Isis Lamphier, MPH, CIC, is an infection preventionist at Moffitt Cancer Center in Tampa, FL, and a member of the 

Camera Gastroscopy, Esophagoscopy that has been cleaned and disinfection in gastrointestinal endoscopy is stored in a medical device storage cabinet.

An endoscope is a medical device with a light attached to look inside a body cavity or organ. Endoscopes have a high risk for contamination and can pose a risk of disease transmission to patients. Proper reprocessing and storage guidelines are imperative to reduce the risk of contamination of endoscopes. Improper storage of endoscopes will result in needing to reprocess the medical device due to recontamination. Reprocessing is often valued above safe storage, but storage of scopes is also a critical component in ensuring scope care and maintenance.

While not in use, endoscopes should be stored in a closed, clean cabinet.Endoscope cabinets can also be used for drying. Storage cabinets should be made of a material that can be disinfected. Store all endoscopes in a vertical position; this position is used to ensure complete drying. Review each endoscope's instructions for use (IFU) and recommendations from AORN (Association for periOperative Registered Nurses) and The Joint Commission for the optimal storage recommendations. Some cabinet designs include provisions for horizontal storage, though most endoscope manufacturers will recommend vertical storage. While in storage cabinets, scopes should hang freely and avoid touching one another to prevent damage. The scope should also avoid touching the walls of the cabinet.

Removable parts can be stored with endoscopes to prevent the loss of these components and for tracking purposes, but do not attach them to the endoscope during storage. Attaching removable parts during storage can trap liquid inside the scope. Organizations such as the Society of Gastroenterology Nurses and Associates, Inc (SGNA) and AAMI (Association for the Advancement of Medical Instrumentation) do not recommend attaching removal parts during storage.

While in storage cabinets, each scope should be identified by a tag or other means. On the tag should be the scope’s hang time or shelf life. The hang time is the time scopes can be stored before needing to be reprocessed. 

 conducting a risk assessment to determine a scope’s specific hang time. Other organizations provide specific recommendations, such as 7-day storage from SGNA. This continues to be an unresolved issue in infection control, and facilities must determine and detail in their own policy what their hang times are for all endoscopes.

Endoscope cabinets should be cleaned routinely. Facilities should maintain a record of their cleaning schedule and know when maintenance of cabinets is approaching. Facilities should have reminders near cabinets and pick easy-to-remember dates for cleaning, such as every Monday. It is recommended to follow each cabinet's IFU for determining compatible products for cleaning and disinfecting. Also, follow the product's label (s) and adhere to the manufacturer's recommended contact time. Remember to clean drip trays and scope holders in the cabinet. Abrasive cleaners and pads are not recommended for cleaning cabinets. It is beneficial to use lint-free cloths. Cabinet filters should be replaced as instructed, and there should be proper documentation of filter change. If a cabinet becomes damaged at any point in time, fix or replace the cabinet before continuing to store scopes.

Proper storage is critical to protect endoscopes from contamination and damage and to promote proper drying. Ensure that cabinets accommodate each scope’s size before storage. Some scopes may be too long for specific cabinets. Cabinets play a significant role in preventing the proliferating of organisms when properly used and regularly maintained. Cabinets should be used for storage rather than transport bins.

Articles

What are the recommendations for storing endoscopes clean, safe, and intact?

Best Practices for Flexible Endoscopes Storage

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.

Clinicians can see a great deal of overlap between patients with long COVID and those with brain and neurologic injuries. They experience similar symptoms such as fatigue, dizziness, headaches, difficulty getting back to their everyday life, mental health concerns, difficulty sleeping, and ringing in their ears. Recently, one clinician started working with a recovery clinic to help these patients manage their symptoms and improve their quality of life.

) spoke with that clinician, Monica Verduzco-Gutierrez, MD, professor and Distinguished Chair of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio. She is the chief of the physical medicine and rehabilitation service line at the University Health System and medical director of Neurorehabilitation and Critical Illness Recovery at Warm Springs Hospitals of San Antonio. She is also the volunteer leader and member of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). Further, she is also a 

Whether Verduzco-Gutierrez treats traumatic brain injury patients or long COVID patients, the common theme is recovery—helping patients fully recover to regain their quality of life. Her clinical focus is traumatic brain injury, stroke rehabilitation, and interventional spasticity management, and she brings that expertise to discuss how to help COVID long haulers as they suffer from physical, cognitive, and functional difficulties.

