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.

Hospital-Acquired Condition (HAC) Reduction Program

The Hospital Value-Based Purchasing (VBP) Program

 are programs to encourage acute hospitals to reduce hospital-acquired infections (HAIs) and other conditions in acute care settings. Together, they use financial motivations to decrease HAIs.

The first program, HAC, “supports the Centers for Medicare & Medicaid Services’ (CMS’) long-standing effort to link Medicare payments to health care quality in the inpatient hospital setting,” according to 

. VBP incentivizes acute care hospitals with payments for the quality of medical care they provide in the inpatient hospital setting. The payments are adjusted according to the 

Inpatient Prospective Payment System (IPPS)

 and are based on the quality of care the hospitals deliver.

During the COVID-19 pandemic, the programs were paused; however, they have been reinstated. 

 spoke with Alice Brewer, MPH, CIC, CPHQ, FAPIC, senior director of clinical affairs for PDI, about how these programs and whether these programs do what they were intended to.

, “They paused them during the pandemic. Beginning with essential data collected in 2020, and 2021, they did not create any penalties for hospitals based on data collected in those two years because of the pandemic. For 2022, any data collected under those programs in 2022 will generate a penalty to hospitals if they don't meet the programs’ criteria. The criteria for hospital-acquired conditions [in the HAC program] are centered around observed versus expected events. If a hospital has more hospital-acquired conditions than they would be expected to base on their baseline performance, then they could receive a 1% payment reduction.”

, Brewer explained, “the hospitals are measured on clinical outcomes, safety, and infections, and if they don't meet the performance standards center, that program, CMS can withhold 2% of their payment. Essentially, the structure of the programs has stayed the same. For the H VBP, some of those thresholds have changed [slightly]; they've become tighter. You must perform a little bit better on your infections to avoid that penalty under the program.”

For the HVAC penalties, Brewer said, they “can be anything from an infection to a fall to pneumonia that are directly the result of a hospital stay. The patient did not arrive with those conditions.”For the VBP conditions, it includes “HAIs, but also some patient safety-type conditions fall under that program as well.”

How these programs incentivize the hospitals, Brewer told 

, is that “not only are these programs publicly reported, but any event reported under these programs is available publicly. [And] it also can result in a financial penalty. If you don't perform well enough under these programs, the hospital is penalized financially. It's a big driver for infection prevention and for hospital leadership to try and switch some things up. That financial piece of it that public reporting of infections or problems becomes a great way for infection preventionists to make that business case for introducing a new intervention and introducing new products.”

Videos

The HAC and Hospital VBP penalties were suspended during the COVID-19 pandemic but are now back in place. Are they forcing hospitals to rethink/reestablish previous practices, and what is the impact?


HAC and VBP Penalties: Will They Reduce Hospital-Acquired Infections? 

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

Editorial Advisory Board, and a frequent contributor to 

As the numbers of hospitalizations and deaths are dropping, many individuals declare the pandemic all but over, comforted by the belief that infections are mild and less dangerous than the seasonal flu. However, the scientific literature these last few weeks has been filled with deeply concerning reports. We are entering a phase of long COVID and chronic disability. 

 million people, or 3% of the total population and 4% of adults aged 16 and over, live with symptoms of long COVID. A recent report from the 

UK Office for National Statistics shows that 2.52 million people

 are off work due to long-term sickness, up 7.9% over the last year.


The number of COVID-19 cases in the United States is unknown since our case reporting system has become unreliable and substantially undercounts cases. In England, as of the week ending March 7, 2023, 

, and reinfections are frequently occurring. 

 estimate that as of November 9, 2022, 94% of the U.S. population has been infected by SARS-CoV-2, and 65% of the United States population has been infected multiple times. Between December 2, 2021, to November 9, 2022, almost twice as many reinfections as primary infections have occurred. During this period, it is estimated there have been over 200 (118-292) million cases of reinfections. Scott 

 concluded, "Our analysis suggests that a single infection from SARS-CoV-2 may not generate the protective immunity required to defend against reinfections from emerging Omicron lineages.”
 
The odds of self-reported long COVID were 28% less after the second infection. Unfortunately, the damage of long COVID from a second infection adds to the first.
 
