Tori Whitacre Martonicz is the editor of 

.  She has been a writer and editor for over 30 years, and she has an MA and BA in English Composition/Literature from the University of Akron in Akron, OH. She lives in Ohio with her husband; son; 2 tiny dogs, Selena Brigid Sophia and Doctor Danger Dog; and a big black cat, Freya. She loves reading, writing, gardening, and spending time with her loved ones.

Vaccines for COVID-19, but what about the next pandemic? 

COVID-19 is not going away, and it is the latest in the world’s pandemics. Undoubtedly, another one will come, and what can scientists and medical professionals do to prepare vaccines for the next pandemic?

Seth Lederman, MD, the CEO of Tonix Pharmaceuticals, a biopharmaceutical company developing new vaccines for COVID-19, smallpox, and mpox (previously known as “monkeypox”), answered that question for 

). He is well versed in vaccine creation, and his research led to the discovery of the CD40 ligand and its role in T-cell helper function.

: In a new age of pandemics, how can we wage a smarter defense?

 Our daily news is crowded with updates on overlapping health emergencies in America. Researchers are modeling a winter COVID-19 wave fueled by 

more than 100 locations where it is not endemic

. There is no shortage of speculation about the next pandemic, and we still can’t shake COVID-19. If sluggish uptake of new boosters continues, projections suggest the United States could average 

As we look ahead to the next public health threat, there’s a great deal that we’ve learned since SARS-CoV-2 swept the world almost 3 years ago. Indeed, we also have lessons dating back to the fight against HIV/AIDS, which is when my work in molecular virology began. It’s a mix of hard-earned reality about immunity, vaccines, and long-term consequences we would be foolish to ignore.

: Why isn’t immunity easier to achieve?

 There are 2 primary ways our immune systems protect us—antibodies and T cells—and the most effective vaccines rely on both. Our first-generation mRNA vaccines recruit antibodies to ward off COVID-19 infection, but only for a few months. The problem is we need T cells to achieve more durable protection, recognize variants, and block forward transmission. Hence, the pandemic is not over, hundreds of Americans are still dying every day, and the virus continues to strike with more 

immune-evasive variants constantly gaining ground

. Our “whack-a-mole” approach has given way to a motley soup of variants spreading exponentially 

We all may have pandemic fatigue, yet SARS-CoV-2 is still busy mutating. People keeping up with the guidelines have now had at least 4 shots since vaccines became available. And even the well-vaccinated are getting infected and reinfected. While current COVID-19 vaccines gave us breathing room and saved many lives, they have not landed a definitive knock-out punch. If we continue relying on perpetual boosters, we will remain in a forever war against COVID-19. If we instead apply our ingenuity and resources to make better vaccines, we can truly end this pandemic—and critically, build the platforms that prepare us for the next one.

: What do we need vaccines to do to better protect those who receive them?

 We must be smarter about the limitations of some vaccines. For instance, the World Health Organization has warned our 

,” in part because it doesn’t block forward transmission. Similarly, it was premature to stop developing more robust COVID-19 vaccines after releasing mRNA shots. But it’s not too late to send COVID-19 into retreat. The possibilities include live-virus vaccines like the ones that eradicated smallpox and protect us from measles, mumps, and rubella; intranasal and oral delivery routes are also being considered. One promising technology is a “chimeric” approach combining a SARS-CoV-2 antigen to target the spike protein with a live-virus backbone that produces T-cell immunity.

What matters most is following the science further. There is 

, either from natural infection or current vaccines. In fact, contracting COVID-19 confers only short-term immunity to those individuals who recover, similar to the protective benefits from current vaccines. This is why we see people getting second and third cases of COVID-19 only weeks after their last bout. The bottom line is to battle any virus successfully, we need vaccines that do 3 things: block forward transmission, provide long-term protection, and protect more broadly against variants.

 Complacency has unrelenting long-term consequences. The history of HIV/AIDS is replete with the tragic results of inaction. We’ve 

, yet outbreaks are surging because countries like ours largely ignored the potential threat, just as we did with Ebola and Zika. And now we have a trailing epidemic of long COVID-19, 

. As many as 23 million people in the US are suffering from long COVID-19, a number that potentially increases with every COVID-19 infection.

Once we build a lasting infrastructure for next-generation COVID-19 vaccines and large-scale production, we will have it to defend against other infectious diseases. We may be on the right track with a 2023 federal budget proposal that includes bolstered funding for pandemic preparedness. There’s also the successful elevation of 

the U.S. Department of Health and Human Services Administration for Strategic Preparedness and Response to a standalone agency

 empowered to mobilize against public health emergencies. Along with a recent 

White House executive order to ramp up biodefense

, these steps could significantly increase our capacity for anticipating lethal viruses and deploying life-saving solutions – but only if we leverage the very tough lessons learned from COVID-19.

From more durable COVID-19 vaccines to prevention and treatment for diseases that strike next, it’s time to take urgent action. We need smarter, longer-lasting, and scalable virus-fighting weapons on the front lines for today’s public health crises and those just ahead.

Articles

Vaccines are one of the best weapons scientists have against pandemics. What can scientists and medical professionals do to prepare better vaccines for the next pandemic?  


How We Can Wage a Smarter Defense Against Future Pandemics

Shannon Simmons, DHSc, MPH, CIC, is a system infection preventionist for CHRISTUS Health in Irving, TX.

She began her career in clinical microbiology and now has over 7 years of experience in infection prevention. Simmons is passionate about advancing the science of infection prevention and elevating IPs as advocates, leaders, and experts.