Verduzco-Gutierrez speaks about how often long COVID is seen in children and how the symptoms in both differ. She also covers the gaps in care for recovery and other challenges that she sees for these long COVID patients. “Some of the gaps in care first [are] health literacy and education. There are still people suffering, who probably don't even realize that they have COVID-19 or that their family members are dealing with long COVID symptoms,” Verduzco-Gutierrez told ICT. “ And so that is one thing, we have to get education about our lack of access to certain treatments. First, we're kind of behind and the trials; we did very much warp speed to get vaccines and to get antivirals. And now we don't have that same warp speed regarding long COVID and [the] treatment for long COVID. And many treatments are just being done as symptom management. And some of that is being done in special long COVID clinics that we support, like an AP [Advanced Placement] seminar where we have a past collaborative, and these are clinics that get together and discuss best practices. But that is not accessible to everyone yet. And they have long waitlists as well.”

Patient care should be patient-centered, Verduzco-Gutierrez said. “I'm always going to be a proponent of making sure that the patient voices are heard, that we center the patient, that we listen to them, that we are making sure that we're addressing their needs, and that we just continue to try to make sure that research is done. Continue to make sure that, you know, Congress is putting money in support into the patients' needs, whether that be their disability, or long COVID clinics or the research to continue to find answers.”

Videos

Listen to how a doctor in rehabilitation who works with patients with brain and neurologic injuries is now working with patients with long COVID. 

How Can Physical Medicine and Rehabilitation Help COVID Long-Haulers? 

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

Editorial Advisory Board, and a frequent contributor to 

No one will disagree that emotions run high when one mentions COVID-19, schools, and children. On one side is a belief that schools pose a grave risk for COVID-19; on the other, it is not a major concern for schools and children.

This contention that schools should not be worried about COVID-19 was again questioned by a 

Journal of American Medical Association Network

, concluding that 70% of household transmissions were started with a child. The study found that children aged 8 and younger were more likely to be the transmission sources than those aged 9 to 17. None of this is a big surprise since early in 2020, a 

 published in CDC’s Morbidity and Mortality Weekly Report found that children can spread the disease, and those aged 10 to 19 years spread it more commonly than adults. The common belief that these reports are disproven by the Swedish Experience is just disinformation. In December 2020 (last available data), the 

 that 75% of non-healthcare SARS-CoV-2 outbreaks originated in their elementary, grammar, and nursery schools.

The concern of teachers for their health is justified. Approximately 

 found that primary school teachers were at the highest risk, being 67% more likely to develop SARS-CoV-2 infections than the average occupation.

Children can also be directly affected. Bloomberg reported in an interview with Daniel O. Griffin, MD, PhD, an infectious disease physician at Columbia University, that 

 who become infected can develop long-term symptoms. Pereira et al also reported 

 that 12-16% of children infected with Omicron had long COVID at 3 and 6 months post-infection. In total, 24% of hospitalized children have persistent symptoms over 5 months.

Similar to adults, the virus strikes multiple systems in children. As many as 

60% of children have subclinical systolic cardiac impairment

 after recovery from asymptomatic or mildly symptomatic COVID-19 (average follow-up of 148 days). During the pandemic, the incidence of 

Type I diabetes in children almost doubled

 in those with a COVID-19 diagnosis (28.5 cases per 100,000 versus 55.2 cases per 100,000). There is also a risk of developing the rare but dangerous 

Multisystem inflammatory syndrome in children (MIS-C)

.

There is mounting evidence concerning immune hypofunction. The large surges of RSV infections seen in the United States 

enacted little public health interventions

, such as masking, and kept kindergartens and primary schools open. The 

Public Health Agency of Sweden also reported

 unusually severe influenza cases, stating that 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

. (translated)”

Those who view COVID-19 as severely impacting children as rare are overlooking reinfections. Reinfections are all too familiar, as reported Amy Edwards, MD, (Associate Medical Director for Infection Control at University Hospitals Rainbow Babies & Children's Hospital) in 

. “A lot more kids are getting repeated COVID infections,” “It’s not unusual to see somebody get COVID in January, then in April and again in September. We often see that by that second or third infection, they develop long COVID. That, for me, is very concerning.”

Unfortunately, unlike adults, 

 also reported that the chances of developing long COVID in children do not appear to diminish with reinfections. This finding is supported by the research published in 

 which found that, unlike adults, children did not develop robust memory (CD4+) T cells, placing them at risk for reinfections.

The good news is that much can be done to prevent and mitigate the above occurrences without the closures of schools. 