One of the most concerning long-term effects of COVID-19 is immune dysfunction or hypofunction. Confirmatory research by Fei Gao, PhD, et al was reported this week and summarized in a National Institute of Health news release, which stated:

"… findings suggest that SARS-CoV-2 infection damages the CD8+ T cell response, an effect akin to that observed in earlier studies showing long-term damage to the immune system after infection with viruses such as hepatitis C or HIV." The authors conclude that this dysfunction causes lasting damage and may “contribute to long COVID, perhaps rendering patients unable to respond robustly to subsequent infections by SARS-CoV-2 variants or other pathogens.”

These findings mirror those reported by 

 who stated, “Overall, expression of these activation and exhaustion markers indicated more severe immune dysregulation of CD8+ T cells in the hospitalized group.” And they found that “CD8 T cell expression of exhaustion markers increased in nonhospitalized individuals over time….” The authors’ finding of damage to the immune system “akin” to HIV is very concerning, as is the amplification of the result in the 

. Mark Davis et al concluded that research is needed into new vaccination strategies which will boost antiviral T-cell immunity.

Figure: Number of laboratory-verfied influenza cases (all types) per week, this season and previous seasons. The chart indicates which subtype or line type dominated each season.

(Further, could this damage also be causing a 

 Results from a Canadian study point that way.) 

 previously reported that the probable cause of the surges in infections we are seeing is an 

. With minimal public health interventions, Sweden also experienced surges in respiratory syncytial virus (RSV) cases. Most recently, Sweden has undergone a significant surge in seasonal flu (see Figure), with reports from the 

 of unusually severe cases. These cases have occurred in “

people under the age of 18 without underlying disease or condition, have been very seriously ill with complications such as myocarditis or encephalitis

Other diseases are also rising, exemplified by reports of 

record-high severe Streptococcal infections

.
These spikes in infections caused by multiple pathogens are associated with the SARS-CoV-2 pandemic and mounting evidence finding post-COVID-19 immune dysfunction. Vaccinations can not only reduce the incidence of severe disease but also can help to prevent long COVID, reducing the incidence by 30% to 40%.    

bivalent booster’s effectiveness on September 2, 2022

reported a rapid waning of booster-induced immunity

 in the elderly. Recently 2 confirmatory research reports have been published. Researchers from the United States found that the relative bivalent booster effectiveness at 5 to 7 months in preventing hospitalizations relative to monovalent vaccine dosages (2, 3, or 4) was 42% and 59% compared to no vaccination. Using the third vaccine dose as a baseline, the 

 found that an additional (fourth) vaccine dosage had effectiveness against hospitalizations at 10 weeks of only 50%. 




This data collectively indicates that booters should be given at a schedule more frequently than once a year. 

, Director of the Center for Infectious Disease Research and Policy (CIDRP), feels that “people who are 50 and older in the U.S. should be offered the chance to get a second booster.”
 
Although the United States is still planning to give a second booster once a year, the United Kingdom, Canada, and Australia plan to boost their high-risk population on a 6-month basis. 

 will provide a second booster 6 months after the first for those over 65, in care homes, or who are immunosuppressed. 

, high-risk individuals will be offered a second booster this spring. 

 after the last booster or COVID-19 infection (whichever is the most recent). Australia recommends an additional booster for those over 65 and at high risk for COVID-19.

We can choose to declare the pandemic over, but SARS-CoV-2 is deaf to these pronouncements. New research regarding Long COVID and immune dysfunction is very concerning. Hopefully, the dysfunction will be temporary and progressive in most individuals. However, just the possibility makes avoiding COVID-19 infections paramount, and we must keep our immunity as high as possible. To accomplish this, vaccine boosters should be offered at least to high-risk individuals and those over the age of 65 more frequently than once a year, possibly every 6 months. All need to implement public health strategies (ie, wearing well-fitted N95 masks and avoiding poorly ventilated indoor spaces) to avoid becoming exposed to SARS-CoV-2 in the first place.

Articles

NIH News Release: "...findings suggest that SARS-CoV-2 infection damages the CD8+ T cell response, an effect akin to that observed in earlier studies showing long-term damage to the immune system after infection with viruses such as hepatitis C or HIV."

COVID-19: Study Suggests Long-term Damage to Immune System 

Marburg Virus Disease (MVD), a rare but deadly disease, is in the same family as Ebola. Still, with a 

, infectious disease experts pay attention when an outbreak happens anywhere in the world. An MVD 

 on February 12, 2023, in Equatorial Guinea, the first to be located there. As of this writing, all 9 confirmed cases have been fatal.

