despite the COVID-19 pandemic highlighting the need for ID medical doctors with IPC/HE expertise, formal training in ID fellowship remains limited. Most program directors support formalization of IPC/HE training by a professional organization. Creation of standardized advanced curriculums for ID fellowship training in IPC/HE could be considered by the Society of Healthcare Epidemiology of America (SHEA) to grow, retain, and enhance the IPC/HE physician workforce.

BackgroundContact precautions for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are a resource-intensive intervention to reduce healthcare-associated infections, potentially impeding patient throughput and limiting bed availability to isolate other contagious pathogens. We investigated the impact of the discontinuation of contact precautions (DcCP) for endemic MRSA and VRE on patient outcomes and operations metrics in an acute care setting.MethodsThis is a retrospective, quasi-experimental analysis of the 12 months before and after DcCP for MRSA and VRE at an academic medical centre. The frequency for bed closures due to contact isolation was measured, and personal protective equipment (PPE) expenditures and patient satisfaction survey results were compared using the Wilcoxon signed-rank test. Using an interrupted time series design, emergency department (ED) admission wait times and rates of patient falls, pressure ulcers and nosocomial MRSA and VRE clinical isolates were compared using GEEs.ResultsPrior to DcCP, bed closures for MRSA and/or VRE isolation were associated with estimated lost hospital charges of $9383 per 100 bed days (95% CI: 8447 to 10 318). No change in ED wait times or change in trend was observed following DcCP. There were significant reductions in monthly expenditures on gowns (−61.0%) and gloves (−16.3%). Patient satisfaction survey results remained stable. No significant changes in rates or trends were observed for patient falls or pressure ulcers. Incidence rates of nosocomial MRSA (1.58 (95% CI: 0.82 to 3.04)) and VRE (1.02 (95% CI: 0.82 to 1.27)) did not significantly change.ConclusionsDcCP was associated with an increase in bed availability and revenue recovery, and a reduction in PPE expenditures. Benefits for other hospital operations metrics and patient outcomes were not identified.

To the Editor—Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) is primarily spread through respiratory droplets with increased risk of transmission in households and congregate settings.1–3 Asymptomatic and presymptomatic transmission of SARS-CoV-2 have also made containment difficult.1,4 Inpatient psychiatry units present unique challenges in controlling infectious disease outbreaks.5,6 Here, we describe the management of a coronavirus disease 2019 (COVID-19) outbreak on an inpatient psychiatry unit, highlighting unique considerations for this patient population. Inpatient Psychiatric Control Interventions Implemented during Outbreak General Patient Level Environmental Level Specific to the Psychiatric Population ▪ Surgical masks for all patients ▪ Surgical masks and eye protection for all employees ▪ Symptom screening patient and staff daily ▪ Increase patient compliance to hand hygiene ▪ Restrict all visitors ▪ Increase frequency of cleaning in shared spaces ▪ Bleach cleaning daily ▪ Enhanced terminal cleaning: ○ Change curtains ○ Deep cleaning with bleach ○ Ultraviolet (UV) light disinfection ▪ Adhere to safety measures for patient masking (ie, no metal nose clips or ties) ▪ Limit number of patients per group therapy session to five and physically distance ▪ Stagger patient meal times ▪ Reduce shared patient supplies The outbreak lasted for a total of 27 days, with the last cases confirmed on day 20. [...]asymptomatic patients and staff were not tested at the time of this outbreak due to limited global testing capacity early in the pandemic.

Purpose of ReviewCandida auris has recently emerged as a pathogen with the potential for nosocomial transmission and outbreaks. The aim of this review is to summarize the global dissemination of this pathogen, characterize patient and facility characteristics associated with infection and outbreaks, and outline evidence to support interventions to prevent of transmission in the healthcare setting.Recent FindingsC. auris has emerged separately in four clades, with international spread within a decade of its first identification and report. Acquisition and infection have predominantly been identified as healthcare-associated events. The presence of invasive devices, intensive care, and broad-spectrum antibiotic and antifungal use may be important risk factors for the development of infection due to C. auris. Nosocomial transmission is likely associated with colonization density and suboptimal infection prevention practices. The optimal strategy for reducing transmission from the environment requires further study.SummaryCandida auris is a recently emerging fungal pathogen that may cause nosocomial infections and outbreaks. Based on observed transmission patterns and interventions, key prevention measures outlined in the review include case finding and surveillance, hand hygiene, and environmental disinfection.

Background: Clostridioides difficile infections (CDI) are associated with patient morbidity and mortality and also may impact reputational and financial metrics. CDI was identified as a healthcare-associated infection of concern at several of the hospitals in our healthcare system and set as a target for improvement. We sought to create an easily interpretable tool to help select hospitals with the greatest opportunity to benefit from this work. Methods: The National Healthcare Safety Network’s (NHSN) data (infection counts and number of predicted infections) for LabID CDI from Oct 2023-Sept 2024 were exported for 3 academic and 8 community hospitals in our healthcare system in eastern Massachusetts and New Hampshire. Using published source code from the Centers for Disease Control and Prevention recreated in R software (v.4.3.3), we calculated the statistical significance of the Standardized Infection Ratio (SIR) relative to 1.0 using the p-value. We then performed the statistical test iteratively by adjusting the number of infections by one in each direction from the true observed number of infections, to establish thresholds for significantly improved or worsened performance. Data were displayed as gauge charts with indication of current SIR statistical significance defined by color (red, yellow and green) and distance to threshold that would alter that significance (See Figure). Viable opportunities for improvement were defined as being within 5 or fewer infections of calculated thresholds. Results: Review of CDI data across all 11 sites demonstrated more improvement opportunities at some sites than others. Four sites were in green ranges, seven in yellow and none in red. All opportunities for viable improvement were identified in the yellow range; 5 of 11 sites had potential for improvement in SIR (Hospitals C, D, E, I, K) and 2 for worsening of SIR (Hospitals G, J); see Figure. Conclusion: In our healthcare system, this model provided insight into site-specific opportunities for improvement in CDI by highlighting sites closest to achieving a statistically significant change in SIR. Although factors such as morbidity and cost may influence selection of targets for improvement, visual depiction of viable thresholds for change in SIR may provide an indicator of facilities likely to yield the most benefit relative to investment required for reduction efforts.