Multiple studies have shown masks to be effective

 in mitigating COVID-19-associated cases in schools. One 

, found that schools without masking requirements were 3.5 times more likely to have COVID-19 outbreaks. 

 that the increase in COVID-19 cases associated with school openings was more than halved in counties with school masking requirements (an increase of 16.32 cases per 100,000 residents versus 34.85 cases per 100,000 residents). Finally, a November 2022 study 

published in the New England Journal of Medicine

 reported that the lifting of masking requirements in the Greater Boston Area School District was associated with an additional 44.9 COVID-19 cases per 1000 students, 11,901 in total, which represented 29.4% of all cases at that time. The 

 that during the Delta period, vaccinations cut adolescent hospitalizations by 90%. 

Two studies have described a multi-layered approach to opening schools. 

 the positive effects of masking and using air cleaners. Mask mandates decreased the detection of SARS-CoV-2 aerosols by 69%, and air cleaners decreased detected aerosols by 39%. This study also illustrates how masking can protect others, not just the wearer. In addition, the average indoor CO2 level was 1064, which is high, indicating that further decreases in aerosols might be obtained with further improvements in ventilation. 

 conducted during the pre-Delta and Omicron period found that the implementation of 7 or more mitigation strategies eliminated the increased risk of in-person school learning.

One of the lessons of the COVID-19 pandemic is that schools can be opened safely if proper mitigation strategies are in place. However, during the pandemic, we witnessed a vicious cycle of concerned and loving parents wanting in-person learning for their children but justifying their position by asserting that COVID-19 in children was “not a thing.” This often led to mitigation strategies not being implemented and teachers being reluctant to return to school. Schools remained closed for a period much longer than would have been necessary. We must start planning for the next infectious disease surge and build an effective school infrastructure, including upgrading ventilation and 

COVID-19, schools, and children are sensitive topics. Some worry about transmission in schools, while others don't see it as a concern. Which is it? 

70% of COVID-19 Cases Transmitted By Children

Saskia v. Popescu, PhD, MPH, MA, CIC is an infection preventionist and infectious disease epidemiologist. Currently, she serves as a senior fellow at the Council on Strategic Risks, where she works to address global health security issues, including national policies impacting health care readiness and biodefense. Saskia is also an assistant professor at George Mason University, teaching courses on health care preparedness and epidemiology in policy. She holds a PhD in biodefense from George Mason University, where her research focused on the political and economic obstacles to investing in infection prevention, a MPH in infectious disease epidemiology, a MA in international security studies--both from the University of Arizona. Prior to her work at CSR, Saskia helped lead global health response at Netflix and was a senior infection preventionist with HonorHealth in Arizona. She has worked with the WHO, supported multiple NASEM workshops and reports, and supports NGO engagement within the Biological Weapons Convention at the UN. Saskia’s work is on building health care biopreparedness and readiness for infectious disease threats, especially in larger global health security efforts.

The article first appeared in our sister publication, 

Invasive procedures carry risk. While this isn’t a novel concept, too often, when procedures are discussed, it’s within the context of surgical site infections (SSI), which are often assumed to be bacterial infections or those related to breaks in sterile technique.

 in the surgical site infection standardized infection ratio for specific procedures from 2020 to 2021. SSIs account for 20% of all health care-associated infections and can drastically increase mortality risk. Furthermore, the CDC notes that 

SSIs are the most costly of healthcare-associated infections

, with a $3.3 billion cost, extending hospital stays by 9.7 days, and the cost of hospitalization for the individual grows by $20,000.

What about the risk of hepatitis B (HBV) and C (HCV) due to exposure to such invasive procedures? A 

 sought to assess this risk—parenterally transmitted hepatitis following an invasive procedure in Italy.

Utilizing the SEIEVA (Integrated Epidemiological System of Acute Viral Hepatitis) database, a surveillance system for viral hepatitis, the research team studied the association between acute HBV and HCV infection and surgical interventions/diagnostic procedures via age-matched controls (hepatitis A cases) and conditional multiple logistic regression analysis. Over 8000 HBV and 2179 HCV cases were studied with age-matched controls. 

The authors reported that the “strongest associations for HBV infection were: gynecological surgery (odds ratio [OR] 5.19; 95% CI 1.12-24.05), otorhinolaryngological surgery (OR 3.78; 95% CI 1.76-8.09), and cardiac/thoracic surgery (OR 3.52; 95% CI 1.34-9.23); while for HCV infection, they were: neurosurgery (OR 11.88; 95% CI 2.40-58.85), otorhinolaryngological surgery (OR 11.54; 95% CI 2.55-52.24), and vascular surgery (OR 9.52; 95% CI 3.25-27.87). Hepatitis C was also strongly associated with ophthalmological surgery (OR 8.32; 95% CI 2.24-30.92). Biopsy and endoscopic procedures were significantly associated with both HCV (OR 3.84; 95% CI 2.47-5.95) and, to a lesser extent, HBV infection (OR 1.48; 95% CI 1.16-1.90).”