But what are the symptoms and treatments of MVD, and what is being done to combat this disease in the future? To find out, 

) spoke with Joseph Hernandez, MSc, MBA, MS, and the CEO of Blue Water Vaccines, about what MVD is and what Blue Water Vaccines is doing to create a vaccine candidate to target MVD to prevent future outbreaks.

 in Marburg and Frankfurt, Germany, and Belgrade, Serbia, in 1967. These outbreaks, which led to the initial recognition of the disease, were associated with laboratory work using African green monkeys imported from Uganda.

, “Human infection with [MVD] initially results from prolonged exposure to mines or caves inhabited by Rousettus bat colonies. Once an individual is infected with the virus, [MVD] can spread through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs, or other bodily fluids of infected people, and with surfaces and materials (eg bedding, clothing) contaminated with these fluids.”

 that MVD “starts very similarly to some other diseases—typical chills and fevers, and then it evolves within 21 days or so into rashes and, ultimately, into hemorrhagic conditions, which effectively means you start bleeding internally and has a very high mortality rate….it carries a very high burden of death, which is why we pay so much attention to it.”

Ironically, Hernandez said, the fact that MVD has a high mortality rate “is a good thing in one sense because it doesn't give the virus a long ability to infect very large populations because effectively, the vector of the infected patient dies [in contrast to] these slow-evolving diseases [like COVID-19], where the patient who may have a disease with a long incubation period can walk around and transmit the virus. There's a double-edged sword related to the mortality rate.”

Hopefully, hope is on the horizon. Hernandez told 

 about Blue Water Vaccines partnering with AbVacc to develop an effective MVD vaccine.

Recently, an outbreak of Marburg virus disease occurred in Equatorial Guinea. Infection Control Today® learned more about this rare but severe and often fatal disease and what is being done to combat it. 

Marburg Virus Disease: What Is It? What Can Be Done About It? 

’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.

Human Metapneumovirus: What Is it and What Is Being Done About It?

Human Metapneumovirus (HMPV) is not as well-known as its relative, respiratory syncytial virus (RSV), so here is the information that infection control and prevention personnel need to know about this respiratory virus.

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

What You Should Know About The Joint Commission

With all the misinformation and confusion about what The Joint Commission (TJC) does and doesn't do, ICT went to TJC to find out. Listen to the detailed interview to find out what health care workers need to know.

Is the global community in danger of a fungal pandemic, as portrayed in the series The Last of Us? Infection Control Today® finds out.

IPs’ Challenges With Facility Cleaning and Disinfection Programs

Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST, continues her interview with ICT about why IPs' involvement with their facility's cleaning and disinfection programs is so critical.

Take 5 minutes to catch up on Infection Control Today®’s highlights for the week ending March 19, 2023.


Weekly Rounds: Product Locator, The Joint Commissions, Human Metapneumovirus, and More

, The HBO hit, is about a fungal infection that becomes a pandemic and destroys civilization. The characters are trying to exist in a post-outbreak world. The series is renewed for season 2 for excited fans, but how realistic is the storyline? With the ever-present thought of the COVID-19 pandemic, is the planet in danger of the global population succumbing to a pathogen, in this case, a fungus? And, if so, is the one featured in the series the pathogen that could?

spoke with Anne Meneghetti, MD, executive director of medical information at epocrates and an avid fan of the series. She discusses whether the series is factual and which, if any, pathogens could do what the series suggests could happen.

“There are deadly invasive infections that often happen in immunocompromised patients in the hospital or patients who have cancer, organ transplants, HIV AIDS, serious chronic respiratory conditions, where infections can go deep in and cause fungal encephalitis,” Meneghetti told 

She also mentions meningitis. “They can cause the entire body to be affected and can be very deadly. And we've seen that, for example, with 

, which is an emerging global health threat that’s typically seen in hospitalized patients, some of these fungi are resistant to multiple classes of drugs. It is a real concern.”

Meneghetti clarifies that she is not worried about the fungus noted in 

—cordyceps fungus—causing a global zombie apocalypse. However, “there is real concern to be had with some of these fungi, especially in immunocompromised patients, and they're becoming more and more resistant to the drugs that we have. There are not a lot of new antifungal drugs in the pipeline that are being developed. 

"It's difficult to know exactly how prevalent some of these fungal infections are because there hasn't been a lot of attention, funding, and surveillance about fungal infections globally. So we don't really know, and in some cases, there's not great tests to even know if there's a specific fungus the way that we have some sort of like rapid tests for certain viruses and certain bacteria, so it's a little bit difficult to know exactly how prevalent they are.”

