Ict0521 High Ezine

May 2021 Vol. 25 No.
PREVENTION
Relax, Reset,
Recharge
How Infection Preventionists
Can Beat Stress
CONFERENCE COVERAGE
SHEA Conference Unveils

New Ways to Kill Pathogens
HEALTH CARE-ACQUIRED INFECTIONS
Make Sure COVID-19

Isn’t Spread in Hospitals
STERILE PROCESSING
IAHCSMM’s New Leader

Wants Stronger Ties With IPs
OPERATING ROOM
Nurses Prove Their Mettle

During Pandemic Infection Fight
HAND HYGIENE
Bug of the Month: “Suddenly I’m

on Health Care’s Radar Again”
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TABLE OF CONTENTS
LITERATURE REVIEW
PERSONAL PROTECTIVE EQUIPMENT
8 Decontaminate Those N95s
By Jared Kaltwasser
COVID-19
10 Universal Surveillance Works
By Frank Diamond
HEALTH CARE–ACQUIRED INFECTIONS

11 Antibiotic Overprescribing
By Frank Diamond
PREVENTION
12 At-home COVID-19 Tests
By Frank Diamond
FEATURES
CONFERENCE COVERAGE COVER STORY

22 Highlights From SHEA Spring 2021
HEALTH CARE-ACQUIRED INFECTIONS
PREVENTION
25 Don’t Let COVID-19 Become an HAI
By Jan Dyer
18 Infection Preventionists Fight PTSD
OPERATING ROOM
Even Superheroes Need Some R&R Now and Then
28 Nurses Kept Pandemic at Bay By Saskia v. Popescu, PHD, MPH, MA, CIC
By Amber Wood, MSN, RN, CNOR, CIC, FAPIC
STERILE PROCESSING
30 Q&A With IAHCSMM’s New Leader
HAND HYGIENE
IN ADDITION 7 Bug of the Month 14 Medical World News® 34 Product Locator
By Frank Diamond
EDITORIAL DESIGN & SALES/MARKETING CORPORATE SENIOR VICE PRESIDENT,

OPERATIONS
EDITORIAL DIRECTOR PRODUCTION EXECUTIVE VICE PRESIDENT CHAIRMAN & FOUNDER
Michael Ball
Alexandra Ward, MA CREATIVE DIRECTOR Brian Haug Mike Hennessy Sr
Robert McGarr bhaug@mmhgroup.com VICE CHAIRMAN SENIOR VICE PRESIDENT,
MANAGING EDITOR
609.325.4780 Jack Lepping I.T. & ENTERPRISE SYSTEMS
Frank Diamond SENIOR GRAPHIC DESIGNER
VICE PRESIDENT OF SALES, HEALTHCARE John Moricone
Maia Thagard PRESIDENT & CEO
COPYEDITING Eric Temple-Morris VICE PRESIDENT,
PRODUCTION DIRECTOR Mike Hennessy Jr
etemple-morris@mmhgroup.com HUMAN RESOURCES
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Jennifer Potash Neil Glasser CPA/CFE Shari Lundenberg
CIRCULATION DIRECTOR REPRINTS, PERMISSIONS
COPY SUPERVISORS Jonathon Severn & INTERNATIONAL LICENSING CHIEF MARKETING OFFICER VICE PRESIDENT,
Rachelle Laliberte, Paul Silverman Eric Temple-Morris Michael Baer MERGERS & ACQUISITIONS
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SUBSCRIPTION CUSTOMER SERVICE EXECUTIVE VICE PRESIDENT,
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Kelly King mmhinfo@mmhgroup.com GLOBAL MEDICAL AFFAIRS AND EXECUTIVE CREATIVE

COPY EDITORS CORPORATE DEVELOPMENT DIRECTOR,CREATIVE SERVICES
Cheney Baltz, Georgina Joe Petroziello Jeff Brown
Carson, Rebekah Harrison, SENIOR VICE PRESIDENT,
Kirsty Mackay, Ron Panarotti CONTENT
Silas Inman
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4 ICT®  May 2021 WWW.INFECTIONCONTROLTODAY.COM
ICT0521_004_TOC.indd 4 4/23/21 10:20 AM

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CHAIRMAN'S LETTER
Lessons Learned as the Rebuilding Begins

I
n 2004, the 90th anniversary of the more of. In that vein, this issue includes Association of Healthcare Central Service
start of World War I, New Yorker writer knowledge gleaned from the annual con- Materiel Management this month. One
Adam Gopnik wrote about the problem ference hosted by the Society for Healthcare of her goals is to forge a closer working
of historical judgment. The question was Epidemiology of America on page 22. The relationship between IPs and sterile pro-
“How much can you blame the people of conference got under way about a minute cessing teams in health care systems. Both
the past for getting something wrong when before we went to press, so to speak, but categories of professionals will benefit
they could not have known it was going to go this issue offers a good primer. from such an allegiance.
so wrong? The question is what they knew, One by-product of COVID-19 is burn- Let’s close with another quote from a
when they knew it, if there was any way out. Editorial Advisory Board member writer you may have heard of: Abraham
for them to know more, given what anyone Saskia v. Popescu, PhD, MPH, MA, CIC, on Lincoln. He said, “Fellow-citizens, we
knew at the time, and how in God’s name page 18 offers IPs some tips about how to cannot escape history. We…will be remem-
we could ever know enough about our own spot burnout in themselves and in other bered in spite of ourselves.”
time not to do the same thing all over again.” health care professionals and what to Please send your ideas, comments, or
As we emerge from the COVID-19 pan- do about it. On page 25, author Jan Dyer questions to Editorial Director Alexandra
demic, the rebuilding begins: of the econ- gets expert input about how to ensure Ward at award@mjhlifesciences.com.
omy, of the health care system, of society that COVID-19 does not become a health
itself. Infection Control Today® seeks to fill in care–acquired infection. Thank you for reading.
Gopnik’s gaps by giving infection preven- Then there’s our Q&A with Tanya Mike Hennessy Sr
tionists (IPs) what they should know now Lewis, CRCST, on page 30. Lewis is slated Chairman and Founder
and looking for whatever they should know to become president of the International MJH Life Sciences™
EDITORIAL ADVISORY BOARD
Fibi Attia, MD, MPH, CIC Kimberly Jones Katherine K. Perez,

Infection Prevention Coordinator Director PharmD, BCIDP
Penn State Milton S. Hershey Medical Center Central Sterile Supply, Ohio State Infectious Diseases & Antimicrobial
HERSHEY, PA University Wexner Medical Center Stewardship Clinical Specialist
COLUMBUS, OH Houston Methodist Hospital System
Suma Chacko, RN, CIC HOUSTON, TX
Infection Control Specialist Kevin Kavanagh, MD, MS
Hospital of the University of Pennsylvania Founder and Board Chairman Saskia v. Popescu, PhD,
PHILADELPHIA, PA Health Watch USA MPH, MA, CIC
SOMERSET, KY Hospital Epidemiologist and
Brooke Decker, MD Infection Preventionist
Director of Infection Prevention Susan G. Klacik, BS, CRCST, FCS HonorHealth
VA Pittsburgh Healthcare System Clinical Educator Senior Infection Preventionist
PITTSBURGH, PA International Association of Healthcare PHOENIX, AZ
Central Service Materiel Management
Jody Feigel, MSN, RN CHICAGO, IL Mary Jean Ricci, MSN, RNBC
Nurse Manager for Infection Prevention Director of Clinical Education
VA Pittsburgh Healthcare System Rebecca Leach, MPH, BSN, RN, CIC
Drexel University College of
PITTSBURGH, PA Infection Prevention Coordinator Nursing and Health Professions
HonorHealth PHILADELPHIA, PA
Maya Gossman, RN SCOTTSDALE, AZ
Vascular Access Nurse Linda Spaulding, RN, BC,
Stillwater Medical Center Theresa Madaline, MD
CIC, CHEC, CHOP
STILLWATER, OK Healthcare Epidemiologist
Infection Prevention Consultant
Montefiore Health System
Yi Guo, PharmD InCo and Associates International, Inc.
Assistant Professor, Infectious Diseases
LAKEWOOD RANCH, FL
Co-Director of the Antimicrobial Albert Einstein College of Medicine
Stewardship Program NEW YORK, NY
Maureen Spencer, MEd, RN
Montefiore Medical Center,
Nancy Moureau, PhD, Infection Preventionist Consultant
Albert Einstein College of Medicine
BOSTON, MA
BRONX, NY RN, CRNI, CPUI, VA-BC
Chief Executive Officer Sharon Ward-Fore, MS,
Jenny Hayes, MSN, RN, PICC Excellence, Inc
CIC, CAIP, CASSPT MT(ASCP), CIC
HARTWELL, GA
Infection Prevention Consultant
Infection Prevention Leader
CHICAGO, IL
Hospital of the University of Pennsylvania
PHILADELPHIA, PA
ICT0521_006_Letter.indd 6 4/23/21 10:22 AM

BUG OF THE MONTH
hand hygiene
Suddenly I’m on Everybody’s Radar (Again)
J
ust call me the comeback kid. Sud- Infections caused by me have increased from 1 or both eyes. Joints can become
denly, after practically disappearing for 63% since 2014. swollen, red, warm, and very painful
decades (or being consigned to the shelf In women, I cause the following symptoms: whenever you move. I might be the cause
marked “easily treatable”), I am returning  Increased vaginal discharge of that sore throat and those swollen lymph
with a vengeance. And I am not easy. That  Painful urination nodes on your neck. There is an entire list
is why the Centers for Disease Control  Vaginal bleeding between periods, such of things you can do to curtail me. Here
and Prevention (CDC) in December 2020 as after intercourse is just one of the CDC websites you can
updated guidelines for how to treat me. Yes,  Abdominal or pelvic pain visit: https://bit.ly/3mzspwL. However, ICT®
December 2020, the beginning of one of the In men, I am responsible for these symptoms: goes out to infection preventionists and
global COVID-19 pandemic’s biggest surges  Painful urination other health care professionals. There is
and, still, CDC investigators took time out to  Puslike discharge from the tip of the penis a systematic approach to fighting me, and
figure out how best to deal with me.  Pain or swelling in 1 testicle just to make this a sporting challenge, I
I am high on the list of any medical expert If you are smart, you would head to your will let you in on it.
who has to deal with…but if I told you what doctor if you exhibit any of these symptoms. Well, I will let the CDC let you in on it.
category of disease I am in, this would not That is no guarantee, however. I can infect CDC: “Antimicrobial stewardship. The 2019
NOBEASTSOFIERCE@STOCK.ADOBE.COM
be much of a quiz, would it? (Although I am you without you showing any signs. I can report on antimicrobial resistance threats
prominently featured in a recent article in cause infertility in women when I spread in the United States highlights that antimi-
Infection Control Today® (ICT®) at https://bit. to the uterus and fallopian tubes. I am the crobial stewardship (ie, the development,
ly/39Mk2J9 if you want to cheat.) The CDC’s driver of pelvic inflammatory disease and promotion, and implementation of activities
updated guidelines that I just mentioned can greatly complicate pregnancies. to ensure the appropriate use of antimicrobi-
recommend attacking me with a single I also make men infertile because I als) remains a major public health concern.”
500-mg intramuscular dose of ceftriaxone. attack the rear portion of their testicles So there you have it. A strong antimi-
My resurgence happened because I where sperm ducts are located. crobial stewardship program in which IPs
became immune to the antibiotics that I can attack your eyes, causing pain, play a part can possibly defeat me.
had historically been used to treat me. sensitivity to light, and pus discharging Who am I? 
To discover who I am, visit InfectionControlToday.com/view/may-2021-bug-month
WWW.INFECTIONCONTROLTODAY.COM May 2021  ICT® 7
ICT0521_007_BOTM.indd 7 4/23/21 10:23 AM

