Citations

Background: We had a large-scale measles exposure event affecting 626 patients. Management of exposed patients was urgent, involving quarantine, post-exposure prophylaxis (PEP), and symptom monitoring on a case-by-case basis. Cases were initially tracked and managed using a combination of multiple spreadsheets amongst stakeholders as well as lists within the electronic health record (EHR). Using shared spreadsheets and lists created significant challenges with maintaining and editing multiple copies and updating workbooks simultaneously. Methods: Infection Prevention and Control (IPAC) worked with primary care personnel and EHR developers to create a shared registry that would prioritize communication and follow-up for exposed patients based on age and immunity. Patients are initially added to the shared registry within the EHR by reviewing non-registry reports and tagging patients, identified using exposure timeframes that overlapped with the index measles cases, in a manner that transferred them to the shared registry. From this registry, measles, mumps, and rubella vaccine status can be confirmed, immune status can be identified, and criteria for PEP assigned. High-risk patients are then contacted with recommendations from IPAC and primary care. Communication and follow-up are tracked directly within the shared registry to ensure appropriate patient management. The exposure management registry is further leveraged throughout the measles outbreak timeframe by allowing real-time monitoring of patients that require additional precautions or guidance related to their exposure. Result: The shared registry enhanced documentation accuracy and transparency between stakeholders. It led to availability of real-time status of exposed patients for the duration of the measles outbreak timeframe. Overall, the registry enabled time-sensitive patient communication to all exposed patients and rapid identification of those who needed PEP. Communication could happen rapidly and seamlessly between care teams within the organization, and the necessary information could be shared quickly with public health authorities as required. Conclusion: Large scale exposures are a challenge to manage and ensure appropriate action and communication occurs. Errors can be prevented by having a single shared exposure management registry. A registry enables care teams to quickly identify and prioritize patients for measles follow-up, communication, PEP, and ongoing management across outbreak timeframes. This process reduces both time and operational burdens of exposure follow-up tracking outside of the EHR.

Background: Measles is a highly transmissible virus. A single case can result in significant exposures within a healthcare facility and prompt action is needed to prevent secondary cases. In October 2025, Infection Prevention and Control (IPAC) was notified of a patient being admitted to our facility with recent international travel and symptoms consistent with measles. The patient was unvaccinated and had five healthcare facility visits prior to measles being suspected and subsequently confirmed. Objective: To describe our facility’s effective identification, prioritization, and prophylaxis of individuals exposed to measles. Methods: IPAC leveraged the electronic medical record to identify potentially exposed patients. Patients were quickly assessed for age and immune status, then prioritized and assigned to primary care teams. These teams promptly contacted patients and coordinated PEP administration. Results: Across five encounters, the index patient exposed 539 other patients. Due to delayed notification, our teams had less than four days to administer PEP for those exposed and still within PEP window. PEP administration began within hours of the index case’s positive test and patients received PEP within three days (Table 1). No secondary measles cases occurred within our facility. Conclusion: Timely and coordinated multidisciplinary effort enabled us to rapidly respond to our first measles case and control secondary transmission. Although the index case resulted in a large exposure, patients that were exposed and eligible for PEP were quickly prioritized to prevent secondary transmission.

Background: Advanced planning and adaptable response strategies are essential for preventing measles transmission in healthcare facilities. Objective: To describe a measles management plan and subsequent modifications in response to a cluster of measles cases. Methods: Drawing on previously published work (doi:10.1017/ice.2025.49), the Infection Prevention and Control (IPAC) team initiated a multi-disciplinary team and developed a measles preparedness plan with the following domains: Guidance and education; early detection and testing; isolation and patient movement; contact tracing and exposure management (Table 1). In October 2025, a patient was admitted during their fifth healthcare encounter and was diagnosed with measles. Two family members were later hospitalized with measles. Delayed recognition of the first case prompted enhancements to our preparedness framework (Table 1). Results: The first case resulted in 539 exposed patients. The second resulted in 87 exposures, and the third resulted in no exposure. Despite the extensive exposure, zero secondary measles were reported. Conclusion: Proactive planning enabled rapid response to our first case and controlled secondary transmission. Despite extensive planning, delayed identification of the first case caused significant exposures. As the cluster unfolded, we refined our plan, resulting in zero exposures from the last patient and zero secondary cases, despite over 850 exposures. These efforts may guide other healthcare facilities in improving their measles preparedness and response.