Is the global community in danger of a fungal pandemic, as portrayed in the series The Last of Us? Infection Control Today® finds out.


The Last of Us: Could it Really Happen?

"Oh, no! The Joint Commission is here!” The infection preventionist’s heart starts pounding, and her mind starts racing. She has heard only terrifying things about surveys by The Joint Commission.

But should infection preventionists (IPs) be nervous when a representative from The Joint Commission comes to do a survey? To find out, 

Sylvia Garcia-Houchins, MBA, RN, CIC, director of infection prevention and control at The Joint Commission, talked with 

 about what The Joint Commission does and does not do, how long it has been around, and what IPs should know.

Listen to the entire interview and the many more topics Garcia-Houchins discusses concerning The Joint Commission.

: Please explain what The Joint Commission does and what its background is.

The Joint Commission is the largest accreditor of health care organizations in the United States, meaning we accredit hospitals…but we also accredit other programs, such as ambulatory surgery centers, Bureau of Primary Health Care, and some of the Veterans Health Administration [hospitals]. We also do US military [institutions] in foreign countries.

0:26: What The Joint Commission (TJC) does and its background

4:38: What Sylvia Garcia-Houchins wishes IPs knew about TJC.

14:03: Explanation of what TJC can do and is not cut and dry.

16:25: The Clarification Period during survey: Clearing up misunderstandings.

20:09: How has TJC changed since the beginning of COVID-19? More explanation of what TJC does and does not do.

27:50: What a good survey consultant does for the facility.

30.19: Who pays for TJC’s services? Why are TJC’s services needed?

32:37: What education does a surveyor need to have?

35:41: Are questions to TJC about a survey anonymous? How can questions be answered?

We accredit, which is very different than some people think. We’re not inspectors; we’re surveyors. We don’t walk around with our little checklist and say, “Check, check, check.” We look for high-risk issues. We look for process issues. That’s an important bit of background for The Joint Commission: It’s about processes.

We don’t look at the individual equipment. We don’t say, “Oh, you have that one. You can’t use that one.” A survey by The Joint Commission would never say that, or it should never say that. Because we don’t survey you [about] your equipment. Or say that you need to use a specific brand. We don’t even say—except in a few instances—that you must follow a particular evidence-based guideline or consensus document. [A survey] is a personalized accreditation process, making sure that you’re following rules and regulations that apply to you in your state and your location, that if you’re being accredited…to get Medicare and Medicaid funding, that you’re following the Center for Medicare & Medicaid Services (CMS) Conditions of Participation

…that you’re following any of the regulatory requirements, such as United States Food and Drug Administration (FDA) rules about reprocessing medical devices. That’s the core of what we do.

[For example:] You decide that you’re not going to allow staff members to have fingernails longer than a quarter of an inch, which is a CDC category 2 safe practice, but is not required by the CDC. If you’ve decided that’s what you’re going to do, then we’re going to survey and say, “Are you following what you say you’re going to do? Are you following your own policies?” That’s part of the survey process.

What we’re doing is trying to identify places where your organization has risk. It might be a risk to a patient, it might be a risk to a visitor, it might be a risk from a regulatory standpoint….We’re trying to be there to point out those things that are risk factors. At the end, we provide a Survey Analysis for Evaluating Risk (SAFER) matrix,

 which is a tool that’s been [in use since January 2017]. That categorizes what we found. And it says, “We only found it in a few places, it’s very limited, or we found it everywhere.” And [it categorizes it as] low, medium, or high risk.

[The Joint Commission has] been in business for more than 70 years…. We’ve developed and grown, and we are a leader in providing the best guidance and survey process to identify risks.

: What do you wish IPs knew about The Joint Commission?

The most important thing that IPs need to know is that the risk assessment is not the solution to everything.

In April 2019, we published for our customers The Joint Commission Perspectives, and it’s available if you go to The Joint Commission website, and on the Infection Control page for anyone to see how we clarified scoring of infection control standards. And it’s following a systematic approach. The answer is going to change depending on where you are in the country.

There is a place for risk assessment. Risk assessment is when you are identifying issues that may pose a risk and deciding how much of a risk. For example, our surveyors use what’s called “tracer methodology.”