The authors noted a particular point they hoped to assess: cases of parenterally-transmitted viral hepatitis in elderly persons with unknown or murky etiology. The increased risk for HBV and HCV in relation to invasive procedure exposures has the potential to explain some risks for older patients. Still, it ultimately represents a more significant public health and research question.

Ultimately, the authors reiterate an important point—there is a consistently increased risk of parenterally-transmitted hepatitis with invasive procedures. While some surgeries were at higher risk for HBV and HCV, surveillance efforts and universal precautions in surgical settings are essential to reduce post-operative infection risk.

While the authors noted a consistent finding in the literature pointing to an increased risk of viral hepatitis transmission in gynecological and cardiothoracic surgeries, they also mentioned that “In fact, assuming a person-to-person mode of viral transmission, the larger pool of individuals infected with HCV than with HBV in the general population causes a higher likelihood of exposure to hepatitis C. In Italy, surveillance of viral hepatitis in health care workers is in place, and the risk of professional-to-patient transmission should be limited. In addition, HBV vaccination could have played a role in the different risks compared to hepatitis C.”

There is a critical need to address the increased risk of hepatitis infections and exposure to invasive procedures, especially in communities with higher infection rates and vulnerable populations.

A recent study published in the Journal of Hepatology aimed to determine the likelihood of parenterally transmitted hepatitis after invasive medical procedures in Italy.

Parenterally Transmitted Hepatitis From Invasive Procedures

’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.

The Duration of Antibiotics: Why Short Is Good in the Long Run

Is it truly beneficial to prescribe longer courses of antibiotics?

Surgical Attire: Policy Development Resources

Human bodies, especially surgical personnel's hair, scalp, and skin, are a major source of bacterial contamination in the surgical environment and a major cause of SSIs. Yet, not it hasn't always been a consideration.

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.

Embarking on the Infection Preventionist Role: The Path of an MPH Graduate

The future infection prevention and control pathway is inclusive and invites master of public health graduates and other degrees besides nursing to enter this evolving field.

IPC PROs Helping Each Other: When to Unmask a Long-term Care Facility

In the first of this new series, IPC Pros Helping Each Other: When is the right time to unmask in long-term care? One IP explains how she and her facility unmasked and what led to their decision.

Take 5 minutes to catch up on Infection Control Today®’s highlights for the week ending June 4, 2023.

Weekly Rounds: Antibiotics Duration, Surgical Attire Policy, and Human Metapneumovirus, and More

In this first installment of a 5-installment series,  

speaks with 2 managers at Sage Memorial Hospital, Navajo Health Foundation, Navajo Health Foundation, in Ganado, Arizona, about their infection prevention and control program, including their strengths, challenges, and what innovative ways they provide the very best care to their patients, staff, and community.

Christian Bigwater, BSBA, director of public relations and marketing, and Tiyarra Wauneka, environmental services supervisor, discuss the hospital's size and the issues that differ from larger hospitals in more urban areas.

The facility follows its Navajo Nation’s values: “The mission of Sage Memorial Hospital is to provide quality healthcare for the Dine people with respect, unity, beauty, and harmony in honor of K‘é an, the sacredness of life,” according to the 

: What is the hospital, how large is it, and whom do you serve?

: We're located in Granado, Arizona, and that's on the Navajo Nation. Primarily, we focus on our immediate community, which includes the chapters of Cornfields Ganado, Kinlichee, Klagetoh, [Lower] Greasewood [Springs], Steamboat, Wide Ruins, and Nazlini.

We do welcome patients and visitors [who] are beyond our service area. We do cater to both Navajo and non-Navajo [for] just little bit about the demographics of the people that we serve. And this is based off the Community Health Needs Assessment. Approximately 95% of patients [who] come in here are of American Indian or Alaskan descent. Although I did mention we do service other people and are welcome to come to the hospital, our primary visitors and patients are mainly Navajo.

 What unique challenges do you have in the infection prevention and control space that maybe a hospital in Boston or Houston may not have?

: Some of the challenges that we currently have with our infection control [within the hospital] is that because our hospital is a private hospital, we do have surrounding facilities, healthcare facilities that are funded by IHS [Indian Health Service]. And so being a private sector, we are faced with the challenge of ensuring that we get the proper training that we need to carry out the services that environmental services provide for our facility. Also, we are in a rural location. So often, we don't have access to those resources. If you were in a bigger city, where resources are nearby, so it takes time for us to receive supplies.

