March 2023 Vol. 27 No.

COVID-19

3 YEARS LATER
WHAT QUESTIONS ARE
STILL UNANSWERED?
PREVENTION
Foundations of
Patient Safety

ENVIRONMENTAL SERVICES
The Joint Commission:
What Should You Know?

PREVENTION
Reach for the Starts: Turn
Weaknesses Into Strengths

ENVIRONMENTAL SERVICES
Water-Free Care
in the ICU

LONG-TERM CARE
Bug of the Month:
Itchy, Itchy

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 TABLE OF CONTENTS

LITERATURE REVIEW
COVID-19
10 Are We Transmitting
SARS-CoV-2 to Our Pets?
By Tori Whitacre Martonicz

PREVENTION
11 Home Infusion Therapy Staff
Need More CLABSI Training,
Investigators Say
By Tori Whitacre Martonicz

22
OPERATING ROOM COVID-19

12 Routine Change of Surgical COVID-19, 3 Years Later:

Gloves/Instruments WHAT QUESTIONS ARE STILL UNANSWERED
Significantly Lowers SSIs An Infection Control Today® Special Report
By Tori Whitacre Martonicz

HEALTH CARE-ASSOCIATED INFECTIONS FEATURES

13 Making It Easier to Categorize PREVENTION PREVENTION
Patients With SAB
By Infection Control Today® Editorial Staff 18 Focus on 4 Foundations of 28 Reaching for the Stars:
Patient Safety Turn Your Weaknesses Into
By Alison L. Galdys, MD; Kari A. Gand, Successes
IN ADDITION MPH, CIC; and Oluwafemi (Femi) By Heather Saunders, MPH, RN, CIC
B. Abimbade, MBBS, MPH, CIC
COVID-19
6 Publisher’s Note PREVENTION
30 First Responders Tackle
LONG-TERM CARE 20 What You Should Know About Infection Control and
The Joint Commission
8 Bug of the Month By Tori Whitacre Martonicz
Prevention Challenges
By Heather Saunders, MPH, RN, CIC By Morgan Waddell and
Mackenzy Rodgers
14 In the News ENVIRONMENTAL SERVICES
26 Stop Infections in Their Sign up for
17 Interactive News Tracks: Water-Free Care Infection Control Today®
in the ICU
33 Product Locator By Isis Lamphier, MPH, CIC e-newsletters

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 PUBLISHER’S NOTE

Paying It Forward
A
s a health care communications disease progressed rapidly, and Robbie died in New Jersey and Ohio, where we have
organization, partnering with non- a few months later. At that time, patients offices. The Leukemia & Lymphoma Society
profit organizations and charities to with leukemia often died within 3 months holds 140 “Light the Night” walks around
raise money for research for diseases that of receiving a diagnosis because there were the United States. For MJH, “Light the Night
do not yet have a cure is important work no viable treatments for the condition. Five New Jersey” and “Light the Night Cleveland”
for MJH Life Sciences®. We work across all years later, Robbie’s parents, Rudolph and both were a great success, bringing asso-
our brands and departments to increase Antoinette de Villiers, frustrated by how ciates and their families out for a night of
awareness and bring much-needed fund- little was being done for patients with this festivities, a short fundraising walk, and, as
ing, an initiative that everyone at MJH Life devastating illness, began a fundraising day turned into dusk, a beautiful moment
Sciences® embraces. In 2022, our company program in their son’s name. The founda- when illuminated white, red, and gold
set a goal of raising $150,000 for the vari- tion steadily grew, eventually evolving into lanterns floated up into the sky (white for
ous charities and nonprofit organizations the Leukemia & Lymphoma Society. Today, survivors, red for supporters, and gold for
we align with, and by end of year, we had it is the largest nonprofit health organi- the memory of loved ones who died).
surpassed that goal, raising $175,000. zation dedicated to funding blood cancer For more information on how you can get
One of the groups I am most passion- research, offering education and patient involved, visit https://www.lls.org/.
ate about is the Leukemia & Lymphoma services throughout the United States.
Society. Backround: In 1944, Robbie de Vil- In October 2022, MJH Life Sciences® was
Mike Hennessy Jr
President and CEO
liers, a 16-year-old boy living in New York, New proud to once again be part of an annual
MJH Life Sciences®
York, received a diagnosis of leukemia. The Leukemia & Lymphoma Society fundraiser

EDITORIAL ADVISORY BOARD

Katherine K. Perez, PharmD, BCIDP
Yi Guo, PharmD
Infectious Diseases & Antimicrobial
Codirector of the Antimicrobial Stewardship Clinical Specialist
Fibi Attia, MD, MPH, CIC Stewardship Program
Infection Control Coordinator Houston Methodist Hospital System
Montefiore Medical Center, HOUSTON, TX
Penn State Milton S. Hershey Medical Center Albert Einstein College of Medicine
HERSHEY, PA BRONX, NY
Saskia v. Popescu, PhD,
Brooke Decker, MD Jenny Hayes, MSN, RN, MPH, MA, CIC
Director of Infection Prevention CIC, CAIP, CASSPT Infectious Disease Epidemiologist and Infection
VA Pittsburgh Healthcare System Director of Infection Prevention Preventionist, Assistant Professor
NIH Clinical Center Schar School of Policy and Government
Jefferson Health New Jersey
PITTSBURGH, PA
STRATFORD, NJ at George Mason University
PHOENIX, AZ
Jody Feigel, MSN, RN
Kevin Kavanagh, MD, MS
Nurse Manager for Infection Prevention Sara Reese, PhD, MPH, CIC, FAPIC
Founder and Board Chairman
VA Pittsburgh Healthcare System System Director of Infection Prevention
Health Watch USA
PITTSBURGH, PA SCL Health System
SOMERSET, KY
BROOMFIELD, CO
Monica Gandhi, MD, MPH
Susan G. Klacik, BS, CRCST, FCS
Director Heather Saunders, MPH, RN, CIC
Clinical Educator
UCSF Center for AIDS Research (CFAR) Director of Infection Control
International Association of Healthcare
Infectious Diseases Doctor and Professor of Central Service Materiel Management Johns Hopkins Office of Population Health
Medicine at UCSF CHICAGO, IL BALTIMORE, MD
University of California, San Francisco
SAN FRANCISCO, CA Rebecca Leach, MPH, BSN, RN, CIC Linda Spaulding, RN-BC,
Infection Prevention Coordinator CIC, CHEC, CHOP
Maya Gossman, RN HonorHealth Infection Prevention Consultant
Vascular Access Nurse SCOTTSDALE, AZ InCo and Associates International, Inc
Stillwater Medical Center LAKEWOOD RANCH, FL
STILLWATER, OK Theresa Madaline, MD
Healthcare Epidemiologist
Robbie Hilliard, MSN, RN, CIC Montefiore Health System Lisa Waldowski, DNP, RN, CIC
Infection Prevention Coordinator Assistant Professor, Infectious Diseases Regional Director in Infection
Carl Vinson V.A. Medical Center Albert Einstein College of Medicine Prevention and Control
DUBLIN, GA NEW YORK, NY Kaiser, Permanente
OAKLAND, CA

La’Titia Houston, MPH, BSN, Nancy Moureau, PhD,

RN, CRNI, CPUI, VA-BC Sharon Ward-Fore, MS,
RN, MT(AAB), CBSPD, CIC
Chief Executive Officer MT(ASCP), CIC, FAPIC
Senior Infection Preventionist
PICC Excellence, Inc Infection Prevention Consultant
Parkland Health
HARTWELL, GA CHICAGO, IL
DALLAS, TX

6 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

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 BUG OF THE MONTH

long-term care

Itchy, Itchy
To discover who I am, visit
BY HEATHER SAUNDERS, MPH, RN, CIC
InfectionControlToday.com/

I
am not a bacterium or a virus, but I view/march-2023-bug-month
am contagious! I can cause significant
clusters of outbreaks in communal
settings such as nursing homes, hospitals, For those who have never been infected partners, and individuals in communal
prisons, day care centers, and schools. It’s by my bite, my incubation period is or other settings where prolonged close
easy for me to cause outbreaks in settings rather long. It takes approximately 4 to contact is common, such as in health care.
where individuals live in close contact 8 weeks after an exposure before a rash Diagnosis is made based on appearance
or where there is prolonged contact. appears and the infected individual and symptoms, as well as careful skin
It is especially concerning when a severe begins to itch. However, for those I’ve scraping to observe microscopically for
form of me presents in an immunocom- infected before, symptoms can appear my presence. Patients infected with
promised population. This form is highly as soon as 1 to 4 days after exposure. me are treated with a topical cream
contagious and requires prompt treat- The itching that I cause most commonly formulated to kill any presence of my
ment to prevent outbreaks. But regardless occurs at night, and the rash looks like eggs and me. It is recommended that
of my form or the setting, I always cause small pimples, frequently located in household members and sexual partners
intense itching (pruritus). the webbing between fingers. However, also be treated. In health care, due to

SCIEPRO@STOCK.ADOBE.COM
I am incredibly old; I’m ancient, in fact. I can also show up on wrists, armpits, the risk of spread, patients found to be
It is believed that the Greek philosopher elbows, genitalia, buttocks, and nipples. infected with me are placed on contact
Aristotle (384-322 BC) first described me In younger children, the rash I cause may precautions until 24 hours after the
in documented literature, calling me “lice also appear on the head, face, neck, and initiation of treatment. Occasionally,
in the flesh.” Although I would be further palms. Sometimes the rash will blister in communal settings and health care,
discussed in early scientific literature in or scab, and it can become infected with direct care staff also may be treated
1100 AD, it would be more than 500 years bacteria (eg, Staphylococcus aureus or after exposure.
until I would be connected to the human β-hemolytic streptococci) if not managed Who am I?
condition I cause. An Italian physician appropriately. Although death from
named Giovan Cosimo Bonomo would my infection alone is extremely rare,
describe me in 1687 as “a creature with subsequent bacterial infections can cause MISSED LAST MONTH'S
6 legs, a sharp head, and [2] little horns severe consequences.
BUG OF THE MONTH?
at the end of a snout.” A fitting descrip- Brief contact between individuals
tion, if I do say so. Bonomo was correct does not generally result in my spread.
in noting that I could be spread through Contact usually needs to be prolonged SCAN THE
direct contact with an infected individual, before an exposure will lead to infec- QR CODE.
or even through the bed linens or clothing tion. This is why I am easily spread
of an infected individual. among household members, sexual

8 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

ICT0323_008_BOTM.indd 8 2/15/23 3:47 PM

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ICT0323_009_MWN 2.indd 1 2/10/23 3:39 PM

 LITERATURE REVIEW

vance to other zoonoses transmitted in a

COVID-19 household setting,” the authors wrote. “In
particular, our findings indicate households

Are We Transmitting in this population are willing to adopt mea-

sures to protect their pets from SARS-CoV-2
infection and that these measures might