 IPs do this every day, all the time. You walk around your organization, and you look at things, and you say, “That doesn’t look [right]. Maybe I should figure out if it is OK to put that sharps dispenser there. They are 2 ft from the ground in a pediatric area.” What’s the first thing you’re going to do? You’re going to say, “Is there any rule or regulation that applies?” In my state, there isn’t. So is there a CMS requirement? I look at the CMS State Operations Manual

, and it says nothing about where I must position my sharps. Next, I look at the building code. There’s nothing in there that says my sharps container can’t be 2 ft from the ground. And then I look at the manufacturer’s instructions. They give me some guidance, but they don’t say, “Put it here.” And then maybe I go to an evidence-based guideline or something else, such as National Institute for Occupational Safety & Health, which might tell you the optimal placement, but that’s just a recommendation.

I am doing a risk assessment. But what do I consider the risk? For instance, what if I’m in a pediatric hospital, and a little girl puts her hand into the sharps container? That’s a much different risk than an area where an adult phlebotomist who is in a wheelchair is drawing your blood and needs the container to be at a certain height to safely dispose of that needle. That’s when you start doing risk assessment. That’s what I’m trying to make sure infection preventionists know. I see survey reports where the survey states they didn’t follow the manufacturer’s instructions for sterilization, they’re not following the parameters. And the infection preventionist says, “We did a risk assessment and decided that those parameters didn’t work.”

Why would you deviate from something that’s a validated parameter that the FDA requires that a manufacturer state? We still [see staff members] doing risk assessments because someone has 15 things to sterilize and they decided they’re going to do it at the average temperature. Or maybe the doctor says, “Something’s happening to the finish on this instrument. I don’t want you to sterilize at that temperature. I want you to do it at a lower temperature.”

The Joint Commission cannot say, “Sure, use this product.” Instead, I have spent 3 years educating IPs that just because it’s biologically compatible…doesn’t mean it’s functionally compatible. It’s sometimes difficult for the IPs to understand that. And so we’ve come up with scoring examples. For instance, if the surveyors see an organization using a product to clean a glucometer, [for example,] that it is not within the manufacturer’s instructions for use, we ask them to take it to the next step. Is this going to kill bloodborne pathogens? Because that’s the big risk. They’re using a product with a label that says, yes, it’s effective against bloodborne pathogens, and then you score at a lower risk from an infection control standpoint. And you say the organization was not following the manufacturer’s instructions. You classify the risk that way.

It was eye-opening for me as an IP to come to work at The Joint Commission 4 years ago. Nearly everything I thought about The Joint Commission went out the window. I used to work for an organization where the accreditation manager said, “You will not ask The Joint Commission a question because then the surveyor is going to come and survey for that.” I assure you, if you send the standards interpretation group a question, it is not going to your surveyor. You’re going to get the best possible answer. If you’re not happy with the answer, you write back and say, “That’s not the answer I was expecting. Could you please help me a little more?”

The Joint Commission is very transparent about what is a requirement. If you hear about something The Joint Commission supposedly said, come to The Joint Commission and ask. On our website, 

, is “Ask a standards interpretation question.”

 You can put your question in there and get it answered.

[But] why don’t people do this? [Instead, they] ask somebody who asked somebody because it seems easier. And they don’t realize it’s not a good question or a good answer. There are nuances to the answer, and they end up making a decision that impacts their organization negatively on the survey because they asked a friend about a policy or listened to a lecture that someone gave or watched [a video] on YouTube. Come to the source. We’re more than happy to answer your questions. 

 No, it is not anonymous. You put in your name, your contact number, and your email. [You may be] worried if you use your work email that there will be a record. But you don’t have to worry.

As I said at the beginning, we all want the best possible care for our patients….Accidents happen. And risks are real. If we can get rid of some of those risks, it’s great.

: What kind of education does a surveyor need?

 At least a master’s degree. You must have a higher degree and leadership experience. Our surveyors have all been leaders in health care. They understand the implications of “If I say something, X is the outcome,” and they must have a knowledge of the program they are serving. For example, I could not be a home care product surveyor, I have no background in that. You must have experience in the areas in which you will be a surveyor. You can’t have worked only in an ambulatory surgery center and expect to be in a hospital service. We can’t teach that kind of background or knowledge. Then there’s a whole training program. It’s lifelong training.

This interview has been edited for length and clarity.