The COVID-19 global pandemic has brought the importance of the infection preventionist (IP) to the forefront and has subsequently highlighted the need for infection prevention and control resources in the rapidly growing ambulatory care sector of health care. Ambulatory care is typically used as an all-encompassing term to describe a wide array of health care services performed outside of a hospital; however, these services ultimately act as a cost-effective alternative to hospital-delivered care. Although ambulatory care can provide the same services to patients at a fraction of the cost and in a fraction of the time, the requirement remains to maintain the same compliance and consistency as its inpatient counterpart. The ambulatory IP can be an important resource in translating widely accepted standards of care and patient safety into ambulatory care facilities.

As hospital systems transition to operating more ambulatory facilities, traditional health care positions should be expanding to fulfill the needs for such positions as a full-time ambulatory IP. Although the requirement for hospitals to have a full-time, dedicated IP on staff is readily maintained, resources have deterred this same regulation from being applied to ambulatory care facilities such as stand-alone clinics and urgent care centers. The quality of ambulatory services is subject to decreased quality outcomes when not provided the same or similar resources as its inpatient counterpart.

The ambulatory [infection preventionists] can be an important resource in translating widely accepted standards of care and patient safety into ambulatory care facilities.

Historically, there has been less scrutiny surrounding ambulatory care facilities, leaving this area prone to problems and errors often linked to their extreme resource constraints. Staffing shortages, the lack of physical space, and financial barriers make it difficult to implement the appropriate infection prevention measures needed for safer patient outcomes. In many clinics, especially those in rural areas, the staff are asked to act in several different capacities, ultimately decreasing the attention available for adhering to the nuances of many infection control and prevention practices, such as those associated with reprocessing instruments.

Ambulatory care facilities primarily rely on the train-the-trainer model, which is a training framework that encourages employees to become subject matter experts who can then teach other members of their team. This framework relies heavily on staff members becoming experts in areas quickly, but without continued assessment of the task or the competency of the trainer. An example would be when a single staff member is expected to carry out direct patient care in addition to performing high level disinfection or sterilization of instruments. On the other hand, in a hospital sterile processing department, these types of processes more often are performed by a certified technician because the evolution of procedural instruments and the composition of these items make sterilization a less straightforward task, requiring specific training that the ambulatory care facilities may not be able to provide. Further, the complexity and difficulty to fully sterilize many procedural instruments is a widely recognized concern that is also attached to patient outcomes.

An ambulatory IP is a resource whose primary purpose is to be an infection prevention and control expert and provide prevention specific knowledge to staff and facilitate changes in practices and protocols to meet or exceed standards and recommendations that are specific to the ambulatory sector. While ambulatory IPs are not considered the subject matter experts in areas of ambulatory care such as high-level disinfection and sterilization, they can offer the guidance associated with meticulous attention to manufacturer’s instructions for use and evidence-based recommendations. The opportunity exists for comprehensive change in the ambulatory health care sector that hinges upon amplifying the resources for both care delivery and quality improvement efforts. The ambulatory IP is an answer to the national priority of strengthening infection prevention and control programs in ambulatory care settings.

Ambulatory health care facilities deserve infection prevention and control resources with the preparedness to address the unique complexities of their health care setting. 


Ambulatory Infection Preventionists: Providing the Resource

To help improve the vital work of those infection preventionists, nurses, and physicians in the infection control field,

searches for interesting, supportive, and innovative products. These are this month's picks.

Hibiclens Antimicrobial Hand Soap System by GP PRO

This soap system combines the effectiveness of Hibiclens’ FDA-approved chlorhexidine gluconate (CHG) 4% solution with GP PRO’s hand soap dispenser. The result is a system that helps improve hand hygiene adherence in the health care environment.

The Hibiclens Antimicrobial Hand Soap System by GP PRO features Hibiclens’ CHG 4% solution inside GP PRO’s automated touchless hand soap dispenser. As part of infection prevention bundles for patient bathing, Hibiclens has demonstrated in study after study that it helps prevent methicillin-resistant 

. Best of all, it is gentle on sensitive skin. The GP PRO is a touchless technology, which reduces cross-contamination and eliminates the potential for hands carrying pathogens from one place to another.

One review of Hibiclens Antimicrobial Hand Soap System comes from Paulina Rodriguez, BSN, RN, an infection preventionist in Abilene, Texas, who shared the following: “My nurses regularly use Hibiclens for handwashing because they know how effective it is at providing a deep and lasting clean, and they love how gentle it is on their skin. Making it available in a touchless dispenser at handwashing stations throughout the health care setting will encourage heightened use, improve overall hand hygiene, and reduce transmission of microorganisms. This is the kind of solution that has the potential to dramatically and positively affect hand hygiene [adherence] and influence a reduction in health care–associated infections.”

Wassenburg Medical Dry 320 endoscope drying cabinet

Wassenburg Medical Dry 320 cabinets dry flexible endoscopes in a patented, controlled, and safe storage manner while preserving the endoscopes’ washed and disinfected state for up to 30 days. Because the storage period is extended, the endoscopes may be accessed for use in a more efficient and timely manner. The endoscopes are stored vertically in a hanging position, which allows gravity to assist in the drying process. Vertical hanging for endoscopes is recommended by the manufacturers and complies with recommendations from the European Society of Gastrointestinal Endoscopy-European Society of Gastroenterology Nurses and Associates guideline 939. The Wassenburg Medical Dry 320’s patented pull-down positioning system allows users of all heights to position, connect, and remove endoscopes easily without straining. Overall, the Wassenburg Medical Dry 320 is more economical to run, has a smaller ecological footprint, and is built to last.

