Pediatric patients undergoing cardiothoracic surgery are at increased risk for health care-associated infections, especially surgical site infections (SSIs). Delayed sternal closures are associated with prolonged lengths of stay and contribute to infection risks and morbidities. At a single-site academic pediatric center, we created an SSI-prevention bundle targeting the preoperative, intraoperative, and postoperative care periods. Using standard criteria, we determined the epidemiology of SSIs and measured SSI rates per 100 procedures from 2017 through 2023 before and after bundle implementation. Infections were predominantly caused by skin commensal bacteria. Despite an initial decrease in SSI rates for routine procedures and procedures with delayed sternal closures, there was no significant difference in SSI rates per 100 procedures during the preimplementation and postimplementation periods. However, compliance with bundle elements was preserved throughout the postimplementation period, including during the COVID-19 pandemic, which suggests that the use of the bundle is sustainable at our facility.

Repositioning a patient from the prone to supine position can delay the initiation of cardiopulmonary resuscitation (CPR). Investigators used high-fidelity simulation to assess the time to initiate chest compressions and the time during which compressions did not occur for supine and prone CPR. Sixty participants completed a knowledge assessment before and after attending an education session and completing two simulations (ie, supine, prone). Mean (SD) knowledge scores improved from 48.7% (17.4%) to 85.3% (14.7%) after the education and simulations (t = -12.32, P < .001). Prone CPR resulted in a significant reduction in the time to initiate chest compressions (13 seconds, prone; 314 seconds, supine; t = -31.79; P < .001) and a higher chest compression fraction (84% prone versus 42% supine; t = 19.1, P < .001). When compared to repositioning to supine, prone CPR decreased chest compression interruptions, and may therefore be beneficial during the perioperative period.

Water quality plays a critical role in health care, particularly in the processing of medical devices. This article highlights the infection control risks associated with water sources and the regulatory requirements for water management plans in health care facilities. The guidance on water quality has evolved from the initial technical information report provided by the Association for the Advancement of Medical Instrumentation in 2014 to the more recent 2023 publication of the American National Standards Institute and Association for the Advancement of Medical Instrumentation standard for water used in medical device processing. The new standard emphasizes the importance of consistent water and steam quality in instrument processing and outlines the chemical and microbiological parameters for water quality. This article also addresses the challenges of implementing these standards, discusses the implications for patient safety and instrument integrity, and provides strategies for health care teams to ensure compliance.

Candida auris is an emerging, multidrug-resistant fungus that poses a threat in health care settings because of its persistence on surfaces and ability to cause severe infections, particularly in immunocompromised patients. First identified in Japan in 2009, C auris has since spread globally, leading to numerous outbreaks. Its unique virulence factors, such as biofilm formation and immune evasion, contribute to its resilience and resistance to eradication. The most vulnerable populations include those with underlying conditions and those undergoing operative or other invasive procedures, highlighting the importance of this topic for perioperative personnel. Effective infection prevention strategies, including strict hand hygiene, environmental cleaning, and the use of appropriate personal protective equipment, are essential to prevent the spread of C auris. Early detection, accurate identification, and prompt isolation of infected patients are critical to mitigating outbreaks. Continued research and education are vital to developing more effective prevention and treatment protocols.

The AORN surgical attire guideline promotes cleanliness in the perioperative environment to minimize patients' risks of developing surgical site infections. In 2020, the surgical attire guideline adherence decision-making model was published based on findings from a study involving New England intraoperative team members. To explore the model's transferability across the United States, we replicated the 2020 study with intraoperative personnel who did not live or work in New England. The study results included the same core category as the 2020 study (ie, critical thinking), and we confirmed that intraoperative team members across the United States weigh the influence of various factors when deciding to what extent they would adhere to the surgical attire guideline. The results showed transferability of the theoretical model to perioperative settings across the United States. This model can be used to enhance intraoperative team members' surgical attire guideline adherence decisions.