SARS-CoV-2 to Our Pets? be effective, indicating an opportunity to

prevent household transmission of zoo-
noses through health education and policy.”
BY TORI WHITACRE MARTONICZ Julianne Meisner, PhD, the study’s lead
author, is a veterinarian and an assistant

S
ince the start of the COVID-19 pets from COVID-19.” professor in the Department of Global Health
pandemic, scientists posited The invest igators conducted a at the University of Washington in Seattle.
that SARS-CoV-2 likely jumped community-based study of pets in house- She and her colleagues wrote, “We defined
from a mammal source to humans. holds with more than 1 confirmed human animal infection or illness with SARS-CoV-2
However, how human and animal inter- SARS-CoV-2 infection. Two study per- as an animal meeting [greater or equal
action affects transmission is still unclear. sonnel, including at least 1 veterinarian, to] 1 of the following criteria: SARS-CoV-2
A cross-sectional, One Health study inves- performed the samplings in the par- [receptor-binding domain] [enzyme-linked
tigated whether SARS-CoV-2 is transmitted ticipant’s home or at a local veterinary immunosorbent assay]-seropositive status,
by humans to their pets. Results of the study, hospital. The study personnel did not PCR-positive status, or illness consistent with
which also described types of human-animal use muzzles, nor did they use chemical SARS-CoV-2 infection...defined as participant
contact and risk factors for household trans- restraints because of biosafety concerns. answer of yes to the survey question ‘Since
mission, were recently published in Emerging The investigators noted that of 81 dogs the time of COVID diagnosis/symptom
Infectious Diseases. In the United States, and 32 cats sampled, 40% of dogs and 43% onset in the household, has this animal had
110 domestic cats and 95 domestic dogs have of cats tested seropositive, and 5% of dogs any new issues with difficulty breathing,
been reported by the US Department of Agri- and 8% of cats were polymerase chain coughing or decreased interest in playing,
culture Animal and Plant Health Inspec- reaction (PCR) positive. The participants walking, or eating?’”
tion Service for SARS-CoV-2 infection as of commonly reported close human-animal The authors showed that in this popu-
October 17, 2022, the study noted. contact and were willing to take measures lation, close contact is usual among indi-
The authors wrote that “the results to prevent the virus’ transmission to their viduals and their pets, and this contact
indicate that household transmission of pets. However, the reported preventive seems to support SARS-CoV-2 transmission.
SARS-CoV-2 from humans to animals measures showed a slightly protective but Fortunately, participants were aware of

HAPPY MONKEY@STOCK.ADOBE.COM
occurs frequently, and infected animals nonsignificant movement for both illness and willing to adopt measures to protect
commonly display signs of illness. We and seropositivity in pets, according to the their pets from COVID-19. Meisner et al
furthermore show that close human- study. In particular, “sharing of beds and noted that their results “largely align with
animal contact is common among persons bowls had slight harmful effects, reaching results from Canada (positive effect for
and their pets in this study population, statistical significance for sharing bowls bedsharing in cats; 41% of dogs and 52% of
[and] that this contact appears to enable and seropositivity,” the authors noted. cats seropositive; however, few PCR-positive
SARS-CoV-2 transmission, and that “Our study contributes useful and novel pets) and studies from Texas and Arizona
pet owners are familiar with and will- findings to the literature on cross-species indicating that household pet interspecies
ing to adopt measures to protect their transmission of SARS-CoV-2, with rele- transmission of SARS-CoV-2 is common.”

10 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

ICT0323_010-013_Lit Review.indd 10 2/15/23 3:46 PM

 LITERATURE REVIEW

Nearly one-third of dogs were engaged

prevention
in activities outside the household during
periods of human isolation. Households

Home Infusion Therapy Staff

whose residents reported awareness of the
CDC guidelines to prevent human-animal
transmission of SARS-CoV-2 had more than
50% of cats and dogs tested for COVID-19.
A total of 48 (41%) dogs and 17 (30%) cats Need More CLABSI Training,
Investigators Say
resided in households that started taking
precautions to prevent transmission to
their household pet(s). Of all the animals
tested, no cats and only 2 dogs resided in
a household where an infected individual BY TORI WHITACRE MARTONICZ
was hospitalized for COVID-19.

H
“Nearly all dogs (83%) and most cats ome-infusion therapy (HIT) staff infusion therapy,” Keller told Infection
(72%) had access to yards or gardens and are vital in allowing patients Control Today®. “And what we saw is
were allowed on furniture (86% of dogs to receive care in their homes. that the [individuals] doing this work
and 100% of cats), and most dogs and cats However, the staff often receive little are working hard without much access
were kissed by (75% of dogs and 68% of or no formal training on performing to the training resources that many
cats) and shared beds with (69% of dogs central line–associated bloodstream
and 73% of cats) human household mem- infection (CLABSI) surveillance, accord-
bers. Almost all bowls for dogs (91%) and ing to findings published in American
cats (95%) were washed in the kitchen,” Journal of Infection Control.1 Investiga-
the authors noted. tors noted specific training barriers
Because [home
One significant limitation of the that need to be addressed to improve infusion therapy]
study’s results was the small sample infection surveillance. involves the
size, even though “variance was high The investigators performed qual- administration
for effect estimates produced by our
regression model,” the authors wrote.
itative interviews of 21 home infu- of medicines
sion staff from 5 large HIT agencies
“By nature of our recruitment methods covering 13 states and Washington,
through a
and study population, generalizability DC. The questions posed to the staff catheter, specific
of our findings is probably limited who perform surveillance activities and careful
to highly educated, higher-income
persons in urban and suburban
focused on their surveillance training, sterilization
barriers to and facilitators for CLABSI
communities.” surveillance, and barriers to training in
procedures must
REFERENCE CLABSI surveillance. be followed.”
Meisner J, Baszler TV, Kuehl KE, et al. Household Study author Sara C. Keller, MD,
transmission of SARS-CoV-2 from humans to pets,
MPH, MSHP, an associate professor acute care infection preventionists
Washington and Idaho, USA. Emerg Infect Dis.
2022;28(12):2425-2434. doi:10.3201/eid2812.220215 of medicine at Johns Hopkins Medi- might have [or] might be able to get
cine in Baltimore, Maryland, and her access to. They frequently lack a formal
colleagues wrote that educational surveillance training program. They
opportunities need to be highlighted might be learning how to do home
and expanded. infusion CLABSI surveillance from
“This paper is based on a series of [individuals] who were in the role prior
qualitative interviews with some mem- to them and who also did not receive
bers of these [home care] agencies, the training resources. Some [home
focusing on educational opportunities care agency workers] are aware of
specifically for home infusion surveil- going to a conference for that kind of
lance, or CLABSI surveillance in home thing. But there’s not a great career

WWW.INFECTIONCONTROLTODAY.COM March 2023 ICT® 11

ICT0323_010-013_Lit Review.indd 11 2/15/23 3:46 PM

 LITERATURE REVIEW

development or formal training

operating room
approach for [those] doing this work.”

Routine Change of Surgical

Because HIT involves the admin-
istration of medicines through a
catheter, specific and careful steril-

Gloves/Instruments
ization procedures must be followed.
CLABSIs are infections that can occur
when bacteria enter the bloodstream

Significantly Lowers SSIs

through central line catheters. These
severe infections are dangerous;
according to the CDC, 12% to 25%
of patients who get a bloodstream
infection from a central line die.2 BY TORI WHITACRE MARTONICZ
To prevent CLABSIs, Keller noted

B
that a checklist is vital to verify that ecause surgical site infections (SSIs) 20 beds. The hospitals are in Benin, Ghana,
everyone involved is following the remain the most common compli- India, Mexico, Nigeria, Rwanda, and South
same guidelines every time. cation of surgery globally and affect Africa. Morton and his colleagues found
The most significant barrier for patients in both low- and middle-income that a routine change of gloves and instru-
individuals performing the home countries,1 investigators continue to look ments before abdominal wound closure
infusions to preventing CLABSIs is for ways to reduce SSIs any way they can. reduced SSI rates by 13% at 30 days post
the “lack of resources and sometimes One of the main issues is that the causes surgery compared with the trial con-
the lack of knowledge about what is of SSI widely vary, and few interventions trol group. This reduction in SSI was
available to them,” Keller said. “Par- work well or at all. seen across the trial. Of the participants,
ticularly if they work for a smaller However, authors of a study2 published 1 1 , 82 5 (8 8 .9 %) were adu lt s, a nd
agency, oftentimes, the [staff ] doing in The Lancet explained that a simple 1476 (11.1%) were children; 54.8% were
this work are the only [ones] that the routine change of surgical gloves female and 45.2% were male.2
agency has. And this is hard work. It’s and instruments can prevent 1 in The investigators concluded
nice to talk to colleagues who have 8 SSIs. One specific surgery that that “this trial showed a robust
done some of this a little bit, and often has an SSI associated with benefit to routinely changing
you learn from them, and they learn it is abdominal surgery. gloves and instruments before
Interested in
from you, and over time, you all gain “SSIs are one of the major more content abdominal wound closure. We
a broader knowledge base. But they health challenges for surgery like this? suggest that it be widely imple-
often do this in isolation and don’t today. The simple and cost-effec-  mented into surgical practice
have as many others to talk to.” tive intervention of clean gloves  around the world.”2
and instruments for wound clo- T he st udy ’s wea k nesses
REFERENCES AVAILABLE AT
sure is appropriate for implementation include “small imbalances in patient
INFECTIONCONTROLTODAY.COM
across the world and can mark an import- characteristics across groups, which are
ant step toward the future minimizing of inevitable in a clustered design, particu-
SSIs and so improve patient outcomes,” larly with such a broad and heterogenous
Dion Morton, MD, MBChB, FRCS (Eng), hospital network,” the authors wrote. They
OBE, Barling Chair of Surgery at the also noted that selection bias and residual
University of Birmingham in England, bias could exist and that some clusters
told Infection Control Today®. included fewer patients than anticipated
Sara C. Keller, MD, MPH, MSHP (left);
Tori Whitacre Martonicz, ICT® editor (right). A total of 13,301 patients were recruited because of low volume or the site opening
for the multicenter, cluster randomized toward the end of the trial. In addition,
ChEETAh trial (NCT03980652). It took they said, investigators did not collect
Watch the full place between June 2020 and March 2022 data around single or double gloving.2
interview online.
across 7 institutions—from large hospitals
REFERENCES AVAILABLE AT
with advanced perioperative services
INFECTIONCONTROLTODAY.COM
to small, rural hospitals with as few as

12 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

ICT0323_010-013_Lit Review.indd 12 2/15/23 3:46 PM

 LITERATURE REVIEW

health care-acquired infections

Making It Easier to
Categorize Patients With SAB
BY INFECTION CONTROL TODAY® EDITORIAL STAFF

