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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.

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

Cryptococcus is a fungus that will not normally affect individuals who have healthy immune systems. However, individuals who are immunocompromised from advanced HIV or immunity-suppressing medicines or conditions are at serious risk of meningitis illness and death. In 2020, approximately 112,000 individuals died from cryptococcus. Of all AIDS deaths worldwide, 19% were from 

International Conference on Cryptococcus Cryptococcosis (ICCC)

. He discusses what cryptococcus is, what Uganda is like, and what further information 

’s audience can receive from the conference.

Pullen is a clinical researcher at the University of Minnesota Medical School and an assistant professor of infectious disease and international medicine. He practices at M Health Fairview University of Minnesota Medical Center.

You recently went to Uganda for an infectious disease conference. Would you mind giving 

s audience an overview of that conference?

It is an offshoot of partly our university’s relationship with Makerere University, Kampala, Uganda, and the Uganda Infectious Disease Institute. The conference itself is called The International Conference on Cryptococcus Cryptococcosis (ICCC). Cryptococcus is a fungus, one of the opportunistic infections that you can see in advanced HIV.

This was a week-long conference where we gathered clinicians, clinical researchers, and basic science researchers. We shared new and upcoming data and had panel discussions about the best ways to care for these patients and our experiences with some of the new guidelines and therapies that have come out in the last few years.

It's great. I lived there for a little over a year back in 2017 or 2018, when I was a fellow. I had a Fogarty fellowship from the NIH [National Institutes of Health] and spent a year there, doing some research, seeing patients, and working with some of the doctors in Mbarara Regional Referral Hospital [in Mbarara City, Uganda].

Our research group is led by David Boulware [MD, MPH, professor of medicine, University of Minnesota]. We've been working over there for about 15 years now. We always have a presence there, whether it's fellows, residents, medical students, or staff.

We have quite a lot of experience there, and they have phenomenal research capabilities. One of our main collaborators is David Meya, [MBChB, MMed, PhD, Assoc Pro Makerere University, Kampala, Uganda], who is a titan of research and clinical work in Uganda. We value our partnership with him quite a lot. He was one of the scientific chairs of the ICCC. It was great to meet him again and work with him.

Would you mind explaining what cryptococcus is and how it affects the patient?

It's a fungus that exists in nature and that, in a normally immunocompetent person, is rarely ever a cause of infection.

But when someone has severe immunocompromised, whether it's through HIV or immunosuppressive medications, things like that, it can lead to most often meningitis, so [the patient] will develop a severe headache, confusion, and can even lead to coma and death.

In parts of the world where advanced HIV is more common, it's a very severe problem, about 15% of AIDS-related deaths worldwide, which comes up to about 180,000 people a year, are attributable to cryptococcal meningitis. It's not a small portion of people at all.

There's a lot of work within our group and others focused on finding new and better ways to screen [individuals] who might be at risk for cryptococcal meningitis and finding effective, more effective treatments for cryptococcal meningitis, whether that means more cost-effective or less toxic medications.

Do you ever find individuals here in the United States who have cryptococcus?

It's less common in the United States. There's a very good website that, not to shamelessly plug myself, but I worked with the Clinton Health Access Initiative last year. They do a lot of work in the cryptococcal meningitis space and wanted an easily accessible website that shows the incidence of cryptococcal meningitis around the world. If you go to 

, I created an interactive map where you can look at every country that we have data for, and it gives you an idea of the incidents in those countries. You can look it up under Uganda, for example, and the website will give you an idea of how many people there are living with HIV percentage with people who know their status and the number of cryptococcal deaths for 2020.

It's a widespread infection, particularly in low- and middle-income countries where advanced HIV is, unfortunately, more common due to resource limitations.

Do you ever get Cryptococcus if you don't have HIV?

You can. There is a subgroup called HIV-negative cryptococcal meningitis. It's very uncommon, but not unheard of. There's still a lot of research being done to see what sort of immunologic quirks or risk factors might predispose someone to that, but it's very uncommon barring immunosuppressive medications. That would be another reason to have it without HIV, anything that would significantly decrease your ability to fight infection.

About 30 years ago, a friend of mine who had cerebral palsy died from meningitis. I don't know what kind, and so that was why I asked.

Yes, if they were on any kind of immunosuppression or chronic kind of steroids like that would increase their risk in America. When you don't have those risk factors, other causes of meningitis are a lot more likely—bacterial and viral being the 2 most prominent.

