 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.

Device Reprocessing Policies Must Be a Living Document

If the policies are not consistently updated, they are “just a piece of paper shoved in a logbook that is not going to effectively improve reprocessing…of ultrasound probes,” said Lisa Waldowski, DNP, RN, CIC.

Long COVID-19 and New Variants: Sounding a Continuing Alarm

It is easy to become complacent, but the SARS-CoV-2 pandemic is not over, and long COVID-19 and the new variants are causing rising concern.

LTC Infection Preventionists’ Responsibilities Have Doubled Due to COVID-19 Pandemic

In all areas, infection preventionists took on more responsibilities and expanded the ones they already had, including staff education and employee health.

Infection Preventionists and EMS Personnel: Nurturing a Relationship

They should be partners making each other and their patients safe through communication, education, and action plans.

Surgical Urology Is an Untapped Area for Infection Preventionists

Despite the initial reluctance for a urology team to work with infection preventionists, the collaboration is beneficial for both specialties.

Articles

Take 5 minutes to catch up on Infection Control Today’s highlights for the week ending July 1.


Weekly Rounds: Device Reprocessing Policies, Long-COVID-19 Alarm, and LTC IPs.

.  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 fiance; 2 tiny dogs, Sally and Doctor Danger Dog; and a big black cat, Freya. She loves reading, writing, gardening, and spending time with her loved ones.

Using information from demographic surveys that Infection preventionists has completed previously, a group of investigators from The University of Michigan studied how long-term infection preventionists’ (IPs’) roles have changed since the beginning of the COVID-19 pandemic. What they found surprised them because the IPs’ roles had increased dramatically.

The lead author of the study, Karen M Jones, MPH, RN, CIC, FAPIC, clinical research project coordinator, The University of Michigan in Rochester Hills, Michigan, presented their study at

Association for Professionals in Infection Control and Epidemiology (APIC) 2022 Annual Conference

, held June 13-15, 2022, in Indianapolis, Indiana. Jones discussed their presentation titled, A Whole New World: Changes in the Nursing Home Infection Preventionist Role in Response to the COVID-19 Pandemic”

“Everything has changed so much,” Jones told 

 about the IPs' responsibilities. “One thing that we did want to highlight in this research is that with all of those changes, the infection preventionist took on a lot more responsibilities in all of those areas. So although they may not have been the one responsible for implementing the visitation procedures, they had a lot of input in that PPE was huge, as was isolation strategies.”

All the additional responsibilities, of course, increased the number of hours an IP spent on IP duties. “One thing that came out very clear was that nursing home infection preventionists have a lot more responsibilities,” Jones explained. “And the time allotment has increased; it's almost doubled since COVID-19. It appeared in our previous surveys; infection preventionists in nursing homes spent on average 20 hours per week. Once COVID arrived…we saw nursing home infection preventionists spending more like 38 hours per week, that increased significantly. And if we broke it down further, we found that half of those nursing home infection preventionists were spending 40 hours or more per week on those infection prevention-related activities.”

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In all areas, infection preventionists took on more responsibilities and expanded the ones they already had, including staff education and employee health. 


 LTC Infection Preventionists’ Responsibilities Have Doubled Due to COVID-19 Pandemic

Infection preventionists (IPs) are not required to report surgical site infections (SSIs) from urology procedures, and yet, urology is a largely untapped source of information for IPs and vice versa. However, the urologist team are sometimes reluctant to work with IPs because they see IPs as punitive auditors and do not want to partner with them even though these medical specialties' work so often overlaps. Two medical professionals are trying to change this point of view.

) spoke with Jill Holdsworth, MS, CIC, FAPIC, CRCST, NREMT; manager, infection prevention, Emory University Hospital Midtown in Peachtree Corners, Georgia; and C. Adam Lorentz, MD, FACS, assistant professor of urology, Emory University School of Medicine, Decatur, Georgia, at the 

, held June 13-15, 2022, in Indianapolis, Indiana. Holdsworth and Lorentz discussed their presentation titled, “Integrating Urology into Your Infection Prevention Program.”