Hospitals must identify and consider differences in perceived barriers and facilitators to enable effective organizational change. --Ana M. Vaughn-Malloy

A new study from Boston Children’s Hospital titled “Using a human factors framework to assess clinician perceptions of and barriers to high reliability in hand hygiene,” published in the 

 (AJIC), highlights the perceptions of and barriers to reliable hand hygiene among specific medical personnel. The study’s results provide insights that, in turn, can be used to design strategies for greater hand hygiene adherence among medical professionals.

, MD, MPH, Associate Hospital Epidemiologist and Associate Medical Director at Boston Children's Hospital, and lead author of this study, answered questions from 

: A summary of the key findings and why they are important.

 Applying a human factors engineering framework, we surveyed clinicians about perceived barriers and facilitators to performing excellent hand hygiene. We found variability by role (which has been shown before), medical vs. surgical specialties, and career tenure. Since there are few published data about what clinicians view as challenges to sustaining highly reliable hand hygiene, it's essential to recognize that different approaches may be required within different clinician subgroups to best meet our goal.

: What is the practical application for this study's key findings for infection preventionists?

 Hospitals must identify and consider differences in perceived barriers and facilitators to enable effective organizational change. Infection prevention teams can and should use human factors engineering concepts as a framework to think about and understand clinicians and the things that support (or get in the way of) their work.

 We were interested in the reported variability between medical and surgical staff in the perception of how often they encounter empty alcohol-based hand rub dispensers and how visible the reminders to perform hand hygiene is in patient care areas, especially since we're not aware of differences in our procedures for refilling dispensers or hanging signage by location across our hospital. Based on these responses, we can monitor more closely to ensure standardization.

: What, if any, future research will there be related to this one?

 We plan to do a follow-up qualitative study, using focus groups or individual interviews with staff members, to hear more details about the reported challenges (in addition to things we're doing that they really like), as well as to solicit their ideas for how we can continue to make it easier for them to sustain high hand hygiene rates.

: Is there anything else that you would like to add?

 Hand hygiene is the most essential way to prevent the spread of infections in the hospital, so it's critically important to keep it as a high-priority focus even while we simultaneously tackle many other challenges in health care.

A new study focuses on insights that can be used to create interventions for better hand hygiene adherence among all medical professionals. 


Perceptions and Barriers to Hand Hygiene Among Clinician Subgroups

As the leader of infection control in their facilities, what challenges do infection preventionists’ face with their facilities’ cleaning and disinfection programs? How should IPs assess the program for their facility to verify it is most usable for the staff? 

) continues with its interview with Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST, principal infection preventionist for The Clorox Company, to receive answers to these questions.

This is the second of 3 installments. Watch the first one 

: What other challenges do facility cleaning and disinfection programs face now?

Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST: 

There are quite a few, but the key ones are:

Staffing challenges. Staff is burned out, and many health care workers have left the field. This has resulted in critical staffing shortages and many new staff who need to get up to speed quickly.

We also know that during the pandemic with some of the supply chain issues, unfamiliar and unapproved products may have found their way into our facilities over the past few years,

And last, while process monitoring activities may have been cut back during the pandemic, staff may have drifted from standardized practices and protocols. This includes adherence to instructions like proper dilution ratios, wearing recommended PPE [personal protective equipment], and adhering to stated contact times. That’s the thing with “drift”—it happens slowly over time and goes unnoticed until we deliberately evaluate it.

These challenges are worrisome, given that studies show that 80% of pathogens are spread by contact. And other studies have shown that half of the surfaces are missed during cleaning. Taken together, we see a significant increase in our patients' risk of health care-associated infections. There truly is a need to get back to basics.

: Why must the IP be involved with the facility's environmental cleaning and disinfection program?

 As previously mentioned, many pathogens responsible for outbreaks and health care-associated infections can be spread by contaminated surfaces. Given the Great Resignation, there are many new IPs in the profession right now, and they are just starting to get their eyes opened to all of the other things that IPs do and know beyond COVID-19 control. These new IPs should understand that they have regulatory oversite for the entire IPC [infection prevention and control] program, including cleaning and disinfection. CMS [Centers for Medicare & Medicaid Services] requires the provision of a clean and sanitary environment for patients. Survey findings will fall under the infection control chapter. The IP is responsible for ensuring that these findings are adequately corrected. Better yet, the IP can avoid this by proactively performing process surveillance and correcting issues as they are identified.

: Where should the IP start when thinking about assessing their facility cleaning and disinfection program?

This is the time when IPs and EVS should work together. They should take a step back to objectively and critically evaluate their program.