Do you have anything else you would like to add to tell 

If you are interested in some of the research discussed at the conference, I am also the sole developer of the conference app. It's on the Apple and Google stores under the title ICCC 2023 app. It has all the abstracts that were presented at the conference in it, so you can see what sort of research was presented there.

Many of those are pending publication as well. The full papers are likely due to come out in the next 6 months to a year. You get a preview of what is to come and look up researchers who maybe have interests that align with your own and look up some of their other work as well.

Did you do any research for this conference?

I didn't have any presentations at this conference. No, I mostly went to meet with all my collaborators for other research and to provide onsite tech support for the app using a live database, so I wanted to be able to make changes as they came up during the conference for scheduled changes.

Experts from around the world shared new data about cryptococcus at the recent International Conference on Cryptococcus & Cryptococcosis (ICCC) in Uganda. 


ICCC in Uganda: Fighting Cryptococcus Worldwide

As online searches for respiratory illness symptoms increase, the potential for misinformation is a growing concern. In an interview with 

, divisional vice president at Abbott ID Rapid Diagnostics, highlights the importance of early testing and professional consultation to manage respiratory diseases effectively.

With the increase in online searches for respiratory illness symptoms, how concerned are you about the potential for misinformation affecting patient decisions and overall public health?

If you experience symptoms of a respiratory illness, it is essential to test promptly. Testing can be an important first step in understanding your condition, but it’s always best to consult a doctor or health care professional if you have questions. Abbott offers accessible testing options, such as ID NOW tests for influenza (flu), respiratory syncytial virus (RSV), and Strep A (Group A Streptococcus), which can be administered by health care professionals at local pharmacies. Seeking timely professional advice is critical, especially during peak illness seasons.

Internet use for health information has surged since the COVID-19 pandemic. Patients often encounter misleading content online, which can lead to inappropriate self-diagnosis and delays in seeking care, worsening health outcomes and potentially contributing to the spread of infectious diseases. Access to accurate, evidence-based information is crucial for effective disease management and better patient outcomes.

: What role can infection prevention personnel play in guiding the public towards reliable sources of information during respiratory illness season, particularly in the face of widespread self-diagnosis through online searches?

 Infection prevention personnel are critical in directing the public to reliable information during respiratory illness season. They can identify common areas of concern and develop targeted communications to address these issues, guiding people toward trusted sources.

How important is accurate testing and diagnosis in preventing the spread of respiratory illnesses, especially when many individuals rely on information found online rather than seeking medical advice?

 Accurate testing and diagnosis are essential in preventing the spread of respiratory illnesses, especially when individuals may rely on online information instead of seeking medical advice. Early, professional intervention can lead to faster recovery, reduce complications, and prevent further transmission. Rapid diagnostic tests, like the BinaxNOW Self-Test, provide an extra layer of protection for individuals and their loved ones.

: What strategies can infection prevention teams implement to educate the public on the risks of self-diagnosis without accurate testing and the importance of professional medical consultation, particularly during peak illness seasons?

 Infection prevention teams can implement strategies to educate the public on the risks of self-diagnosis without accurate testing and the importance of professional consultation, particularly during peak illness seasons. Furthermore, raising awareness about accessible testing options—such as Abbott’s ID NOW tests, which can be administered by health care professionals at pharmacies like CVS and Walgreens to detect influenza, RSV, and Strep A—can encourage individuals to seek timely professional advice, especially during peak illness seasons.

On Get Ready for Flu Day, Dr. Aparna Ahuja discusses the importance of accurate respiratory illness testing, the risks of self-diagnosis, and the role of infection prevention personnel in public health education.

The Role of Accurate Testing in Preventing Respiratory Illnesses: Insights from Dr. Aparna Ahuja

Infection prevention has never been more critical, especially in high-risk settings like hospitals and long-term care facilities. Diagnostic innovations are reshaping the landscape of infection control, providing faster, more accurate results that can dramatically reduce the spread of infectious diseases.

, Alesia McKeown, PhD, infectious disease scientific partner for Roche Diagnostics, highlights how advancements in molecular point-of-care (mPOC) diagnostics and flexible testing solutions are transforming health care practices. With rapid molecular tests bringing diagnostic capabilities closer to the patient, these tools enable faster diagnosis and intervention, often within the same patient visit. McKeown also discusses the growing demand for customizable testing options, the impact of rapid testing on respiratory illness management, and the integration of real-time data to enhance infection prevention protocols, ultimately improving patient outcomes across health care settings.