LITERATURE REVIEW
personal protective equipment
Most Decontamination Methods for

N95s Work
BY JARED KALTWASSER
Necessity might be the mother of inven- Schumm, MD, of the UCLA David Geffen can fail if the reprocessing system cannot
tion, but the inventions themselves—at School of Medicine, and colleagues noted kill all the pathogens that accumulate on
least at first go-around—often wind up that filtering facepiece respirators such the mask material itself, if the filters are
being abandoned. That was not an option as N95 masks have been in limited sup- compromised and lose filtering efficiency,
for infection preventionists and other ply since the pandemic’s start last year. or if the mask elasticity is altered such
health care professionals forced to use Unable to purchase adequate supplies of that it no longer provides a tight fit and
various methods to decontaminate and the theoretically single-use masks, health air leaks around the mask.”
reuse N95 masks early in the COVID-19 systems had to begin reprocessing them, Hoping to provide better guidance on
pandemic. Luckily, though, most methods something the Centers for Disease Control how best to reprocess the masks, Schumm
used for this purpose were adequate. and Prevention (CDC) says is acceptable in and colleagues set about examining exist-
Such are the findings in a study in emergency conditions. ing studies. They found 42 studies eval-
JAMA.1 Corresponding author Max A. “However, that [CDC] guidance is asso- uating 5 decontamination processes:
ciated with few recommendations for how UV germicidal irradiation, moist heat,
to reprocess these devices,” Schumm et microwave-generated steam, vaporized
al wrote. “Filtering facepiece respirators hydrogen peroxide, and ethylene oxide.
The authors extracted data from the stud-
ies on a variety of parameters: process
method, pathogen removal, mask filtra-
tion efficiency, facial fit, user safety, and
processing capability.
The shape The results were mostly positive. Most
and material methods proved reliable and relatively easy
to implement. The investigators found
composition that UV germicidal irradiation, vaporized
of the N95 hydrogen peroxide, moist heat, and micro-
respirators varied wave-generated steam all were effective in
sterilizing the respirators, and the respira-
widely from tors sterilized in these methods retained
manufacturer to their filtration performance. The first
2 methods—UV germicidal irradiation,
manufacturer,
vaporized hydrogen peroxide—caused the
which can result
DARIA NIPOT@STOCK.ADOBE.COM
least damage to the respirators, Schumm

in variations in and colleagues found. Irradiation, moist
heat, and microwave-generated steam
the efficacy of a were found to have short treatment times
particular method and could be done with readily available
equipment. Vaporized hydrogen peroxide
from one product
was a suitable option, although it takes
to the next. longer and is more expensive, they said.
The fifth method, ethylene oxide, could
ICT0521_008-013_LitReview.indd 8 4/23/21 10:28 AM

LITERATURE REVIEW
potentially leave toxic residue and is
Q&A
harder to implement, they concluded.
“Overall, the results of the review A Conversation With
should be reassuring to health care work- J. M. van Niekerk
ers because we can effectively decontam-
inate this essential [personal protective
equipment] without damaging its filtering Infection Control Today® (ICT®) caught up with J. M. van
capability or the polymers that make up Niekerk, corresponding author of a recent study in
the mask,” Schumm said. However, he BMC Infectious Diseases, via email to discuss some of
added 2 important caveats. First, some
the implications of his study’s findings: namely that because nurses
methods are more likely to damage the
are everywhere within health care facilities, they are often the ones
devices. Second, the shape and material
responsible for spreading microbes (albeit unconsciously).
composition of the respirators varied
widely from manufacturer to manufac- ICT®: A part of ICT®’s readership includes infection preventionists, who are charged
turer, which can result in variations in the with trying to—as their name suggests—prevent and control infections in health
efficacy of a particular method from one care settings. What practical takeaways might they get from your findings?
product to the next. “For these reasons,
we recommend clinicians and leaders van Niekerk: The spatiotemporal behavior and social mixing pat-
of health care systems confirm that the terns of health care workers play an essential role in spreading harm-
reprocessing system in use at their facil- ful microorganisms in health care settings. Quantifying these patterns
ity has been tested for the specific brand can help to develop measurements to prevent the spread.
and model of the N95 respirator in their ICT®: It appears as if nurses are more likely to spread pathogens because they’re
stockpile,” he said. more on the move and interact more with other health care professionals and pa-
Schumm said that because N95 respi- tients. Are there certain systemic remedies that could be applied to make them less
rators have irregular surfaces and porous likely to spread pathogens?
material, it is possible the SARS-CoV-2
virus or other pathogens could be pro- van Niekerk: Inform the hand hygiene policies and the strategic place-
tected or shielded from sterilization or ment and choice of dispensers using these insights [from this study].
become absorbed into the material. He ICT®: As you know, hand hygiene adherence among health care professionals has
said masks with a fluid-resistant coating been poor for decades. What might your findings bring to the conversation that
may perform better for this reason. He might better encourage hand hygiene adherence?
also said decontamination performance
in the studies is different from real-world van Niekerk: The results of our study can inform occupation-
exposure scenarios, which could have an specific hand hygiene education. For example, based on nurses’
impact on real-world decontamination social mixing patterns, when and where is the best time for them to
efficacy. “Taken together, more research perform hand hygiene? Also, the strategic placement and choice of
should be directed toward reprocessing dispensers, especially in locations with high numbers of interaction.
effectiveness for SARS-CoV-2 to better
ICT®: You monitored interactions via radio frequency identification. Should such
characterize optimal decontamination
monitoring be considered a first step in improving hand hygiene adherence?
protocols for this pathogen,” he said. 
van Niekerk: Understanding health care workers’ social mixing
REFERENCE patterns in a health care setting is an essential first step to strategi-
1. Schumm MA, Hadaya JE, Mody N, Myers BA,
Maggard-Gibbons M. Filtering facepiece respirator
cally determine where and when they should perform hand hygiene
(N95 respirator) reprocessing: a systematic review. to minimize the spread of harmful microorganisms.
JAMA. Published online March 3, 2021. doi:10.1001/
jama.2021.2531
To read more about van Niekerk’s

study, visit https://bit.ly/3cye8Nm

LITERATURE REVIEW
COVID-19
Universal Surveillance for

COVID-19 Works for One Hospital
BY FRANK DIAMOND
Test all patients who go to a hospital for (63%) exhibiting symptoms and 38 (37%) is based on the indirect finding that they
COVID-19, even those who do not exhibit considered asymptomatic. “The propor- shed live virus,” the study states. “Thus,
symptoms and are there for other medi- tion of SARS-CoV-2 patients who were the premise of isolating asymptomatic
cal reasons. It is very possible that more asymptomatic varied over the duration positive patients is to contain the shedding
than one-third of patients not there for of the study but trended up from 20% at of live virus.”
COVID-19 will be asymptomatic carriers the onset of the study period to 60% at the The most common reasons for admit-
of the virus who may endanger health end,” investigators wrote. ting asymptomatic patients were trauma
care workers and other patients, or childbirth. Investigators also
according to a study in the Amer- found some socioeconomic fac-
ican Journal of Infection Control.1 tors involved.
“The proportion of asymp- “Identifying and isolating “Known risk factors for COVID-
tomatic patients admitted with asymptomatic patients likely 19 include persons frequently
SARS-CoV-2 was significant,” in congregate settings with an
investigators with the University prevented exposure and development increased likelihood of close con-
of Louisville in Kentucky reported. of hospital-acquired COVID-19 cases tact,” the study states. “The risk
“Identifying and isolating asymp-
tomatic patients likely prevented
among health care workers and other factors were exemplified in our
population as pregnancy, pov-
exposure and development of patients, supporting the universal erty, and crowding. These clusters
hospital-acquired COVID-19 surveillance of all admitted patients.” represented a group of pregnant
cases among health care workers Hispanic patients from one area,
and other patients, supporting and additional clusters of both
the universal surveillance of all symptomatic and asymptomatic
admitted patients.” Forest W. Arnold, DO, MSc, the study’s patients in densely populated urban parts
Investigators reached this conclusion corresponding author and an associate of [Louisville]. This type of information
even while acknowledging that such an professor in the Division of Infectious could contribute to outbreak investigations
approach can present logistical and finan- Diseases at the University of Louisville, by a health department.” 
cial hurdles including an increase in the tells Infection Control Today® that a pos-
cost of testing and use of the laboratory. sible reason for this is that “there was REFERENCES
1. Arnold FW, Bishop S, Oppy L, Scott L, Stevenson G.
Universal surveillance was instituted at much less travel early, during the national Surveillance testing reveals a significant proportion
the University of Louisville Hospital last quarantine, but later people got out more of hospitalized patients with SARS-CoV-2 are as-
ymptomatic. Am J Infect Control. 2021;49(3):281-285.
April. The data were collected on patients and thus hurt themselves in car wrecks or doi:10.1016/j.ajic.2021.01.005
from April 9, 2020, to July 1, 2020. Those once they got to where they were going— 2. Symptoms of coronavirus. Centers for Disease
Control and Prevention. Updated February 22, 2021.
who tested positive for COVID-19 were to work or whatever. Traveling not only Accessed March 10, 2021. https://www.cdc.gov/coro-
divided into symptomatic or asymptomatic put them at risk for trauma, but also for navirus/2019-ncov/symptoms-testing/symptoms.html
categories, using the 11 symptoms that the acquiring COVID-19.”
Centers for Disease Control and Prevention Investigators concluded that asymp-
says should be watched for.2 tomatic carriers increased the duration Subscribe to our
After reviewing 2882 COVID-19 tests, of the pandemic. “The reason that we cur- eNewsletter to get
investigators found that 103 individuals rently isolate asymptomatic and symptom- our latest articles!
tested positive for the disease, with 65 atic SARS-CoV-2 patients in the hospital

LITERATURE REVIEW
health care–acquired infections
CDC Wants to Improve Antibiotic

Overprescribing by More Than 90%
BY FRANK DIAMOND
The Centers for Disease Control and Pre- opinion, I know it’s ambitious, but I think surveys that occurred from May 1, 2015, to
vention (CDC), along with the Pew Char- we should line up with that.” September 30, 2015. They were analyzed
itable Trusts, recently unveiled a goal Srinivasan also said that infection between August 1, 2017, and May 31, 2020.
to decrease inappropriate prescribing of preventionists (IPs) should be a part of any But even though the data came before the
antibiotics for community-acquired pneu- effective antimicrobial program. “I think COVID-19 pandemic, Pew and the CDC say
monia (CAP) and urinary tract infections that the key is for the [IPs] to make sure that they have relevance to what’s been
(UTIs) by 90% and the overprescribing of that they’re connected with their steward- going on with COVID-19. According to Pew,
fluoroquinolone antibiotics and vancomy- ship programs,” Srinivasan told ICT®. “And 52% of patients who have been hospitalized
cin by 95% in hospitals. The recommen- I think in almost every instance where I for COVID-19 received at least 1 antibiotic,
dation was made by a panel of antibiotic interact with hospitals, that connection and many of those prescriptions were
prescribing experts chosen by Pew and is already present, and it’s very strong.” likely unnecessary.
based on CDC data published March 18, In the JAMA Network Open study, antibi- In his interview with ICT®, Srinivasan
2021, in a study in JAMA Network Open.1 otic treatment was unsupported for 876 of said antibiotic overprescribing that the
“In this cross-sectional study of 1566 patients. That broke down to “110 of CDC tracked during the COVID-19 pan-
1566 patients at 192 hospitals, antimi- 403 (27.3%) who received vancomycin, 256 demic “represents the fact that you had a
crobial use deviated from recommended of 550 (46.5%) who received fluoroquino- lot more patients presenting to the hospital
practices for 55.9% of patients who received lones, 347 of 452 (76.8%) with with signs and symptoms con-
antimicrobials for [CAP] or [UTI] present a diagnosis of UTI, and sistent with pneumonia.
at admission or who received fluoro- 174 of 219 (79.5%) with a They had cough, they
quinolone or intravenous vancomycin diagnosis of CAP. Among had fever, they had
treatment,” the study states. patients with unsup- chest x-ray infiltrates.
Shortly after the study was published, ported treatment, common And in some of those
Arjun Srinivasan, MD, the CDC’s associate reasons included excessive instances, it was likely
director for health care association infec- duration (103 of 174 patients
tion prevention programs, told Infection with CAP [59.2%]) and lack of
Control Today® that he envisions reaching documented infection signs
the goal by 2025, adding that a lot of prog- or symptoms (174 of
NEIRFY@STOCK.ADOBE.COM
ress has already been made in the effort to 347 patients with
cut back on inappropriate prescribing of UTI [50.1%]).”
antibiotics since 2015.2 “The first phase of The data were
that so-called CARB [Combating Antibiot- collected from
ic-Resistant Bacteria] action plan was from the medical records
2015 to 2020,” Srinivasan told ICT®.3 “And of patients included
the second phase is 2020 to 2025. In my in hospital prevalence
Scan this code to view ICT ®’s

video interview with
Arjun Srinivasan, MD.
WWW.INFECTIONCONTROLTODAY.COM

LITERATURE REVIEW
difficult to distinguish who had a true public and private insurers to launch in US hospitals. JAMA Netw Open. 2021;4(3):e212007.
doi:10.1001/jamanetworkopen.2021.2007
respiratory tract bacterial infection and reimbursement programs to bolster appli- 2. Diamond F. Antibiotic stewardship programs need
whose symptoms were only due to COVID- cation service providers; and health care infection preventionists. Infection Control Today®. March
19. So not very surprising that we did see a systems, particularly the smaller ones, will 23, 2021. Accessed March 29, 2021. https://www.infec-
tioncontroltoday.com/view/antibiotic-stewardship-pro-
rise in prescribing of those agents.” need technical and financial assistance.  grams-need-infection-preventionists
Hospitals are encouraged to report use 3. National action plan for combating antibiotic-re-
of antibiotics to CDC’s National Healthcare REFERENCES sistant Bacteria. CDC. March 2015. Accessed March
1. Magill SS, O’Leary E, Ray SM, et al; Emerging Infec- 23, 2021. https://www.cdc.gov/drugresistance/pdf/
Safety Network Antimicrobial Use Option. tions Program Hospital Prevalence Survey Team. As- national_action_plan_for_combating_antibotic-resis-
In addition, the CDC and Pew encourage sessment of the appropriateness of antimicrobial use tant_bacteria.pdf
prevention
At-home COVID-19 Tests tional testing expenditures ($12.5 billion)