Background: In 2025, 50 measles outbreaks drove 87% of confirmed cases reported in the United States. As a highly infectious virus with an estimated R ranging from 12-18, we sought rapidly scalable and implementable measles preparedness measures for our facilities. Methods: The electronic health record (EHR) has flags that can be placed on patient records to denote the presence of, or concern for, active, transmissible infections. These flags are highly visible in the EHR and represent a good usability heuristic as front line providers are already trained to look for this information. Infection Prevention and Control (IPAC) worked with nursing informatics to develop measles-specific flags for suspected, confirmed and exposed patients in the EHR, expanding flagging functionality in preparation for potential measles cases and exposures. The flagging was tied to registry functionality to allow for tracking of exposed and confirmed cases longitudinally for supporting IPAC investigations in addition to clinical operations. Results: Three different flags were developed in the EHR to address measles. Specific criteria were created for each flag, as shown in Table 1. Table 1: Attached as Image Conclusion: As a highly contagious virus, measles presents unique challenges to healthcare facilities managing both cases and exposures. Measles flags within the EHR can be leveraged to assist facilities with case tracking, exposure management, and infection prevention and control.

Background: Carbapenemase-producing organisms (CPO) are a serious public health threat. The Centers for Disease Control and Prevention (CDC) guidelines for combating CPO includes a recommendation to screen selected high risk patients. We describe a program to identify and screen patients at risk for CPO. Setting: An academic, tertiary care center with 2,059 licensed beds and 74,359 admissions a year. Methods: A report was created in the electronic medical record (EMR) to identify adult patients admitted in the previous 24 hours who were from countries and states with known CPO transmission based on address and zip code. A nursing protocol was subsequently developed in the EMR to facilitate CPO screening for eligible patients at admission. After the CPO order is placed, an electronic communication is sent via the EMR alerting the patient care team of the order, the rationale for screening, details on swab collection, and links to a toolkit with resources to help answer patient questions. A single perirectal swab is obtained by the patient’s primary nurse and is tested for Klebsiella pneumoniae Carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), oxacillinase-48 (OXA-48), and Verona integron-encoded metallo-β-lactamase (VIM) by polymerase chain reaction (PCR). Patients may refuse testing. Results: From May 2018 through November 2025, 6,039 patients were identified for CPO screening using case-finding report. Of these patients, 2,424 had CPO swabs completed. Eighteen patients with CPO were identified with an overall yield of 0.75% on admission screening. There was one patient who tested positive for KPC, 10 patients who tested positive for NDM, and 5 patients who tested positive for OXA-48. Two patients were identified to have both NDM and OXA-48. Conclusions: The EMR can be leveraged for early identification and screening of patients with epidemiologically significant pathogens. Use of the nursing protocol has enabled IPAC to complete timely CPO surveillance and prevent transmission to other patients. Protocols within the EMR can be effectively replicated for a timely response to emerging infections.

Background: A measles case requires immediate action to identify and administer prophylaxis to exposed individuals in healthcare settings. Infection preventionists (IPs) often balance proactive contact tracing with waiting for a positive test result. Objective: To develop a tool that enables IPs to stratify suspect measles cases by risk level, thereby supporting the decision to prioritize or defer active intervention while awaiting test results. Methods: In spring 2025, we developed a preliminary matrix and used 19 additional suspect patients to further refine the scoring of the tool. In August 2025, we deployed a finalized tool. The two-dimensional risk matrix incorporated both epidemiological risk factors and clinical risk factors, each scored numerically based on yes or no questions. The sum of both categories was used to assign a final risk level that determined the recommendations for IPs (Figure 1). The study population included patients tested for measles during the implementation period. Descriptive statistics were used to summarize the distribution of risk categories and outcomes. Among the whole cohort, Firth’s logistic regression was used to evaluate the association between clinical or epidemiological risk score and measles diagnosis. Among the production cohort, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to evaluate the diagnostic performance. Results: Since implementation, the matrix was applied to 56 patients tested for measles. Of these, 10.7% (n=6) were categorized as high risk, 32.1% (n=18) as medium, and 57.1% (n=32) as low. Four of the 56 patients were positive for measles, 3 were categorized as high-risk and 1 as medium risk. Each one-unit increase in epidemiological risk was associated with a 2 folds increase in the odds of a positive measles diagnosis (odds ratio = 2.0; 95% CI, 1.3–3.6). The low-risk category had an NPV of 1, indicating that all low?risk patients tested negative, thus supporting safe workload reduction by deprioritizing these cases. Conclusion: The Measles Exposure Response Risk Matrix effectively stratified cases and supported IP prioritization efforts. Low-risk groups required no action, expedited testing was reasonable for medium-risk cases, and proactive actions were reserved for high-risk cases. Clinical and epidemiologic risk scores progressed from arbitrary assignment to validated metrics, confirmed by statistical analysis. The flexible design permits adaptation to other infectious diseases, including avian influenza and mpox. With rising measles incidence, tools like this matrix will be essential to support rapid, evidence-based actions by infection prevention teams.

