 Resource-intensive interventions and education are susceptible to a lack of long-term sustainability and regression to the meme. The respiratory culture nudge changed reporting to commensal respiratory flora only, no s. aureus misa or p originosa. This study demonstrated sustained reduction in broad-spectrum antibiotic duration and long-term sustainability three years after implementation. This article was authored by Supreet Kaur, Mary Hutton, Rachel M. Kenney, and others.