S
taphylococcus aureus bacteremia uncomplicated and complicated SAB. treatment strategy for the average patients
(SAB) is uniquely characterized by Explicitly defining patient characteris- with this clinical picture, including route
its capacity to involve metastatic tics and SAB diagnosis would allow a of administration, duration, and load
infections in nearly every organ system in more personalized treatment including reduction,” the authors explained.
the body. Approximately 20% of patients shorter durations of intravenous (IV) The last step, the authors noted, was “to
with SAB die within 30 days of infection, therapy and more convenient routes of establish the final treatment plan for the
and thus it’s important to address the administration.” individual patient by further streamlining
limitations of categorizing the disease, “Clinicians need a classification for SAB or changing the duration of the treatment
according to a results of a study recently that directs the diagnostic work-up and based on clinical factors.” The investi-
published in Journal of Infection. individualizes antibiotic treatment. This gators note, however, “for this classifica-
Currently, patients with SAB are put framework can also be used to identify tion to work in clinical decision-making,
into 1 of 2 therapy durations based on knowledge gaps for future research.” it must be able to accurately identify
whether they have complicated or uncom- The classification proposed in the study the absence of metastatic infections in
plicated disease. Patients are grouped begins after the patients’ initial positive patients with SAB, even when traditional
into largely comparable groups by cli- blood culture. Each patient with SAB evaluations fail to identify one.”
nicians, but this approach neglects to would have an evaluation, including phys- The classification of patients with SAB
consider SAB’s intrinsic heterogeneity, ical examination, echocardiography, and proposed in the study has the potential to
the authors noted. Risk factors for meta- repeat blood cultures. The patients would resolve the inadequacies of only identifying
static infection and confirmed metastatic then be classified as having a high or low uncomplicated and complicated SAB. This
infection are not differentiated in most risk of metastatic infection. Only patients format consists of 4 steps. The first step is risk
scoring methods, they said. identified as high risk for complications stratification for the presence of metastatic
Further, including predisposing host could then undergo a more extensive infection. If positive, then the clinician is
characteristics, features of bacteremia, diagnostic work-up to find or exclude directed to do a diagnostic work-up to find
and the clinical course key restrictions in these specific complications. the infection. The “final clinical diagnosis”
the definition of complicated SAB causes Meanwhile, patients identified with no is determined with a general direction for
issues because SAB increases the risk of risk factors present at baseline or with treatment. And finally, treatment can be
metastatic infection but SAB cases are negative results from the initial work-up individualized for the patient. Also, “this
not metastatic infections. would be noted as “low-risk SAB” would framework guides the clinician and a
“As a result, it is possible for patients at not receive the more extensive diagnostic context for future research to improve
TUMEGGY@STOCK.ADOBE.COM

risk for metastatic infection but without its work-up. “Ideally, the result of the more patient outcome and individualized treat-
confirmed presence to be diagnosed with in-depth diagnostic work-up would delin- ment,” the authors noted.
and treated presumptively for complicated eate the extent and nature of the patient’s
REFERENCE
XXXX@STOCK.ADOBE.COM

SAB,” the authors wrote. “In addition, S aureus infection. This ‘final clinical diag- Kouijzer IJE, Fowler VG, Ten Oever J. Redefining
the current classification can discourage nosis,’ and not a designation of complicated Staphylococcus aureus bacteremia: a structured
approach guiding diagnostic and therapeutic
a precise clinical diagnosis, since SAB SAB solely on the basis of the presence of
management. J Infect. 2023;86(1):9-13. doi:10.1016/j.
encompasses a much wider range of factors that are associated with metastatic jinf.2022.10.042
clinical manifestations than infections, would correspond with a certain

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 IN THE NEWS

Hot Topics in IPC: Ebola Outbreak Ends,

“Kracken” Is New COVID-19 Subvariant
BY SASKIA V. POPESCU, PHD, MPH, MA, CIC

Uganda Declares Ebola 2 weeks. 2 Frustratingly, deaths were advantage, boosting infectivity while
Outbreak Over higher, averaging 555 per day, an retaining XBB’s ability to sneak past
The outbreak of Ebola disease (Sudan increase of 61%. human defenses. In other words, it’s less
ebolavirus) has officially been declared The US is a patchwork of both drop- of a trade-off and more of a turbocharge.”4
over in Uganda. Four mont hs of ping and rising cases, with some states Immune system evasion and a high trans-
containment efforts helped keep the cases showing improvements. If we look at a mission capacity mean that scientists are
at 143 and deaths at 55. First identified state-by-state example, in mid-January closely watching XBB1.5.
in September 2022, this is the eighth Florida was seeing a spike in cases and However, much of the hysteria is
outbreak the country has experienced was up by 90%, whereas California’s cases unnecessary and should be met with
since 2000. “Uganda has shown that were down 33%. Washington, DC, had a skepticism—including calling the
Ebola can be defeated when the whole 53% decline in cases, whereas Alaska was subvariant “Kracken.” Although it is a
system works together, from having an experiencing an increase and had seen a worrisome variant, it’s not one that entirely
alert system in place, to finding and caring 43% rise in cases.2 evades our immune system. In short, if
for people affected and their contacts, to Kracken is on the brain, perhaps turn to
gaining the full participation of affected Clash of the Titans rather than the latest
communities in the response,” Tedros COVID-19 news.
Adhanom Ghebreyesus, director-general As Jacob Stern noted in The Atlantic,
of the World Health Organization, said in In short, if “For Stephen Goldstein, an evolutionary
a news release.1 Kracken is on the virologist at the University of Utah, the
Ebola outbreaks will continue to occur, brain, perhaps new names are not just unnecessary but
stressing public health efforts, but the turn to Clash of potentially harmful. ‘It’s absolutely crazy
capacity for rapid response and interna- that we’re having random people on Twitter
tional support speaks to increasing skills
the Titans rather name variants,’ he told me. For Goldstein,
in containment and collaboration. than the latest dressing up each new subvariant with an
COVID-19 news.” ominous monster name overplays the dif-
What’s Going on With ferences [among] the mutations and feeds
COVID-19? into the panic that comes every time the
It appears we may have avoided a harsh Many conversations in the media and coronavirus shifts form. In this view, dis-
COVID-19 surge this winter. I’m surprised, infection prevention circles have cen- tinguishing one Omicron sublineage from
as I think so many infection prevention tered on the latest variant—a subvariant another is less like distinguishing a wolf
specialists were, given the lax public of Omicron called XBB1.5,3 which some from a cow and more like distinguishing
health restrictions and sluggish desire have dubbed “Kracken.” Although XBB1.5 a white-footed mouse from a deer mouse:
JUAN@STOCK.ADOBE.COM

for boosters. Cases were down 2% in the is rapidly spreading and is considered to important to a rodentologist but not really
US in early January 2023, with a daily be very transmissible, we’re still learning to anyone else.”5
average of 63,000 cases.2 Test positivity how this new subvariant will behave.
was up 8%, hovering around 15%, and “By contrast, XBB.1.5’s defining feature All figures were accurate at time of publication.
approximately 46,000 individuals a day and its main difference from XBB is a
REFERENCES AVAILABLE AT
were hospitalized with COVID-19 in the spike protein mutation known as F486P.
INFECTIONCONTROLTODAY.COM
US, which was an increase of 12% in This mutation gives XBB.1.5 a significant

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 IN THE NEWS

Omicron XBB.1.5: Yet Another

COVID-19 Variant to Know
BY NINA COSDON

O
micron continues its reign as the XBB.1.5 swept across the US rapidly, stated that XBB.1.5 has a low “growth
dominant COVID-19 strain, and its making up only 1% of new infections a advantage,”3 meaning there is currently
new subvariant, XBB.1.5, is now mere month ago.2 The subvariant appears no indication it will cause more severe
most prevalent in the US. to be 5 times more infectious than earlier or fatal disease. Symptoms of XBB.1.5
As of the end of December 2022, the Omicron strains, which were already are believed to be consistent with those
CDC genomic surveillance1 found that 5 times more infectious than the original, of earlier Omicron strains.
XBB.1.5 was responsible for 40.5% of new wild-type COVID-19 virus. Recent holiday
This article first appeared on ContagionLive.com.1
COVID-19 infections in the US. In the gatherings, resistance to immune system
Northeast, the CDC estimates XBB.1.5 is antibodies, and the virus’ improved ability
REFERENCES AVAILABLE AT
causing 75% of new infections.2 Omicron to bind tightly to the body’s ACE-2 recep- INFECTIONCONTROLTODAY.COM
BQ.1.1 and BQ.1, previously the reigning tors all likely contributed to the explosion
variants, are responsible for 26.9% and of XBB.1.5 infections.2
18.3% of new cases, respectively.2 The World Health Organization has

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 IN THE NEWS

FROM THE
PAGES OF

New Survey: Many Health Care

Workers Don’t Like Their Jobs
BY RON SOUTHWICK

I
n a comparison with 27 other industries,
health care didn’t rank near the bottom
in employee satisfaction. Instead, health
care ranked dead last, according to a new
report1 by Qualtrics released in January
2023. Qualtrics surveyed nearly 3000 health
care workers about their experiences. The
company also queried nearly 9000 con-
sumers about their hospital experiences.
More health care workers now say they
don’t intend to stay in their jobs. Survey
results showed that 61% intend to stay
in their jobs, down 4 percentage points
from 1 year ago. Put another way, approxi-
mately 4 out of 10 health care workers are
considering leaving their positions. That
mirrors other studies that have found
some doctors and nurses are thinking their managers help employees focus on of patients said their providers should do
about walking away.2 work, which was 3 percentage points below a better job of listening to their feedback,
With a substantial number of health care other industries.1 and 69% of consumers said payers need to
employees thinking of leaving, patients Women were less likely than men to feel improve in this area.
could pay the price, the survey results they can succeed in the health care indus- 2023 should be the year that the health
suggested. Only a little more than half (52%) try, and they were less likely to be satisfied care industry “makes the lives of everyone
of health care workers surveyed said they with their pay and benefits and their work- health care touches easier,” said Adri-
feel they are paid appropriately for their life balance, according to survey results. enne Boissy, MD, chief medical officer of
work, and that also ranked the lowest of all In a positive finding, 2 out of 3 health Qualtrics, in a news release accompanying
industries examined. Less than half (38%) care workers said they feel engaged in the study.4
said they feel their compensation is tied to their work, an increase of 2 percentage “It has to be – and we have to revolution-
their performance. Industry analysts say points over 2022. ize our approaches,” Boissy said. “Emotions
TOMMYSTOCKPROJECT@STOCK.ADOBE.COM

the growing dissatisfaction of health care Qualtrics also surveyed patients on are running high no matter what industry
workers is likely to lead to more labor battles their experience and found mixed results. you are in, which amplifies when things
and more strikes in 2023.3 Survey results showed that 74% of con- are not easy, and yet people still put their
Health care workers also rated their work sumers said they were satisfied with their trust in us. We earn that trust when we
environment below that of other industries experience in hospitals, which trailed the intentionally listen across channels, use
in other areas. Survey results showed that cross-industry average (77%). And 70% advanced analytics to understand emotion,
61% of employees said their work processes said they were likely to recommend their intensity, and intent, and immediately take
allow them to be as productive as possible, health care provider.1 In addition, 79% of action on what we hear.”
which is 6 percentage points below the patients said they trust hospitals.1
REFERENCES AVAILABLE AT
average of all industries examined. And Still, many patients don’t feel that they
INFECTIONCONTROLTODAY.COM
65% of health care workers surveyed said are heard. The Qualtrics survey found 61%