“Urology procedures aren't something that are required reporting service line for surgical site infections (SSIs)…[so] it's a new territory for us,” Holdsworth said to 

 “So we're exploring a lot of different things in the surgical world of urology because we haven't done that yet. What we are doing is bringing in urology to all of the current quality initiatives that we already have in the operating room (OR) and looking at all of the different things that overlap, which has been an interesting exercise. All of the high-risk scopes that they use, they overlap into some of the colon procedures. There's a lot of things that are…overlapping into the things that are required for us that we never really looked into before. It's really an untapped potential area for us in infection prevention.”

However, how the urology team can assist IPs goes even further. Lorentz explains, “There are a lot of areas where urologists have overlap…we do a lot of high risk procedures [where urologists] have used high risk instrumentation in terms of need for subject matter expertise from the infection preventionists and terms of processing, and all these other things that the average urologist doesn't think about in the infection preventionists’ role and how they can really leverage what they're already doing and other areas to improve on their outcomes.”

Despite the initial reluctance for a urology team to work with infection preventionists, the collaboration is beneficial for both specialties. 


Emergency medical services (EMS) personnel are often unclear about the role of infection preventionists (IPs) in pre-hospital transport and EMS. Yet, EMS personnel face challenges of undisclosed or unknown possible infectious bodily fluids as well as other dangers, and the EMS and IP partnership can benefit all parties, including the patients being transferred. Communication, like for all partnerships, is key to a successful collaboration.

To discuss this relationship, recently at the 

, held June 13-15, 2022, in Indianapolis, Indiana, 

) spoke with Jill Holdsworth, MS, CIC, FAPIC, CRCST, NREMT; manager, infection prevention, Emory University Hospital Midtown in Peachtree Corners, Georgia; and Alexander Isakov, MD, MPH, FACEP, FAEMS, professor of Emergency Medicine; director, Section of Prehospital and Disaster Medicine; Department of Emergency Medicine; Emory University School of Medicine, in Atlanta, Georgia. Holdsworth and Isakov discussed their presentation titled, “IP's Role in EMS & Pre-Hospital Transport.”

“I think in a perfect world, the infection prevention officer is helping to keep the EMS personnel safe from infectious bodily fluids from communicable diseases,” Isakov told 

. “EMS agencies most often do have an infection control officer, and they're trying to build a hierarchy of controls to keep their personnel safe. They're providing education and training for field personnel. They're developing work practices, administrative policies; they're making recommendations about personal protective equipment. And in this way, they're creating a hierarchy of controls to keep EMS personnel safe.”

Isakov continues, discussing the importance of communication. "Having infection preventionist as partners in those hospitals, especially as it relates to even information flow, after a patient's transport, who may be had an unrecognized communicable disease to have that relationship to communicate back to the EMS agency about that potential exposure and what to do next” Isakov said.

However, the IPs and EMS personnel must get over the first hurdle. Holdsworth explains, “But you do have to form those relationships first…do you even know who has an IP? Do you even know who to reach out to? That's step one as an IP because they probably don't know who to reach out to in the hospitals either. And it takes a little bit of effort to start those relationships.”

They should be partners making each other and their patients safe through communication, education, and action plans. 


Defining policies and procedures for ultrasound probe, specifically, surface probes, reprocessing must be highly reliable and sustainable. How infection preventionists (IP) are engaged in devising the policies and procedures is vital for them to be standardized, used, referenced, and implemented.

) spoke with Katharine J Hoffman, MPH, CIC, infection preventionist, JPS Health Network, Fort Worth, Texas; and Lisa Waldowski, DNP, RN, CIC, regional director of Infection Prevention & Control, Kaiser Permanente, the 

, held June 13-15, 2022, in Indianapolis, Indiana. Hoffman and Waldowski discussed Waldowski’s presentation: “Strategies to Inform Device Reprocessing Policy Toward Patient Safety.”

“Typically, policies and procedures are developed with key stakeholders involved clinicians, infection prevention and control (IPC) for ultrasound probes,” Waldowski said. “It could also be the ultrasound department as to ownership of a policy and procedure with IPC being part of that review process.”