and workdays lost ($14.0 billion), yielding
Are an ‘Effective Strategy’

incremental cost-effectiveness ratios of
$7890 per infection averted and $1.43 mil-
lion per death averted.”
Their conclusions apparently reached
BY FRANK DIAMOND
the ears of federal health care experts
because the study is featured on the COVID-
Any national strategy to contain SARS- that they said represents individuals most 19 Science Update website maintained
CoV-2, the virus fueling the COVID-19 likely to transmit the virus in the US pop- by the Centers for Disease Control and
pandemic, should include antigen-based ulation, the investigators computed what Prevention.2 Investigators tinkered a bit
at-home testing even if that testing is would happen if at-home testing were used, with the model methodology, splitting the
less than perfect and even if many who acknowledging that for a proportion of the infected compartment into 4 subgroups:
obtain the tests decide not to go through population, the tests will asymptomatic, mild/
with them. Such at-home testing would show negative for people moderate, severe, and
NAEBLYS@STOCK.ADOBE.COM
greatly reduce hospitalizations, deaths, who are in fact positive Even assuming that critical.
and the accompanying health care costs for COVID-19. But even up to 75% of people “This permitted us
involved in treating individuals with factoring that in, the to capture more fully
COVID-19, according to a study in the results place at-home testing positive would the natural history, epi-
Annals of Internal Medicine.1 That at-home testing in a positive not follow isolation demiology, and resource
testing is less than perfect has been a light, with results that use associated with pro-
guidance, the tests
linchpin, with critics saying there would investigators describe gressive COVID-19,” the
be too many false negatives and no guar- as “staggering in their would greatly
antee people would take the tests. But the magnitude.” curtail infection,
investigators—A. David Paltiel, PhD, of Yale “Without a testing
School of Public Health; and Amy Zheng, intervention, the model
hospitalization,
BA; and Paul E. Sax, MD, both of Harvard anticipates 11.6 million and death, argue
Medical School—crunched the numbers infections, 1 19,000
investigators.
and reached a different conclusion. deaths, and $10.1 billion
“High-frequency home testing for SARS- in costs [including] ($6.5
CoV-2 with an inexpensive, imperfect test billion in inpatient care and $3.5 billion in
could contribute to pandemic control at lost productivity) over a 60-day horizon,”
justifiable cost and warrants consideration the study states. “Weekly availability of
as part of a national containment strategy,” testing would avert 2.8 million infections
the study states. Using a traditional sus- and 15,700 deaths, increasing costs by
ceptible-exposed-infected-recovered com- $22.3 billion. Lower inpatient outlays
partmental epidemic modeling framework ($5.9 billion) would partially offset addi-
12 ICT®  May 2021

LITERATURE REVIEW
study states. “Second, we introduced a par- the findings. They state that they “assumed have included almost every possible reason
allel set of states to distinguish between that even among the minority who did why the at-home COVID-19 tests should
epidemiologically ‘susceptible or infec- perform the test, a large proportion (50% not make a difference—and yet conclude
tious’ individuals and persons no in the base case; 75% in the worst case) that those tests would in fact make a huge
longer susceptible or infectious would elect to ignore a positive test difference. They urge readers to focus less
due to isolation or death. finding and refuse to self-isolate. on the numbers and more on their conclu-
In ‘susceptible or infec- This means that in the worst sion that a nationwide rollout of at-home
tious’ compartments, we case, only 6.25% (25% of tests would make sense. “Our bottom-line
assumed that individu- 25%) of persons would be message is: Do not let the perfect be the
als interact in ways that assumed to adhere to the enemy of the good; even a highly imperfect
permit infectious contact recommended testing and home-based testing program could confer
and transmission of SARS-CoV-2; isolation protocols. Finally, enormous benefit.” 
in ‘isolation’ compartments, no we assumed that even among
REFERENCES
transmission was possible.” that small proportion of persons who
1. Paltiel AD, Zheng A, Sax PE. Clinical and economic
Investigators tried to account for the might elect to self-isolate, 20% each day effects of widespread rapid testing to decrease SARS-
unpredictability of individuals’ behavior, would abandon isolation and return to the CoV-2 transmission. Ann Intern Med. Published online
March 9, 2021. doi:10.7326/M21-0510
and purposely made what they described active population, against recommended
2. COVID-19 science update. CDC. Updated March 19,
as highly pessimistic assumptions about guidance.” 2021. Accessed March 25, 2021. https://www.cdc.gov/
how those who take the tests might react to Paltiel, Zheng, and Sax argue that they library/covid19/03192021_covidupdate.html
education • exposition • engagement

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Annual Conference & Expo, you’ll build
upon your knowledge with industry-leading
educational opportunities, examine new
product and service innovations at our
Expo, catch up with peers, network with
fellow participants, and discuss best
practices with industry experts.
This can’t miss event will be held face-to-
face in Columbus, Ohio, with two different
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October 9-11 (Option A) or October 12-
14 (Option B). Additionally, a full virtual
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be held October 15-22.
Register and learn more about the
2021 IAHCSMM Conference & Expo at
www.iahcsmm.org/GreatExpectations
ICT Half Page 1.indd 1 4/6/21 11:28 AM

MEDICAL WORLD NEWS®
Endoscopes Are Causing Infections,

FDA Warns Providers
BY INFECTION CONTROL TODAY® EDITORIAL STAFF
T
he United States Food and Drug lying factor in the infection.” (For more Disease Control and Prevention, published
Administration (FDA) wants health about the sterile processing of endoscopes a document called “Essential Elements
care providers to know that some and all surgical devices, see our interview of a Reprocessing Program for Flexible
medical devices have caused serious with Tanya Lewis, CRCST, of the Interna- Endoscopes—Recommendations of the
infections in patients. The information tional Association of Healthcare Central Healthcare Infection Control Practices
comes from numerous medical device Service Materiel Management on page 30.) Advisory Committee.”3
reports (MDRs) focusing mainly on endo- Jeffrey E. Shuren, MD, JD, the director “Not only does it give you good informa-
scope malfunctions. MDRs can be filed by of the FDA’s Center for Devices and Radio- tion related to scopes and processing, but if
providers, manufacturers, importers, or logical Health, said in the press release that you don’t have a strong program setup, it
anybody else who sees a problem. “while some reports indicate the potential gives you everything to put that program in
In a press release,1 the FDA said that causes could be inadequate reprocessing place,” Spaulding said. “It gives you a policy
the MDRs describe “patient infections or device maintenance issues, we’re also format [and] audit tools. It gives you a com-
and other possible contamination issues evaluating other possibilities, including petency verification tool so you can make
associated with reprocessing urological device design or the reprocessing instruc- sure your people are competent, [and]…
endoscopes, including cystoscopes, ure- tions in the labeling. Although we believe an inventory repair and maintenance log,
teroscopes, and cystourethroscopes— that the risk of infection is low based on so you can log every single time a scope
devices used to view and access the uri- available data, we’re reminding health breaks and when it goes out.”
nary tract. Reprocessing these types of care providers how important it is to follow The letter the FDA sent to providers
medical devices involves both cleaning the labeling and reprocessing instruc- offers “recommendations for reprocessing
and high-level disinfection or sterilization tions to properly clean and reprocess the and using these devices, including following
so the devices can be reused.” devices, including accessory components.” the reprocessing instructions, not using a
The FDA received 450 MDRs from Jan- Linda Spaulding, RN, BC, CIC, CHEC, device that has failed a leak test, developing
uary 1, 2017, through February 20, 2021, CHOP, a member of Infection Control schedules for routine device inspection and
ROMASET@STOCK.ADOBE.COM
that describe how patients were infected Today®’s Editorial Advisory Board, warned maintenance, and discussing the potential
through devices post procedure, with the in an interview in last month’s issue of benefits and risks associated with proce-
cause likely to be faulty decontamination. ICT® that much can go wrong in sterile dures involving reprocessed urological
Olympus Corporation, a manufacturer of processing. She told of a time when she endoscopes with patients,” according to
endoscopes, filed 3 MDRs concerning cases was working for a hospital accreditation the FDA press release. 
in which patients died from bacterial infec- company and inspected hospitals “where
tions outside the United States (the FDA said they didn’t even track their scopes. They REFERENCES AVAILABLE AT
MDRs are not evidence that an infection didn’t know what scope was used on INFECTIONCONTROLTODAY.COM
was caused by a device malfunction). what patient or…that a
“Two of those reports were associated particular scope kept
with a forceps/irrigation plug, an accessory breaking down. And
component used to control water flow and that’s the same one they
enable access to the working channel of the kept sending out, because
endoscope,” the FDA press release stated. their tracking programs
“Lab tests confirmed the same infectious just aren’t there.”2
bacteria [were] present in both the forceps/ There’s a solution,
irrigation plug and in the patient with the though, Spaulding said.
infection. The third patient death report The Healthcare Infection
involved a cystoscope that did not pass a Control Practices Advi-
leak test, indicating possible damage to the sory Committee, which
device, which could have been an under- is under the Centers for
14 ICT®  May 2021
ICT0521_014-017_MedWorldNews.indd 14 4/23/21 10:38 AM

Your Future Telehealth Just putting a screen between patients and

providers is not enough.
Program Starts Now

“Everyone ran out with COVID-19 and
tried to do video visits. The market is kind
of paused now as vendors look at enabling
BY RACHEL ZIMLICH, RN
virtual health throughout the entire care
continuum,” says Patrick Rainville, direc-
T
he health care industry has for that there is much more to telehealth than tor of engineering at Iron Bow Healthcare
years been trying to figure out how a virtual connection. Solutions, a telehealth firm headquartered
to get people to buy into telehealth in Herndon, Virginia.
services. Were users concerned about Unique Needs
security? Was it too hard to use? Would When it comes to telehealth platforms, Agile, Integrated
older patients be comfortable seeing their there is no such thing as a one-size-fits- Health care systems should be looking for
doctor online? It turns out that a pandemic all approach. Patients and providers have enterprise platforms that do not need to
was the catalyst no one saw coming. unique needs, and there is a wide range be developed from scratch. Software plat-
The Centers for Disease Control and of services offered in every health system. forms that can be configured for individual
Prevention reports that telehealth usage Organizations need a flexible vendor part- workflows at the use level—not coded—are
increased 50% in the first quarter of 2020 ner that can satisfy different preferences in high demand, Rainville explains.
compared with the first quarter of 2019,
with a 154% increase noted by the start of
the second quarter of 2020 from the prior
year.1 Changes in how telehealth visits
COVID-19 HELPED TO SPEED UP ADOPTION OF TELEHEALTH.
were reimbursed helped make this happen
and encouraged vendors and health care
providers to offer increased support for
WHEN IT COMES TO TELEHEALTH PLATFORMS, THOUGH,
virtual platforms. THERE IS NO SUCH THING AS A ONE-SIZE-FITS-ALL APPROACH.
The problem became how providers
could quickly pivot to provide services
their patients needed without seeing them among physicians and patients, says Dan “A vendor should offer something that
in person. According to a Kaiser Family Olson, senior vice president of provider can scale from home use and wellness
Foundation (KFF) report,2 many providers solutions at Amwell, a Boston, Massachu- to ambulatory, skilled, acute care, and
at the beginning of 2020 did not have the setts–based telemedicine company. more,” he says.
capacity to offer telehealth at the level the “We find that our customers have a
pandemic required. Regulatory changes wide range of needs and many want an Proven Record, Adaptability
brought a new influx of cash to health care integrative solution,” Olson says. “But they A vendor must be able to evolve with your
systems to create or upgrade telehealth also have providers that really want fast, needs and scale across an enterprise, too.
systems. KFF revealed that although 50 of easy, and simple.” Many technology solutions can connect
America’s largest health systems already Early in the pandemic, some health people, but delivering care is different. A
had telemedicine programs in place, only care providers resorted to private sys- vendor partner should have a record of
about 15% of physicians in those systems tems like Zoom and FaceTime to see success and be able to prove it.
used the platform. patients if their systems were not ready “You need a partner that has done its
The explosion of demand to meet virtual needs. But due diligence and vetting,” Olson recom-
for telehealth services and FROM THE PAGES OF these platforms raise pri- mends. Experience matters when it comes
new financial support for vacy concerns, and there is to telehealth platforms, he adds.
this channel meant many no consistency throughout A good vendor will be able to demon-
health care systems had to the health care system. The strate success elsewhere and be willing to
consider revising or replac- focus should not be just see- create work-arounds and flexible solutions
ing their platforms and offering support ing a patient over a video stream but also where needed. They should share where
and education to providers and patients. providing them with a safe, secure space their gaps are and what they are planning
Health care systems that did not have that will allow providers to integrate care to be able to move forward. Telehealth is
platforms already in place quickly learned with their electronic medical record (EMR). not a static platform.