I recommend starting with observation to gather data on the program's current state.

Look at the EVS carts—are they all set up the same? The department should have a cart set-up checklist. There should be no “rogue” products on the cart. All chemicals should be labeled, including secondary containers. And this is one reason that I prefer ready-to-use products—no secondary containers to deal with.

Be sure to talk to frontline staff. Be curious, not punitive. You are trying to discover 

 they are doing a task the way they are. This will provide great insight into misunderstandings and help you focus your education efforts.

While you are boots-on-the-ground performing these observations, be sure to be on the lookout for those “rogue” products. Look behind every closed door in the EVS closets, cupboards in the nurse’s station, etc. Inventory what you are seeing out there. 

We know that with a disrupted supply chain early in the pandemic, we sometimes had no choice but to bring alternative products. Are there products that were implemented without going through the proper approval process? Are all of the disinfectants hospital-grade and EPA-registered? Are you finding essentially the same disinfecting chemistry from multiple vendors? For example, let’s say you found canisters of quat-based disinfecting wipes from 2 different manufacturers. Also, be sure to include outpatient areas where you might have oversight.

: Is there anything else IPs should consider when assessing their cleaning disinfection program?

 Yes, they should be sure to observe cleaning practices. Are staff cleaning methodically? This means cleaning in a clockwise or counter-clockwise fashion around the room, from higher to lower surfaces, and of course, from clean to dirty—the patient's room should be cleaned before the bathroom, and the toilet should be the last thing cleaned in the bathroom.

Cloths used in the bathroom should not be used outside of the bathroom. Having color-coded microfiber cloths is helpful, but consider disposable disinfecting materials. This way, there is no worry about what color cloth to use, no risk of dilution errors, and no microfiber to launder, track, and periodically replace as it serves its useful life.

Are staff using the right product at the right time? For example, a sporicidal product for C. diff patient rooms.

Are they following the instructions for use, including the contact time? Are they properly diluting when indicated? Are they wearing appropriate PPE?

And, most importantly, are they following the facility policies and protocols? For example, if you watch 5 EVS perform a terminal cleaning, you should not see the task completed in 5 different ways. Use a checklist and compare what you see to what the policies say—it should all align. Surveyors will hold you to what your policies say, so I recommend keeping your policies high level. For example, state that a “health care grade EPA registered disinfectant will be used according to the instructions for use” rather than saying, "Product by X-manufacturer will be used at a 2-minute contact time.”

Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST, continues her interview with ICT about why IPs' involvement with their facility's cleaning and disinfection programs is so critical. 

IPs’ Challenges With Facility Cleaning and Disinfection Programs  

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.

Did you know Gaius Julius Caesar had epilepsy? The 

 has been thrown around from a brain tumor to even neurosyphilis, but we will likely never know.

It may no longer be the days of 44 BCE and the Roman Forum, but syphilis is still causing health ailments. Unfortunately, rates of congenital syphilis are drastically rising in the United States. We often see syphilis rarely, and in terms of congenital, it’s so preventable that when it does occur, it’s quite unexpected. Unfortunately, the United States is struggling to combat infectious diseases. 

, “there’s been about a 700% increase in the cases of congenital syphilis in the United States,” said Robert McDonald MD, MPH, of the CDC’s Division of STD [sexually transmitted diseases] Prevention, Surveillance and Data Management. “It really is upsetting because this is something that is fully preventable if we have the right screening and treatment,” he said. “It’s out there; people just need to be connected with that.” There are many reasons for this–uneven coverage, access to care, decreasing funding, and health resources rerouted from sexually-transmitted infections (STIs) to COVID-19 response. More and more, though, this highlights the importance of health education, screening of pregnant individuals, and ensuring sustained STI intervention programs.

Alas, another mammal has stumbled into the world of H5N1, as health officials in British Columbia, Canada, reported the deaths of two skunks who succumbed to avian influenza. Upon more investigation, the British Columbia government 

, “Testing has confirmed 8 skunks found dead in late February in Richmond and Vancouver are positive for avian influenza.” Moreover, they noted that “testing revealed the skunks were infected with the same strain of H5N1 avian influenza that caused the deaths of wildlife and domestic poultry in the province since the April 2022 outbreak began. The skunks may have contracted influenza by scavenging infected wild birds.” The area has seen 20 species of birds impacted, these skunks and a fox. Here’s a 

 regarding the more significant implications of H5N1 and its ecological aspects.