Waldowski continues, “I think it's important that infection prevention is understand that hierarchy of what needs to be included. And it also strongly supports when there are challenges and opportunities with frontline staff or other key stakeholders in understanding the why,” Waldowski said. “And what is in line regulation. What is in accreditation standards, what is in the manufacturer's instructions for use and evidence-based guidelines that all pulled together to support that policy and procedure to support a safe, highly reliable practice and process. So I think that knowledge and understanding and then being able to connect the dots to implement such a document is very important. And the recognition of that with an infection preventionist going into that work. They need to have that first and foremost because this is a challenging area that a lot of practitioners have been using these probes in various manners, and they didn't realize what they didn't know. So it takes a lot more than just IP saying, 'Do this.' So this background information and supporting documentation will help in a successful out.”

Hoffman concurs, “Standardization is key, having been stakeholders and permitting everybody at the table to sit down and talk through that process together [in a] roundtable and get everyone's thoughts and considerations on the table ahead of time, so you can move forward in the right direction together.”

If the policies are not consistently updated, they are “just a piece of paper shoved in a logbook that is not going to effectively improve reprocessing…of ultrasound probes,” said Lisa Waldowski, DNP, RN, CIC.   


Katharine Hoffman has spent over 14 years in health care in various roles and subspecialties to include mother infant care, occupational health, preventative medicine, and pediatrics, providing direct patient care as a certified medical assistant. She is board certified in infection prevention and control (CIC). Further education and training include a Bachelor of Science in health administration and health management, as well as a Master of Public Health focused in epidemiology. She currently works as an infection preventionist at JPS Health Network.

Eye devices are too often overlooked and not being correctly cleaned, disinfected, or sterilized. To discuss this topic, 

 spoke with Katharine J Hoffman, MPH, CIC, infection preventionist, JPS Health Network, Fort Worth, Texas; and Lisa Waldowski, DNP, RN, CIC, regional director of Infection Prevention & Control, Kaiser Permanente,

, held June 13-15, 2022, in Indianapolis, Indiana. Hoffman and Waldowski discussed their presentation titled “Don't Lose Sight: Intentionally Approaching Eye Device Reprocessing.” In addition, they wrote the following article exclusively for 

Multiple eye devices in health care settings that touch the eye are reused on patients without being appropriately cleaned, high-level disinfected, or sterilized according to the specific device manufacturer’s instructions for use (MIFUs). Outbreaks associated with eye devices have occurred due to lack of cleaning, incorrect cleaning, or failure to high-level disinfect (HLD) or sterilize the eye device between patient use in neonatal intensive care units (NICUs), eye care clinics, and operating rooms (ORs).

Urgent care clinics (UCCs), emergency departments (EDs), NICUs, eye care clinics, ORs, and ambulatory surgery centers (ASCs).

Optometrists, Ophthalmologists, ED/Trauma physicians, and Ophthalmic surgeons.

Tonopens, ocular gonioscopes, A/B scan probes, Yag laser lenses, and eye specula.

Eye Device Manufacturer’s Instructions for use (MIFUs).

Many eye device MIFUs are not readily available, are outdated, or are not read and followed when it pertains to cleaning, high-level disinfection, and sterilization instructions. Eye device MIFUs should be reviewed and supported by central sterile processing, infection prevention and control, the respective manager, and end user of the device. Ideally, eye device MIFUs should be a component of a device/products analysis team before purchasing the device to assure that cleaning, disinfection, and sterilization instructions can be adhered to.

Eye Device High-level Disinfection (HLD) or Sterilization Opportunities

Eye devices that touch the eye according to the Spaulding Classification System, would be considered a semi-critical or critical device based on intended use, therefore, requiring minimally HLD or sterilization.Eye device MIFUs state the recommended HLD or sterilization requirements. What is frequently noted is that eye devices are being cleaned with either soap and water or a low-level disinfecting wipe in the patient exam room and allowed to air dry on a paper towel before next use. Required next steps of transporting the eye device to central sterile processing for HLD or sterilization never occur. Precleaning steps if noted by the manufacturer, or based on selected HLD or sterilization guidelines, and appropriate means of transport to central sterile processing are typically not known or implemented. Additionally, re-usable eye devices have been noted to be stored in their original wooden box, which is not only uncleanable storage containment, but also likely to be contaminated over time.

