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Objective: To examine the relationship between race and ethnicity and central line-associated bloodstream infections (CLABSI) while accounting for inherent differences in CLABSI risk related to central venous catheter (CVC) type., Design: Retrospective cohort analysis., Setting: Acute care facilities within an academic healthcare system., Patients: Adult inpatients from January 2012 through December 2017 with CVC present for ≥2 contiguous days., Methods: We describe variability in demographics, comorbidities, CVC type/configuration, and CLABSI rate by patient's race and ethnicity. We estimated the unadjusted risk of CLABSI for each demographic and clinical characteristic and then modelled the effect of race on time to CLABSI, adjusting for total parenteral nutrition use and CVC type. We also performed exploratory analysis replacing race and ethnicity with social vulnerability index (SVI) metrics., Results: 32,925 patients with 57,642 CVC episodes met inclusion criteria, most of which (51,348, 89%) were among non-Hispanic White or non-Hispanic Black patients. CVC types differed between race/ethnicity groups. However, after adjusting for CVC type, configuration, and indication in an adjusted cox regression, the risk of CLABSI among non-Hispanic Black patients did not significantly differ from non-Hispanic White patients (adjusted hazard ratio [aHR] 1.19; 95% confidence interval [CI]: 0.94, 1.51). The odds of having a CLABSI among the most vulnerable SVI subset compared to the less vulnerable was no different (odds ratio [OR] 0.95; 95% CI: 0.75-1.2)., Conclusions: We did not find a difference in CLABSI risk between non-Hispanic White and non-Hispanic Black patients when adjusting for CLABSI risk inherent in type and configuration of CVC.

Background: The Society for Healthcare Epidemiology of America (SHEA) is a leading medical society for infection prevention and antibiotic stewardship. This descriptive study evaluated speaker demographics at the annual SHEA Spring conferences from 2019 to 2022., Methods: This was a retrospective, descriptive analysis of the demographic composition of speakers at the annual SHEA Spring conferences between 2019 and 2022, excluding the cancelled 2020 conference. Self-reported demographics were available for gender, race, ethnicity, age, primary practice setting, and professional degrees in speaker and membership categories., Results: In total, 447 speaker slots were filled by 305 unique speakers over 3 years. Average annual membership included 55.2% female, 44.8% male, 69.3% White, 21.4% Asian, 6.0% Hispanic/Latino, 2.9% Black, and 0.4% American Indian/Alaska Native or Native Hawaiian/Pacific Islander (AIAN/NHPI); 48.9% did not report a race or ethnicity. Speakers during the same period were 63.5% female, 36.5% male, 68.2% White, 13.3% Asian, 3.8% Black, 3.4% Hispanic/Latino, 0.8% AIAN/NHPI; 13.4% did not report race or ethnicity. In 2021, pharmacists represented 11.6% of speakers (and 2.9% of members) and members with nondoctoral degrees represented 11.6% of speakers (and 21.5% of members) ( P < .0001). In each year, we detected underrepresentation of community and private-practice speakers relative to membership (eg, in 2022, 4.3% of speakers vs 15.7% of members; P < .05)., Conclusions: The SHEA Spring conferences demonstrated an increase in pharmacist speakers over time, but speakers from community hospitals and with nondoctoral degrees remain underrepresented relative to membership. Racial and ethnic minoritized individuals remain underrepresented as members and speakers. Intentional interventions are needed to consistently achieve equitable speaker representation across multiple demographic groups.

Objective: To evaluate whether a series of quality improvement interventions to promote safe perioperative use of cephalosporins in penicillin-allergic patients improved use of first-line antibiotics and decreased costs., Design: Before-and-after trial following several educational interventions., Setting: Academic medical center., Patients: This study included patients undergoing a surgical procedure involving receipt of a perioperative antibiotic other than a penicillin or carbapenem between January 1, 2017, and August 31, 2019. Patients with and without a penicillin allergy label in their electronic medical record were compared with respect to the percentage who received a cephalosporin and average antibiotic cost per patient., Methods: A multidisciplinary team from infectious diseases, allergy, anesthesiology, surgery, and pharmacy surveyed anesthesiology providers about their use of perioperative cephalosporins in penicillin-allergic patients. Using findings from that survey, the team designed a decision-support algorithm for safe utilization and provided 2 educational forums to introduce this algorithm, emphasizing the safety of cefazolin or cefuroxime in penicillin-allergic patients without history of a severe delayed hypersensitivity reaction., Results: The percentage of penicillin-allergic patients receiving a perioperative cephalosporin improved from ∼34% to >80% following algorithm implementation and the associated educational interventions. This increase in cephalosporin use was associated with a ∼50% reduction in antibiotic cost per penicillin-allergic patient. No significant adverse reactions were reported., Conclusions: An educational antibiotic stewardship intervention produced a significant change in clinician behavior. A simple intervention can have a significant impact, although further study is needed regarding whether this response is sustained and whether an educational intervention is similarly effective in other healthcare systems.

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).

Objective: To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI)., Design: An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours., Setting: Four hospitals in an academic healthcare network., Patients: All patients with a C. difficile order after hospital day 3., Intervention: Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order ("nudge")., Results: Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73-0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98-1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61-1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93-0.97)., Conclusion: An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.