With over 40 years of serving the endoscope market, Wassenburg Medical has accessories, endoscope storage, and many other products to meet endoscope disinfecting needs.

Actizone F5 by Solvay is a ready-to-use broad-spectrum disinfectant with 24-hour antimicrobial sanitation for hard surfaces. Actizone F5 is residue free on a variety of surfaces and specifically designed to combine cleaning performance and 1-step disinfection of harmful viruses and bacteria. Actizone F5 kills 99.9% of harmful bacteria and viruses, including 99.9% of all bacteria for 24 hours.

SteriTite containers by Case Medical, Inc, are rigid, reusable sterilization containers proven to be more safe, efficient, cost-effective, and sustainable. Already competitively priced, the SteriTite container is designed for durability and continuous use and is virtually repair and replacement free. Cleared by the FDA, the SteriTite system with MediTray inserts has the Conformité Européenne marking for all methods of sterilization.

The SteriTite sterilization containers are constructed of anodized aluminum, platinum-cured silicone, and passivated stainless steel hardware. Because of this, they are less likely to have performance issues that could lead to unsuitably processed devices and operating room interruptions.

The SteriTite sterilization container is available as a universal system and is compatible with all medical devices and current sterilizers. The containers have a perforated base for all sterilization modalities. For prevacuum steam and Sterizone low-temperature sterilizations, the containers are available with a solid base.

Case Medical, which is FDA registered, was the inaugural recipient and is the most recent recipient of the US Environmental Protection Agency’s Safer Choice Partner of the Year Award.

Hand hygiene is vital to protecting patients and staff from bacteria and viruses that lead to health care–associated infections. With this in mind, BioInteractions has developed a new company and product. The product, called Primel Skin Protection, is a skin-safe antimicrobial spray based on TridAnt technology, a coating for medical devices. Primel stays on the skin for 2 days and safeguards both the user and every surface they touch from harmful microbes using Kill-on-Touch Technology. It uses biocompatible components, absorbs quickly, and does not need water. It is ideal for use in all health care and sanitation environments in addition to anywhere high levels of hand hygiene are needed.

“The launch of Primel represents a paradigm shift in the way we approach patient care,” Arjun Luthra, chairman and CEO of Primel, told 

. “Building on the success of TridAnt, Primel was founded to advance antimicrobial protection in all patient care environments. TridAnt, developed by BioInteractions, is a revolutionary coating technology for medical devices that incorporates active and passive components to create the first truly nonleaching, effective, safe, and durable antimicrobial coating, which lasts for up to 365 days and helps save lives and time needed for medical treatments. The intended end result is improvement in well-being and reduction in risks to both patients and professionals.”

Infection Control Game is a fun simulation board game and video game that can be used for training, exploring, and discussing infection prevention and control. The game was developed by leading National Health Service infection control professionals. It is based on a simulated ward that has a norovirus outbreak, and the game encourages players to make real-world connections while minimizing infection. Infection Control Game challenges players to figure out how to manage infection and encourages teamwork to improve players’ confidence when managing a real-life outbreak. Some of the issues that players will learn about include warning signs of infection, infection prevention methods, managing an outbreak, the importance of timely communication, and multidisciplinary collaboration. It may be used as an informal activity or as part of more formal, structured training. Infection Control Game requires 6 to 14 players but no facilitator. It has a standard 60 minutes of play time, but sessions can be fitted to the allotted time and tailored for the players’ level of knowledge.

Infection Control Today's® Product Locator is a monthly column highlighting some of the latest advanced technology in the infection prevention field.


ICT’s Product Locator: December 2022

’s) wide-ranging coverage of the infection prevention and control world. Everything from interviews with known opinion leaders, to the news that infection preventionists and other health care professionals can use on their jobs.

New Research Demonstrates a 50% Decrease in Hospital-Onset C difficile Infections

Any decrease in the devastation of Clostridioides difficile is welcomed, but an investigative team brought the numbers down by 50%. See what control measures they used.

A summary of the top stories of 2022, and what to look for in the new year.

How to Address Concerns About the Influenza Vaccine

Reluctance to receive the influenza vaccine continues despite years-long campaigns to increase vaccination rates. William Schaffner, MD, speaks to ICT® about how health care workers can respond to the most common questions and assure of the vaccine’s safety and efficacy.

Infection Control Today® observes the 34th annual World AIDS Day by speaking to Ambassador Deborah Birx, MD, and looking back at what has been done and what the world still needs to do to fight HIV/AIDS.

LTC Facilities Face Unique Infection Control Issues During COVID-19 Pandemic

Integrating home and community, long-term care facilities are supposed to be a haven for patients and their families. But during the COVID-19 pandemic, keeping the patients and the staff safe was a constant battle. An infection preventionist who lived through it discusses the challenges at her facility.

Take 5 minutes to catch up on Infection Control Today®’s  highlights for the week ending December 2, 2022


Weekly Rounds: 50% Decrease in C difficile, Top Stories of 2022, and More

Every autumn and winter, the media is filled with infectious disease leaders urging everyone from babies older than 6 months to adults to receive the influenza vaccine. Yet, despite the vaccination campaigns for influenza, COVID-19, and even pneumonia, the rates of vaccinations are still disappointingly low. 