I will give the example of going into the pandemic. When we went into the pandemic, a lot of the health care facilities that were in a bigger city or town, I had access firsthand to all the PPE [personal protective equipment] supplies or any kind of disinfection solutions that they needed. But for our hospitals located on the reservation, it was hard to get those supplies for not only our hospital but for our community that we serve.

And here on the reservation, that community that we

 serve, we have a wide spread of community members. We don't have anything like street signs or streets with houses that are clustered together. We spread across a big section of land, where we're just scattered here and there. So that was our biggest challenge. And it's still our biggest challenge to ensure that we can get to all those communities [and] and team members that we serve and be able to find a reliable resource where we can get the things that we need for infection control, [like] our supplies, and sometimes it does take time for them to get it to us.

For example, if you were down in the Phoenix area, they could get supplies within a day, overnight. But for us, it could take anywhere from a week to 3 months to receive those supplies. So we have to plan ahead at least 3 months in advance to ensure that we constantly have the supplies that we need to take care of our community and our health care facility.

: You have everything all there in the hospital, [and] you have sterile processing environmental services. Do you have an IP [infection preventionist] on staff?

: Yes, we have 1 IP [who] is currently with us. And then myself included. So my team and I are the infection control and infection preventionist team that oversees our facility.

(This interview has been edited for clarity.)

What is infection control and prevention like on the Navajo Nation? Find out in this first of 5 installments in a conversation with managers at the Sage Memorial Hospital, Navajo Health Foundation. 

Providing Infection Prevention on the Navajo Nation

A version of this article first appeared in our sister publication, 

Yesterday, Pfizer Inc. declared that the US Food and Drug Administration (FDA) gave approval for their respiratory syncytial virus (RSV) vaccine, Abrysvo, to be used by older adults. This endorsement permits the use of Abrysvo in people aged 60 years and older to prevent lower respiratory tract disease caused by RSV.

Pfizer’s Abrysvo vaccine targets both RSV A and B strains with its 2 preF proteins. The FDA has approved Abrysvo based on comprehensive trial data that confirms its safety and efficacy.

“A vaccine to help prevent RSV had been an elusive public health goal for more than half a century," stated Annaliesa Anderson, PhD, senior vice president and chief scientific officer of vaccine research and development at Pfizer. “Abrysvo will address a need to help protect older adults against the potentially serious consequences of RSV disease. We are extremely grateful to the clinical trial participants, study investigator teams and our dedicated Pfizer colleagues for their roles in making this vaccine available.”

With Abrysvo being granted approval, it becomes the second RSV vaccine to be approved after GSK's 

 after more than 50 years of working to develop an RSV vaccine. The approval was based on data obtained from a Phase 3 clinical trial (NCT05035212) called RENOIR (RSV vaccine Efficacy study iNOlder adults Immunized against RSV disease). This study is designed to evaluate the efficacy, safety, and immunogenicity of a single dose of the vaccine in adults aged 60 and above. The trial enrolled around 37,000 randomly assigned participants to receive either RSVpreF 120 μg or a placebo in a 1:1 ratio. The study is ongoing, and efficacy data is being collected during the second RSV season.

Edward E. Walsh, MD, Professor of Medicine at the University of Rochester Medical Center and principal investigator of the RENOIR trial, commented, "This 

 demonstrated the serious consequences and potential health risks this virus poses for older adults. Today’s FDA approval of Abrysvo recognizes significant scientific progress, and importantly helps provide older adults potential protection against RSV and an opportunity to improve community health by helping prevent the disease.”

RSV is a virus that spreads easily and causes respiratory illnesses worldwide. It mainly affects the lungs and airways, which can lead to serious health problems and even death. Older adults in the US are especially at risk from RSV, with the severity of the illness increasing with age and the presence of other health issues like asthma, congestive heart failure, or chronic obstructive pulmonary disease (COPD).

For most people who are generally healthy, RSV causes mild symptoms similar to a cold. They usually recover within 2 weeks without realizing they had the virus. Infants and young children, however, are more vulnerable to severe RSV infections. Pfizer is therefore seeking approval to give RSVpreF to pregnant people, to prevent medically attended lower respiratory tract disease (MA-LRTD) and serious MA-LRTD caused by RSV in babies from birth to 6 months old. The maternal vaccine was 

 by the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC), and a decision is expected by August 21, 2023.