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ICT0323_014-017_In The News.indd 16 2/15/23 3:46 PM

 @ICT_magazine @VIRGO.InfectionControlToday @Infection-Control-Today

INTERACTIVE
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expert insights delivered
directly to your inbox.
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TOP TWEETS
Expert Interviews
Infection Prevention and Control #TUH
@InfectionTuh How Dangerous Are the Cleaning Products That Environmental
Increasingly agile response from
#IPC during the #COVID19 pan- Hygiene Personnel Use?
demic is accurately outlined here! At the start of the COVID-19 pandemic, questions asked among environ-
Simplifying Infection Preventionist
Requirements From the COVID-19 mental hygiene personnel were “Did the CDC and the EPA give enough
Pandemic. How do infection pre- guidance on how to use the proper cleaners? Were the disinfectants they
ventionists navigate the many—and
often contradictory—requirements recommended safe? Or were they dangerous and ineffective if not used
that fighting the COVID-19 pandemic correctly and with the proper personal protective equipment?”
has brought upon them?
http://bit.ly/3HdDY7N LISTEN: https://bit.ly/3wdgVEX

Sepsis: One Father’s Story of Loneliness and Strength, Parts 1-3

Carolina Girl This is a father’s story about how his son lived through sepsis, but it took
@CarolinaGirl585 a huge toll not only on his son but on his whole family.
Replying to @ICT_magazine;
@CDCgov; @EPA. Surface disin- LISTEN: http://bit.ly/3WK2kvj
fection is yet another element of
infection control that should have
been planned in advance as part of a APIC’s CDS Education Committee Member Discusses Cleaning
comprehensive pandemic playbook, Resources and Ambulatory IPs
but it wasn’t, so the EPA list was
thrown together real time in 2020,
Infection Control Today® talks to Shannon Simmons, DHSc, MPH, CIC,
leaving IPs and everyone else to about her work with the APIC's Cleaning, Disinfection, Sterilization Con-
figure it out as we go.
https://bit.ly/3WTnrM0
ference and her position as an ambulatory infection preventionist.
LISTEN: http://bit.ly/40ck3i7

For more interviews with expert clinicians and health care professionals, visit
Pet Partners www.medicalworldnews.com
@pet_partners
#NewsworthyPets: Therapy dog
Caymus & handler Michelle were
featured in an article from
@ICT_magazine for the steps they
take to protect health & safety for
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people they visit. Great job, Caymus delivered directly to your inbox.
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“
Notable Quotables
— Saskia v. Popescu, PhD, A friend recently joked that I had lost my street ‘cred’ as an infection
MPH, MA, CIC preventionist, which was both comical and a bit eye-opening. Mostly,
Hospital epidemiologist and infection it highlights much of the guilt or even shame many of us experience
preventionist.
when we feel as if we’ve failed at the very thing we specialize in. I still

”
beat myself up at times for getting COVID-19 and knowing better as
SCAN TO an infectious disease specialist, but I also don’t want to associate any
READ MORE:
sense of shame with an infectious disease.

WWW.INFECTIONCONTROLTODAY.COM March 2023 ICT® 17

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 FEATURE

prevention

Focus on 4 Foundations of Patient Safety

BY ALISON L. GALDYS, MD; KARI A. GAND, MPH, CIC; AND OLUWAFEMI (FEMI) B. ABIMBADE, MBBS, MPH, CIC

H
ealth care–associated infections patient and family engagement; workforce reported spending an average of 12.2%
(HAIs) and other health care–asso- safety; and learning system. These areas of their effort on management/commu-
ciated conditions are among the are already, in many respects, hardwired nication.4 Although the current state of
prevailing threats to patient safety. To into the fabric of IP programs. The fol- health care governance gives IP profes-
combat the threats, infection prevention lowing paragraphs delve into some of the sionals a seat at the table, ongoing work
(IP) professionals’ common goal is to be ways IP activities are already exemplified is needed to ensure this seat is consis-
patient safety champions. One of the in the NSC plan, and how the plan can be tent and valued. In addition, because
Association for Professionals in Infec- a road map for IP professionals to expand diverse teams are best suited to solving
tion Control and Epidemiology’s (APIC) their patient safety role. complex problems, IP programs should
strategic goals is to “demonstrate and continue to recruit professionals from
support effective infection prevention Culture, Leadership, and a variety of backgrounds and prioritize
and control as a key component of patient Governance the diversity that other stakeholders
safety.”1 In short, IP professionals work In a complex environment such as health bring to key partnerships. Along the
tirelessly to ensure the safety, health, care, diversity is a strength. IP programs same lines, IP programs should value
and well-being of all. are composed of professionals from collaboration across health care settings.
Not surprisingly, the field of IP is well diverse educational backgrounds. Key Medical care operates on a continuum
practiced in promoting patient safety. In personnel include infection prevention- and includes care settings devoted to
1976, the CDC published the landmark ists who operate in close collaboration acute care to everything from ambulatory
SENIC project (Study on the Efficacy with physicians serving as health care to residential care. HAI reduction mea-
of Nosocomial Infection Control).2 The epidemiologists who are often, but not sures and strategies in most health care
findings demonstrated a 32% reduction always, trained in infectious diseases. organizations are focused on acute
in HAIs in hospitals with established IP In a recent survey of 4079 APIC-affil- hospital setting practices. As many health
programs compared with an 18% increase iated infection preventionists, 82.0% care delivery systems implement mea-
in hospitals without such programs over reported a background in nursing, 9.9% sures to shift care toward a more accessi-
a 7-year period.2 Following the publication a background in laboratory science, ble outpatient care system, it is imperative
of SENIC, tremendous strides were made (eg, medical technologists, microbiol- to educate and train to evidence-based IP
in HAI prevention. However, there is still ogists, laboratory researchers), 4.7% practices and recruit more IP personnel in
progress to be made. a background in public health, and outpatient settings. Patient safety threats
In May 2022, the Institute for Health- 3.3% reported another background. 4 in one setting often have ripples in other
care Improvement (IHI) convened the The diverse educational backgrounds settings, and interconnectedness across
National Steering Committee for Patient represented in IP programs permit sub- independent health care systems or pub-
SDECORET@STOCK.ADOBE.COM

Safety (NSC), a collaboration among 27 US ject matter expertise in a multitude lic health entities adds another layer of
organizations dedicated to health care that of areas critical for program success. complexity.4-6 Finally, the recent global
is safe, reliable, and free from harm. The Diversity is also a tremendous asset in health disruptions related to infectious
NSC published Safer Together: A National engaging with the multidisciplinary pathogens serve as a reminder that IP
Action Plan to Advance Patient Safety,3 a plan clinical teams that intersect with programs should maintain awareness of
that emphasizes driving improvement initiatives to reduce HAIs. emerging and reemerging pathogens and
in 4 foundational areas of patient safety: In the same survey of APIC-affiliated should work to preserve networks that
culture, leadership, and governance; infection preventionists, respondents are dedicated to ensuring that the health

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 FEATURE

care infrastructure is prepared to safely care, IP programs advocate patient vac- HAI data is one of the many ways that
care for high-consequence pathogens.7 cination as a key tool for primary pre- IP professionals preserve engagement
vention. Additionally, IP professionals among other clinicians in IP programs.10
Patient and Family educate clinicians on the clinical and IP professionals should continually
Engagement diagnostic work-up of patient conditions seek a better understanding of how sur-
As patient safety advocates, IP profes- that may pose a transmission so that veillance data can be leveraged to eluci-
sionals frequently interact—directly and these conditions are recognized early. IP date the mechanisms underlying health
indirectly—with patients and families. professionals maintain expertise in the care associated infections, whether those
This interaction may take several forms. environment of health care and promote infections are due to endogenous or exog-
IP professionals can educate patients and the hierarchy of controls to minimize haz- enous flora. Understanding the mecha-
families on hand hygiene, respiratory eti- ards to patients and health care workers. nisms that drive HAIs may permit better
quette, and other fundamental strategies More recently, and especially during understanding of the extent to which HAI
for IP. Sometimes this education is even the COVID-19 pandemic, the impor- “preventability” exists on a spectrum,
more tailored: for example, in the setting tance of health care worker wellness has which will in turn assist with fram-
of a novel pathogen or medical device for become an additional area of focus for ing interventions as capturing low- vs
which specific IP recommendations exist. health care systems. IP professionals can high-hanging fruit. In addition, microbial
IP professionals are often in a position to enhance their promotion of workforce genomics is a powerful tool that, when
assess and influence patient and family safety by promoting total worker health combined with standard epidemiology, is
experiences across the care continuum. (TWH).7 TWH promotes interventions poised to assist IP professionals in gain-
Several opportunities exist for IP pro- that collectively address worker safety, ing a better understanding of pathogen
grams to prioritize patient and family health, and well-being. transmission in health care settings.11
engagement. Evidence suggests that IP professionals are veterans in
greater awareness of HAIs is needed.8 Learning System preventing patient harm. An effort that
IP programs could meet this need by Key responsibilities of IP programs aims to prevent harm can be regarded as
enhancing education about HAIs on the include finding cases of infections in a difficult entity to quantify, and this can
local level and also serving as sources health care settings, compiling infec- have implications in health care economic
of clarification about the implications of tion-related data, and analyzing data landscapes that prioritize the quantifica-
publicly reported measures, including to characterize HAIs. IP professionals tion of services. However, it is important
HAI incidence. Additionally, there is continually adjust their methods of HAI to stress that the assurance of safe care,
emerging evidence that racial and ethnic surveillance to keep pace with a dynamic although challenging to quantify, is truly
disparities exist in how patients experi- clinical care environment that is defined a priceless commodity for the patients
ence health care, including the incidence by rapid technologic advances. IP pro- served by health care systems.
of HAIs.9 By better characterizing these fessionals have a sophisticated under-
ALISON GALDYS, MD is an assistant professor
disparities, IP professionals can take standing of how HAI data convey gaps
in the Division of Infectious Diseases and
steps so that safe care is truly safe care that could result in preventable HAIs.
International Medicine at the University of
for all. Finally, IP professionals should This understanding arises not only from Minnesota Medical School in Minneapolis.
stay mindful that stigma is a powerful detailed knowledge of what HAI data She also is assistant medical director of
force in shaping the way infectious dis- measure, but also from the conversa- infection prevention and an assistant hospital
eases are transmitted. They must work to tions IP professionals hold with their epidemiologist.
ensure that strategies that intend to limit colleagues about how HAI data intersect
transmission of infectious pathogens do with the experience of clinicians. In the KARI A. GAND, MPH, CIC, is an infection
not perpetuate the stigma experienced by cycle of quality improvement efforts, IP prevention manager, at M Health Fairview,
Minneapolis, Minnesota.
patients who are (or are perceived to be) professionals continually measure the
at risk for those pathogens. expected and observed impact of HAI
OLUWAFEMI (FEMI) B. ABIMBADE, MBBS,
reduction strategies. HAI prevention
MPH, CIC, is an infection prevention manager
Workforce Safety hinges on successful adherence to best of outpatient clinics and post-acute care sites at
IP professionals and occupational health practices over the long haul, and lon- M Health Fairview in Minneapolis, Minnesota.
professionals enjoy longstanding part- gitudinal surveillance by IP programs
nerships because prevention of infec- reminds clinicians and administrators REFERENCES AVAILABLE AT
tion in patients leads to fewer exposure not to let down their guard. By the same INFECTIONCONTROLTODAY.COM
risks for health care workers. In clinical token, highlighting success stories with