Obtain an inventory of all eye devices in your organization

Obtain current MIFUs for all eye devices. Have central electronic access for all key stakeholders to use MIFUs (central sterile processing department, infection prevention department, managers, physicians, frontline staff)

Consider single-use disposable eye device options

Follow eye device manufacturer’s MIFUs for cleaning, HLD, or sterilization

Include eye devices in the Infection Prevention and Control Risk Assessment

Include eye devices in HLD and sterilization process rounding/audits

Assure key stakeholders are competent, trained, and educated based on their role in the reprocessing of eye devices (frontline staff, central sterile processing, infection prevention, and managerial oversight)

Audit this process across settings for standardization as appropriate

Infection prevention and control has yet another opportunity to lay eyes on and validate evidence-based, manufacturer supported eye device HLD and sterilization reprocessing. Like other re-usable medical equipment and devices, omissions of HLD and sterilization reprocessing pose a significant risk to patient safety.

Eye devices often are not cleaned nor sterilized as they should be according to manufacturer’s instructions for use, which leads to poorer patient outcomes. 


Seeing Eye to Eye: Reprocessing of Eye Devices

KEVIN KAVANAGH, MD, is the founder of the patient advocacy group Health Watch USA

The news regarding the SARS-CoV-2 pandemic has been very concerning on 2 fronts. The first is the recent evidence regarding the immune-escape properties of the newly surging variants BA.4 and BA.5, and the second concerns the growing dangers of long COVID-19.
 
The potential for infection or reinfection or breakthrough infection with BA.4 and BA.5 is alarmingly high. Yes, this viewpoint is sounding an alarm. Two recent news articles from 

 have reported rising rates in Israel and the United Kingdom, with increases in hospitalizations. These reports are supported by 

 which found that “…data show that the BA.2.12.1, BA.4, and BA.5 subvariants substantially escape neutralizing antibodies induced by both vaccination and infection.”
 
In addition, the BA.4 and BA.5 variants " In addition, the BA.4 and BA.5 variants may be the 

 on society than a high case fatality rate. As evidenced by the United States’ COVID-19 death data, an individual’s chances of dying from Omicron (BA.1) variant was greater than from the Delta variant. Participating in high-risk activities during Omicron was more likely to result in a severe outcome and death. For those individuals who had infection or vaccine-induced immunity, once infected with BA.1, the disease may have been milder. However, 

 was comparable to previous variants.

Even as many of our policymakers have focused on deaths, long COVID-19 is continuing to take a toll on society by impacting multiple organ systems. Long COVID-19 has been found to 

 of brain fog, memory, or other cognitive problems. It also can have a profound 

 and other organs. Also, long COVID-19 is responsible for approximately doubling COVID-19 deaths with 

 occurring after the acute infection. In addition, now biomarkers are starting to emerge in patients who have long COVID-19. A report from 

 found viral antigens in the serum of long COVID patients up to a year after their acute infections, which may indicate an ongoing subacute active infection. Noted in 

, investigators identified biomarkers associated with kynurenine pathway activation in those patients who suffer from long COVID-19 with cognitive decline.
 
Even more concerning is the report that 

 for most long COVID-19 symptoms, specifically:

Beyond 30 days after the acute illness, the risk of death after a breakthrough infection is significantly decreased compared to an infection in an unvaccinated individual (HR= 0.66, or a 34% decrease in risk). However, there is a lesser effect on other delayed sequelae (HR = 0.85, or a 15% decrease in risk).

Compared to non-infected controls, patients with breakthrough infections “exhibited increased risk of death and post-acute sequelae in the pulmonary and several extrapulmonary organ systems.” This was also observed in non-hospitalized patients.

Compared to non-vaccinated SARS-CoV-2 patients, patients with breakthrough infections also showed a lower risk of death and post-acute sequelae. The risk reduction was more evident in hospitalized patients.

