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

Isis Lamphier, MPH, CIC

The Centers for Disease Control and Prevention urged consumers to stop using EzriCare Artificial Tears immediately.

The Centers for Disease Control and Prevention (CDC) issued a statement recently,

 urging the immediate discontinuation of the use of EzriCare Artificial Tears until epidemiological investigation and laboratory analyses are complete.

EzriCare Artificial Tears are eye drops containing 1% Carboxymethylcellulose Sodium designed to relieve eye irritation and dryness. According to the CDC, these lubricant eye drops are preservative-free. These eye drops are dispensed in multidose bottles.

The CDC has linked these eye drops to a multistate cluster of Verona Integron‐mediated Metallo‐β‐lactamase (VIM)‐ and Guiana‐Extended Spectrum‐β‐Lactamase (GES) producing carbapenem‐resistant Pseudomonas aeruginosa (VIM‐GES‐CRPA) associated with multiple different types of infections, including eye infections. In addition to demonstrating carbapenem resistance, isolates in this cluster have shown resistance to ceftazidime and cefepime.

The cluster identified by the CDC, in partnership with state and local health departments, contains 56 isolates from 50 case-patients from 11 states (CA, CO, CT, FL, NJ, NM, NY, NV, TX, UT, and WA). The date of specimen collection is from May to December 2022, and isolates came from the corneum, sputum or bronchial wash, urine, other nonsterile sources, blood, and rectal swabs.

Patient outcomes in this cluster have included permanent vision loss resulting from ocular infection, hospitalization, and the death of one patient with a bloodstream infection.

Exposures were reviewed for each patient, and the majority of patients used artificial tears. The most common brand reported among patients in the cluster was EzriCare Artificial Tears.

Individuals who use this product should follow the CDC’s recommendation and discontinue current usage. Contact your health department’s healthcare-associated infections contact for submitting isolates.

For users of lubricating eye drops, it is always recommended to avoid touching the tip of the container to any surface- including the user’s eyelids or lashes. Always wash your hand before and after the use of eye drops. It is also recommended to follow the provided instructions for use and storage. 

 states to never share eye drops, whether prescription or over the counter. Sharing eye drops increases your risk of infections, primarily eye infections. If you have questions regarding instructions for eye drops, always ask your doctor.

Articles

EzriCare Artificial Tears have been linked to a multistate cluster of VIM‐GES‐CRPA associated with multiple different types of infections, including eye infections.  

Multistate Cluster of Carbapenem-Resistant Pseudomonas aeruginosa Linked to Use of Artificial Tears

Because patients with cancer or receiving cancer treatments are at an increased risk for infections, health care workers should assure that their patients know how to protect themselves.

Cancer and chemotherapy can weaken patients' immune systems and reduce the number of white blood cells. Also, chemotherapy can kill healthy white blood cells while targeting cancer cells. Neutropenia is a common side effect after receiving chemotherapy that causes a decrease in the number of white cells, called 

. While neutropenia cannot be prevented, patients can take steps to reduce their risk of getting an infection while their white blood cell count is low.

Health care providers should make sure their patients know these guidelines to protect against infectious diseases while their immune systems are low. 

: Patients should wash their hands often with soap and warm water. They should carry alcohol-based hand sanitizer to clean their hands while they are out. Moments for performing hand hygiene include before eating or handling food products, after using the bathroom, after visiting a public place or touching an item touched by others, after taking out the trash, and after touching animals. Hand hygiene is the number one way to prevent the spread of infections, according to the Centers for Disease Control and Prevention (CDC).

: Patients are encouraged to receive their flu shot every fall. It is also recommended that household members of patients with cancer also receive the flu shot. Cancer patients should always consult with their physician before receiving any vaccine.

 and discuss foods that should be avoided with the health care team. Before handling food products, patients should wash their hands. They should also ensure that all meat or poultry products are cooked thoroughly before eating. 

The US Department of Agriculture (USDA) recommends that individuals read food packaging before cooking

. Not all frozen foods are fully cooked or ready to eat; some can come partially cooked. In a study conducted by the USDA, 22% of participants preparing frozen foods were unaware if the products were raw or fully cooked despite reading the product instructions. A food thermometer can also ensure that cooked meat and poultry have reached their safe internal temperature. Cancer patients should also follow best-by-dates and expiration dates present on the packaging. These dates are printed to ensure the quality of foods, and it is imperative that patients only consume fresh, unexpired foods. It is also a recommendation for cancer patients to avoid foods linked to outbreaks.