“Ask for 2 or 3 references in a similar key. If waivers and reimbursement change to watch for, including vendors that over-
specialty,” Chad Anguilm, vice president once the pandemic subsides, you should promise, Olson warns.
of in-practice technology services at the not need to find a new platform. A good “That should raise a red flag, in my
Michigan-based health care consulting partner will have a full implementation opinion,” Olson says. “A vendor saying that
firm Medical Advantage, says. “If it’s taking plan laid out, detail how you it can do anything a customer
a long time to find those references, that will reach out to and educate wants is not practical in the
should be a red flag.” patients, provide reimburse- real world.” Ask vendors for
Health care systems will also want to ment information, and more. references from providers that
make sure their vendor partner is prepared Avoid long-term contracts, use their system already. They
TO READ MORE,
to stay around and help long after a contract he adds, because there is not SCAN THE QR CODE. should be willing to share suc-
is signed. “Choosing a partner that has done much information yet on what cess stories, Olson says.
this before or who has a customer base reimbursement for telehealth will look Anguilm adds that it is also important
where they have demonstrated success like a year from now. to look for glitches and delays during
is important,” Olson says. “A lot of people “Simply put, a good vendor partner demonstrations of the program. If it hap-
claim they can do things, but they might program should feel like an extension of pens in a demo, it will happen live, he
not be health care specific. It’s important to ongoing operations. Health care organiza- warns. Make sure the company can sup-
have that experience in health care because tions looking for a strong partner for tele- port the technology it promises.
workflows and all the different systems you health should expect a level of support that Brennan suggests that part of the
work with are very different than turning maximizes opportunity and minimizes vendor partner selection process should
on a web meeting. You need account man- headaches and interruptions to current include a discussion of failure and con-
agement and support teams that will walk workflows,” adds Roland Therriault, pres- nection rates. Where are people dropping
you through it and build trust.” ident and executive vice president of sales off and what can the vendor do to help
The biggest question, says telehealth at InSync Healthcare Solutions, a Tampa, address this?
expert Joseph Brennan of Moonshot Health Florida–based health care technology “When you’re looking for a partner,
Consulting in Grand Rapids, Michigan, is company. “Vendor partners should take look for someone who has been around
how the system and patients will be sup- on the heavy lifting of implementations, and has a full-service offering,” says Kevin
ported after the health system signs on. technology adoption, and optimal use of Greene, director of business development
“When implementing a technology that a telehealth solution. In addition, the best at Iron Bow. It is not enough for a vendor
is in health care, whoever is supporting relationships ensure ongoing success by to supply a product. There needs to be
you—the relationship is critical,” Brennan keeping providers apprised of evolving operational and clinical support with an
says. “So I would ask [the vendor], ‘What regulatory movements, ensuring infra- understanding of the outcomes you are
is your model for support and what do I structures align with the most advanced trying to reach, he adds.
get with what I’m buying?’ ” security functionality and ongoing support Overall, Brennan says, understand that
It is helpful to have a dedicated project and oversight of end-user education.” not every solution works for every system,
manager or support team from start to and that there is a big difference between
finish, Anguilm adds. Sustainability is also Red Flags technology and health care. The key is find-
When it comes to telehealth, the big ing someone who understands your goals
challenge seems to be on the and knows what it will take to get you there.
technology end. But solu- “It’s all the same thing. It’s videoconfer-
tions that focus only on encing bolted onto your EMR,” he says. “But
technology are not if the person you’re talking to doesn’t have
enough. Telehealth any health care references, that’s a big red
CHINNAPONG@STOCK.ADOBE.COM
platforms must have flag. They’re either brand new and you’re
a deep understand- going to be their first customer, or it’s not
ing of health care going that great. Many tech people don’t
and the needs of understand how intricate every aspect of
patients and provid- health care is. This isn’t a retail shopping
ers. When search- experience; this is health care.” 
ing for a telehealth
platform, there are REFERENCES AVAILABLE AT
a number of things INFECTIONCONTROLTODAY.COM
WWW.INFECTIONCONTROLTODAY.COM

INTERACTIVE
@ICT_magazine
@VIRGO.InfectionControlToday
@Infection-Control-Today
Featured in our Medical World News® Broadcast

Top Tweets
Q&A: Infection Preventionists Will Join the conversation @ICT_magazine
Be Needed Even More After COVID-19
Priya Nori, MD: “The immediate thing that the
health care industry has to grapple with, even as @ICT_magazine interviews me in a
brief video about #infectioncontrol &
COVID-19 hopefully starts to settle down after the
#patientsafety. “Stimulus Will Boost IP
mass vaccination campaign … [will be] superbugs.” Efforts, but Cultural Change Needed”
WATCH: https://bit.ly/31XjZFP https://bit.ly/3rZzQ1n @hhask
@armandonahum @PLAN4ZERO
Q&A: Stimulus Will Boost IP Efforts,
but Cultural Change Needed MICHAEL MILLENSON @MLMillenson
Michael L. Millenson: “The CDC will pay more
attention to infections. But there’s also an asterisk
here. Will Congress continue to pay attention to With so many questions still circu-
infections? Will the administration’s budget con- lating about the #COVID19 vaccine,
tinue to pay attention to infections? Will the media one thing is for certain: infection
continue to pay attention to infections?” preventionists will be at the front of
the pack to lead nation-wide vaccina-
WATCH: https://bit.ly/3sWjV5k
tion efforts, due to their education and
training. https://bit.ly/3qZJl0Q via
Q&A: With Personal Protective @ICT_magazine
Equipment, 1 Size Does Not Fit All
Beau Wangtrakuldee, PhD: “In the health care PDI HEALTHCARE @PDIHealthcare
industry in general, small sizes are typically based
on Caucasian males, so once you get to women who
truly have smaller frames, there are no products Like other HAIs, COVID-19 can be
available for them.” prevented. Hospitals should be places
WATCH: https://bit.ly/3cWiGO2 where patients come to get better, not
sicker; where diseases are treated, not
To see more interviews with expert clinicians and health care professionals, acquired via: https://bit.ly/3wyOfoQ
visit www.mjhlifesciences.com/news-network
PULMONARY APPS @PulmonaryApps
Notable Quotables
“
See this Q&A with @ICT_magazine and
@KellyCawcuttMD, to learn how vascu-
The World Health Organization…released its report on possible lar access methods are changing with
COVID-19. https://bit.ly/3t80oPa
origins of the virus that causes COVID-19…. Not all were satisfied
with the report though…. While there is a larger need for multi- BD @BDandCo
lateral review and continued efforts, the truth is that the source
of the pandemic does not change the poor response from so many
countries, including the United States. I think we can safely say
that understanding the origin is critical, but not the most imme-
Get breaking news and
diate concern we have. For infection prevention efforts, this is a expert insights delivered
welcome reminder that regardless of source, a virus could have directly to your inbox.
”
pandemic potential and that continued readiness is critical. Sign up for Infection Control
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COVER STORY
prevention
As COVID-19 Recedes, tionists (IPs). Most people do not know

about IPs but we are always there. We
work to ensure education and training,
Infection Preventionists support our fellow HCWs, review supply

chain challenges, try to prevent health
care–associated infections (HAIs), ensure
Must Still Battle Stress

adequate personal protective equipment,
and perform myriad other duties in our job
descriptions. Helping respond to COVID-19
has been up to IPs.
BY SASKIA v. POPESCU, PHD, MPH, MA, CIC We are the experts in transmission,
prevention, and interpreting nuanced (and
W
hen we learn about and train for Not Good Enough? often changing) guidance while answering
pandemic response, the focus The photography and stories from those questions from frontline HCWs.
is often on ensuring we have working on the front lines have been a We do this even as a novel pathogen
adequate resources, enough health care window into how devastating and painful upends our society and challenges us
workers (HCWs) to respond, and various this pandemic has been and underscore with a unique situation in which we are
other nonpharmaceutical interventions. the health care system’s failure to contain scrambling to train fellow HCWs in a high-
One of the things we frankly do not teach, it. The pain of this pandemic has been stress environment where the guidance
or even talk enough about, is the post- widely felt, but especially among health will likely evolve. It is a lot, with testing
traumatic stress of living and working in care professionals. As we battle waves of challenges, a choked supply chain, and
a pandemic. surges, isolation, and disconnect in our politicized response thrown in.
There has been a wealth of information efforts to help as many patients as possible, Let us not forget that HAIs do not stop
written about the impact on HCWs and we have realized we are running a mara- in the face of a pandemic and that things
how traumatized they have been by the thon in which the finish line continuously like proning a patient with COVID-19 can
COVID-19 pandemic, and for good reason. moves farther out of reach. Formerly stable make central line care more difficult.
These are the people who are caring for
patients in the face of a novel infection
that has been poorly managed nationally,
is challenging us globally, and has been
DURING THIS TIME, AS HOSPITAL CASE COUNTS DROP, IPs
heavily politicized to further isolate us.
A recent JAMA Network Open study ARE EXPECTED TO JUST SWITCH BACK TO NORMAL WHILE
found that 21% of surveyed HCWs con- STILL ENSURING A READINESS TO RESPOND TO COVID-19.
sidered leaving the workforce and 30%
THIS, QUITE FRANKLY, HAS BEEN THE HARDEST PART FOR MANY IPs.
considered reducing their hours.1
The authors noted, “In this survey of
5030 faculty, staff, and trainees of a US
health system, many participants with
caregiving responsibilities, particularly systems seem to be falling apart as the I could probably go on for several pages
women, faculty, trainees, and (in a subset realization sinks in that your best efforts about the stress and burden placed on IPs
of cases) those from racial/ethnic groups may not be good enough. regarding how COVID-19 affected our roles.
that are underrepresented in medicine, The impact of this pandemic will take In so many ways, we are the recipients of
considered leaving the workforce or reduc- years to understand. From long-haul anxiety, anger, sadness, and frustration
ing hours and were worried about their COVID-19 to those preventable deaths for those in health care—not intentionally,
career development related to the pan- and the mental health outcomes, we will but as a by-product of the work we do.
demic. It is imperative that medical centers be feeling this for a while. Preparedness, like public health, is often
support their employees and trainees It is important to take a moment to not valued until it is needed, and it has
during this challenging time.” discuss the impact on infection preven- certainly been needed the last 15 months.
ICT0521_018-020_CoverStory.indd 18 4/23/21 11:05 AM

COVER STORY
Stressed Out the Toronto SARS-CoV-1 outbreak in 2002-2003,

There has been increasing conversation about there were reports that IPs formed their own
posttraumatic stress disorder (PTSD) for health phone trees and groups to ensure information
care workers. Most professionals in health care was shared across hospitals and to fill gaps that
will experience this. The National Institute of existed.4 Despite finding ourselves in this middle
Mental Health (NIMH) defines PTSD as a disorder area of the Venn diagram, very little attention
resulting from experiencing a shocking, scary, or is paid to IPs.
dangerous event. NIMH notes that “while most
but not all traumatized people experience short- Underappreciated
term symptoms, the majority do not develop My research has primarily focused on this,
ongoing (chronic) PTSD. Not everyone with and one thing I find myself continuously saying
PTSD has been through a dangerous event. Some is that we are often seen as a cost center and
experiences, like the sudden, unexpected death not a revenue generator. That attitude hinders
of a loved one, can also cause PTSD. Symptoms us as IPs take on COVID-19. We are expected
usually begin early, within 3 months of the to ensure hospitals can respond to novel
traumatic incident, but sometimes they begin pathogens and yet still maintain our daily
years afterward. Symptoms must last more than duties. Too soon after undergoing the stress
a month and be severe enough to interfere with of dealing with the Ebola virus disease in
relationships or work to be considered PTSD. The 2014, we find ourselves once again in the
course of the illness varies. Some people recover situation of managing preparedness,
within 6 months, while others have symptoms response, and anxiety. With COVID-19,
that last much longer. In some people, the con- though, this is not an isolated case.
dition becomes chronic.”2
In a pandemic that has stretched well over
15 months and will likely continue for several
more, the fallout for all of us will be significant.
Beyond the horrific number of lives lost, and lives
changed forever by COVID-19 even for survivors,
the pandemic’s traumatic ramifications bleed
into our economy, throwing millions of people
out of work and—significantly for the health
care system—leaving them without insurance
coverage. There is a lot of suffering going on that
is not immediately noticeable.
Although there has been a lot of focus on HCW
PTSD, it should be noted that IPs have experienced
this from the beginning. Last July, Ed Yong of
the Atlantic wrote about public health specialists
experiencing burnout, noting that pandemic
experts are not doing well. Yong wrote that “the
same experts who warned of the coronavirus’s
resurgence are now staring, with the same
YINGYAIPUMI@STOCK.ADOBE.COM
prophetic worry, at a health care system that is

straining just as hurricane season begins. And
they’re demoralized about repeatedly shouting
evidence-based advice into a political void.”3
IPs fall into the middle of the Venn diagram
that is health care and public health. We are
uniquely poised to protect patients and HCWs
while ensuring there is a strong bond and link
between public health and health care. During

