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Background Active surveillance testing (AST) is one element of a comprehensive Carbapenem-resistant Enterobacteriaceae (CRE) prevention strategy. However, the utility of AST may be impacted by compliance with sample collection and the quality of specimens. Here, we describe strategies used to optimize a CRE AST program at a large academic medical center. Methods Tests ordered, collected, rejected, and processed were tracked weekly for each participating unit. Sample collection compliance and acceptance rates were calculated and tracked weekly. Strategies were implemented to improve collection compliance and sample acceptance rates, including computerized provider order entry, printed educational materials, and audit and feedback. Weekly dedicated Infection Preventionist (IP) time was estimated. Results Over 35 months, mean collection compliance increased from 82.7% to 91.2%, and then decreased to 86.2%. Over 27 months, sample acceptance rate increased from 57.7% to 83.6%, and then remained stable at 83.4%. Over 39 months, dedicated weekly IP time decreased 92%. Discussion Use of evidence-based quality improvement strategies optimized our CRE AST program. Optimizing the AST process aids in early CRE detection, leading to timely isolation and preventing the spread of CRE to other patients. Other hospitals may benefit from these lessons and enhance local AST programs.

We present a case of an invasive Curvularia infection in a patient who developed following bilateral orthotopic lung transplantation despite receiving post-transplant antifungal prophylaxis. This infection presented as mold colonies studding the interior surface of his chest tubes. Despite surgical washout of his bilateral pleural cavities and antifungal treatment with liposomal amphotericin B, micafungin, and isavuconazonium sulfate, the patient died.

Background During the COVID-19 pandemic, the critical role of the hospital Infection Prevention department was highlighted. To serve as a resource, Infection Preventionists (IP) at a large, quaternary-care center are reachable during normal hours and an IP covers a 24-hour on-call pager on a rotating basis. During the pandemic, the number of IP pages skyrocketed from an average of 6 pages to over 50 pages per day. With this unprecedented strain and limited human resources, innovative changes were made within the department. Methods During the acute phase of our COVID-19 response, IPs flexed from a 7 day on call period to a shortened 3–4-day period. To offload the number of IP pages, a hospital epidemiologist pager was created. The department physically relocated to the hospital's centralized incident command center and implemented Microsoft TeamsTM. System-wide IP videoconferences were scheduled. Lastly, structured work-at-home options were created. Results Shortening the length of time covering the on-call pager reduced the burden and allowed IPs to obtain adequate rest between periods of coverage. The hospital epidemiologist pager served as a resource when physician input was requested, which helped offload the number of calls placed to the IP. Physically relocating and implementing Microsoft TeamsTM promoted teamwork, accessibility, and communication within the department and the hospital. During the 4-week acute phase of our COVID-19 response, 16 videoconferences improved communication and needs of the 3-hospital system. Lastly, many IPs opted for work-from-home options, improving the sense of support and well-being of team members. Conclusions We describe strategies that may be implemented by departments to meet organizational needs while promoting the wellbeing of staff. These changes may be used during periods of high-demand or may be permanent based on feedback from key stakeholders.

This article examines factors that influence support for local-government initiated mangrove protection activities. Using an ordered probit approach, we show how fisher characteristics and regional variation affect the level of support given to mangrove protection activities. Our results suggest that education levels, knowledge of the dangers of mangrove depletion, and pre-existence of mangrove-related ordinances in their municipalities are the factors that significantly affect the level of support for mangrove protection activities. In addition, we find that surveyed fisher communities from the southern region of the Philippines are less likely to support mangrove protection activities probably due to the higher rate of poverty incidence in these areas. These results have important implications for local government units in charge of mangrove planning and management.