: How do you foresee integrating new diagnostic technologies in shaping the future of infection prevention protocols, particularly in high-risk settings like hospitals and long-term care facilities?

Alesia McKeown, PhD: Integrating new diagnostic technologies will significantly influence the future of infection prevention in high-risk settings like hospitals and long-term care facilities. One major development is increased access to molecular testing at the point of care. We have seen heightened interest in developing and implementing rapid, CLIA-waived molecular tests that bring testing closer to the patient. These easy-to-use systems enable faster diagnosis and intervention, ideally within the same patient visit, thereby reducing symptom onset and treatment time. This can be particularly critical in high-risk environments, where swift action is necessary to prevent the spread of infections.

Additionally, we are seeing an increase in the demand for more customizable and flexible testing options. These options will allow institutions to define their diagnostic multiplex panels, tailoring their infection prevention strategies to monitor local prevalence and respond uniquely to regional outbreaks.

As these technologies evolve, they will become essential tools in shaping infection prevention protocols, enabling faster, more targeted responses to outbreaks, and ultimately improving patient outcomes.

: How do you think advancements in diagnostic technology can reduce the time between symptom onset and accurate diagnosis in respiratory illness cases?

 Advancements in diagnostic technology are significantly reducing the time between symptom onset and accurate diagnosis in respiratory illness cases. As previously discussed, one critical development is the rise of molecular point-of-care (mPOC) technologies, which allow for rapid, onsite testing. These technologies support a test-to-treat approach within a single patient visit, enabling health care providers to diagnose and begin treatment in one encounter. This improves patient outcomes and enhances antimicrobial stewardship by ensuring proper treatment starts as soon as possible. However, not all institutions can support mPOC testing. For those unable, flexible diagnostic solutions, such as placing rapid point-of-care (PCR) platforms in central laboratories for STAT testing, ensure that fast turnaround times are still achievable for critical cases.

Another crucial advancement is the focus on at-home sample collection, which allows patients to get tested without visiting a doctor’s office. This expedites diagnosis and helps control the spread of infection by keeping potentially infectious patients away from other vulnerable individuals. When combined with telehealth consultations, this approach enables a complete test-to-treat workflow from the comfort of home, providing both convenience for patients and an additional layer of infection control.

These innovations are shaping a more patient-centric health care model, where rapid and accurate diagnosis is accessible regardless of setting.

: Can you explain how point-of-care (PCR) diagnostic tools or rapid testing technologies might streamline infection prevention processes within healthcare facilities?

 One of the critical infection prevention measures in healthcare settings is the swift identification and isolation of infectious patients. With POC molecular diagnostics, a patient presenting with respiratory symptoms, for example, can be tested on-site for common pathogens like influenza, respiratory syncytial virus (RSV), or SARS-CoV-2, and have results often within 20 minutes. If the test is positive, the patient can be immediately isolated, preventing them from spreading the infection to other patients, health care workers, or visitors. This reduces the risk of outbreaks within high-risk areas like emergency rooms, ICUs, and long-term care units.

Additionally, in health care settings where patient volumes are high, such as during the height of respiratory season or a viral outbreak, molecular POC diagnostics can help to identify clusters of patients with the same infection within an hour of intake. This allows for cohorting, ultimately reducing the spread of pathogens to uninfected patients and minimizing the need for cross-contamination prevention measures across the entire facility.

Another critical component of more sophisticated mPOC technologies is the ability to connect and interface with institutional health records and infection control dashboards. This capability allows health care facilities to track infection trends in real time, respond quickly to any increase in cases, and adjust their infection prevention protocols as needed.

: How can the latest diagnostic technology help distinguish between respiratory illnesses with overlapping symptoms, such as influenza, COVID-19, and respiratory syncytial virus, to enable targeted treatment and prevention?

 Over the last decade, PCR has become the gold standard in pathogen detection for respiratory infections due to the technology’s high sensitivity and specificity for the unique genomic regions targeted in each pathogen. In response, targeted multiplex molecular assays have become the standard of care for most patients presenting with respiratory symptoms. These targeted multiplex assays are typically designed to detect two to five of the most common respiratory pathogens from a single patient sample. This capability is crucial because influenza, SARS-CoV-2, and RSV share many symptoms—such as cough, fever, and fatigue—that make empirical diagnosis by symptoms alone unreliable.