To discuss these rates and ideas on how persuade more people to receive the vaccinations, 

Medical Director for the National Foundation for Infectious Diseases (NFID), 

a professor of infectious disease at Vanderbilt University Medical Center, and an 

 in infectious diseases, about what health care workers can say to address the questions and concerns that patients have about receiving the vaccines.

During the interview, Schaffner also spoke about the data NFID released in October, 2022, that showed that Americans are sharply divided over the influenza vaccination, in spite of experts warning of a potentially severe influenza season ahead. This survey of US adult knowledge, attitudes, and practices toward influenza and pneumococcal disease also revealed: Americans expressed significant concerns about the safety of getting influenza and COVID-19 vaccines at the same time, a growing number of Americans say they will consider masking to fight influenza, and concerning data about intention to vaccinate among individuals at high risk for influenza complications.

The vaccine is made up of fragments of the virus, they can't put themselves together and make a[n influenza] virus in your body and give you influenza.

, Schaffner answers the most common questions about getting the influenza vaccination. “One of the things that cannot happen…is you cannot get [influenza] from the [influenza] vaccine. That's a myth that's out there, and it's remarkably persistent. It doesn't go away. But it's not true. The vaccine is made up of fragments of the virus, they can't put themselves together and make a[n influenza] virus in your body and give you influenza. That's never happened, and it certainly doesn't happen now. So I can reassure them about that."

Schaffner also said to remind the patient “that millions of people have gotten an influenza vaccine.” He said to be make it personal to the patient, “I say, ‘I've been vaccinated, my wife has, everybody in the office has been vaccinated, [and] we want to make sure that this measure of protection is available for every single one of our patients.’ So be very gentle, acknowledge that their concerns are real and common. They feel relaxed, then they can talk with you about it.” Finally, he suggested, “Then bridge back to the patient [by saying], ‘We want to make sure that this measure of protection is available for all the patients who come here.’”

Videos

Reluctance to receive the influenza vaccine continues despite years-long campaigns to increase vaccination rates. William Schaffner, MD, speaks to ICT® about how health care workers can respond to the most common questions and assure of the vaccine’s safety and efficacy. 


Isis Lamphier, MPH, CIC, is an infection preventionist at Moffitt Cancer Center in Tampa, FL.

Today, December 1st is World AIDS (acquired immunodeficiency syndrome) Day. 

This year’s theme for World AIDS Day is “Putting Ourselves to the Test: Achieving Equity to End HIV.”

 World AIDS Day has been observed since 1988 to remember those lost to AIDS-related illness and to continue to fight to end the human immunodeficiency virus (HIV) epidemic. 

Globally, there are currently 37.7 million people living with HIV/AIDS.

 While there has been significant progression in prevention and treatment, HIV continues to be a public health concern. According to the Centers for Disease Control and Prevention (CDC), 

HIV is largely an urban disease affecting metropolitan areas with 500,000 or more people in the United States.

 Today, thousands of individuals and organizations around the world are working together to raise awareness surround HIV/AIDS and increase efforts in the development of prevention, treatment, and care.

) reached out to Ambassador Deborah Birx, MD, to get her input on this 34th observance. Birx is a world-renowned medical expert and leader whose long career has focused on HIV/AIDS immunology, clinical and basic immunology, infectious disease, pandemic preparedness, vaccine research, and global health. Birx served the United States as an Army Colonel and later, running some of the most high-profile and influential programs at the US CDC and US Department of State.

Birx has special insight in HIV/AIDs. In 2014, Birx oversaw the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) program and served as the United States global AIDS coordinator for presidents Barack Obama and Donald Trump until 2020. She also served as the United States special representative for global health diplomacy from 2015 to 2021. Today, she joins us in celebrating World AIDS Day 2022.

, “World AIDS Day reminds us how we have worked together around the globe to change the course of the HIV/AIDS pandemic. We have learned the critical role of community. Misinformation and disinformation are battled by being on the ground. Meeting, listening, and dialoguing with community members from all walks of life. Not dismissing. Not blaming, but by investing in peer counselors and peer outreach and peer service delivery. We need to apply these same lessons to develop an effective response to COVID-19, so everyone can survive and thrive. Use today’s tools to control our current pandemics, and then we will be ready for the next pandemic.”

The WHO (World Health Organization) has several calls to action for World AIDS Day 2022

Improving the safety of working conditions in health care settings by ensuring there is appropriate and sufficient personal protective equipment (PPE) and hand hygiene items;

Speaking out against stigma and discrimination;

Ensuring essential HIV services are maintained in the community;

Supporting and empowering frontline health workers to deliver high-quality HIV services;

Focusing efforts to reach populations that are vulnerable to HIV;

Expanding high quality HIV services for youth at risk, adolescents, pregnant women, men who have sex with men.

https://www.whitehouse.gov/briefing-room/presidential-actions/2022/11/30/a-proclamation-on-world-aids-day-2022/

CDC (Centers for Disease Control and Prevention): 

https://www.cdc.gov/hiv/library/awareness/wad.html

https://www.hiv.gov/blog/world-aids-day-2022-putting-ourselves-to-the-test-achieving-equity-to-end-hiv

The Biden-Harris administration released new public health strategies to end HIV/AIDS at home and abroad today.

 In his proclamation, President Joseph R. Biden Jr. stated, “I have asked the Congress for $850 million to increase the use of preexposure prophylaxis (PrEP), expand treatment, and fight the stigma that stops many people from getting care.” With the new 2023 strategies, the Biden-Harris administration will also work to remove barriers to employment with the Armed Forces and repeal or reform HIV criminalization laws, which can criminalize people with HIV for potentially exposing others to HIV with or without actual transmission or intent to transmit.