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 FEATURE

prevention

What You Should Know About

The Joint Commission
BY TORI WHITACRE MARTONICZ

"OH, NO! THE JOINT COMMISSION IS HERE!” The Commission: It’s about processes. a regulatory standpoint….We’re trying to
infection preventionist’s heart starts We don’t look at the individual equip- be there to point out those things that are
pounding and her mind starts racing. She ment. We don’t say, “Oh, you have that one. risk factors. At the end, we provide a Sur-
has heard only terrifying things about You can’t use that one.” A survey by The vey Analysis for Evaluating Risk (SAFER)
surveys by The Joint Commission. Joint Commission would never say that, matrix,2 which is a tool that’s been [in use
But should infection preventionists or it should never say that. Because we since January 2017]. That categorizes what
(IPs) be nervous when a representative don’t survey you [about] your equipment. we found. And it says, “We only found it
from The Joint Commission comes to do Or say that you need to use a specific in a few places, it’s very limited, or we
a survey? To find out, Infection Control brand. We don’t even say—except in a found it everywhere.” And [it categorizes
Today® (ICT®) went to the source. few instances—that you must follow it as] low, medium, or high risk.
Sylvia Garcia-Houchins, MBA, RN, a particular evidence-based guideline [The Joint Commission has] been in
CIC, director of infection prevention and or consensus document. [A survey] is business for more than 70 years….We’ve
control at The Joint Commission, a personalized accreditation process, developed and grown, and we are a leader
talked with ICT® about what The Joint making sure that you’re following rules in providing the best guidance and survey
Commission does and does not do, and regulations that apply to you in your process to identify risks.
how long it has been around, and what state and your location, that if you’re being
IPs should know. accredited…to get Medicare and Medicaid ICT®: What do you wish IPs knew about
funding, that you’re following the Center The Joint Commission?
ICT®: Please explain what The Joint for Medicare & Medicaid Services (CMS)
Commission does and what its Conditions of Participation1…that you’re SG-H: The most important thing that IPs
background is. following any of the regulatory require- need to know is that the risk assessment
ments, such as United States Food and is not the solution to everything.
Sylvia Garcia-Houchins, MBA, RN, Drug Administration (FDA) rules about In April 2019, we published for our cus-
CIC: The Joint Commission is the largest reprocessing medical devices. That’s the tomers The Joint Commission Perspectives,
accreditor of health care organizations in core of what we do. and it’s available if you go to The Joint
the United States, meaning we accredit [For example:] You decide that you’re Commission website, and on the Infec-
hospitals…but we also accredit other not going to allow staff members to have tion Control page for anyone to see is how
programs, such as ambulatory surgery fingernails longer than a quarter of an we clarified scoring of infection control
centers, Bureau of Primary Health Care, inch, which is a CDC category 2 safe standards. And it’s following a systematic
and some of the Veterans Health Adminis- practice, but is not required by the CDC. approach. The answer is going to change
tration [hospitals]. We also do US military If you’ve decided that’s what you’re going depending on where you are in the country.
© THE JOINT COMMISION (SEAL)

[institutions] in foreign countries. to do, then we’re going to survey and say, There is a place for risk assessment.
We accredit, which is very different than “Are you following what you say you’re Risk assessment is when you are iden-
some people think. We’re not inspectors; going to do? Are you following your own tifying issues that may pose a risk and
we’re surveyors. We don’t walk around policies?” That’s part of the survey process. deciding how much of a risk. For example,
with our little checklist and say, “Check, What we’re doing is trying to identify our surveyors use what’s called “tracer
check, check.” We look for high-risk issues. places where your organization has risk. methodology.”3 IPs do this every day, all
We look for process issues. That’s an It might be a risk to a patient, it might be the time. You walk around your organi-
important bit of background for The Joint a risk to a visitor, it might be a risk from zation, and you look at things, and you

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 FEATURE

say, “That doesn’t look [right]. Maybe I want you to do it at a lower temperature.” and they end up making a decision that
should figure out if it is OK to put that The Joint Commission cannot say, “Sure, impacts their organization negatively on
sharps dispenser there. They are 2 ft from use this product.” Instead, I have spent the survey because they asked a friend
the ground in a pediatric area.” What’s 3 years educating IPs that just because it’s about a policy or listened to a lecture that
the first thing you’re going to do? You’re biologically compatible…doesn’t mean it’s someone gave or watched [a video] on
going to say, “Is there any rule or regu- functionally compatible. It’s sometimes YouTube. Come to the source. We’re more
lation that applies?” In my state, there difficult for the IPs to understand that. than happy to answer your questions. Is it
isn’t. So is there a CMS requirement? I And so we’ve come up with scoring exam- anonymous? No, it is not anonymous. You
look at the CMS State Operations Manual,4 ples. For instance, if the surveyors see an put in your name, your contact number,
and it says nothing about where I must organization using a product to clean a and your email. [You may be] worried if
position my sharps. Next, I look at the glucometer, [for example,] that it is not you use your work email that there will
building code. There’s nothing in there within the manufacturer’s instructions for be a record. But you don’t have to worry.
that says my sharps container can’t be use, we ask them to take it to the next step. As I said at the beginning, we all want
2 ft from the ground. And then I look at Is this going to kill bloodborne pathogens? the best possible care for our patients….
the manufacturer’s instructions. They Because that’s the big risk. They’re using Accidents happen. And risks are real. If we
give me some guidance, but they don’t a product with a label that says, yes, it’s can get rid of some of those risks, it’s great.
say, “Put it here.” And then maybe I go effective against bloodborne pathogens,
to an evidence-based guideline or some- and then you score at a lower risk from ICT®: What kind of education does a
thing else, such as National Institute for an infection control standpoint. And you surveyor need?
Occupational Safety & Health, which say the organization was not following the
might tell you the optimal placement, but manufacturer’s instructions. You classify SG-H: At least a master’s degree. You
that’s just a recommendation. the risk that way. must have a higher degree and leadership
I am doing a risk assessment. But what It was eye-opening for me as an IP to experience. Our surveyors have all been
do I consider the risk? For instance, what come to work at The Joint Commission leaders in health care. They understand
if I’m in a pediatric hospital, and a lit- 4 years ago. Nearly everything I thought the implications of “If I say something,
tle girl puts her hand into the sharps about The Joint Commission went out the X is the outcome,” and they must have
container? That’s a much different risk window. I used to work for an organization a knowledge of the program they are
than an area where an adult phleboto- where the accreditation manager said, serving. For example, I could not be a
mist who is in a wheelchair is drawing “You will not ask The Joint Commission home care product surveyor, I have no
your blood and needs the container to a question because then the surveyor is background in that. You must have expe-
be at a certain height to safely dispose going to come and survey for that.” I assure rience in the areas in which you will be a
of that needle. That’s when you start you, if you send the standards interpre- surveyor. You can’t have worked only in
doing risk assessment. That’s what I’m tation group a question, it is not going an ambulatory surgery center and expect
trying to make sure infection preven- to your surveyor. You’re going to get the to be in a hospital service. We can’t teach
tionists know. I see survey reports where best possible answer. If you’re not happy that kind of background or knowledge.
the survey states they didn’t follow the with the answer, you write back and say, Then there’s a whole training program.
manufacturer’s instructions for steriliza- “That’s not the answer I was expecting. It’s lifelong training.
tion, they’re not following the parameters. Could you please help me a little more?” This interview has been edited for
And the infection preventionist says, “We The Joint Commission is very transpar- length and clarity.
did a risk assessment and decided that ent about what is a requirement. If you
REFERENCES AVAILABLE AT
those parameters didn’t work.” hear about something The Joint Commis-
INFECTIONCONTROLTODAY.COM
Why would you deviate from something sion supposedly said, come to The Joint
that’s a validated parameter that the FDA Commission and ask. On our website,
requires that a manufacturer state? We jointcommission.org, is “Ask a standards
still [see staff members] doing risk assess- interpretation question.”5 You can put
ments because someone has 15 things to your question in there and get it answered.
sterilize and they decided they’re going to [But] why don’t people do this? [Instead,
do it at the average temperature. Or maybe they] ask somebody who asked somebody To hear the
the doctor says, “Something’s happening because it seems easier. And they don’t entire interview
to the finish on this instrument. I don’t realize it’s not a good question or a good scan the QR code
want you to sterilize at that temperature. I answer. There are nuances to the answer,

WWW.INFECTIONCONTROLTODAY.COM March 2023 ICT® 21

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 COVER STORY

COVID-19

COVID-19, 3 YEARS LATER:

WHAT QUESTIONS
ARE STILL
UNANSWERED? AN INFECTION CONTROL TODAY® SPECIAL REPORT

22 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

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 COVER STORY

M
ore than 1100 days after the start of the COVID-19 pandemic, everything has changed: our knowledge
of SARS-CoV-2, the medical world, and all our lives. However, as much as we know, questions remain.
To find out what those questions are—and perhaps get a glimpse of what the answers might be—
Infection Control Today ® reached out to 7 leaders in the infection control and prevention field, including
those in sterile processing, surgery, environmental hygiene, microbiology, and infection prevention, for
their take on what the medical world still needs to learn.
These interviews have been lightly edited for clarity and space.