: Cooked or ready-to-eat foods should be placed on upper shelves while raw foods are on lower shelves to avoid leaking or dripping. While at the grocery store, it is recommended that non-perishable items are gathered first. Deli items, dairy, and eggs should be collected last for items to maintain the appropriate temperature while in the shopping cart. When selecting foods, check for proper refrigeration- the items are cold to the touch, the odors are fresh and mild, and the packaging is tightly sealed and free of tear. Groceries should be taken home immediately and stored in the refrigerator or freezer.

Avoid anyone with a fever, influenza, or other infections

. Cancer patients and survivors are at an increased risk of developing influenza complications. Consider asking friends and family to wash their hands when visiting. Care teams could also recommend that patients stay home or wear masks during respiratory virus season.

 with warm water and mild soap. If they have a PICC (peripherally inserted central catheter) line or dressing- maintain the area dry.

 several times a day with a soft, clean toothbrush. Chemotherapy drugs can cause sores in the mouth and throat; therefore, oral hygiene is strongly recommended to prevent sores from becoming infected. All dentures, bridges, and retainers should be cleaned daily as well.

Avoid keeping fresh flowers and live plants in their bedroom

Plants and flowers and their water in vases and pots can harbor harmful fungal spores and bacteria

. These fungal spores and bacteria can place cancer patients at a higher risk for infection. Cancer patients should discuss with their care team if they can garden. If they can, garden gloves and hand hygiene is recommended. The skin is the first line of defense and should be protected during gardening.

 such as food, drink cups, utensils, and other personal items.

Discuss with their care team any travel plans.

 Care teams need to know if patients are traveling, especially since there may be times when flying is not recommended, such as after surgery, when platelets are low, etc. Doctors and nurses will also inform patients if there are any vaccines they may need for traveling purposes.

: if they feel well, clean the home with disinfectants to kill germs on high-touch surfaces such as telephones and doorknobs. Also, they should try to keep their house dust free. 

Dust can contain thousands of fungal and bacterial organisms

: protect skin from contact with pet bodily waste, if possible, have someone else change litter pans, wash hands after handling pets, avoid being scratched or bitten by pets, and stop pets from licking any open cuts, wounds, or catheters. Also, pets must remain clean and are taken to the veterinarian for regular check-ups and vaccinations. Pets are beneficial in providing companionship and reducing stress and anxiety, but cancer patients need to protect themselves from the germs carried by pets.

Care for catheters, ports, and other medical devices

. Patients should always follow their care team’s instructions and keep their devices clean and dry. Before touching or caring for their devices such as a Foley, port, or PICC ensure that hands are clean and perform hand hygiene. Monitor all insertion sites for redness, swelling, soreness, or drainage and notify physicians timely and appropriately.

Information for health care workers and patients to protect patients from infections. 


Preventing Infections in Cancer Patients at Home

December is International Sharps Injury Prevention Awareness Month.

December is International Sharps Injury Prevention Awareness Month. The International Sharps Injury Prevention Society (ISIPS) started International Sharps Injury Prevention Month in 2013. The month reminds healthcare workers, waste management workers, laboratory staff, and others to practice sharp safety and follow safety protocols.

According to Occupational Safety and Health Administration (OSHA), it is estimated that 600,000 to 800,000 needlestick injuries and other percutaneous injuries occur annually among health

 Punctures and cuts can introduce bloodborne pathogens into the body, such as hepatitis B virus (HPV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).

Most sharps-related injuries can be prevented 

and occur during or immediately after use

. It is important to understand safe sharps waste disposal and that your organization effectively manages this type of waste.

Health care workers should first understand which items can account for sharps injuries; it can include more than needles. Other sharps include syringes, lancets, auto-injectors, connection and infusion sets, wires, and scalpels. 

All sharps are biohazardous waste generated during care, treatment, or services.