The Biden-Harris Administration also remains committed to implementing the National HIV/AIDS Strategy (NHAS) which accelerated efforts to end the HIV epidemic in the United States by 2030. The NHAS was implemented in August 2022 with four goals: prevent new HIV infections, improve HIV-related health outcomes, reduce disparities and health inequities, and establish a more coordinated effort to address the HIV epidemic among partners and stakeholders.

HIV can affect anyone regardless of their sexual orientation, race, gender, or age. 

AIDS is a chronic immune system disease caused by HIV

. HIV is a sexually transmitted infection that can be spread by contact with infected blood, from infected mother to baby during pregnancy, birth, or breastfeeding, and through sex with an infected person. Risk factors for HIV/AIDS include injection drug use, having unprotected sex, having a sexually transmitted infection, and having certain jobs.

Many advancements in response to HIV/AIDS have been made, which include:

Morbidity and Mortality Weekly Report (MMWR) 

which marks the first official reporting of AIDS in 1981;

Scientists identifying the cause of AIDS in 1983;

Screening blood donations for HIV starting in 1985;

The first drug to treat HIV infection AZT (azidothymidine) made available in 1987;

The US Food and Drug Administration (FDA) approves the female condom in 1993;

The FDA approves the first HIV home testing and collection kit and the first HIV urine test in 1996;

The CDC issues the first national treatment guidelines for the use of antiretroviral therapy in adults and adolescents with HIV in 1998;

The Obama Administration releases the first comprehensive National HIV/AIDS strategy for the United States in 2010.

The work is not done, however, and HIV/AIDs continues to be a global public health threat. Today, we honor those individuals we have lost to the disease, and those who are valiantly fighting against it right now.

The Fight Continues: World AIDS Day 2022

Findings from a prospective observational study

 on health care workers’ adherence to a novel hand hygiene protocol in the operating theater (OT) were published recently in 

According to Manon D. van Dijk, Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, the Netherlands, and colleagues, this uniform way of observing hand hygiene adherence (HHA) in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, the HHA rate in the OT was below 50% and needed to be addressed in teaching hospitals and among physicians.

Because the Netherlands does not have protocols or observations tools in the OT, witnessing nonsterile health care workers (HCWs) perform HHA proved difficult, and a protocol needed to be created.

“Furthermore, regardless of the department or health care setting, hand hygiene observations are often performed by using the 5 moments of hand hygiene as stated by the World Health Organization (WHO),” the investigators wrote in the study. “These 5 moments are the golden standard and are in general easy to apply on clinical wards where there is a clear distinction between the patient zone and the health care zone. The patient zone includes everything that is attached to the patient or belongs to a specific patient, while everything that is not patient specific is referred to as health care zone. Health care workers should apply hand hygiene when changing from patient zone to health care zone, and vice versa.”

The study included 9 hospitals in the Rotterdam-Rijnmond region. Because these hospitals did not have specific hand hygiene protocols for nonsterile HCWs in the OT, the investigators created one with the hospitals’ input. Once the protocol was agreed upon, an observation tool was developed and tested. Using the tool, investigators calculated HHA rates by type of hospital and HCW.


Written hand hygiene rules specifically for anesthesia and surgery


Visual representation of the OT, divided into 4 hand hygiene areas.

Generally, hand hygiene should be performed when moving from one area to another. Across all hospitals, an average HHA rate of 48.0% (95% CI, 45.2%-61.2%) was observed in OTs. The academic teaching hospital received the lowest score at 23.1% (95% CI, 0.0%-45.8%), and the 2 specialized hospitals scored highest at 64.0% (95% CI, 30.6%-89.8%) and 76.7% (95% CI, 62.8%-84.5%). Interestingly, the average HHA scores from anesthesiologists were the lowest,31.6%, (95% CI, 19.2%-62.4%), whereas OT assistants scored the highest, at 57.4% (95% CI, 50.1%-78.2%).

“Nonetheless, adequate hand hygiene in the OT by nonsterile HCW and surgeons (performing nonsterile actions) is of utmost importance to prevent postoperative wound infections. Considering patients undergoing surgery are vulnerable to infection, exposure to infection risks in the OT should be kept as low as possible,” the authors wrote.

Some strengths of this study included the following: enabling uniform hand hygiene observations from one hospital to another, specifically designed for nonsterile HCW in the OT. This information will help infection preventionists to know which departments need extra assistance. The authors also mention that comparisons between hospitals could lead to friendly competition on which has the higher HHA rate. Competition also increases the rate of HHA in each hospital’s OT. Also, as many HCWs work in more than 1 facility, if the protocols were consistent among all the facilities, then the HCWs’ HHA could remain high because the infection prevention and control policies are the same, and they do not have to remember different policies.

Some limitations of this study included the implementation of COVID-19 infection prevention protocols. Also, because of COVID-19, 3 hospitals were not included in the final study, which did not allow for as many observations of HHA. Finally, because all the observations were only performed in 1 region of 1 country, more testing is needed to assess whether these protocols would function the same way in other countries and in other styles of OTs.

“However,” the investigators noted, “[because] almost all observations in the OT nowadays are still performed by using the 5 moments of hand hygiene of the WHO, we think that our protocol and observation tool could be a valuable addition to the existing literature.”

 Dijk MD van, Breejen MCMW den, Vermeeren JMJJ, Berg S van den, Beeck EF van, Vos MC. Compliance to a novel hand hygiene protocol tailored to non-sterile health care workers in the operating theatre. 