COVER STORY
It is felt in nearly every facet of our lives. available can help. They are free and reiter-
When people were frustrated by work-
ing from home and feeling isolated, many
CDC Resources for ate many things that, frankly, we all need
to start doing, like taking deep breaths
of us felt the opposite—wanting a quiet Coping With Stress and a moment to stretch, making time to
moment at home away from the stress of unwind, and ensuring we are exercising
hospitals and having to deal with surges and eating healthy (doing our infection
and wave after wave of patients with prevention rounds does not count).
COVID-19. Being at this intersection means Moreover, these tips routinely empha-
we fail to realize how much COVID-19 size the importance of connecting with
affects us. Missing from our discussions: Health care Personnel others and taking time to unwind. Some
the oddness of de-escalation. That quiet and First Responders: strategies I have really latched onto as a
between storms, when the adrenaline and How to Cope With Stress way to cope (and these are by no means
craziness of responding to surges eases a and Build Resilience During perfect) include taking a walk outside
bit and IPs are expected to just switch back the COVID-19 Pandemic during lunch with a colleague to discuss
to normal. That has been one of the most how we are feeling about it all, virtual cof-
challenging things for me. fee happy hours with friends, unplugging
We ramp up and work to ensure things from TV and social media for the weekend,
are functional in order to keep HCWs and, frankly, talking to other IPs.
and patients safe, but then come those More and more, we need to care of
moments when cases decrease and patient ourselves during all of this. Seeking help
Employees: How to Cope
numbers drop…and there is a desperate for mental well-being and PTSD is vital
With Job Stress and Build
need to go back to normal. “Normal” is and something we all need to invest in.
Resilience During the
what got us here, and there is a fundamen- COVID-19 Pandemic It might be odd to prioritize yourself
tal need for us in both infection prevention during a pandemic, but this is the exact
and health care—but also nationally— time to do so.
to establish a sustainable approach to COVID-19 is not the only infectious dis-
COVID-19 and novel pathogens. During ease we face, and as they tell you when you
this time, as hospital case counts drop, IPs are flying on a plane, you have to put your
are expected to just switch back to normal oxygen mask on first before caring for others.
while still ensuring a readiness to respond Exposure to Stress: I am eternally grateful for the infection pre-
to COVID-19. This, quite frankly, has been Occupational Hazards vention community during this pandemic,
the hardest part for many IPs. in Hospitals and now is the time we need to prioritize
The Association for Professionals in our health and well-being because PTSD is
Infection Control and Epidemiology has truly more prevalent than we realize. Care
been focusing on this more, emphasizing for yourself with the dedication you put into
that our work and roles within commu- protecting patients and other health care
nities often wipe out our reserves. The workers. 
attention to ancillary people in health Workplace Health
care, like IPs, is so critical. Fundamentally, Promotion SASKIA v. POPESCU, PHD, MPH, MA, CIC, is a
we are a team in hospital response. There hospital epidemiologist and infection preventionist.
has been a concerted effort to provide During her work as an infection preventionist, she
well-being services and ways to recharge. Resources performed surveillance for infectious diseases,
preparedness, and Ebola-response practices.
As I write this, though, I think about my More and more, it is important that we
She holds a doctorate in biodefense from George
own process in doing so. take the time to do this. Difficulty sleeping
Mason University in Fairfax, Virginia, where her
Truth be told, in health care we are or changes in energy are normal byprod- research focuses on the role of infection prevention
often trained to just keep going and get the ucts of stress and not always easy to deal in facilitating global health security efforts. She is
job done. It is important though, that now with. There are several resources, such as certified in infection control and has worked in
we focus on our well-being. The Centers mental health specialists, online guides, pediatric and adult acute care facilities.
for Disease Control and Prevention has and confidential crisis resources, avail-
reiterated this with resources for coping able to help guide people through these REFERENCES AVAILABLE AT
with stress. challenging times. Utilizing the resources INFECTIONCONTROLTODAY.COM

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CONFERENCE COVERAGE
Findings From the Annual Conference

of the Society for Healthcare
Epidemiology of America (SHEA)
As may have been expected, the COVID-19 pandemic cast a into place when the pandemic struck. One of the hallmarks
long shadow over the annual conference of the Society for of this pandemic that historians may note is how the health
Healthcare Epidemiology of America (SHEA Spring 2021), held care system adapted and found innovative ways to confront
virtually from April 13 to April 16. Although much of the data it, and infection preventionists (IPs) were very much a part of
gathered for the presentations and study results unveiled at that innovation. Infection Control Today® (ICT®) covered SHEA
the conference were gathered prepandemic, their applicabil- Spring 2021, and a sample of what we learned follows. Readers
ity to the COVID-19 crisis was often noted. And some of the can find more ICT® stories generated by the SHEA conference
studies did indeed result from systems and processes put at infectioncontroltoday.com/conference/shea.
Integrate HAI Tracking With EMRs

BY FRANK DIAMOND mont’s infection surveillance manager, to select variables essential for HAI drill
tells ICT®. “We were creating this dash- downs and where the data existed in the
Electronic medical records (EMRs) operate board for COVID-19. And that’s when EMR,” the study states. “The BI team
along the lines of most data-crunching we determined that there are these new worked to find the correct data tables
technology: They’re only as effective as functionalities within this software that within the EMR so that the data could
the data they’re given to crunch. One of would make our vision possible. So if it automatically refresh daily in the data
the many jobs of IPs involves surveillance weren’t for COVID-19, we might have not visualization software.”
to prevent health care–acquired infections even thought to do this, honestly. But The BI team could identify HAI vari-
(HAIs) or to control them—ie, eliminate because we were so resource strapped, ables that had once been entered manually
them—once they appear. A study by investi- we were trying to work smarter and not within the EMRs. “This automation of
gators with Piedmont Healthcare in Atlanta harder by using technology.” drill downs allows for quick analysis of
(among the 5 largest health care systems in As the study notes, before COVID-19, trends and areas for opportunity to prevent
Georgia) underscores just how important the infection prevention team performed future HAI,” the study states. It concludes
a role EMRs can play in combating HAIs.1 HAI surveillance “through a home-grown that “this utilization of technology can
The challenges of controlling HAIs in the system that didn’t interface with their EMR” be applied to other health care facilities
maelstrom of a worldwide pandemic that by entering information gained on rounds who have similar software systems to
requires a proportionate response by health into a spreadsheet. However, this meant streamline IP workflows. The automation
care systems can’t be overstated. that only 1 person could enter data at a time. of quickly and efficiently recognizing areas
With help from the health system’s “Due to the necessity of increasing effi- for opportunity will give more time for
business intelligence (BI) department, IPs ciency in the current pandemic, the IP team the IPs to be rounding preventing HAI.”
at Piedmont, which comprises 11 separate proposed using technology to automate our Piedmont got much better at tracking
hospitals, refined software to allow the HAI drill down process,” the study states. and treating HAIs, but that can create other
information collected about HAIs to be The IP and BI teams wanted to see whether problems, Pearson tells ICT®. “When you
easily integrated into EMRs. This was a the HAI data in the infection surveillance start to look for something, of course you’re
case in which COVID-19 was definitely the system could be registered in interactive going to find more, and that’s exactly what
mother of invention. data software that the health care facility we found with our situation when we got
“We actually put it into place during uses in other HAI prevention dashboards. this more robust surveillance system,” she
COVID-19,” Meri Pearson, MPH, CIC, Pied- “The existing spreadsheet was reviewed says. “We had to explain to our physicians
ICT0521_022-024_Conference.indd 22 4/23/21 11:05 AM

CONFERENCE COVERAGE
and surgeons that you aren’t doing worse Centers for Disease Control and Preven- because that’s not currently in their NHSN
per se than you were before. We were just tion, culture-based surveillance systems patient safety annual surveys,” Pearson
not detecting this patient harm because miss between 50% and 60% of surgical tells ICT®. “We really want to make sure
we were just looking at cultures.” site infections. “We did write an SBR [sit- that we’re being compared fairly against
Hospital officials reminded doctors uation-background-assessment-recom- other hospitals across the nation who have
that according to the National Healthcare mendation] to the NHSN to request that other enhanced software systems like this
Safety Network (NHSN), a division of the they revise how they risk-stratify facilities because that’s not currently being done.” 
Quick Action Keeps NICU But the precautions didn’t end there.
Other departments got involved.
Respiratory Illness in Check “Dedicated staffing and equipment

were assigned,” the study states. “Environ-
mental cleaning and disinfection with hos-
BY INFECTION CONTROL TODAY® EDITORIAL STAFF pital-approved disinfectant wipes [were]
performed daily. Visitors were restricted
The COVID-19 pandemic presented daunt- to a single pod of the NICU and placed in in the NICU. All employees entering NICU
ing challenges to hospital departments all contact with droplet isolation precautions.” underwent daily symptom screening for
too familiar with them: neonatal intensive Navalkele tells ICT® that when the front- respiratory tract illness. All NICU babies
care units (NICUs). However, COVID-19 line health care professionals realized they were screened daily for respiratory tract
isn’t the only pathogen in town, as IPs and were dealing with a cluster, they contacted illness with prompt isolation and RPP
other health care professionals can attest. the infection prevention department. [respiratory pathogen panel] testing on
One of those health care professionals is “When we step in with our role as infection positive screen.”
Bhagyashri D. Navalkele, MD, an assistant prevention specialists, we…make it a…bit The multidisciplinary team included
professor at the University of Mississippi more organized and structured,” she says. NICU nurses, physicians, nurse practi-
Medical Center in Jackson, who specializes “We provide them definitions. We provide tioners, and—perhaps most important of
in infectious diseases. them a complete plan on all aspects that all—environmental services (EVS) per-
The study1 that Navalkele cowrote might have been missed.” sonnel. “We met with the environmental
explains how staff at the medical center’s services staff, and we explained to them
NICU sprang into action to contain an that this is a critical situation in the neo-
outbreak of human parainfluenzavirus natal ICU,” Navalkele tells ICT®. “And this
type 3 (HPIV-3). It is a common respiratory
The multidisciplinary cannot spread more.”
tract illness in infants and young children. team included NICU EVS came through. “They helped us
“Early diagnosis and isolation of respi- nurses, physicians, nurse with cleaning, the disinfection,” Navalkele
ratory tract viral infections [are] import- continues. “Cleaning was occurring very
ant to prevent an outbreak,” the study practitioners, and— meticulously, almost every few hours. All
states. “Successful control of outbreak in perhaps most important the surfaces were getting cleaned, and the
NICU requires prompt implementation equipment was getting cleaned.”
of all—environmental
of [infection prevention] measures with The hospital’s laboratory also needed to
focus on symptom screening, cohorting, services personnel. get involved. “Lab was notified,” Navalkele
and disinfection practices.” notes. “We said, ‘Hey, we’re going to test all
One infant was identified as having these babies for [parainfluenzavirus] type
hospital-onset HPIV-3 on April 30, 2019. For instance, the IPs established a 3 so that we can identify it immediately.
In May 2019, the virus was diagnosed in symptom screening system for all babies They made sure that they had an adequate
3 other infants in the NICU. An investigation in the NICU, as well as all staff going in and supply of testing kits. And they helped us
into the outbreak began on May 3, 2019. out of the department. “All those added transport those specimens to the health
“Enhanced [infection prevention] measures measures—and data mining when the department” as well as the Centers for
were immediately implemented,” the study outbreak ends—are performed by infec- Disease Control and Prevention (CDC).
states. “All positive cases were cohorted tion prevention,” Navalkele said. The CDC tested the HPIV-3–positive