 All these items should go in sharps containers which should be rigid, puncture-resistant, and leak-resistant. All sharps containers should have a tight-fitting puncture-proof lid, a clear label, and a sturdy upright design. Containers should also be marked with a line to indicate when the container is three-fourths full. Once the container reaches that point, do not place any more sharps in the container—this line is to prevent injuries. One of the leading causes of sharps injuries is overfilled containers. Never force items into the sharps container. If you have difficulties inserting a sharp into a receptacle, it may be too full; therefore, find another nearby container. Once three-fourths full, seal the sharps container and dispose of it per your biomedical waste regulations.

During this year’s International Sharps Injury Prevention Awareness Month, reflect on your organization’s sharp safety program. A comprehensive program can promote safe work practices and reduce the risk of injury. 

) spoke to Jackie Noble, RN, BSN, an oncology nurse at Holmes Regional Medical Center in Melbourne, Florida, regarding sharp safety. She stated, “Sharp safety is important to me because it is a large safety risk for infection for my patients and myself. I have seen coworkers accidentally stick themselves after sticking a patient. In one instance, the patient was HIV-positive. This led to many blood tests and medications for the employee to help prevent the HIV infection in their bloodstream. If we aren’t practicing sharp safety properly, a quick incident like this can have lifelong effects for the employee. These safety measures are not only for the safety of infection prevention for the patient but important to prevent infection for us as healthcare providers.”

, “I rarely ever feel at risk for getting a needle stick injury because I always ensure that I follow all the precautions. Caps on needles are essential to keep on prior to inserting a needle. All needles now have a safety measure that can be activated after the needle has been used to prevent unwarranted sticks. Using precautions will provide reassurance that needle sticks are preventable. Always ask for help if you feel uneasy about a shot for a patient who may not be able to hold still! We have annual sharp safety modules that remind employees of the importance of sharp safety and ways we can prevent unwarranted sticks. We are taught not to recap needles, uncap the needle only right before we use it, utilize the safety measure immediately after use, and then throw the sharp into the sharps container as soon as possible. If there is any fear that a patient may not hold still, we always have multiple people help keep a patient distracted and still for the shot.”

Other Rules of Sharps and Sharps Container Use

Never reach inside these containers to retrieve items.

Sharps containers should only be reserved for items that could puncture the skin

, do not place other medical items and devices such as medications, batteries, tape, gauze, and gloves into these containers. Containers with Federal Drug Administration (FDA)-marked clearance are recommended.

Follow manufacturers’ instructions for use (IFUs), and use engineering controls. 

Many sharps now contain safety features engineered into them. Be sure to know how to use these features to prevent sharps injuries. Some of these features include retractable needles, needless systems, and sheaths/shields for needles. An essential part of an organization’s bloodborne pathogen protection program or sharps safety program can be selecting appropriate devices with safety features.

Other recommendations for using sharps include never bending, breaking, or recapping needles or blades.

Always maintain visual contact with sharps during use.

Immediately placing needles and other sharps into a sharps disposable container

 is instrumental when using sharps. Be aware of staff nearby to protect them from any sharps you are handling or disposing of.

The location of a sharps container should be deliberate

, especially in procedure rooms. Sharps receptacles should be nearby and not be blocked by other furniture or equipment. The flow of a procedure, such as a central line insertion, should incorporate the location of the receptacle, and staff should be able to access it easily. Ensure that adequate sharps containers are located in your organization and that staff knows whom to contact if they need another container due to fullness or issues with the receptacle.

 If a sharps injury has occurred, it is essential to report it to your employer and file an injury report. Reporting is critical to receiving immediate post-exposure care and preventing future accidents. By reporting, you may be helping another employee from the same injury. Lastly, report to your supervisor if you find a needle or sharp left at the bedside or in the regular garbage.

December is International Sharps Injury Prevention Awareness Month. This month serves as a reminder to health care workers, waste management workers, laboratory staff, and others to practice sharp safety and follow safety protocols.

Sharps Safety Guidelines

Handwashing is the most effective tool to protect against infectious diseases.