. 2022;0(0). doi:10.1016/j.jhin.2022.10.009

The study's investigators noted that adequate hand hygiene in the OT by nonsterile health care workers and surgeons is vital to prevent post-operative wound infections. 

Hand Hygiene Adherence in the Operating Theater: Data From the Netherlands

Sharps are needles, syringes, scalpels, or other medical instruments that patients or health care workers use to perform a medical procedure. They typically cause a prick or lacerate the patient’s skin. Sharps are considered biomedical waste and must be carefully handled. 

However, as we find out from a long-time user of sharps, dealing with their disposal is occasionally easier said than done. J. Thomas Dukes, PhD, professor emeritus at the University of Akron, in Akron, Ohio, has lived with Type 1 diabetes (TD1) since 1972, and knows all too well that a place to dispose of sharps is sometimes nonexistent.

For the first day of International Sharps Safety Awareness Month, 

) reached out to Dukes to describe his life with dealing with the challenges of sharps' disposal.

 I was diagnosed with TD1 at 16 in 1972, I was already too well acquainted with sharps. In 1970, after extensive tests, almost all involving blood tests with sharps, I was found to have spherocytosis, resulting in a splenectomy: more sharps!

Then, my grandfather got Type I. He lived with us for a while, and I gave him his shots until he learned to do that himself. Good training for what awaited me!

For over 50 years now, I have lived with sharps in all kinds of forms, including lab and hospital blood tests and routine vaccinations. Of course, my primary experience with sharps comes through daily, multiple injections of life-saving insulin.

I was lucky to come along just after disposable syringes were introduced. (I’ve met a couple of people who came up under the old system of boiling syringes and needles, etc. Ugh.) Of course, the challenges were 2-fold: how to give myself shots discreetly and how to dispose of the syringes and needles.

For many years, I would excuse myself just before a meal with others, “shoot up,” then return. Sometimes I would cap the syringe and throw it in the trash. Other times, I would put it in my pocket—diabetes is a disease of pockets, my friends—take it home, and put it in the trash there. As social rules relaxed, I would shoot up, unobtrusively I hope, at the table, then put the used, capped syringe in my pocket.

This sometimes led to the caps coming off and my getting stuck in the thigh or finger when I took the syringe out of my pocket. Ouch!

About 10 years after I was diagnosed, I was in Chicago, spending a long weekend with a friend. I miscounted my syringes and found myself without any before we were to go off to Saturday night supper, and none could be rescued from the garbage because I bent the needles so they could not be used by others. We went to a drug store, only to be told I could not buy syringes without a prescription. I was in a real jam as home then was West Lafayette, Indiana, where I was in graduate school at Purdue University, almost 3 hours away.

The only thing to do was to go to a hospital emergency department. They would either have to give me a script for the syringes or admit me to give me a shot. Rather than do a lot of paperwork, a wise nurse took me to talk to a resident physician. After the resident asked me several questions related to TD1—and listening to my extended answers—she said, “You either have Type 1, or you are the smartest junkie I’ve ever met.” She gave me the script, we got my bag of syringes, then headed off to a wonderful meal.

I entered another challenge with sharps when home glucose testing became readily available, about 12 years after I was diagnosed with Type 1. We were to use one lancet for every test. They were not major sharps, until, of course, you stuck yourself accidentally with a used one!

As the culture became more conscious about medical waste and the dangers sharps posed to others, I adopted different measures. Rather than buy the pricey sharps disposal boxes, I simply resorted to using old milk jugs, detergent containers, or the plastic boxes the cats’ treats came in. I would screw on the cap of these containers when full and put them in the trash.

Through the years, I have had misadventures. A capped syringe I accidentally left in a sport coat pocket pricked a worker at the dry cleaner. The used, capped syringes, as well as new ones, have fallen out of my pockets to be found—or not—by friends or, if I were walking and one fell out, by a stranger. Syringes have dropped onto the floor from my pocket while I am sitting at a meeting or in a restaurant. I have lost a few syringes that way but not many. I try to keep careful count.

But between using all the syringes and the lancets, I am sure I have lost track of a few. Right now, there is an unrecoverable syringe in the well of the elevator door of my building. Is it one of mine? I don’t know!

When I tried the insulin pump several years ago (disaster), I still had sharps to dispose of. I am about to try the pump again. I don’t know how the new models work, but I suspect sharps are not out of my life.

To my knowledge, I have never lived in a place where the law required [individuals] like me to keep sharps in certain kinds of containers and dispose of them in certain ways. However, some years ago, a custodian reported me for throwing my capped syringes in the trash. Turns out, the university had rules about such things. Health and Safety began dropping off sharps’ containers, then picking them up and replacing them when I called. This practice was marvelous but stopped with the pandemic. When we went back and I asked for the same thing, I was told I would have to file for formal accommodation, get a doctor’s letter, etc. So, I am back to collecting my capped sharps and lancets, this time in baggies, and bringing them home.

I am very, very lucky to have survived so long with TD1 and with, to date, so few side effects. But when I say sharps are a pain, I don’t mean physically—the shots are nothing, the pricks from blood sugar tests not much worse—but disposing of them systematically for the safety of all can be difficult. I am also conscious that I and millions of others are contributing to medical waste. But given the alternative—

A long-time user of sharps tells of his challenges with and gratitude for sharps. 