The CDC Advisory Committee on Immunization Practices (ACIP) will have a meeting on June 21, 2023, to discuss the use of RSV vaccines in older adults. Pending the outcome of this meeting, Pfizer expects Abrysvo to be available in the third quarter of 2023, just in time for the anticipated RSV season this fall. Pfizer also reported positive top-line results earlier this month from a Phase 3 study on the safety and effectiveness of Abrysvo when coadministered with seasonal inactivated influenza vaccine (SIIV) in adults aged 65 and older. Additionally, Pfizer plans to conduct multiple clinical trials to evaluate RSVpreF in healthy children aged 2 to 5 years, children aged 5 to18 years with comorbidities, adults aged 18-60 years with comorbidities, and adults aged 18 years and older who are immunocompromised and at high risk for adverse RSV outcomes.

The FDA's decision to approve Abrysvo was based on data from a Phase 3 clinical trial, RENOIR, demonstrating the RSV vaccine's efficacy, immunogenicity, and safety in adults 60 and older.


FDA Approves Pfizer's Abrysvo Vaccine for Older Adults

As a student in college, I was desperate to find a career that spoke to me that resonated with my aspirations and passion for aiding others. I was at a crossroads when asked to declare my major in the second year of my studies. I sampled various majors, but none captured my interest until infection prevention seemed to serendipitously come my way after countless late nights on my computer searching and seeking answers. The next day after the triumphant final night of my quest, I capered to my school’s college of public health and declared my major. At present, I proudly hold a master of public health (MPH) degree and have actively served as an infection preventionist (IP) for the past few years, including during the COVID-19 pandemic.

Traditionally, IPs have been recruited from nursing; in the last few years, a new pipeline has prepared students to enter careers in infection prevention and control, emphasizing public health or alternative degrees beyond nursing, such as microbiology. Colleges and universities have also designed certificate programs enabling students to obtain a certification in infection prevention.

In Association for Professionals in Infection Control and Epidemiology’s (APIC’s) MegaSurvey, there was a slight shift between 2015 to 2020 regarding the educational background of respondents

. In 2015, 82% of infection preventionists came from the nursing discipline; in 2020, 78% came from a nursing background.

 Among the respondents in 2020, a mere 8% originated from a public health background. The skillset of a public health graduate must continue to be considered when welcoming new infection preventionists to the table.

Lamphier in 2020 after completing her master of public health.

MPH graduates are trained in epidemiology, biostatistics, outbreak investigations, health care research

, and other invaluable disciplines. Within our studies, there is also an emphasis on critical thinking, leadership, and health communication. As an IP, delivering information is a regular function; therefore, understanding how to convey the information appropriately and to different audiences is key. This communication can include presenting infection rates to physicians, educating nurses about the different types of isolation, or being a stakeholder in a facility’s design and construction project.

Schools of public health also prepare future infection preventionists to learn the basics of epidemiological investigations, calculate and interpret critical data, and find and utilize relevant scientific literature. Through my experience as a student, I felt prepared to investigate my first outbreak when I started my first role as an IP and how to organize the data strategically. Cluster and outbreak investigations are unique features in public health programs. Public health programs also educate students on driving individual, interpersonal, and organizational change, essential for infection preventionists when introducing new products in a facility, drafting policies, and more.

Lamphier in 2023 at Moffitt Cancer Center

I express immense gratitude to the nurses and other professionals who have provided invaluable clinical assistance and understanding in my journey in infection prevention. I also appreciate those who listened attentively to my voice and professional opinion and embraced my diverse background without hesitation. I acknowledge the potential challenges associated with witnessing someone from a different background entering a field that has been traditionally nurse-driven. I plan to continue to be an advocate for the inclusion of public health graduates in the field of infection prevention and control.

The future infection prevention and control pathway is inclusive and invites master of public health graduates and other degrees besides nursing to enter this evolving field.


SHARON WARD-FORE, MS, MT(ASCP), CIC, FAPIC, is an infection prevention consultant located in Chicago. She is also a member of Infection Control Today®’s Editorial Advisory Board.

According to the Surgical Site Infection Guidelines published in 2017 by the American College of Surgeons and Surgical Infection Society, the most common and costly type of health care–associated infections (HAIs) are surgical site infections (SSIs), accounting for 20% of all HAIs. SSIs occur in an estimated 2% to 5% of patients undergoing inpatient surgery and up to 25% of major surgical procedures.

 Annual incidence of SSIs in the United States is between 160,000 and 300,000, costing from $3.5 billion to $10 billion annually. On average, an SSI increases a patient’s length of stay by 9.7 days, yet approximately half of all SSIs are preventable when evidence-based prevention strategies are implemented.