But the burden of disease in those patients with breakthrough infections is not trivial. Vaccination only partially reduces risks and has the same range of long COVID-19 involving several organ systems “including cardiovascular, coagulation, and hematologic, gastrointestinal, kidney, mental health, metabolic, musculoskeletal, and neurologic disorders.” 

 are reported to have an additive effect, resulting in a stepwise progression of disease with each infection. Presumably, this is due to added damage to the involved organs.
 
All the studies regarding long COVID-19 have data acquisition periods before the BA.4 and BA.5 variant—a variant which may be even more problematic.
 
Thus, the world has a highly infectious variant, having an uncertain case fatality rate, but with overseas reports of increased hospitalizations. This, combined with disturbing new data on long COVID-19, dictates we need to be on the side of caution and maintain strong public health guidance, including the use of N95 masks along with improving ventilation in all indoor settings. Vaccinations, although weakening, are still advisable since they are low risk and may still make the difference between hospitalization and death and being treated at home. Medical professionals and infection preventionists (IPs) know how this virus spreads and how to mitigate its impact. Now, more than ever, it is important they maintain strong messaging which encourages the following of public health measures.


It is easy to become complacent, but the SARS-CoV-2 pandemic is not over, and long COVID-19 and the new variants are causing rising concern. 


Long COVID-19 and New Variants: Sounding a Continuing Alarm 

Communication Is Key in Controlling Isolation Precautions in Ambulatory Settings

Infection preventionists should take an active role supporting ambulatory partners to help them follow infection prevention and control practices.

Fighting Pathogens in a Children’s Hospital: Two Posters at APIC Conference

Investigators look for and find MRSA and C difficil widespread on floors, especially in patient rooms, and MRSA inside NICU isolette beds.

Using J-SIPHE System Could Promote Antibiotic Resistance Measures in Japan

Recently, investigators studied the correlation between antibiotic use and antibiotic resistance using the J-SIPHE system. The results suggest that using the system may be beneficial for promoting antibiotic resistance measures antimicrobial stewardship implementation.

New Hospital Design/Development Needs to Involve Infection Preventionists

An IP can use their expertise to make decisions that will lead to cost savings and improved design flow.

ACIP Recommends High-Dose Influenza Vaccine for Patients 65 Years or Older

This recommendation comes at an critical time as this flu season is feared to be a rebound after the low numbers the last few years due to COVID-19 precautions.

Take 5 minutes to catch up on Infection Control Today’s highlights for the week ending June 24.


Weekly Rounds: Controlling Isolation Precautions, Fighting Pathogens in a Children’s Hospital, and More

Older woman with influenza (Adobe Stock) 

As the United States prepares for the next influenza season, the Center for Disease Control’s Advisory Committee on Immunization Practices (ACIP) has granted preferential recommendation for the use of differentiated flu vaccines for adults 65 years and older. Prior to this recommendation, there has never been a preferred flu vaccine for older adults, and no updated ACIP recommendations for influenza vaccines for this population have been made since 2010.

Because people over 65 years old are especially vulnerable to influenza, which can lead to life-threatening complications, this recommendation comes at an auspicious time as the US prepares for the next influenza season. With precautions for COVID-19 in place, flu cases have been low, and now with those precautions minimized, flu cases are expected to rebound, and the older population is at higher risk again. With this mind, the recommendation by the ACIP supports that not all flu vaccines are created equal, and that this susceptible population requires better protection than what a standard dose vaccine may provide.

Seasonal influenza is a serious illness that disproportionally affects people 65 years or older and can lead to pneumonia, serious heart conditions, hospitalizations, and death. Other people who are especially susceptible to complications are people of color, and people with co-morbidities such as diabetes, asthma, chronic obstructive pulmonary disease, and heart disease.

“We are encouraged that the ACIP has recommended tailored influenza vaccines for adults 65+, and believe this is the first step in creating clearer guidance on protection against the flu for this high-risk population,” Christopher Rizzo, MD, U.S. Senior Medical Director at Sanofi, the manufacturer of the recommended vaccine, said in the company's 

. “We are hopeful this recommendation will mean more adults 65+ will be immunized with a flu vaccine that is best suited for their needs. Available clinical data and real-world evidence clearly support differentiated flu vaccines as being more effective than a standard dose vaccine at preventing influenza infection, helping to lower the burden of disease and minimize health disparities in the U.S. population. We look forward to a final decision from CDC.”