International Sharps Safety Awareness Month: One User's Life-Long Experience

SASKIA V. POPESCU, PHD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University where her research focused on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in both pediatric and adult acute care facilities.

Environmental service worker in full prevention gear

As we head to the end of 2022, which I’m convinced has been the longest of years, there are so many topics and issues we’ve faced and some to which we may not have given enough attention. To bring this year to a close and look at all we’ve managed to do to prevent the spread of infectious diseases, here’s a breakdown of the top infection prevention and control (IPC) stories of 2022.

Respiratory syncytial virus (RSV) is a respiratory virus we tend to see in children. It is a mostly seasonal bug that can be devastating to a child’s body. With public health interventions such as masking, distancing, hand hygiene, and staying home in place because of COVID-19, we’ve seen a significant drop in cases since 2020. In fact, I think many forgot about RSV. Unfortunately, the United States is now seeing a surge of RSV infections and hospitalizations, which is deeply worrisome. Starting in September, we saw a rapid rise in cases that’s beginning to strain health care facilities.

 Many reasons are being cited: the immune debt we would often see addressed through childhood socialization and exposure related to school and social interactions, a lack of respiratory precautions in place, etc. With this significant surge, many are calling for a renewed interest in RSV vaccines, which have been long discussed but have not come to fruition. The surge in RSV cases across the United States is a recent reminder that we’ve been shielded from the more seasonal respiratory infections since the pandemic began. But we must continue to be vigilant; COVID-19 isn’t the only infectious disease we face.

Omicron, Bivalent Boosters, and Paxlovid, Oh My!

It’s hard not to include COVID-19 in an annual review of IPC stories, but it’s also challenging to know where to start. A year in the COVID-19 pandemic feels like 5 years on Earth. Because of the Omicron variant, the year started with the most significant wave of COVID-19 infections we’ve faced. Per the Centers for Disease Control and Prevention (CDC), we saw a peak on January 19, 2022, with 5.58 million cases of COVID-19 that week in the United States.

 Omicron spread far, wide, and efficiently. Its capabilities also changed, and we saw this new variant spreading with ease. COVID-19 reinfections increasingly posed a challenge; gone was the robust immune protection we had from previous variant infections, and we encountered immune-evasive variants. Omicron revealed that immunity acquired from previous infections was a lot less effective at protecting us against the new variant. Although Omicron didn’t yield the same level of hospitalizations and deaths, its rapid spread and shorter period of immune protection against reinfection challenged us in many ways. Now we have 2 subvariants of Omicron, BA.4 and BA.5, which may be challenging for response because of the concern that previous infection may yet again offer less protection. There’s good news, however. “Recent research shows that previous infection with an older variant (such as Alpha, Beta, or Delta) offers some protection against reinfection with BA.4 or BA.5 and that a prior Omicron infection is substantially more effective. That was the conclusion of a study that evaluated all of Qatar’s COVID-19 cases since the wave of BA.4 and BA.5 infections began” as noted in an article in Nature.

In 2022, we also had new interventions and tools in our arsenal against this pandemic: bivalent boosters and Paxlovid. The bivalent boosters were rolled out in September of this year to intervene against Omicron subvariants BA.4 and BA.5. Uptake has been slow, in some ways mirroring the level of interest and attention that individuals give COVID-19 in the third year of the pandemic. Ultimately, this underscores the need for faster development and response to variants as they are identified, so we can intervene during surges instead of well after them. Paxlovid has been a newer tool for us against COVID-19, changing the game by preventing the need for hospitalization. The antiviral therapy is widely prescribed to help reduce symptoms and risk for severe disease, which has been great. It did, however, alert us to rebound, which is when symptoms flare up a few days after recovery. At first, this rebound was experienced by those taking the antiviral. But now we’ve found individuals can experience rebound without having taken the medication, which is an interesting aspect to acute infection but a bigger issue for infection prevention.

 Those who experience rebound can still spread the virus, and they need to isolate. This poses a risk to those around the person, but it also muddies the waters; will they think it’s the same infection and not isolate as a result? Is there less incentive to report rebound if you know it’ll lead to isolation? In either case, rebound has underscored a new aspect of acute SARS-CoV-2 infections that require our attention.

One last important piece to add about COVID-19 in 2022 is related to the CDC guidance. In late December 2021, the CDC recommended shortened isolation and quarantine periods. The shift in August of this year to continue relaxing public interventions and lessen the necessity for contact tracing encourages spread of the disease in high-risk areas like health care and congregating settings.

 The national relaxation of masking requirements for public transportation, such as on trains, also had a huge impact, signaling for many that the pandemic was over. CDC guidance has been a challenging aspect of COVID-19 infection prevention. On one hand, we understand the impact such restrictions have on the public. But on the other hand, the shifting nature of these restrictions and questionable decisions have affected trust in the federal agency. The recommendation for shortened isolation periods of 5 days has had a large impact, whereas many studies underscore that individuals can still be infectious after 5 days.

 Developing guidance during a pandemic was never going to be easy (and many cite progress, not perfection), but we need to work harder to achieve a middle ground and better science communication.

Many reasons are being cited: the immune debt we would often see addressed through childhood socialization and exposure related to school and social interactions, a lack of respiratory precautions in place, etc. With this significant surge, many are calling for a renewed interest in RSV vaccines, which have been long discussed but have not come to fruition. The surge in RSV cases across the United States is a recent reminder that we’ve been shielded from the more seasonal respiratory infections since the pandemic began. But we must continue to be vigilant; COVID-19 isn’t the only infectious disease we face.

we also had new interventions and tools in our arsenal against this [COVID-19] pandemic: bivalent boosters and Paxlovid."