We might be seeing an uptick in cases across the globe… Locally, the news is good – the United States isn’t seeing a spike, and cases are down 

, hovering at 28,000 new cases daily. The part that worries me is: Cases worldwide are up 200%. That’s 452k cases per day. Some 

countries are seeing major spikes in cases

. For example – Ukraine is reporting a 1,228% increase in cases in the last 2 weeks, Libya is up 1,200%, Togo 367%, Iran 152%, etc. 

So many of these countries are severely impacted by vaccine inequity that stresses their health infrastructure and capacity to respond. Consider this, Ukraine is reporting that steep increase in cases, and only 34% are considered fully vaccinated. Madagascar is reporting a 700% increase in cases, and only 7% of the population is fully vaccinated. 

Why should we worry if cases aren’t increasing in the United States? That might be temporary, and time has shown that SARS-CoV-2, like any virus, mutates when it can spread (hey, a virus is going to virus, eh?), so when we still spread in areas with little vaccination rates and already stressed infrastructures, that can translate to delayed control and surveillance measures. Global health is the key to getting a leg up on COVID-19.

Saskia v. Popescu, PhD, MPH, MA, CIC, gives updates on congenital syphilis, skunks and H5N1, and COVID-19 on this Ides of March.

IC Today Hot Topics: Congenital Syphilis, Skunks and H5N1, and COVID-19 Mixed News

Lois Anzelowitz Levine, MA, is the associate editorial director of 

The FDA has just approved a booster dose of the Pfizer-BioNTech COVID-19 vaccine for children aged 6 months through 4 years. The booster dose must be administered at least 2 months after the competition of the primary vaccination, with 3 doses of the single strain vaccine.

"This is fantastic news," notes Tina Tan, MD, FAAP, FIDSA, FPIDS, editor-in-chief of 

®. "This will allow us to provide optimal protection to the pediatric population aged between 6 months to 4 years against COVID disease and the current subvariants that are circulating."

Kevin Kavanagh, MD, founder and board chairman of Health Watch USA, and  

’s Editorial Advisory Board member, agrees. “Even though children are at a much lower risk for severe disease, there is significant concern that they can spread the virus to others. In Sweden, early on in December 2020, 75% of the nonhealth care outbreaks 

were in elementary (45%), nursery (20%), and grammar (12%) schools

. In addition, children can still develop long COVID along with severe disease. According to findings in a systematic review and meta-analyses by 

 long COVID can develop in 25% of children, with the most prevalent manifestations being mood symptoms, fatigue, and sleep disorders.”

Children of this age group who received the first 2 doses of the monovalent Pfizer-BioNTech COVID-19 vaccine should have completed their 3-dose primary series with the Pfizer-BioNTech COVID-19 vaccine, bivalent. These children would not be eligible for a booster dose of a bivalent vaccine, as they should already have protection against serious COVID-19 consequences. This authorization targets the children who completed their 3-dose primary vaccination series with the monovalent Pfizer-BioNTech COVID-19 vaccine before the Pfizer-BioNTech COVID-19 vaccine, bivalent was authorized to provide the third dose in the 3-dose primary series.

The FDA decided on this approval from several clinical studies, including one which evaluated primary vaccination with the monovalent Pfizer-BioNTech COVID-19 vaccine in children aged 6 months and older; those which evaluated booster vaccination with monovalent Pfizer-BioNTech COVID-19 vaccine in children aged 5 years and older; a study that looked at a booster dose with Pfizer-BioNTech’s investigational bivalent COVID-19 vaccine (original and omicron BA.1) in those greater than 55 years of age; and postmarketing safety data with the monovalent Pfizer -BioNTech COVID-19 vaccine and Pfizer-BioNTech COVID-19 vaccine, bivalent, among other studies. Safety data accrued with the investigational bivalent vaccine and with the monovalent Pfizer-BioNTech COVID-19 vaccine was relevant to the Pfizer-BioNTech COVID-19 vaccine bivalent because the vaccines are created in the same way.

Additionally, the Pfizer-BioNTech COVID-19 vaccine, bivalent, includes an mRNA component that corresponds to the original virus strain and provides an immune response that is protective against COVID-19 and an mRNA component corresponding to the omicron variant BA.4 and BA.5 lineages. This component provides robust protection against the Omicron variant of COVID-19.

Pfizer's COVID-19 vaccine must be administered at least 2 months after the primary vaccination series.     