CONFERENCE COVERAGE
specimens using whole genome testing. NICU had lower respiratory tract illnesses, investigation. Maximum likelihood phylo-
Investigators confirmed 7 cases of hospital- and 1 had an upper respiratory tract illness. genetic tree of HPIV-3 WGS [whole genome
onset HPIV-3, 6 from the NICU and 1 from “Average time from admission to diag- sequencing] showed that sequences from
the newborn nursery. Investigators deter- nosis was 71 days (range: 24 to 112 days). the 6 HO cases clustered together sepa-
mined that the case in the newborn nurs- None had severe illnesses requiring intu- rately from the 3 CO controls suggesting
ery was unrelated to the NICU cases and bation and all had full recovery,” the study single source of transmission and 3 CO
that the nursery baby had been infected by states. “No CO [community-onset] HPIV-3 cases were not related to the HO cases or
a sick visitor. Five of the infants from the cases were reported from NICU during the source of the outbreak.”
N95 Decontamination The study concludes: “VHP repro-

cessing did not diminish the efficacy
Process Allows 25 Reusages of respirators based on the [4] metrics

we assessed: filtration rate, seal check,
qualitative fit, and quantitative fit. Of
BY FRANK DIAMOND tal, for instance. But as Yen’s study states, significance, the filtration rate remained
“little is known about its impact on N95 well above the 95% standard filtration for
When it erupted around the end of 2019 respirator efficacy. We assessed whether N95 respirators—even through 25 cycles of
and the beginning of 2020, the panic that repeated VHP reprocessing altered [4] reprocessing. VHP reprocessing is a safe,
COVID-19 inflicted on the US health care key respirator efficacy qualities: quanti- viable strategy to disinfect respirators
system could be felt on many levels: How tative fit, qualitative fit, seal check, and and extend their use, particularly during
do you treat it? How does it spread? Can filtration rate.” supply shortages.”
a vaccine be developed? Nothing seemed When the experiment first began, Yen In the study, 7 participants were fitted
to rattle health care providers as much as tells ICT®, she didn’t know what to expect. with N95s. The N95s were disinfected
finding out that N95 respirators were in She says that “for a lot of us, especially 25 times in a VHP generator.
short supply. The US simply didn’t have myself, when I first took on this project, “After each cycle, participants donned
enough in stock, and the countries that I was not sure what we were and doffed respirators and
manufactured them were not willing to going to find.” performed a seal check. Partic-
part with them because they wanted to Yen says that she did “a lot ipants were given [2] attempts
protect their own populations. IPs and of reading” before, during, and to pass their seal check,”
other health care professionals needed after the prospective cohort the study states. “Every 10
to improvise. That improvisation led to study that took place from cycles, qualitative fit testing
investigations into how many times an June 15 to August 31, 2020, and Scan the QR was done….Appropriate fit is
N95 can be reused and still keep SARS- discovered that there was a code to view defined as a fit factor score of
Yen’s Q&A
CoV-2 at bay. growing amount of literature 100 or greater. Quantitative
with ICT®.
The answer is anywhere from 20 to looking at VHP even before testing was done at cycles 1, 3,
25 times, says Christina Yen, MD, an the pandemic. She found that 5, 7, 10, 15, 20, and 25.”
infectious disease specialist at Beth Israel encouraging and says “because more pro- As with many other efforts to stave off
Deaconess Medical Center in Boston, grams outside of our own program were COVID-19, the N95 mask decontamination
Massachusetts. In a recent study,1 Yen also doing it, we were developing a body of was a team effort, says Yen.
applied old technology—vaporous hydro- literature as the months went on during the “It was not just infection prevention-
gen peroxide (VHP)—to the challenge of initial pandemic that was demonstrating ists,” Yen tells ICT®. “It was environmental
thoroughly disinfecting N95s. over and over that this was, I think, actu- safety. It was health care epidemiologists.
VHP had been used in health care ally not only safe but probably doable for So many people from so many different
settings for some time to decontaminate many of us.” The results seem to support backgrounds with so many different skills
ambulances and different areas of a hospi- her enthusiasm. sets made this possible.” 
REFERENCES FOR ALL ARTICLES IN THIS SECTION ARE AVAILABLE AT INFECTIONCONTROLTODAY.COM

FEATURE
health care–acquired infections
How to Keep COVID-19 From Becoming

a Health Care–Acquired Infection
BY JAN DYER
E
arly in the COVID-19 pandemic, mys- pitals were still coming to grips with what illnesses was 3.7% during the first part of
teries abounded about this ninjalike exactly they could do to prevent spread.2 the pandemic, 20% lower than at the same
disease striking a defenseless pop- As the pandemic took hold, some time the previous year.3 A hospital in Spain
KARRASTOCK@STOCK.ADOBE.COM
ulace seemingly out of the blue. Who experts warned that rates of health care– saw the incidence of nosocomial Clostrid-
was most at risk? What were the best acquired infections (HAIs) might rise ioides difficile infection drop by 70% from
steps for protecting the vulnerable—when because of patients with the virus being March 11 to May 11, 2020, compared with
those were identified? Epidemiologic data sicker, with longer lengths of stay, and the same time span the year before.4 In
on transmission were scarce, consisting other COVID-19–related factors. Over time, Singapore, investigators found enhanced
mainly of small case reports, cohort stud- however, universal masking, “extreme” infection prevention and control (IPC)
ies, and governmental reports.1 A review of hand hygiene, and other intensified measures had the “unintended positive
40 studies suggested 44% of COVID-19 cases measures—when properly adhered to— consequence” of containing respiratory
worldwide were nosocomial, but many hos- were countering those predictions. Hospi- viral infections: Incidence shifted dra-
tals around the world were seeing striking matically downward, from 9.69 cases
drops in many HAIs. per 10,000 patient days prepandemic to
A study at Kerman University of Med- 0.83 cases.5
ical Sciences in Iran, for instance, It is not surprising that intense precau-
found the total rate of nos- tions would also reduce cases of nosocomial
ocomial infection for all COVID-19. A comprehensive infection control
program implemented at Brigham and
Women’s Hospital in Boston, Massachusetts,
in March 2020 included dedicated COVID-19
units, personal protective equipment (PPE)
in accordance with Centers for Disease
Control and Prevention recommendations,
donning and doffing monitors, universal
masking, visitor restriction, and reverse
transcriptase–polymerase chain reaction
(PCR) testing of symptomatic and asymp-
tomatic patients.6 Despite the high burden
of COVID-19 in the hospital, only 2 patients
were identified as having HAIs, 1 of whom
was likely infected by a visiting spouse
before visitor restrictions and universal
masking. Between March and June 2020,
of 8370 patients with non-COVID-19–
related hospitalizations, 11 tested positive
for the virus. Only 1 of the 11 was deemed
an HAI—but with no known exposures
inside the hospital.
May 2021  ICT® 25
ICT0521_025-027_Feature 4.indd 25 4/23/21 11:03 AM

FEATURE
Best Method whereas the community-acquired cases previous 4 weeks.

The protective precautions have become and cases with no clear source continued Were the staff the reason? Jain said
routine. At Penn State Health Milton S. to mirror the cumulative incidence rates he “armored” himself with N95 masks
Hershey Medical Center, in Pennsylva- in the communities surrounding Duke covered with a surgical mask and a face
nia, limited visitation, screening of all Health. At Mass General Brigham in Bos- shield, plastic gown, and gloves. Still, one
employees and visitors upon each arrival, ton, a study involving more than 75,000 of his colleagues, who was taking similar
universal mask wearing, contact tracing, workers also found universal masking precautions, tested positive. Again, there
hand hygiene, and equipment cleaning could quickly reverse the trajectory of was no discernable cause. However, Jain
“are essential parts of our everyday work,” nosocomial spread: Prior to the new rule, noted, in the doctors’ lounge food is served,
says Fibi Attia, MD, MPH, CIC, infection new infections among HCWs spiked from and health care workers frequently gather,
control coordinator, and a member of the 0 to 21%; afterward, the positivity rate “often taking off their masks to share
Infection Control Today® Editorial Advisory declined linearly from 14.65% to 11.46% COVID-19 war stories.”11
Board. All those measures “are definitely during a 3-week period.9 When outbreaks have been reported in
working together to limit any exposure.” hospitals that are using universal masking,
The least, and potentially the best, of ‘Rampant’ Spreading unmasked exposure to other health care
these measures is masking. According Similarly, results of a study at the Ger- workers is often the cause. Transmissions
to Aaron Richterman, MD, et al in JAMA: man Heart Center in Berlin showed that have been traced to break rooms and
“[M]ounting evidence supports the effec- measures including obligatory surgical cafeterias. Last November, more than
tiveness of a relatively simple interven- face masks for patients and employees, 900 Mayo Clinic staff contracted COVID-
tion in reducing hospital transmission SARS-CoV-2 screening for all patients, and 19 in 2 weeks.
of SARS-CoV-2: universal use of surgical symptom-based testing for employees led Amy Williams, MD, executive dean of
masks by health care workers [HCWs] and to an overall 0.4% prevalence of positive clinical practice, in a briefing said 93% of
patients,” even when physical distancing tests (5 of 1128 tests). The incidence of staff contracted the virus in the commu-
is not possible.7 new infections was 0.5%. No nosocomial nity. Most of those who contracted it at
It did not take long to find out that infections were found, despite a mean work had been eating in a break room with
masking was a simple but effective mea- number of 14.8 in-hospital contacts.10 a mask off. She later updated that to say
sure to flatten the curve of nosocomial Notably, the investigators said, during the they could have been exposed while eating
COVID-19. From March 15 to observation period the number with a mask off in campus cafeterias.12
June 6, 2020, investigators at of positive SARS-CoV-2 tests One of the ways to prevent these
Duke Health (a system of ter- sharply increased in Germany. “breaches in now-routine preventive mea-
tiary care academic hospitals, Nonetheless, “[m]y experi- sures,” Richterman et al wrote in JAMA,
community hospitals, and ence tells me that nosocomial would be to provide adequate, well-venti-
clinics) assessed all HCWs—of Like what COVID-19 is rampant,” Manoj lated and, ideally, dedicated space for breaks
21,014—who had tested positive you’re Jain, MD, an infectious diseases and meal times, perhaps staggering times
for the virus. Of those cases, reading? physician and contributing to minimize contact and conversation.7
38% were community acquired, Sign up to health writer for the Washing-
22% were health care associ- receive the ton Post, wrote in a January 2021 Unprecedented
ated, and 40% had no clear eNewsletter. op-ed, “and hospitals are not The unprecedented demands of this pan-
source. Of note, the investiga- sounding the alarm.”11 demic call for unprecedented responses.
tors said, 80% of the HCWs did not work His concern was raised about a patient Abbas et al, in their literature review,
in COVID-19 units.8 who died of nosocomial COVID-19. Jain found that many hospitals are breaking
Of the HAI cases, 70% were related to was perplexed—how could the virus have with traditional management of respira-
unmasked exposure to another HCW for reached the patient? It was not lack of tory viral illness, particularly nosocomial
more than 10 minutes, less than 6 feet handwashing. It was unlikely the virus outbreaks. In a “paradigm shift,” they
apart; 30% were thought to be secondary (a had come from surfaces; the hospital’s said, hospitals are expanding testing
non–COVID-19 infection) to direct care of environmental services staff had been criteria: testing asymptomatic patients/
patients who tested positive for the virus. diligent. All the family members who had residents and health care workers, as
However, only 1 week after the hospital visited the patient had tested negative.11 well as conducting serial testing or repeat
system initiated universal mask wearing, That was not the only patient either. point-prevalence surveys. When Brigham
the cumulative incidence rate of noso- Jain said in his op-ed that he had seen 5 and Women’s instituted liberal universal
comial COVID-19 dropped significantly, other cases of nosocomial COVID-19 in the testing on admission, the investigators