SHANNON SIMMONS, DHSC, MPH, HENRY G. SPRATT JR, PHD, senior microbiologist and professor in the Department
CIC, MLS (ASCP), ambulatory infection of Biology, Geology, and Environmental Science at the University of Tennessee at Chattanooga;
preventionist for CHRISTUS Health in Irving, Texas DAVID LEVINE, PHD, DPT, PT, professor and the Walter M. Cline Chair of Excellence
in Physical Therapy at the University of Tennessee at Chattanooga:
THE YEAR 2020 marked a moment in history
when infection preventionists around the world THE PAST 3 years with the SARS- were either vaccinated (and boosted)
were forced out of cruise control and into an CoV-2 coronavirus have been a sober- or not, the number of deaths reported
uncontrollable level of high gear in an effort to ing period of time for health care for unvaccinated was from 5 to
recognize and combat a novel respiratory virus providers. After 3 years with this novel 10 times greater than for individuals
now known as COVID-19. Although nurses and coronavirus, 2 critical question areas who have had at least 1 booster shot.2
physicians became the face of COVID-19 rescue have emerged: How effective are the Infectious-disease experts estimate
efforts, infection preventionists also had long vaccines against SARS-CoV-2? And that vaccinating 70% to 85% of the
days and sleepless nights trying to develop and how do we deal with the growing population could enable a return to
implement protocols to keep patients and health number of antivaccine and antiscience normalcy. We are currently far from
care workers safe during that uncertain time. voices that have spread misinforma- this goal.
The chaos of the COVID-19 pandemic rejuve- tion related to vaccines and scientific There are those individuals who
nated many infection preventionists’ sense of measures to target SARS-CoV-2? The reject scientific measures to fight the
purpose as health care leadership looked to us answers to these questions will help COVID-19 virus based on misinfor-
for validation of the protocols being suggested guide us as we work to maneuver mation, mistrust, or other reasons.
by various health care agencies. Now in 2023, newly evolving strains of this virus. As populations of the unvaccinated
there is a greater need to elevate infection The development of new types of grow, these populations allow for
preventionists as essential advocates, leaders, vaccines targeting the SARS-CoV-2 mutations in the virus, allowing for
and experts. We are still looking to engage and virus has provided a new tool to use the development of new strains of
influence key leaders on the value of the infec- against pathogens. Much of the data the virus. In fact, as new variants of
tion prevention field and profession. on the effectiveness of these COVID-19 COVID-19 have accumulated, even the
Transmission-based precautions were fun- vaccines have pointed to reduced hos- monoclonal antibodies developed for
damental in the fight against COVID-19, but pitalizations and deaths in vaccinated the earliest strains now do not work
there is still a need to understand whether individuals.1 Some naysayers have to kill the virus. These new strains of
many of the improvisational methods imple- raised the alarm at the potential for the virus also impact the efficacy of
mented during the pandemic can be used to negative [adverse] effects, particularly the vaccines (and boosters) currently
consistently break the chains of transmission. the mRNA vaccines. After admin- available. A study of parental regrets
Understanding how, when, and in which istration of hundreds of millions of of unvaccinated children contracting
© BEDNAREK@STOCK.ADOBE.COM

settings infected individuals transmit the doses of these vaccines in the US, childhood diseases suggested several
virus will be beneficial in efforts to influence studies of the incidence of negative factors contributed to the decision not
permanent change in policies and protocols. adverse effects suggest that there to vaccinate.3 One of the key factors
Ultimately, many infection preventionists are are no significant problems with the that encouraged parents to have their
still asking, “Was it all worth it?” while con- administration of these vaccines.2 Of children vaccinated was the infor-
sidering which protocols were only necessary course, limited complications exist as mation received from their doctors.
during crisis circumstances and which proto- they do for most vaccines, but these Thus, the education of parents and
cols are effective in continued transmission have limited impact. Examining data physicians regarding the importance
mitigation efforts. on individuals over 50 years old who of becoming vaccinated is a must.

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 COVER STORY

DAMIEN BERG, BA, BS, CRCST, AAMIF FRANKLIN DEXTER, MD, PHD, FASA
vice president of strategic initiatives for Healthcare Sterile Processing Association. professor of anesthesia and health management
and policy at the University of Iowa Carver College
WITH THE 3-YEAR mark of the “start” in reprocessing and the science behind of Medicine in Iowa City.
of COVID-19 upon us now and the events disinfection. We have been working in
that changed our world, our hospitals, and this space for years; however, COVID-19 COVID-19, INFLUENZA, AND respira-
our personal lives forever, I can’t help but put a bright spotlight on what we do and tory syncytial virus (RSV) cause severe
reflect on the early days and all the con- how we do it. Contact time, dwell time, perioperative pulmonary complications.
fusion and questions we had in the sterile and various chemical names are now Some worldwide and US regions perform
processing (SP) profession to where we common languages in hospitals outside preoperative polymerase chain reaction
are today. I think about those early days our departments. The work that the SP testing (eg, for patients who are expected to
and the approach we took. Was it right, department performs finally has us at be hospitalized after surgery) that includes
effective, and able to be sustained? After the table with decisions on these items, not only SARS-CoV-2, but also influenza
3 years, we know that it is a trust in the and that is one of the positive byproducts and RSV. Even during influenza and RSV
basics, an understanding of standards, of the pandemic. “season,” the prevalence of asymptomatic
and a reliable education and competency It is also important to discuss the COVID-19 tests among these patients can
program around cleaning, disinfecting, supply chain disruption that happened be greater than 20-fold more. Why, and
and sterilizing that helps us focus on the and is a challenge today as we struggle to does this matter clinically? In addition,
process that is key to safely working in get must change or substitute products. whereas some countries and US regions
this challenging environment. However, that comes with risks because report asymptomatic testing having COVID-
As I speak, travel, and meet with SP of the training, compatibility, and efficacy 19 positive rates very low (eg, 0.2%), other
professionals around the globe, the com- of these changes. I also see the opportu- regions simultaneously have sustained
mon theme is we had—and continue to nity to share knowledge, supplies, and rates greater than 20-fold more. Such dif-
have—an opportunity to be the experts support with our peers worldwide. ferences are obtained when county and
state agencies report few COVID-19 cases.4
Why? Is COVID-19 fundamentally different
DIDIER PITTET, MD, MS, CBE, hospital epidemiologist and director of the Infection frominfluenza and RSV with greater infec-
Control Programme & World Health Organization (WHO) Collaborating Centre on Infection tivity or greater prevalence of asymptomatic
Prevention and Control and Antimicrobial Resistance. ALEXANDRA PETERS, PHD, infection? Suppose that to prevent infection
scientific lead for Clean Hospitals, both in Geneva, Switzerland.
of health care workers and other patients
that all patients having inpatient surgery
should be tested preoperatively unless the
MANY QUESTIONS still surround behavioral tendencies of different popula-
percentage prevalence of asymptomatic
COVID-19; we still need to better under- tions. All these actors influence the others
patients testing positive was very low (eg,
stand the phenomena of exactly how and account for the vast differences in
0.2%).4 Then, what would be the rationale for
SARS-CoV-2 spreads and infects individ- protective measures implemented glob-
not testing patients preoperatively because
uals, its tendency for extreme dispersion, ally. The impacts of both the pandemic
the asymptomatic prevalence rate would no
the precise role of aerosolization, the and response have health effects reaching
longer be known? Can community-reported
long-term impact of infection, etc. But far beyond the scope of the disease itself.
COVID-19 prevalence rates be used instead,
if we can only pick 1, the most pressing When coupled with the “fog of war” of
even if most patients with symptoms are
question is: How can we find ways to bet- an emerging pathogen, decision-making
using rapid home tests? For the patients
ter address the challenges of cooperation and implementation become far more
who are asymptomatic (or symptomatic) but
and communication at crucial interfaces complex. An inevitable scientific learn- infected, and for whom surgery proceeds,
to improve future responses to new ing curve occurred about the physical what treatments are beneficial for the patient
health emergencies? attributes of SARS-Cov-2, the etiology, and and for preventing infection of health care
Throughout the pandemic, decision- the impact of the disease. This created workers and other patients? If there will be
and policy making and implementa- challenges for deciding on protective a patient in the operating room soon after a
tion have centered on a few different measures, communication, as well as a patient with symptomatic COVID-19, should
interfaces—the relationship between mistrust of said measures, and a fertile terminal cleaning be applied between cases
WHO, governmental bodies (on both breeding ground for misinformation. or is routine cleaning sufficient?
national and local levels), the scien- We need to encourage interdisciplinary
tific and expert community, and, more cooperation to address these issues to REFERENCES AVAILABLE AT
indirectly, lobbies, industry, and the have a better global response in future. INFECTIONCONTROLTODAY.COM

24 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

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 powered by

What’s coming next in

the business of medicine?
Engaging interviews with expert guests on the
pressing challenges facing physicians, tied around
exclusive physician survey data that tackles the
major trends impacting the market today and
into tomorrow. Burnout, new practice models,
reimbursement forecasts and more trends physi-
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 FEATURE

Environment

Stop Infections in Their Tracks:

Water-Free Care in the ICU
BY ISIS LAMPHIER, MPH, CIC

P
atient rooms with sink drains have the medical director and consulting the same, the outbreaks will be stopped….
a higher load of bacterial pathogens, microbiologist at Radboud University It was the most sustainable way of dealing
study results have shown.1 Sinks can Medical Center in Nijmegen, Netherlands. with it. We tried cleaning and disinfection,
be a reservoir for gram-negative bacteria Hopman conducted a 2-year pre/post- putting disinfectants in the drain, every-
(GNB) and facilitate colonization and infec- quasi-experimental study to evaluate the thing, but nothing worked. Now years
tion of patients, especially in the intensive effect of removing sinks and introducing later, we have the experimental settings
care unit (ICU).1 Patients in the ICU are at water-free patient care in the ICU of a that proved biofilms will grow very fast.
high risk for health care–acquired infec- large tertiary care medical center in the Studies showed us that it doesn’t matter
tions (HAIs) because of “the high preva- Netherlands.3 The ICU in the study had how much disinfectant you put into it; they
lence of invasive procedures and devices 34 operational single-patient rooms. will always grow back. Bacteria are much
and their induced immunosuppression, Staff members sought to eradicate multi- more resistant and resilient than we can
comorbidities, frailty, and increased age.”2 drug-resistant gram-negative bacteria in ever come up with solutions [to combat].
Implementing a water-free environment the immediate patient environment after To me, the only sustainable solution is to
in the ICU can be an innovative way for ICU sinks tested positive for Enterobacter remove this source. And when we did this,
hospitals to remove threatening microbial cloacae extended-spectrum β-lactamase- it was very radical. Nobody believed this
exposure from splashes, aerosols, and producing organisms. could be the way forward [because] you
contaminated water. Hopman said, “We had this in mind: always need water and soap.”

KIRYL LIS@STOCK.ADOBE.COM (LEFT); ALEXANDERUHRIN@STOCK.ADOBE.COM (RIGHT)

Infection Control Today® (ICT®) spoke ‘We have a similar problem, we have a sink How can sinks be implicated as a res-
with Joost Hopman, MD, PhD, DTMH, with multidrug resistance.’ If we remove ervoir for gram-negative bacteria? First,
because the water coming into the sink
is not sterile, it can contain gram-neg-
ative bacteria such as Pseudomonas
aeruginosa and Legionella. Using of tap
water in medical care can be a potential
risk for exposure.4 Tap water can be used
as a diluent for solutions, as a water source
for medical instruments and equipment,
and for performing hand washing by
health care workers. Contaminated water
can also invade the patient’s zone through
the backsplash and aerosols created by
the water’s pressure or dripping. Sur-
faces near sinks can be unknowingly
contaminated, and staff may use these
areas to prepare medicine or patient
equipment. Although unintentional, this
contaminated water can cause infections
in patients who are immunocompromised
or susceptible.

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 FEATURE

Contaminated water can invade

the patient’s zone through the
backsplash and aerosols created by
the water’s pressure or dripping.
Surfaces near sinks can be
unknowingly contaminated, and
staff may use these areas to prepare
medicine or patient equipment.