Infection preventionists (IPs) are vital in supporting the perioperative team by sharing the most current, evidence-based surgical infection prevention strategies to help improve SSI prevention. The operating room (OR) is a challenging environment, with various surgical personnel and medical devices coming together to help improve patients’ lives. Covering surgical services as a novice or even a seasoned IP can be intimidating. In addition to the basic environment of care items, the OR has unique infection prevention challenges. Surgical attire, or OR scrubs (the special surgical clothing required for personnel within the OR suite), is intended to promote cleanliness and reduce microbial contamination in the surgical suite to prevent SSIs.

The human body is a significant source of bacterial contamination in the surgical environment. SSIs have been traced to bacteria from surgical personnel’s hair, scalp, and skin.

 However, maintaining a clean surgical space and reducing microbial contamination wasn’t always a consideration. Through the timeline of surgical attire (

), one can begin to see the development of a better understanding of infection and organism transmission through the changes in clothing.

Surgical attire was initially known as surgical greens because of their color, then were later referred to as scrubs because they’re worn in a scrubbed environment. In 1894, Dr Hunter Robber said, “It is safer and better that all should put on a complete change of costume rather than simply don a sterilized coat and pair of trousers over ordinary clothing.”

 He also suggested that the clothing be made white so they could easily be washed.

When electricity was discovered and electric lights were used in the OR instead of windows and skylights, the combination of bright lights and white attire led to significant glare. “There was a green ghosting effect when shifting gaze from bloody red innards to white backgrounds,” Hunter said.

In 1914, Harry Sherman, MD, FACS, believed that a color scheme might evolve from the red of blood and tissues. He recommended green, a color “less wearisome to the eyes, and [one that] minimized reflection.” He also said green “keeps the surgeon’s eye acute to red and pink.”

 Sky blue became popular for surgical apparel in the 1950s when color television began to be used for videotaping and closed-circuit teaching.

 Today, our surgical scrubs are primarily jade green or misty blue, depending on the vendor’s name given to the color.

Surgical attire has come a long way, but it is—and will probably always be—a hot-button issue due to the variety of organizations and agencies providing input as well as the difficulty of creating and enforcing policies designed for patient and staff safety. The guidance and recommendations are plentiful, which is why it’s vital for IPs covering the OR and the perioperative team to know what the surgical attire policies are as well as the sources used to develop them. Some of the regulatory agencies and professional organizations that have provided recommendations, guidelines, or position statements include the following:

Association of periOperative Registered Nurses (AORN)

Centers for Medicare & Medicaid Services (CMS)

Occupational Health and Safety Administration

Association for Professionals in Infection Control and Epidemiology



To further complicate the surgical attire issue, some states have established their own surgical attire dress code requirements or have adopted a version of AORN or other guidelines. Your local health department may also have further information about state-specific surgical attire requirements, so be sure to contact them as you develop your surgical attire policy.

If your health care facility participates in the CMS programs, you’ll need to follow their surgical attire requirements to be in compliance. They have their own Hospital Infection Control Survey Worksheet that includes a section on surgical procedures with specific surgical attire elements to be assessed by surveyors.6 You’ll need to follow these or risk getting cited. In some instances, they do differ from AORN. Some medical devices and equipment also include manufacturer instructions for use (MIFU) that require wearing specific surgical attire. Check those devices and equipment MIFUs carefully.

Ensure your health care facility’s surgical attire policy complies with the state and local agencies, MIFU, and CMS (if applicable). If none of these are relevant, then the health care facility’s chosen surgical attire, evidence-based guidelines, and consensus statements can be used to develop policies. If your health care facility does not have specific state or local surgical attire requirements, does not have MIFUs that mandate specific surgical attire, is not a CMS participant, and a Joint Commission standard does not explicitly require your facility, then you can choose which evidence-based guidelines or consensus statements to develop your surgical attire policies.

 Surveyors, like The Joint Commission, will survey your specific surgical attire policy. As you know, they don’t make the policy; they confirm that you are following your surgical attire policy.

Most facilities follow AORN’s surgical attire guidelines or incorporate parts of them into their facility-specific surgical attire policies. AORN recently updated the 2015 guidelines on surgical attire in 2019, published in 2020. IPs, including me, have struggled with issues that are addressed in these updated guidelines, including head coverings, arm coverings, beards, shoes, and scrubs outside the surgical suite. What’s not discussed in AORN’s 2020 surgical attire guidelines are patient clothing or linens used in the OR, masks as personal protective equipment, and the use of masks at the sterile field. If you want this information, refer to the AORN Guideline for Sterile Technique

 and the AORN Guideline for Transmission-Based Precautions.

addresses wearing rings, bracelets, watches, nail polish, artificial nails, and other nail treatments.