FEATURE
observed fewer late-onset cases (diagnoses carried out faithfully. As more viral strains and temporal dynamics of transmission.
on hospital day 3 or later). evolve and people relax their vigilance They identified 8 patient contact clusters
At 2 Minnesota skilled nursing facilities because of the vaccines, more waves of with significantly increased similarity in
(SNFs), serial testing identified COVID-19 the pandemic are only too possible. Can genomic variants, compared with non-
cases among 64% of residents and 33% all this experience benefit hospitals and clustered samples.
of health care workers. Following up their workers in a future wave of this The investigators found that incorpo-
with genetic sequencing revealed facility- pandemic—or in a future pandemic? rating the location of the HCWs identified
specific clustering of viral genomes from
HCW and resident specimens, suggesting
intrafacility transmission.13
However, such information is not use- WHEN OUTBREAKS HAVE BEEN REPORTED IN HOSPITALS
ful by itself: It needs to be supported THAT ARE USING UNIVERSAL MASKING, UNMASKED EXPOSURE
by action. Although transmission was
TO OTHER HEALTH CARE WORKERS IS OFTEN THE CAUSE.
reduced by early identification of asymp-
tomatic infections and prompt implemen- TRANSMISSIONS HAVE BEEN TRACED
tation of mitigation efforts, there were TO BREAK ROOMS AND CAFETERIAS.
challenges. The Minnesota Long-Term
Care COVID-19 Response Group found
that, in the SNFs, continued SARS-CoV-2
transmission was “potentially facilitated” Rhee et al said that their findings additional links in transmission pathways
by “low baseline knowledge of and expe- at Brigham and Women’s suggest that and enhanced identification of outbreak
rience with [IPC] and PPE use,” delays of “robust and rigorous infection control clusters. Looking forward, they said, adopt-
up to 12 days in receiving half of the HCW practices” can minimize the risk of nos- ing genomic approaches in real time (eg,
test results at one facility, and incomplete ocomial spread of COVID-19, and “provide within 48 hours) along with consideration
HCW participation.13 reassurance” as some health care systems of patient movement data sets will enhance
The Minnesota study is an example reopen services and others continue to rapid identification of linked nosocomial
of how none of the measures is entirely face surges.6 SARS-CoV-2 infections. Their approach,
effective on its own (although masking they suggested, could optimize infection
comes close). For instance, serial testing, Better Tools control management strategies, lead to
investigators said, needs to be done until The basics can also be supplemented with targeted interventions, and ultimately
no new cases are detected after 14 days— more sophisticated tools. When there prevent avoidable harm.
along with IPC strengthening. Testing was no routine SARS-CoV-2 screening of In his op-ed, Jain said he told his regional
should be accompanied by “IPC education, asymptomatic HCWs, 5 hospitals in the Memphis and Shelby County COVID-19 Joint
flexible medical leave, and PPE resources United Kingdom assigned different loca- Task Force, consisting of hospital executives
targeted to this at-risk workforce.”13 tions within the hospitals as either green and mayors, that hospital staff need to be
Investigators at Changi General Hos- (virus negative) or red (positive) zones, regularly tested through “the affordable
pital, Singapore, developed a prediction combined with staff bubbles. That tactic technique of pooling up to 20 test sam-
model to identify patients at low risk for helped keep nosocomial infections down. ples.”11 Such PCR gold-standard testing,
COVID-19 to better guide resource alloca- But as patients tested positive even after he said, would amount to the cost of a cup
tion.14 They said that their risk prediction spending prolonged periods of time in of coffee and a few doughnuts. Without
score would have obviated the need for iso- green areas, the investigators realized that testing, he said, “we are flying blind.”
lation and testing in up to 41% of patients there were unrecognized transmission Like other HAIs, COVID-19 can be
with pneumonia and acute respiratory events between the 2 areas.15 prevented, Jain said: “Hospitals should be
infection. Missed cases of COVID-19 are They turned to viral genome sequenc- places where patients come to get better,
“expected trade-offs” of their risk strati- ing as a realistic possibility to track and not sicker; where diseases are treated,
fication strategy, they conceded, but they identify root causes of nosocomial trans- not acquired.” 
pointed to “reassuring reports” that basic missions. They sequenced SARS-CoV-2
infection control measures (eg, masks, genomes for patients and HCWs, obtaining JAN DYER is a writer and editor specializing in
clinical topics. She lives in Suffern, New York.
hand hygiene) are effective in minimizing 173 high-quality genomes. They then inte-
the risks of nosocomial spread. grated patient movement and staff location REFERENCES AVAILABLE AT
Crucially, the precautions need to be data into the analysis to understand spatial INFECTIONCONTROLTODAY.COM

FEATURE
operating room
COVID-19 Underscores Nurses’

Role in Infection Prevention
BY AMBER WOOD, MSN, RN, CNOR, CIC, FAPIC
T
he COVID-19 pandemic thrust every- discussions as allies, informed advisers, We also learned that meeting the psy-
one deep into the world of infection and advocates for patient and health care chological needs of nurses is critical to
prevention, probably more than worker safety. their ability to be effective. Making difficult
anyone other than an infection preven- Nurses have been on the front line of decisions about PPE management, COVID-
tionist (IP) cared to venture, and kept us the battle against COVID-19 and are often 19 protocols, and patient care prioritization
all there longer than we wanted to stay. hailed as our first line of defense against has taken a toll on the mental health of
But nurses would be remiss not to take infection. However, declaring that nurses IPs, occupational health professionals, and
some lessons from this experience to are on the front line implies that there is health care leaders (Figure). It is essential
explore what our role is and should be in backup on the way. If there is anything to acknowledge the impact this pandemic
infection prevention. this pandemic has taught us, it is that has had on our mental health as we find
The key lesson is that nurses can be there is no relief crew coming—nurses are our path forward.1 Simply seeing the IP in
effective only when their basic physiologic our front, back, and only lines of defense the hallway may trigger a nurse to recall
and safety needs are met. The global regardless of the setting, whether it is the a mixed bag of emotions and traumatic
disruption in supply of personal protec- emergency department, inpatient unit, memories of COVID-19 training days that
tive equipment (PPE) dealt a devastating operating room, nursing home, or behav- they would rather forget. Offering a forum
blow to our safety efforts and eroded ioral health. Because of this, the health for peer support and grief counseling can
the trust nurses have in the system. The and safety of nurses and other frontline help bridge the divide and move individ-
reuse and decontamination of single-use clinicians and health care workers must uals toward healing. Pastoral care can
PPE, although necessary in some dire be the top priority if we are going to win also be a great resource for restoring the
situations as part of critical strategies to the war against pathogens. emotional well-being of nurses and IPs.2
conserve PPE, led nurses to feel they were
left unprotected, at risk of infection, and
putting their patients at risk of infection Figure. Maslow’s SELF-FULFILLMENT NEEDS
and that their respiratory health was at Hierarchy of Needs
risk from chemical exposure. Nurses who SELF-ACTUALIZATION:
attempted to supply their own PPE were achieving
rejected and, in some cases, reprimanded full potential
for trying to meet this perceived safety
need, which nurses interpreted as a lack ESTEEM:
of concern for their health. confidence, achievement,
respect, emotional well-being PSYCHOLOGICAL
Although the situation may seem bleak,
IPs must identify what went wrong and
prevent recurrence to build back trust. LOVE & BELONGING:
relationships, friendships, peer support
To that end, nurses need a seat at the
BASIC
table when discussing PPE stockpiling NEEDS
SAFETY: security, health, employment, resources
and purchasing practices to share their
lived experiences and help the team dis-
PHYSIOLOGICAL: breathing, water, food, warmth, rest
cover where practice deviated from plans.
IPs should support the nurses in these

FEATURE
Perioperative Nurses by continuing to support using external of this role, nurses should be a source of
The nurse’s role in infection prevention female catheters for CAUTI initiatives and credible, evidence-based information, espe-
is also that of an expert adviser. In the also advocated for preventing pressure cially in an era of prevalent misinformation
earlier stages of the pandemic, elective injuries from the tubing. and fake news. The IP can support nurses
surgery was canceled across the country. with prepared information on COVID-19
This left a large portion of the nursing infection, testing, and vaccination in a ques-
workforce being laid off, working at testing tion-and-answer format to equip nurses
centers, or being deployed to other areas with credible speaking points.
of the hospital to support or provide care
GRIEF IS A FUNNY
to patients with COVID-19. The full impact Moving On
of the delay in elective surgical procedures
CREATURE; THE MORE It may be difficult to imagine how to begin
on patient outcomes may not be known WE IGNORE IT, THE LONGER healing and planning for future events when
for years. Delays in elective surgery may IT SEEMS TO CONTINUE. we are still living in a pandemic. But grief
have led to worsening patient conditions is a funny creature; the more we ignore it,
that necessitated an urgent or emergent the longer it seems to continue. You cannot
surgical procedure. The cancellation of just tuck it away deep inside and pretend it
elective surgery was also a huge setback YOU CANNOT JUST never existed. Grief and healing take hard
to the pocketbooks of hospitals and sur- TUCK IT AWAY DEEP work, but you are not alone. We have a shared
gery centers, from which many facilities INSIDE AND PRETEND experience that bonds us all, for better or
may never financially recover. In future for worse. If you are struggling, please talk
events, we may see increased resistance IT NEVER EXISTED. to someone, and if you are in crisis, get
to cancellation of elective surgery, and in immediate help. Your physical and mental
anticipation of this, hospitals and surgery health are of the utmost importance. 
centers need to start planning now to be
GRIEF AND HEALING
prepared to continue surgery safely. This is AMBER WOOD, MSN, RN, CNOR, CIC, FAPIC, is
a prime opportunity to call in perioperative
TAKE HARD WORK, BUT
a senior perioperative practice specialist at the
nurses who are skilled in the use of PPE YOU ARE NOT ALONE. Association of periOperative Registered Nurses
and preventing surgical site infections. (AORN), where she has served as lead author
The perioperative nurse will be the key and editor for several AORN guidelines. Wood
partner to the IP for successful planning. offers clinical information to members via the
AORN Consult Line and contributes regularly to
the Clinical Issues column in the AORN Journal.
Implementation Experts IPs as Educators
She has served as the AORN staff liaison to the
As problem-solving MacGyvers, nurses are Nurses are the portal to the patient and the Centers for Disease Control and Prevention's
the premier implementation experts. IPs community. In this position, the nurse’s Healthcare Infection Control Practices Advisory
can count on nurses for practical advice role is to be a champion and advocate for Committee, is a member of the ASTM International
when implementing new practices and health and wellness in each interaction. committee on personal protective equipment, and
processes. For example, external female This role is not limited to the nurse’s is a fellow of the Association for Professionals in
catheters have been a game changer as an interactions with a patient. It permeates Infection Control and Epidemiology.
alternate to indwelling urinary catheters their being and exists in every interaction
for women to prevent catheter-associated they have with family, friends, colleagues, REFERENCES AVAILABLE AT
urinary tract infections (CAUTIs). How- and members of their community. Because INFECTIONCONTROLTODAY.COM
ever, there are some practical issues that
can be a barrier to implementation, such as
leaking. Nurses troubleshoot these issues
Resources for Nurses and Infection Preventionists
every day and can provide expert advice
for improvement like adjusting the level
A
ssociation of periOperative Nurses https://www.aorn.org
of suction. When clinicians began placing
patients in prone position to improve ven- A
ssociation for Professionals in Infection Control and Epidemiology
https://apic.org
tilation because of COVID-19 infections,
nurses thrived in the role of implementa- A
merican Hospital Association https://www.aha.org
tion experts and patient safety advocates

FEATURE
sterile processing
Sterile Processors, Infection

Preventionists Need to Team Up
We just want to make sure that we give
When Tanya Lewis, CRCST, takes the helm as president of the International Associ- our members the tools that they need to
ation of Healthcare Central Service Materiel Management (IAHCSMM) this month, do their jobs successfully.
she will bring with her good memories of working with infection preventionists (IPs)
at Wellstar North Fulton Hospital in Roswell, Georgia. Lewis supervises the sterile ICT®: You mentioned disposable
processing department at the hospital and has had a great working relationship medical instruments. I know that
with the IPs there. “Now, I can say in the past that I haven’t had good relationships duodenoscopes were in the news
with my infection preventionists, because they didn’t really know what we did,” because more of them were becom-
Lewis tells Infection Control Today® (ICT®). “And some of them—I don’t know if it was ing disposable. Do you welcome dis-
posable medical instruments in your
fear, or what—but because they didn’t know, they never came to see what we did.”
job? Or do you think your members
There’s a lesson there for IPs: Visit the sterile processing department when you
might feel that, “Well, if everything
can because the job has gotten more challenging than in the days when all that
becomes disposable, will they need
needed disinfection were knives, scalpels, forceps, and other classic tools of surgery.
us as much anymore?”
For instance, “there are a lot of steps in cleaning robotic instruments,” says Lewis. Lewis: That’s always a question that
She says that one of her main goals when she becomes IAHCSMM’s president comes up, and I really think that,
will be to lobby states to mandate that anybody who works in sterile processing regardless if we have disposable this
be certified. Now, that’s a goal many infection preventionists can relate to.1 and disposable that, because we do have
a lot of disposable tools now. We also
have reusables, like you said the duode-
ICT®: Is that assumption correct? Did ICT®: What are the major challenges noscopes, the disposable ureteroscopes
COVID-19 change how sterile pro- you see for IAHCSMM as a whole and things of that sort. We have those,
cessing is done? Or is it basically the going forward? but we’re going to always have to have
same thing? Lewis: I think that as we move forward, our reusable products where we have
Tanya Lewis, CRCST: Oh no, it we’re going to have to look at a lot of the disposables as a backup. It may
changed it dramatically. We were hav- ways that we’re doing things differently. come to a point where we have the reus-
ing to reprocess disposable masks, the For instance, the reprocessing of disposables as a backup due to manufacturer
N95 masks, and we didn’t have to do able items that we have not done in the back orders or whatever. So no, I don’t
a lot, but at some of my other sister past. I think that we have to actually give think we’re going away anytime soon.
facilities, they did. But here at North our members real-life situations where
Fulton, we didn’t have to do hardly any. what we’re doing right now, in this ICT®: Disposable and reusable—might
But yes, it absolutely did change the pandemic, reprocessing things that we they sometimes intersect? In other
dynamics of sterile processing. Because normally wouldn’t reprocess, we have words, you could have a reusable
we were always [saying], “No, we can’t to give them the information and the instrument but at a certain point you
reprocess unless we have validated or tools that they need in order to be able have to dispose of it. That’s up to the
anything like that.” We weren’t used to do that and do it successfully. There sterile processing expert, right?
to reprocessing disposable items. But are going to be a lot of different changes Lewis: That’s correct. Yes, they really do
when COVID-19 came along, it took a going forward. I’m so sure of that. And intersect. I’ll use an example of a flexible,
whole new turn for a lot of things; our because I don’t believe that with the pan- reusable ureteroscope. And you know, if
respirators and N95 masks and things demic…. We’re not sure when it’s going you have an issue with that scope, and
of that sort. to end or what else [will happen] with all you don’t have another one available
the different variants and everything. right at that time, then you can open up a