Next, sinks can create a suitable envi- thing we put a lot of emphasis on. It’s some- of gram-negative bacteria in health care
ronment for bacteria to proliferate and thing we did together with the intensive settings, primarily from water sources.
create biofilms. In sinks, biofilms prefer to care doctors and intensive care nurses in There has been a move toward water-free
grow in areas such as the U-shaped bend in conjunction with the infection prevention patient care in various hospital practices.
pipes, Hopman told ICT®. Removing these and control teams. You cannot do this on Waterless hand rubs have become the
biofilms is extremely difficult and can your own. It has to be a team effort.” agents of choice for hand hygiene and are
involve taking apart structures in the sink Between May and August 2014, Hopman universally used throughout health care
and plumbing and replacing components. and his team removed all the sinks in all facilities in the United States.5 Waterless
Infection control and prevention is ICU patient rooms. A water-free method bathing and oral care are also preferred
“always a multimodal intervention,” was introduced, meaning that all patient in specific patient populations, such as
Hopman said. “Several elements must care-related activities normally involving ICU patients. Many products are available
be in place to prevent our patients from tap water were adapted to a water-free for use, such as bathing wipes, dry sham-
becoming colonized and infected. And this alternative. Adapted activities included poo, rinse-free shower caps, oral swabs,
holds true in the entire facility, the ICU medication preparation, cannula care, and more. Hospital water supply can be
included. If you want to prevent patients hair washing, shaving, and dental care. a source of nosocomial infections, and
in the ICU from becoming colonized with Participants included all patients 18 years facilities should have an established water
gram negatives, you have to do hand and older admitted to the ICU for at least management program and policy to man-
hygiene; you have to do cleaning and 48 hours during the study period.3 age the risks associated with the water
disinfection your environment; you have The study results concluded that remov- system. Water-free care is an upcoming
to have your protocols; you have to have ing sinks from patient rooms and introduc- movement for ICUs with evident benefits
the prevention of bloodstream infection ing water-free patient care was associated for patients and staff.
programs in place. However, if you have with a significant reduction of patient
ISIS LAMPHIER, MPH, CIC, is an infection
a continuous source of multidrug resis- colonization with gram-negative bacteria.
preventionist at Moffitt Cancer Center in
tance next to your patient, no matter what This reduction in colonization was more
Tampa, Florida. She entered the field of infection
you do, it will remain a risk. We tried to pronounced in patients with a longer ICU prevention and control after completing her
analyze for what purposes the sinks were length of stay.3 The results showed from a bachelor’s and master’s degrees at the University
used in our ICU. And this is something we 1.22-fold reduction during a greater than or of Florida in Gainesville.
had to do prior to removing the sinks out equal to 2 days’ stay to a 3.6-fold for greater
REFERENCES AVAILABLE AT
of the rooms.” than or equal to 14 days in the ICU.3
INFECTIONCONTROLTODAY.COM
Hopman continued, “It’s a complicated This study demonstrated an avant-
onboarding process….And this is some- garde approach to the increasing threat

WWW.INFECTIONCONTROLTODAY.COM March 2023 ICT® 27

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 FEATURE

prevention

Reaching for the Stars:

Turn Your Weaknesses Into Successes
BY HEATHER SAUNDERS, MPH, RN, CIC

A
s their eyes bore into me and silence
filled the room, I felt panic bubbling
up from deep within. I stammered
and I stuttered as I muddled my way
through my highly technical presentation.
I fought to keep my anxiety quiet as I
finished my short educational update on
“Epidemic Keratoconjunctivitis,” which I’d
been invited to present at that morning’s
meeting. After I concluded discussing my
last slide, one of the physicians stood up
and asked a very complex question to
which I didn’t have an answer. Unfortu-
nately, I made up the answer on the spot
instead of simply saying, “I don’t know. I’ll
investigate that and get back to you.” I felt
my cheeks turn a bright shade of red, and
my heart was beating so loud that I could
hear it inside my ears. I could tell by the
rolling of eyes and the sighs in the room
that I had failed miserably at this speaking
assignment. I was beyond mortified. surprise to many who enter the field. better public speaker. Today, I’ve lost count
The truth is, when I began my infection For those who have a master’s degree of how many speaking opportunities I’ve
prevention and control career, I knew in public health, understanding clinical been offered and completed. I’ve had the
very little about what the job entailed. practice can be challenging. And nurses opportunity to speak at conferences and
Furthermore, I had never spoken publicly entering the field may find statistics and virtual webinars, to provide education to a
outside of small group settings. I was just epidemiology have a steep learning curve. wide variety of audiences, and to lead our
an emergency department nurse who had For me, being able to confidently speak in state’s weekly COVID-19 updates. I look back
a particular interest in infectious disease. public was a significant area of weakness. on that first speaking opportunity to that
Assuming the role of infection prevention- After that presentation, a part of me small room of physicians, and I smile at how
ist came with an enormous learning curve. wanted to throw in the towel. I wanted to far I’ve come in my career simply because I
JANKOVOY@STOCK.ADOBE.COM

Statistical analysis, epidemiology, and walk back into the emergency department made the conscious decision not to give up.
many of the professional skills required where I had transferred from, my head And with a fierce tenacity, I sought to turn
for the job were absolutely foreign to me. down, trailing shame. Instead, I decided my weaknesses into strengths.
Regardless of your background, everyone to keep pushing forward, to not to be held We all have areas of weakness that we’d
has something to learn when they enter back by my areas of weakness. I resolved like to make our strengths. Acquiring the
the infection prevention and control that I would do whatever it took to turn skills and knowledge we desire is much
field. No one walks into this profession those weaknesses into my strengths. With easier than it first appears. However, it does
fully prepared, and this is a challenging grit and determination, I fought to become a take time and effort.

28 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

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 FEATURE

Here is how I have sought to where you need to improve your the assistance of human resources,
change, evolve, and grow in my professional skills or knowledge. management, and experienced
areas of weakness. Once you have a complete list, infection preventionists to identify
1. Keep moving forward. I tell my prioritize these items so that you opportunities for improvement.
children that no one is successful know where to focus your energy 5. Don’t quit. Don’t ever quit. See step
at anything the first time they try first. Begin with skills and knowledge No. 1. Despite our failures, we must
it. Despite failure, we must pick essential to your career. Work keep moving forward if we ever want
ourselves up and keep trying. I didn’t with mentors and management, to reach the stars. Did you know that
learn to walk without falling. I wasn’t as needed, to determine which 12 publishers rejected J.K. Rowling
given writing opportunities without professional skills and expertise you before she found one who would
first being rejected multiple times. should focus on. publish her first Harry Potter book?
And I didn’t become good at public
speaking until I got past that first
atrocious attempt. Continuing to We all have areas of weakness that we’d like to make our
move forward through failure takes
grit and determination. But over time
strengths. And acquiring the skills and knowledge we desire
you’ll begin to see your failures for is much easier than it first appears. However, it does take
what they are: learning opportunities. time and effort. Here is how I have sought to change, evolve,
2. Strategically identify what your
areas of weakness are. Do you
and grow in my areas of weakness.
need to learn more about central
sterile processing? Is statistical 4. B
 egin to identify resources Imagine if she had given up all hope
analysis a foreign language to you? and opportunities to grow your after that first rejection, that first
What are the areas where you need weaknesses into strengths. Then failure. Failure is not a reason to quit.
to grow? Consider asking your make a plan. Do you need to read It’s an opportunity to learn so that
colleagues to help you identify your a book? Do you need to practice a we can grow. Success comes when
weaknesses and where you might skill? Do you need to take a class? you repeatedly try to get better at
be able to improve. Make a list of You cannot grow if you do not seek something you’re not good at. So
all the professional weaknesses you the knowledge and experience don’t be discouraged if the room full
can identify to prepare you for the needed to succeed. Professional of physicians is rolling their eyes at
next step. growth does not spontaneously your atrocious speech. Don’t quit.
3. P rioritize your list of professional happen. It is intentionally planned Keep moving forward, keep learning,
weaknesses. I guarantee that for, sought out, and acquired. Seek and keep growing.
you’ll have more than 1 or 2 areas

READ
MORE For more on the latest infection control and prevention literature, visit InfectionControlToday.com

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Mutating, and Infecting Mammals with Cancer at Home Immunity, Imprinting, and
Kevin Kavanagh, MD, examines the current Health care workers should ensure COVID-19 Hospitalization Rates
bird flu outbreak and the possible dangers it patients with cancer know how to protect The FDA's Vaccines and Related Biological
holds for humans. themselves against infections.. Products Advisory Committee discussed
SARS-CoV-2 development and deployment.

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 FEATURE

COVID-19

First Responders Tackle Infection

Control and Prevention Challenges
BY MORGAN WADDELL AND MACKENZY RODGERS

F
or first responders, including emer- protect themselves and their patients N95 respirator masks. At first, it was not
gency medical services (EMS) per- from infectious materials of all types. so bad; you could hide your bad breath
sonnel and firefighters, safety isn’t Working as an emergency medical from your coworkers and hide your tired
just about getting home alive. It’s also technician or firefighter comes with face after getting up at 3 AM.
about making conscious decisions to known and unknown risks. The many After a month of being worn contin-
safety protocols that must uously, the masks began to smell and
be followed include infec- discolor, leaving a reminder of the last
tion control and use of per- call you went on. For many months as
sonal protective equipment frontline paramedics, we were told to
(PPE). PPE can range from use these masks sparingly. “We have
nitrile gloves and a surgical a limited supply, and we cannot get
mask to a fully incapsulat- any more soon,” our supervisors told
ing suit with an indepen- us. N95s, along with most respiratory
dent air supply. Protocols protection masks, are not made for this
help us determine what is kind of wear. They are supposed to be
appropriate for the call we disposed after being contaminated. How
are responding to. helpful was it to health care workers to
The National Institute reuse potentially contaminated masks
for Occupational Safety for weeks and months?