This year, National Handwashing Awareness Week is December 5-11, 2022

. It is observed during the first full week in December to educate individuals on the proper technique for handwashing and the importance of maintaining hand hygiene. It is celebrated in addition to Global Handwashing Day which occurs on October 15, 2022. According to the 

Centers for Disease Control and Prevention

 (CDC), handwashing is one of the most effective methods to prevent the spread of germs. Proper hand hygiene adherence is critical in health care settings and is one of the simplest and most cost-effective elements of infection prevention but remains unacceptably low.

spoke to Garik Nicholson, MPH, CIC, the chair of the Hand Hygiene Committee at Moffitt Cancer Center in Tampa, Florida, and he said, “Handwashing remains one of the most effective ways to prevent the spread of infections. Here at Moffitt, we provide all departments with near-real-time data on how they are performing. This transparency shows each department how their role fits into the overall goal of maintaining compliance while reducing the risk of spreading infections.”

Studies show that health care workers practice hand hygiene less than half of the time they should.

 How can you encourage health care workers to perform hand hygiene? To promote handwashing practices, it is important to understand the science behind it and remind staff that their unique microbiome can act opportunistically, especially in hosts rendered susceptible. This acknowledgment is what first led to the discovery that unclean hands were contributing to 

 in Europe in the mid-1800s which was killing postpartum women. Reinforce with your staff that the skin is colonized with 2 types of microbes—

. Resident flora or colonizing flora consists of microorganisms that continuously live in or on our bodies. An example of resident flora is 

. Transient flora is microbes that are temporarily harbored on the superficial surface of the body and primarily spread via direct skin contact or indirect contact with touching objects or surfaces such as 

. Transient flora is most frequently associated with hospital-acquired infections. With handwashing, transient flora on the hands of healthcare workers can be reduced.

Ever facility must have an adequate supply of hand hygiene products, sinks, gloves, dispensers, and disposable towels available. Combating noncompliance begins first and foremost by removing all barriers to access. Hand hygiene products should be readily available throughout a facility and conveniently placed to promote handwashing such as before and after entering a patient’s room, before eating, after using the restroom, in procedure rooms, in operating rooms, etc. Hand hygiene education should be placed throughout health care facilities for staff and patients to read and should be changed periodically to prevent object desensitization that can occur from seeing the same signs posted in the same spots.

Health care facilities should also have a comprehensive hand hygiene policy to establish the indications and procedures for the performance of hand hygiene. This policy should be reviewed periodically to ensure it remains up to date with current recommendations. Facilities can appoint a hand hygiene committee to review this policy and enhance all handwashing efforts.

Hand hygiene compliance monitoring should also be maintained via an electronic hand hygiene system or observation system. Train staff members to be hand hygiene observers to monitor compliance and provide real-time feedback if noncompliance is observed. Real-time feedback can capture the root causes of missed handwashing opportunities. 

Reinforce washing hands with soap and water for at least 20 seconds and that technique matters

. Always use the right amount of product to clean your hands, and use friction to help lift dirt and microbes from the skin. Lastly, remind staff that gloves are not a substitute for cleaning hands; hands should be cleaned before and after removing gloves.

Handwashing also combats the rise in antibiotic resistance because keeping your hands clean prevents the spread of infections that could require antibiotics to treat. Hand hygiene also removes antibiotic-resistant microbes from our hands and prevents us from spreading them further to others. 

Antimicrobial resistance is an alarming public health threat that is associated with high mortality and morbidity—over 2.8 million infections and 35,000 deaths each year in the United States

We have come a long way since hand hygiene was first introduced to health care in the 19th century by Hungarian physician, 

. The evidence is overwhelming that hand hygiene is the most effective action to reduce the spread of pathogens, and handwashing should be at the forefront of all disease-fighting efforts in hospitals. With newer technology, research, and more access to hand hygiene products than ever before, barriers to cleaning hands have significantly decreased. So soap up, and join the efforts to stop the spread of infections!

National Handwashing Awareness Week 2022 highlights the first and most effective weapon that every individual can use to prevent the spread of infectious diseases--handwashing. 