FEATURE
disposable one. Disposable and reusable eras, but there are a lot of steps in clean- why it’s so important for us to make
at some point will intersect. ing robotic instruments. You hand wash sure that we get our instructions for
them, you flush them, you soak them, use from the manufacturer, because
ICT®: And everything is disinfected you rinse them, and then you attach we can never just guess. We’re not ever
after use, correct? them to the ultrasonic and then you going to guess on how we would clean
Lewis: Everything that is used we abso- send them through the disinfector—the an item, or a camera, or a scope, or any-
lutely do clean and then disinfect, if the washer disinfector. There are a lot of thing of that sort. We have to have that
instructions for use say so. Some things steps involved with that. Everything information. And we have to be able to
are hand washable. Some cameras, you that we get in that’s new or that we’ve do it according to the manufacturer’s
cannot disinfect them, so you can ster- not seen before, I try my best to make instructions because if we don’t, then
ilize them, but you have to manually sure that my team has an in-service we’re setting our patients up to fail. And
clean them and clean them thoroughly [training]. They’re educated, and they’re we’re setting our patients up for infec-
in order for them to be processed and competent, and they complete a compe- tion. And that we’re never going do. Not
sterilized. You can’t get anything sterile tency [test] once they’ve completed their intentionally.
unless it’s clean. in-service to make sure that they are
very confident with what they’re doing. ICT®: A core of our readership com-
ICT : You’re the head of the sterile
®
So, like I said, a lot of cameras are lapa- prises infection preventionists. Does
processing department there. What roscopes, and our robotic [instruments]. your department and infection pre-
worries you in terms of being a vention have much back and forth?
manager of other people and what ICT®: Medical television shows Or further, whom do you interact
they might miss or what they might where the surgeon is asking for a with the most in terms of
rush through, especially during a scalpel, scissors, or knife…. other departments?
pandemic? Everybody was working Lewis: That’s what we do. We reprocess Lewis: OR [the operating room]. Of
many hours and exhausted. What all of those items, we reprocess the course, OR, we interact with them. But
set off alarms for you? knife handles that you put the scalpel my infection control practitioner is
Lewis: Let’s see. I don’t like to brag, blade on, and we reprocess the scissors, excellent. She knows…this is the first
but I have to say that my team is really, and we just try to do our best and make one—well, maybe the second—I’ve
really conscientious. And they really sure that we’re giving our patients 100% known, who really understands what
understand that our patients are our of what they need. we do, why we do it, and why we have
top priorities. I don’t really stay up at
night…if they think that they have
something they’re not really sure about,
they’re always able to call me or go to “I just think that infection preventionists and sterile
the manufacturer for different things. processing should always work as a team. It should
We use 1 source a lot. That being said, if
there’s something that they’re not sure
always be a team effort. It’s not them or us. It’s not sterile
about, they’re going to reach out to [me] processing. It’s not infection prevention, but it’s us as a team.
or they’re going to go to the manufac- And that’s the way we’re going to keep our patients safe.”
turer and see what they need to do to
make sure that that item is clean and
processed properly.
ICT®: It sounds like the reprocess- to do it correctly every single time. And
ICT : What would you say offhand
®
ing is more difficult with the more so, she’s been in this arena before. She
are the 5 things that you have to dis- sophisticated instruments. I’m worked in the GI [gastroenterology] lab.
infect the most? assuming that scalpels and scissors We have a very great relationship. Now,
Lewis: I would say cameras, laparo- have been done for decades. You I can say in the past that I haven’t had
scopic cameras, general cameras, Cisco have that down pat. It’s the new good relationships with my infection
cameras, laparoscopic instruments. And stuff that’s a bit of a challenge, right? preventionists, because they didn’t really
they have to go through the process that Lewis: Correct. You’re absolutely cor- know what we did. And some of them—I
they go through…. I guess the robotic rect, the new things are a challenge. don’t know if it was fear, or what—but
instruments not so much as the cam- They’re a challenge for us. And that’s because they didn’t know, they never

FEATURE
came to see what we did. But for…I’m pandemic. But we have quarterly meet- ICT®: Stepping back a little to talk
going to say the last 2 IP professionals ings…composed of OR and pharmacy, about your position as the upcoming
I’ve worked with, we have a really close housekeeping, IP, and nursing. There president of IAHCSMM, what do you
relationship. And they know exactly are others that are there as well but see as the priorities in that position?
what we do, because they’ve come down, those are the main departments. We do Lewis: Communication should be first,
and they’ve come to see exactly what we talk about our infection rates and talk I think, for our membership. My goal
do. I think that’s a great thing. I think about our instructions for use and IUSS is…with the staff at IAHCSMM to really
you should always have a great working [immediate-use steam sterilization], work on trying to get more states with
relationship with your IP person. which is very, very minimal; little to mandatory certification. Now, we’ve
none. We do not [use] IUSS, unless it’s done a great job; IAHCSMM has done an
ICT®: We’ve written articles here at an extreme emergency…. excellent job. But I think we can move
Infection Control Today® about how, just a little bit on a quicker level. They
when this pandemic happened, all ICT®: IUSS? may not agree with me at headquar-
of a sudden infection prevention- Lewis: Immediate-use steam steriliza- ters, but I just think that we should be
ists were people to whom different tion. I guess back in the old times they moving just a little bit faster with trying
departments would go to seek infor- used to say a flash sterilization, like… to…. And it’s a process; they have to go
mation about how to protect yourself when you have a one-of-a-kind…but before the legislature in that state and
as a health care worker from getting we don’t have that anymore. But if you everything. It really is a process. But I
COVID-19. Was that what happened had a one-of-a-kind or if you had some think it’s a process worth moving for-
in your case? loaner instruments that were brought in ward with in trying to expedite where
Lewis: Oh, yes. She was very adamant for a patient and the surgeon dropped more states are requiring mandatory
OKRASIUK@STOCK.ADOBE.COM
about trying to make sure that we had that instrument, then—once it was certification in order to work in sterile
everything that we needed. Everything cleaned—it would be run on an imme- processing. That’s one of the things; I
we [needed] to protect ourselves, first diate-use cycle, which is a 3-minute or think we have a great membership. And
and foremost. She wanted to make sure 4-minute cycle with no dry time. And I want to make sure that our members
that we protected ourselves. And so, then it’s run in a container that’s used are qualified and educated to do the
if we were short—which I have to say to transport it back into the room. We jobs that they do every day. We try really
thank you, that we were not short—but hardly have any of that going on here at hard to give them education, things that
had we had any limited supplies of PPE North Fulton. they can Zoom in on or they can do a
[personal protective equipment] or
anything, she was right on it, because
she knew exactly what we needed to do.
And she knew that our job was just as
important as making sure that the OR
had the things that they needed. So, you
know, she really did a great job during
the pandemic. And of course, we’re still
in the pandemic. She’s still keeping in
contact, checking in on us to see if we
need anything. And I just think that’s
the relationship that you should have
with your infection preventionists.
ICT®: Whom do you report to when

you have to give a report about how
things are going in your department?
A hospital administrator?
Lewis: Well, we have an IC [infection
control] committee, and we meet quar-
terly. We’ve probably been meeting on
some Zoom calls, of course, since the

FEATURE
podcast. And we have lots of [training it’s just a matter of people really sitting about vaccine hesitancy among
opportunities] for them. I think we’ve down reading, understanding. I think a health care professionals. And it’s a
come a long way with that. And moving lot of places have schools where you can real concern.2 Have you had conver-
forward, I’m sure we’ll be having a lot go…anywhere from 4 months to a year sations with your team about vacci-
more education-wise for our mem- at a technical college and nation?
bers. But I think, to this point, even take a class, and courses Lewis: I’ve talked to
with the pandemic, we didn’t have our are for sterilization, too. “I think we my team, and some of
IAHCSMM conference last year, but we After you complete that [IAHCSMM] them have had the vac-
did have a virtual conference. We’re just class you can then sit for cine already. I took it
have a great
trying to do what we can to make sure the sterilization certifi- in December, and then
that our members know that we’re fine. cation exam, whichever membership. And I I took my second dose
And we want to make sure that they get one you choose to sit for. want to make sure in January, but some of
the education that they need. that our members them have had the vac-
ICT®: What would you cine already. And then
ICT : What you said about lobbying
®
tell your fellow sterile
are qualified and some of them are still
to mandate certification for sterile processing profession- educated to do a little leery. You can’t
processing employees sort of mir- als about how to fur- the jobs that they force them, but I just
rors what’s going on with infection ther get through this
preventionists. They’re also lobbying pandemic? The num-
do every day. We keep trying to explain
the positive part of it. It
states so that anybody who’s called bers look good, as you really try hard may not be 100% effec-
an infection preventionist should know, right now, but to give them tive. But if you get it, you
have certification. How many states the variants are out will not get a real severe
education.”
have you convinced so far? there. What advice do case of COVID-19. So that
Lewis: Let’s see, New York, Massachu- you have for your fel- in itself…. I don’t have a
setts, Denver [Colorado]…. low sterile processing professionals? lot of millennials, but the ones I have,
Lewis: I have this to tell my cowork- they’re like, “No. I don’t know what’s
ICT®: What does certification ers—because that’s what I think, we’re in that vaccine. I’m not taking it.” You
involve? Do you have to go to school all one big family. We should just con- can’t force them. Maybe at some point
for a year or take a certain number tinue doing what we’re doing and follow it might be mandatory, but most of my
of hours of a course of some sort? CDC [Centers for Disease Control and people have received a vaccine.
Lewis: Well, IAHCSMM has a certifi- Prevention] guidelines. Just maintain-
cation course…. Well, we have several ing wearing your masks, and those of ICT®: Is there anything I neglected to
as a matter of fact—but us who want a vaccine—I ask you, that you think is pertinent
where you can actually would like to think a lot of that you want sterile processing pro-
purchase your book and them would, but you know, fessionals and infection prevention-
your workbook, and you some people don’t. But if ists to know?
work through that…at your you want a vaccine, make Lewis: No, I just think that infection
own pace. And when you sure that you get it when preventionists and sterile processing
feel like you’re ready to Register it’s available to you. Keep should always work as a team. It should
take the examination, then for our your hands washed, wear always be a team effort. It’s not them
you can go through Pro- e-newsletter your mask, social distance, or us. It’s not sterile processing. It’s not
metric. We are partnered to receive just all the basic things. We infection prevention, but it’s us as a
with Prometric Testing for similar have to stay safe. We have team. And that’s the way we’re going to
them to take their tests content. to stay safe for ourselves, keep our patients safe. 
through the certification our families, and our
exam. We have several patients. Right now, those This interview has been edited for clarity
different options for them. We have the are the things that we have to do to stay and length.
sterile processing [technician], and then safe. I just think that they’re doing what
we have the instrument specialists. We they’re doing. Just keep doing it.
have the endoscopic specialist certifica- REFERENCES AVAILABLE AT
tion. We have several certifications. And ICT®: I’m always a little shocked INFECTIONCONTROLTODAY.COM

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May 2021 Vol. 25 No.

SHEA Conference Unveils

HEALTH CARE-ACQUIRED INFECTIONS

Make Sure COVID-19

IAHCSMM’s New Leader

Nurses Prove Their Mettle

Bug of the Month: “Suddenly I’m

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Lessons Learned as the Rebuilding Begins

EDITORIAL ADVISORY BOARD

Fibi Attia, MD, MPH, CIC Kimberly Jones Katherine K. Perez,

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Suddenly I’m on Everybody’s Radar (Again)

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personal protective equipment

Most Decontamination Methods for

least damage to the respirators, Schumm

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potentially leave toxic residue and is

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Universal Surveillance for

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health care–acquired infections

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At-home COVID-19 Tests tional testing expenditures ($12.5 billion)

Are an ‘Effective Strategy’

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education • exposition • engagement

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Endoscopes Are Causing Infections,

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Your Future Telehealth Just putting a screen between patients and

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