WEBERFOTO@STOCK.ADOBE.COM (LEFT); MONSITJ@STOCK.ADOBE.COM (RIGHT)

and Health and the CDC Some supervisors recommended
research and make rec- microwaving the masks to help kill the
ommendations for the bacteria on the masks. It was only months
prevention of work-related later that commercial companies started
injury and illness. Simi- coming out with innovative cleaning
lar to other occupations, materials for the masks.
individual departments can Hospital employees who were working
strengthen and go above the with patients with COVID-19 were pro-
recommendations given. vided with disposable gowns and extra
I n 2 0 2 0, whe n t he gloves to help against risk exposure, but
COVID-19 pandemic began, those of us working in the EMS services
everything in the health received rain protectors and garbage
care field was flipped upside bag–like gowns that were restrictive and
down. First responders, uncomfortable. These “gowns” caused
nurses, doctors, and any- many of us to question how important
one working with patients we were and whether what we were
had no idea of the changes doing really mattered. Morale was at an
and shortages that were all-time low, with the feeling that no one
about to occur. We grew to cared about our protection or our families
hate wearing the mandated that we were going home to. Many of us

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 FEATURE

Today, first responders have easier

access to information, but there is still a
question of whether the information they
receive is factual.

exposed to infection were quarantined of their patients. Facilities were under- Employers can also help by providing an
from the very people we needed most. staffed and workers were burned-out. atmosphere where their employees feel
Although first responders were doing Burnout often leads to complacency provided for and cared for. Health care
their best to help lower the exposure within the workplace, and the effects employers should help provide the pub-
rate, there were some first responders showed at every facility we went to, from lic with educational information about
who were uninformed and uneducated short tempers to lackadaisical work ethic. infectious diseases and how to provide
about SARS-CoV-2 and the risks that As time went on, PPE shortages grew proper self-care at home.
came with it. worse, and EMTs and other first respond- Although health care will always be
Today, first responders have easier ers as well as other health care workers a revolving door with constant change,
access to information, but there is still became more accustomed to being in lessons we’ve learned over the past few
a question of whether the information environments with possible exposures years hopefully will help pave the path
they receive is factual. Although the CDC without the proper equipment needed to safer work environments. Infection
was doing its best to provide accurate to protect themselves. When these PPE control will always be at the forefront
data and put safety procedures into place items became more readily available, of health care. Therefore, training and
for the public and health care during many workers were already complacent being open-minded to the ever-changing
the pandemic, it often appeared some about being infected with COVID-19. N95 world around us is vital to keeping each
of the media were giving out incorrect masks were swapped for the much more other and ourselves safe.
information. Both health care and the accessible surgical masks, and protective
MORGAN WADDELL is a firefighter and
public were at the mercy of conflicting gowns became a thing of the past.
emergency medical technician. She earned her
information, which made it difficult to One of the most effective ways to
240 certification in 2022. She works for East Wayne
protect ourselves. combat complacency is training in patient Fire District in Dalton, Ohio.
The public often had no idea what care safety. Healthy habits can become
was truly going on. Health care and ingrained through proper training and MACKENZY “MACK” RODGERS started his EMT
EMS services were inundated with accurate, up-to-date information. career in 2017 by enrolling in EMT school. He then
record-breaking numbers of critically ill Employers can help to combat earned his 240 certification at the Akron, Ohio,
patients. These unprecedented numbers employee burnout by providing the fire academy in 2018. Rodgers became a certified
of patients caused shortages in hospital resources they need and developing a paramedic in 2019 and earned his hazardous
materials certification in 2022. He currently works
rooms, which in turn caused longer wait professional, yet friendly, environment
for Akron Fire Department, in Ohio.
times for EMS personnel to transfer care between administration and employees.

WWW.INFECTIONCONTROLTODAY.COM March 2023 ICT® 31

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 PRODUCT LOCATOR

VireXbuster Spray MedMaster M4SEDIC Series

Ken a l l’s Med M a s t er
The COVID-19 pandemic has changed everyone’s life. Despite
M4SEDIC24 Series features
masks, social distancing, and vaccinations, which are all important
405-nm LED Indigo-Clean
measures, the virus continues to mutate and circulate.
light combined with white
According to the makers of VireXbuster Spray,
LEDs provide continuous
individuals potentially can touch 5 infected surfaces
environmental disinfection
in an hour. And results of a study have confirmed
as well as ambient light.
that individuals touch their face up to an average of
Indigo-Clean, a patented, continuous environmental disin-
20-plus times per hour, thus potentially exposing
fection technology, safely and automatically kills harmful
themselves to the SARS-CoV-2 virus.1 Using the
bacteria linked to health care–acquired infections (HAIs). This
VireXbuster spray can interrupt this infection trans-
narrow-spectrum light fixture can be used in surgical suites,
mission channel by keeping frequently touched
critical care, and recovery areas. Unlike UV light disinfection,
surfaces continuously disinfected with a permanent
staff members can be in the room when the light is in use.
and affordable antiviral and antimicrobial coating.
Indigo-Clean targets naturally occurring molecules within
Enrico Brega, chief operations officer for
the bacteria to produce intracellular reactive oxygen species,
DaXem GmBh, which invented and manufactures
which create an oxidative environment that kills the bacteria.
VireXbuster Spray, said to Infection Control Today.®
“Unlike UV disinfection, this technology is safe for occu-
“Our ultimate goal is to provide our customers with coating
pants, and it reaches places normal cleaning doesn’t touch,”
solutions that improve their quality of life so that they can live
Cliff Yahnke, PhD, chief scientist and head of clinical affairs at
in a safer and more hygienic environment. Furthermore, the
Kenall, told Infection Control Today®. “Indigo-Clean is clinically
underlying technology of our products is a patented hybrid coating
proven to safely kill harmful bacteria, including SARS-CoV-2,
composition that has 2 important characteristics, namely excellent
influenza-A, [methicillin-resistant Staphylococcus aureus] and
biocidal properties toward a broader spectrum of biocide activity
[Clostridioides difficile] without damage to eyes, skin, or materi-
combined with high compatibility with most substrates.”
als. Cost effective and efficacious, Indigo-Clean pays for itself
According to DaXem GmBh, a single application of VireXbuster
in just months by reducing surgical site infections by 73% and
Spray coating will keep surfaces hygienically clean for up to
helping health care facilities provide a better standard of care.
12 months; in addition, VireXbuster Spray deactivates SARS-CoV-2 by
These results, combined with the additional cost per patient
99.9% and kills bacteria such as Escherichia coli and Staphylococcus
due to contracting an HAI, suggest that preventing even a
aureus by 99.99%. VireXbuster Spray helps repair scratched sur-
single infection creates a positive [return on investment] and
faces, filling the thin grooves where virus and bacteria can settle.
drive down costs for health care providers.”
www.virexbuster.de/home-en/
https://kenall.com/

HAT-B containers “We’re very excited to be able to provide an extended product

line that continues to be key for protection against moisture, while
In July 2022, Airnov Healthcare Packaging launched HAT-B, an
helping our clients in the pharmaceuticals and nutraceuticals
active and ergonomic flip-top container designed to protect test
industry meet their sustainability goals,” Dirk Maehr, global head
strips, pharmaceuticals, and nutraceuticals from moisture. Mois-
of sales and marketing at Airnov, told Infection Control Today®.
ture protection is integrated in the bottom of the tube as a raw
Suitable for the diagnostic, pharmaceutical, and nutraceutical
desiccant, according to the company website. The vials are made
markets, the vials come in 2 sizes. They are also compatible with
with a reduced amount of plastic, contain adjustable desiccant
existing filling lines and desiccants. The product is manufactured
quantities, and are composed of versatile sorbent material to fit
in China, and Airnov has also increased its manufacturing capac-
stability requirements, the website notes.
ity to meet growing demand for its HAT-SNAP line of products.
Key features of HAT-B include tamper-evidence security, easy
snapping of the closure onto the container, and customization
with options such as molecular sieve, silica gel, or a combination
of both, according to the company website.
https://www.airnov-healthcare.com/

WWW.INFECTIONCONTROLTODAY.COM March 2023 ICT® 33

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 PRODUCT LOCATOR

IntelliSep NOVA infection

Cytovale’s diagnostic
prevention programs
tool, IntelliSep, is a first- Nozin NOVA infection prevention pro-
of-its-kind test aimed at grams are clinically proven to signifi-
decreasing the time, cost, cantly reduce health care–associated
and complexity of sep- infections (HAIs) and surgical site infec-
sis identification to help tions (SSIs). In partnership with more
hospital staff save lives. than 1000 hospitals, Nozin has pioneered
IntelliSep, which received and implemented successful infection
510(k) clearance from the reduction programs that demonstrate
FDA in January 2023, has improved patient outcomes.
the potential to simplify and accelerate sepsis care and improve patient out- “According to the CDC, there’s been a significant
comes. Designed for clinical laboratory use, a benchtop instrument is used increase in HAIs,” John Willimann, CEO, told Infec-
to assess the state of innate immune activity in just 10 minutes. A routine tion Control Today®. “Nasal colonization represents a
blood sample is evaluated to determine the biomechanical properties of the leading risk factor contributing toward HAIs. Nozin
sample’s white blood cells, which differ in patients who have sepsis. provides hospitals with a clinically proven decoloni-
IntelliSep’s unique approach assesses the body’s immune response to an zation solution to mitigate the risk of infection while
infection using immune cell morphology, the act of interrogating cells and improving patient outcomes. We’re grateful to support
observing their reaction. In simple terms, it applies pressure to cells to see hospitals with sustainable programs of universal nasal
how quickly they return to their normal shape. The test provides a score, decolonization as this paradigm shift in patient safety
called the IntelliSep Index, from 0.1 to 10. Clinicians can use that score to help becomes standard of care.”
inform rapid treatment decisions to optimize resource utilization, improve NOVA infection prevention programs are powered
care, and ultimately save lives. by Nozin Nasal Sanitizer antiseptic. Nozin Nasal
“Sepsis is one of the fastest-moving, costliest, most prolific, and least Sanitizer contains a patented formula that delivers
understood causes of death,” Ajay Shah, PhD, Cytovale’s cofounder and 12-hour persistence, kills 99.99% of pathogens, and is
CEO, told Infection Control Today®. “Cytovale’s IntelliSep test provides a rapid clinically proven.
evaluation of a patient’s likelihood of having sepsis within 3 days. This key Independent hospital outcomes demonstrate that
information may help health systems comply with SEP-1 guidelines, preserve daily application of Nozin Nasal Sanitizer antiseptic
resources, and support quick, confident physician decisions to improve care can help reduce the risk of HAI and SSI.
and reduce mortality.” www.nozin.com/nova
www.cytovale.com

Halo Disinfection System their difficulty to inactivate.

“HaloMist applied with the
For more than a decade, Halosil International has helped health
HaloFogger kills Clostridioides dif-
care and research facilities destroy pathogens with the Halo
ficile, a spore-forming organism,
Disinfection System, which pairs sporicidal HaloMist disinfec-
on hard, nonporous surfaces.
tant with the HaloFogger to ensure whole-room coverage with
Therefore, HaloMist meets the
repeatable efficacy and reliable results. Touchless application of
guidance for effective use against
HaloMist reaches everywhere to ensure complete disinfection of
all 3 tiers of viruses. The Halo
the treated space. Compatibility with electronics is excellent. The
Disinfection System is a solution
reasonable cost of acquisition and consumables makes the Halo
for combating pathogens both
Disinfection System an affordable choice for facilities of all sizes.
today and tomorrow,” Maryalice
HaloMist hydrogen peroxide-based disinfectant was listed as
StClair, chief executive officer
a fogging formulation on EPA’s recently created List Q, which pro-
of Halosil International Inc, told
vides cleaning and disinfection guidelines for rare and emerging
Infection Control Today®.
viral pathogens. List Q facilitates the search for products eligible
for use against any of the 3 main categories of EVPs grouped by https://halosil.com/

34 ICT® March 2023 WWW.INFECTIONCONTROLTODAY.COM

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