           --Saskia v. Popescu, PhD, MPH, MA, CIC

Yes—we had a monkeypox outbreak on an international scale that was declared a public health emergency of international concern. Monkeypox, an orthopoxvirus and cousin of smallpox, is not one we typically see in the United States. In fact, most of the cases in this global event were in countries that historically had not reported the virus. Not only is this a unique event and a reminder that a disease anywhere is a threat everywhere, but this outbreak brought to light social stigma and a mishandled response we haven’t seen since HIV/AIDS. Early in the monkeypox outbreak, there were epidemiological findings that cases were initially being spread in social networks among men who have sex with men (MSM). Each outbreak yields its own findings early on, and we find trends that can help us target interventions. But sadly, US response struggled with this.

 Much time had to be spent explaining that monkeypox is not spread solely in MSM, that it is not considered a sexually transmitted infection, and that stigma only hurts response.

From delays in testing access to vaccine distribution, the United States was woefully inadequate in its response. I mention this because it underscores the increasing and continued threat of emerging infectious diseases but also shows that managing a new global outbreak during a pandemic comes with an increased burden, requiring continued vigilance and awareness for how we operate and communicate risk.

Other Important IPC Stories You May Have Missed

. Wastewater samples in New York City and other counties in New York state pointed to several cases. In those areas, vaccination rates were around 60%, which is low. We know that vaccine-preventable diseases have been on the rise with vaccine hesitancy, but polio always seemed like one we had a handle on. Although this clustered concern doesn’t pose a risk to the public, it does reiterate the importance of childhood vaccines and improving uptake in areas with low vaccination rates and that such diseases are only as controlled as we allow them to be.

. Uganda saw a new outbreak of Ebola caused by the Sudan strain (not the strain we saw in the 2014/2016 outbreak).⁹ As of October 26, 2022, there were 115 confirmed cases, 21 probable cases, and 1844 contacts under active follow-up. Although this strain of Ebola virus is not as fatal as the Zaire strain, there have 32 confirmed deaths. Now is a good time to initiate travel-related emergency department and urgent care warnings and have educational talks with providers about the ongoing outbreak.

. Not what you thought I’d mention in a talk about top IPC stories, right? I share this for a few reasons. The effort to improve biosecurity is an important global topic, and even though we don’t often deal with geopolitics in IPC, they still trickle into our realm. Earlier this year, Russia accused the United States and Ukraine of violating the Biological Weapons Convention (an international treaty) as it invaded Ukraine. In an effort to distract with disinformation, it triggered a review within the United Nations despite few countries backing Russia’s claim (and even then, it was mostly a consultation process, not support for the allegations). Why is this important? Russia’s claims made use of disinformation surrounding biolabs and portrayed US military biological activities as nefarious rather than supportive of global biosecurity and health initiatives. This poses a concern for larger work in science, efforts to keep the world free of bioweapons through biodefense, and partnership on a global scale that could affect research and innovation.

I’ll admit my own bias—I’m an infection preventionist and hospital epidemiologist who has focused a lot of my research and work on the roadblocks we face to building and supporting biopreparedness programs within health care. We’re often forgotten when it comes to discussing health care worker burnout and what frontline responders did during the COVID-19 pandemic. Facing the third year of the pandemic, we’ve seen increases in health care–associated infections (HAIs) and antimicrobial resistance and a deep need for sustained response to infectious diseases, and that means infection prevention. We’ve battled monkeypox, extreme burnout, and changing CDC guidance, and carried the burden of ensuring ongoing COVID-19 safety while reducing the risk for HAIs. The world is learning more about IPC efforts and the role we’ve played in this pandemic, but such change doesn’t happen overnight. While we wait for a more recognized role within health care and public health, I want to end on this note: Infection preventionists are critical resources for responding to infectious disease threats, be they HAIs or novel pathogens, and ultimately form the intersection of public health and health care.

Thompson D. Cases of child RSV are swamping hospitals. What are the symptoms, treatments? 

. October 25, 2022. Accessed October 28, 2022. 

https://www.usnews.com/news/health-news/articles/2022-10-25/cases-of-child-rsv-are-swamping-hospitals-what-are-the-symptoms-treatments

Trends in number of COVID-19 cases and deaths in the US reported to CDC, by state/territory. Centers for Disease Control and Prevention. Accessed October 28, 2022. https://covid.cdc.gov/covid-data-tracker/#trends_weeklycases_select_00

Prillaman M. Prior Omicron infection protects against BA.4 and BA.5 variants. 

. July 25, 2022. Accessed October 28, 2022. 

https://www.nature.com/articles/d41586-022-01950-2

Sheikh K. Covid-19 symptoms can rebound even if you don’t take Paxlovid. 

. October 27, 2022. Accessed October 28, 2022. 

https://www.nytimes.com/2022/10/27/well/live/covid-symptoms-rebound-paxlovid.html

Massetti GM, Jackson BR, Brooks JT, et al. Summary of guidance for minimizing the impact of COVID-19 on individual persons, communities, and health care systems - United States, August 2022. 

. 2022;71(33):1057-1064. doi:10.15585/mmwr.mm7133e1

Marquez C, Kerkhoff AD, Schrom J, et al. COVID-19 symptoms and duration of rapid antigen test positivity at a community testing and surveillance site during pre-Delta, Delta, and Omicron BA.1 periods. 

A summary of the top stories of 2022, and what to look for in the new year. 