The rationale for AORN’s 2020 Guideline for Surgical Attire

 includes recommendations for selecting, wearing, and cleaning surgical attire. They are based on the highest-quality evidence available. Recommendations are rated as regulatory requirement, recommendation, conditional recommendation, or no recommendation. These categories are based on the level of evidence, an assessment of the benefits vs harms of implementing specific interventions, and consideration of resources required to implement the interventions

Regulatory requirement: Perioperative team members must implement the recommendation.

Recommendation: Perioperative team members should implement the recommendation unless there is a clear and compelling rationale for an alternative approach.

Conditional recommendation: Perioperative team members may implement the intervention, although the degree of implementation may vary depending on the benefit-harm assessment for the specific setting.

No recommendation: Perioperative team members will need to evaluate whether to implement the practice issue.

AORN states that the guidelines’ recommendations are intended to be achievable and represent what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and clinical situations that determine the degree to which the guideline can be implemented. AORN recognizes the “many diverse settings in which perioperative nurses practice; therefore, this guideline is adaptable to all areas where operative or other invasive procedures may be performed.”

 AORN recognizes that one size does not fit all, and not every organization or professional specialty will use or agree with these guidelines. However, the document does provide evidence-based guidance on surgical attire that can serve as a credible resource to help health care facilities develop perioperative policies and procedures while also considering guidance from professional organizations, state and local agencies, MIFU, and CMS (if applicable).

Development of policies and procedures for surgical attire should be a team sport, ensuring input from all the disciplines (eg surgeons, anesthesia, nursing, infection prevention, environmental services, sterile processing, nurse educator) that contribute to providing quality patient care based on the most up-to-date, evidence-based best practices, with SSI prevention at top of mind.

 which features infection prevention and control professionals at all levels speaking with each other, giving best practices, and telling stories of what has worked—and not worked—for them in their facilities. 

Do you have a best practice to share? A question you need answering? Or have an answer to the weekly question?  If so, please send them to tmartonicz@mjhlifesciences.com and help out those in the IPC community. 

Next week: Do you have an answer to "How do you help others in your facility to remember infection prevention and control requirements that they consistently seem to forget?"

“We are never getting rid of these masks, are we?” a nurse on the rehab wing asked me as I passed through the nurse’s station. I had heard the question numerous times and still did not know the answer. The staff—and patients—wanted our facility to go back to normal.

A few weeks later, the conversation on unmasking finally happened. Our Director of Nursing broached the subject of unmasking. She discussed that all counties in the state had been in moderate community transmission for a few weeks, and the numbers in the state had been good. She questioned if this was the time to do it. As the infection preventionist, my initial gut response was ‘NO! We need our masks.' The reality of the situation said if we are ever going to try it, now is the time to do it.

Once the decision was made to unmask, the question became, how do we do it? I knew that doing it wrong could lead to chaos! What I learned is that the key to successfully unmasking is staff education.

The Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic

 in the Sept. 27, 2022, update lays out the guidelines for when masks can be removed in health care settings. That is the easy part. Once the masks are off, the risk increases for COVID-19 outbreaks, so we must ensure we are taking all possible precautions. This is where staff education comes into play.

The staff needs to understand that not wearing masks is a privilege. As with all privileges, this one comes with great responsibility. The responsibilities that come along with no masks in a long-term care facility are self-reporting exposures to COVID-19, self-reporting illness, and masking during periods of illness and exposure.

Education should include what situations would require the facility to return to mandatory masking and how that will be communicated to staff and visitors. Ensure the team understands that you, as the IP, will expect 100% compliance when such situations occur. A reminder that in the future, when they are asked to mask it, it will be for a reason (ie outbreak, high COVID-19 levels, etc.) can be helpful.

When educating staff, I recommend taking the time to speak to staff one on one or in small groups. This allows you to make sure they understand what you expect from them.

My facility was unmasked on March 16, 2023. It has been several weeks, and things have been going great. The staff is happy, and the residents are pleased to see their caregivers' faces. When we had an exposure that required one floor to be put back in masks during exposure testing. The staff was adherent with no pushback. The reality of no masks is that, eventually, there will be an outbreak. But we had outbreaks with our masks on too. So, in the end, it was worth taking the chance to get back to this little bit of normal.