The recommended influenza vaccine, Fluzone® High-Dose Quadrivalent is touted as the first and only influenza vaccine with superior flu protection and 10 years of evidence [from 2009-2019] in preventing flu-related hospitalizations in adults over 65 years.

 by Sanofi urged the ACIP to recommend their 65 years and older vaccine has this description of the Sanofi Fluzone High-Dose vaccine: “With protection against 4 flu strains, Fluzone High-Dose is the only influenza vaccine licensed for use in adults 65 years of age and older to have demonstrated superior efficacy in a randomized controlled trial versus a standard dose influenza vaccine for the prevention of laboratory-confirmed influenza illness and the only influenza vaccine with 10 years of data demonstrating protection from flu and its related complications. In a real-world analysis of approximately 34 million people, those who received Fluzone High-Dose experienced an 18% reduction in cardio-respiratory hospitalizations and over a 27% decrease in pneumonia hospitalizations, both of which are reductions above what the standard dose vaccines provided.”

This recommendation comes at an critical time as this flu season is feared to be a rebound after the low numbers the last few years due to COVID-19 precautions. 


Controlling isolation precautions can prove to be complex when moving patients. Therefore, how can infection preventionists (IPs) assist ambulatory partners manage transmission-based precautions when the partners often have competing priorities? Some solutions were described on a poster presented by Gladys Martinez, MPH, CIC, Infection Preventionist II, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, at the 

, held June 13-15, 2022, in Indianapolis, Indiana.

) spoke with Martinez about her poster titled “Management of Isolation Precautions in Ambulatory Care Settings.”

Please give us a brief description of your poster presentation.

 My presentation is “Management of Isolation Precautions in the Ambulatory Setting.” What we were looking out to do is to help support our ambulatory partners and being able to manage the transmission-based precautions, which at times can be a little bit complex, or can be a little bit difficult to manage, especially since they might be having competing activities at the time while they're in clinic. Since we ultimately as infection preventionists are the true experts behind the transmission-based precautions and, helping [isolations] get removed, we found--and we sought to find--a process that would be able to be sustainable and manageable without over-exhausting our own resources. And we did that by both collaborating with clinics and identifying reports that we run.

: What do you hope that the APIC conference attendees and 

 What is important to take away from this presentation is that again, transmission-based precautions can be complex. And if we want our ambulatory partners to follow infection prevention and control practices, we also need to take an active role in being able to support them, in meeting them halfway.

: What surprised you about the research that you did for this presentation?

 What surprised me the most was the willingness of the ambulatory clinics to be able to work together, I feel sometimes, especially in inpatient, they're definitely a little bit more hurried, or they have competing priorities. But I was fortunate in that our ambulatory partners, were very willing to collaborate with us; they didn't know as much necessarily. They did recognize that we're the experts, and so I think they were  so willing to take on the information. That makes our job so much easier. Also, what's important is how important it is to have the use of technology. Just as [we as] infection preventionists maybe might not use as much technology or might not have as much background, I think it's really important to either brush up on that, or just to be willing to explore new things.

: What is the most difficult part of the isolation precautions? What do you think that fails the most?

 What is the most probably with isolation precautions is definitely knowing all of the criteria to come out of it. It can be a little complex sometimes. Because some people might be excluded for some reason or another because they might be immunocompromised, or they might have to stay in isolations for longer periods of time or depending on the type of resistant organism, again, might have to stay on there for a longer time because of colonization and having to explain that. That can definitely be a barrier sometimes, which is why I think it's important for us to be able to help support them not only by helping them to remove isolations, but also to continue to educate or re-educate on these ideas.

: Is there anything else you would like to add?

 I know that some hospitals might be limited in the resources that they might have. But I think that trying to make a case for being able to have more technology will help you to clear yourself so that you're not so strapped to your desk and do so much desk work, but instead so you're actually out there being able to do the prevention work.

Infection preventionists should take an active role supporting ambulatory partners to help them follow infection prevention and control practices.
		