Soap Up—It’s National Handwashing Awareness Week

Infection preventionists (IPs) play a principal role in preventing hospital-acquired infections (HAIs). Now and then for IPs, it may seem as though we have read every article and tried every preventive measure to reduce catheter-associated urinary tract infection (CAUTIs) and central-line associated infections (CLABSIs), but they remain a persistent problem. If CLABSIs and CAUTIs continue to persist amongst your facilities and units, consider the Targeted Assessment for Prevention (TAP) Strategy developed by the Centers for Disease Control and Prevention (CDC).

 is a framework for quality improvement that stands for 

revent. The program uses data reported by health care facilities to CDC’s National Health Care Safety Network (NHSN) to identify health care facilities and specific units with an excess burden of HAIs. Once these health care facilities and specific units have been identified, individuals can utilize the TAP Facility Assessment Tool to identify gaps in their infection prevention program. The identification of these gaps through the TAP Strategy brings new alertness to IPs on which areas need to be reviewed in the infection prevention and control program of their facility. Some of these gaps can include nurse and physician champions for prevention activities, training of proper central line and Foley insertions, routine audits of proper central line and Foley insertion practices, and documentation gaps. The TAP Strategy also provides IPs and other health care professionals with access to educational resources to address these gaps such as testimonials from other hospitals “How To” guides, and implementation guides.

“The TAP Strategy would be a great method of identifying where facilities have an above-average number of infections and ensuring that resources are available to aid those facilities in effectively setting prevention goals, in the private sector,” said Robbie Hilliard, MSN, RN, CIC, infection control coordinator, Carl Vinson Veterans’ Administration Medical Center (VAMC) in Dublin, Georgia, and a member of the 

the Strategic Analytics for Improvement and Learning (SAIL)

 metrics [from the US Department of Veterans Affairs] to look at VA hospital performance data by location since approximately 2012,” Hilliard told 

. “It is similar to the TAP strategy as it looks at HAIs (ie CAUTI, CLABSI, ventilator-associated events [VAE], methicillin-resistant 

) as one of the metrics, and quarterly SAIL reports are publicly released and used as a learning tool and guide for performance improvement for VA facilities. In many ways, I think SAIL and the TAP Strategy resemble each other closely.”

The TAP Strategy also provides IPs and other health care professionals with access to educational resources to address these gaps such as testimonials from other hospitals “How To” guides, and implementation guides.

In January 2015, the TAP Reports became available within the NHSN application.

In 2016, TAP Implementation guides were developed and are available for HAIs.

 IPs should run reports for their facilities on NHSN and determine which specific HAIs, such as CAUTI, CLABSI, MRSA, or CDI, and unit(s) would benefit from this program the most and where prevention efforts will be the most impactful. To start the program, I recommend 1 or 2 units at a time for prevention efforts. The TAP Strategy is a free resource to utilize to evaluate and improve any facility’s infection prevention and control program.

After using the TAP Strategy at my facility, Moffitt Cancer Center in Tampa, Florida, we were able to identify and address gaps in our infection prevention and control program. We identified one unit to target CLABSI efforts and one unit to target CAUTI efforts based on the findings from our report. The findings from the TAP Strategy were also beneficial for other departments such as nursing, quality, leadership, and more. My coworkers and I were able to present our findings to various committees within our health care facility, such as the CAUTI Committee, the CLABSI Committee, and the Infection Control Committee, to discuss gaps in our facilities and our upcoming improvement efforts.

If you feel as though you have exhausted every possible resource, consider the CDC’s Tap Strategy and the VA's SAIL as new methods for quality improvement efforts in your facility. The goal of the program is for HAI elimination through a customized approach.

The TAP Strategy developed by the CDC and SAIL from the US Department of Veterans Affairs prove to be key tools for setting health care-associated infection prevention goals on CLABSI and CAUTI.


TAP into CAUTI and CLABSI Prevention: A Quality Improvement Framework

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

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

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

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

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

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

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

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

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

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

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

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

Speaking out against stigma and discrimination;

Ensuring essential HIV services are maintained in the community;

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

Focusing efforts to reach populations that are vulnerable to HIV;

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

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

CDC (Centers for Disease Control and Prevention): 

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

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

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

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

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

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

AIDS is a chronic immune system disease caused by HIV

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

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

Morbidity and Mortality Weekly Report (MMWR) 

which marks the first official reporting of AIDS in 1981;

Scientists identifying the cause of AIDS in 1983;

Screening blood donations for HIV starting in 1985;

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

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

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

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

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

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

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