Abstract Background Staphylococcus aureus (SA) infections, both methicillin-susceptible and methicillin-resistant (MSSA, MRSA), cause significant morbidity among infants in neonatal intensive care units (NICU). Colonization usually precedes infection. We studied the molecular epidemiology of SA colonization in NICU infants using whole genome sequencing (WGS) and in relation to the opening of a new NICU with single-family rooms. Methods From 2019-22, a prospective cohort of infants admitted to the Level IV NICU at Mayo Clinic, Rochester, MN was screened twice weekly for SA colonization using cultures of nares/axilla/groin swabs. Infection control procedures were consistent throughout, including use of Contact Precautions for infants colonized with MRSA but not for MSSA. The study was divided into period 1 (1/1/2019-11/30/2020) and period 2 (12/1/2020-12/31/2022) due to a move from a 34-bed unit (26 beds in four open-bay rooms and 8 beds in single-family rooms) to a new 34-bed unit (all single-family rooms). WGS was performed using Illumina MiSeq instrumentation and chemistry with Illumina Nextera XT library chemistry. Assembly and core genome multilocus sequence typing analysis were performed with Ridom SeqSphere+ software. Groups of related isolates were identified based on the number of allelic differences (related 0-8 differences, possibly related 9-29 differences, unrelated ≥ 30 differences). Groups of MRSA-related isolates were compared with reference USA genotypes. Chi square tests did not adjust for clustering. Results There were 663 admissions in period 1 and 730 in period 2. The prevalence of MSSA and MRSA colonization was unchanged in the two periods (MSSA, 18.6% vs. 16.7%, p=0.37; MRSA 1.8% vs. 3.3%, p=0.08). By WGS, most MSSA and MRSA isolates were unrelated to another isolate in both periods (Table). Groups of related MSSA and MRSA isolates differed between the two periods and the number of isolates/group was small (< 6 isolates). Groups of related MRSA isolates were associated with reference genotypes USA100 (period 1), USA1000 (periods 1 & 2), and USA300 (period 2). WGS Results for MSSA and MRSA in Periods 1 and 2 Conclusion NICU infants were usually colonized with unrelated strains of MSSA and MRSA, with only small clusters of related strains. The new NICU was not associated with a change in MSSA or MRSA colonization. Disclosures Priya Sampathkumar, MD, Merck Vaccines: Advisor/Consultant Robin Patel, MD, Abbott Laboratories: Advisor/Consultant|Adaptive Phage Therapeutics: Grant/Research Support|Adaptive Phage Therapeutics: Mayo Clinic has a royalty-bearing know-how agreement and equity in Adaptive Phage Therapeutics.|BIOFIRE: Grant/Research Support|CARB-X: Advisor/Consultant|ContraFect: Grant/Research Support|Day Zero Diagnostics: Advisor/Consultant|HealthTrackRx: Advisor/Consultant|Mammoth Biosciences: Advisor/Consultant|Netflix: Advisor/Consultant|Oxford Nanopore Technologies: Advisor/Consultant|PhAST: Advisor/Consultant|See details: Patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic|See details: continued, patent on an anti-biofilm substance issued|TenNor Therapeutics Limited: Grant/Research Support|Torus Biosystems: Advisor/Consultant|Trellis Bioscience, Inc.: Advisor/Consultant W. Charles Huskins, MD, MSc, ADMA Biologics: Advisor/Consultant|Bristol Myers Squibb: Stocks/Bonds|Pfizer: Advisor/Consultant|Pfizer: Stocks/Bonds|Zimmer Biomet: Stocks/Bonds

Abstract The integration of personal protective equipment (PPE) and procedures into breast imaging and intervention practices will mitigate the risk of transmission of COVID-19 during the pandemic. Although supply chain shortages have improved, understanding the proper use of PPE and protocols to mitigate overconsumption are important to ensure efficacious utilization of PPE. Protocols and best practices are reviewed, and guidelines and resource materials are referenced in order to support breast imaging healthcare professionals.

Candida auris is an emerging fungal pathogen with cases reported in countries around the world and in 19 states within the United States as of August 2020. The CDC has recommended that hospitals perform active surveillance upon admission for patients with the appropriate risk factors. Currently, active surveillance requires that local hospitals send surveillance swabs to a public health laboratory for analysis. In this work, a real-time PCR assay was developed for the specific detection of C. auris from surveillance swabs, blood, and urine to enable rapid detection of this pathogen. The assay uses commercially available primers and reporter probes and it was verified on the LightCycler 480 PCR platform. Contrived specimens and prospectively collected composite groin/axilla surveillance swabs were used to validate the assay. The performance of the PCR assay on surveillance swabs was also compared to a second PCR assay targeting C. auris that was performed at the Minnesota Department of Health–Public Health Laboratory (MDH-PHL). Our PCR assay is able to detect and differentiate C. auris from closely related Candida species such as C. duobushaemulonii, C. haemulonii, and C. pseudohaemulonii on the basis of melting curve temperature differences.