By identifying the specific pathogen causing the illness, these diagnostics enable health care providers to implement targeted treatments, such as prescribing antivirals for influenza or SARS-CoV-2. This precision also prevents the misuse of antibiotics for viral infections, improving antimicrobial stewardship and patient outcomes. Moreover, rapid and accurate identification allows for more effective infection prevention measures, such as isolating contagious patients, cohorting cases, and implementing targeted public health interventions.

These technologies also play a critical role in managing high-risk populations, such as older adults and immunocompromised, by enabling early and appropriate care. The ability to quickly and accurately differentiate between respiratory pathogens supports a more precise, effective, and timely response to respiratory illness outbreaks.

: How important is having real-time, accurate diagnostic data in infection control decisions, and how do new technologies enhance your ability to act swiftly to prevent outbreaks?

 Real-time, accurate diagnostic data is critical for making informed infection control decisions and managing public health effectively. It enables rapid identification of pathogens, which leads to swift implementation of targeted treatment and containment measures. It also provides enhanced surveillance, leading to more efficient resource use and outbreak preparedness.

On a broader scale, real-time diagnostic data is vital for managing public health crises and outbreaks. Real-time data integration with electronic health records and infection surveillance systems enables continuous infection trends and patterns monitoring. This ongoing surveillance helps identify emerging threats, guide resource allocation more effectively, track the effectiveness of control measures, and adjust strategies as needed. This information can then inform local, regional, and national decision-making, guiding vaccination strategies, travel restrictions, and public advisories. The ability to track and respond to outbreaks in real time helps prevent widespread transmission and manage health care system demands effectively.

Alesia McKeown, PhD, discusses the pivotal role of cutting-edge diagnostic technologies in enhancing infection prevention, especially in high-risk health care environments, during an interview with Infection Control Today.

Advancing Infection Prevention With Diagnostic Innovation: Insights From Alesia McKeown, PhD 

I am honored to have been asked to write the monthly column “The Clean Hospitals Corner.” I hope to explore some of the aspects of the field that I find especially relevant or interesting and share some of my passion for it with you

I want to use this platform to explore various topics: to talk about new technologies, look into implementation strategies, keep updated on the latest news, or delve into challenges faced in clinical settings. The format is still flexible, and I am happy to use this forum to explore topics you want to know more about or answer some of your questions.

The fact that health care environmental hygiene even gets a column in a prestigious infection prevention magazine attests to the recent changes we have seen in the field in the last 10 years. Yet, these changes feel like they have been long overdue. If you walk down the street and ask the first person you meet whether they think it is essential that hospitals are cleaned well to protect patients, their answer is almost always a resounding “yes.”

However, medical professionals and hospital administrators sometimes give different answers. The reason for this difference is that although there is long-standing biological plausibility about the importance of the health care environment to patient safety, the literature lagged decades behind. The main reason was that most people doing important research in infection prevention weren't as interested in the health care environment as in other subjects.

Reasons for this lack of interest are also multiple and couched in their socio-cultural contexts. We often hear environmental services (EVS) referred to as “housekeeping” services, and many health care facilities don't view those who clean as medical professionals. Traditionally, cleaning health care facilities were often managed in the same way as cleaning a hotel. It was considered “women’s work” and treated as an entry-level job for relatively uneducated, often immigrant populations who were willing to work long, hard hours with dangerous chemicals and alongside infectious people for low wages. The EVS workforce in much of the world remains predominantly female and often has a low level of education.

Thankfully, some pioneers in the field fought to get environmental hygiene recognized as a key domain in IPC. I want to dedicate this first column to Professor Stephanie Dancer, MD, MBBS, MSc, BSc, FRCPath, DTMH, FRCP(Ed), who is a consultant microbiologist in National Health Service Lanarkshire and Professor of Microbiology at Edinburgh Napier University, Scotland, who refers to health care environmental hygiene (HEH) as the “Cinderella of infection control” and whose work laid the foundations for many of the recent advances in the field. Only through the work of people like Dancer and her peers could HEH finally get an actual “seat at the table” in infection control and prevention.

Over the last 10 years, the literature has finally been able to show not only that the health care environment is a key factor in the transmission of pathogens but also that improvements in the health care environment can reduce health care-associated infections. We have seen the recent development of national guidelines and a huge upswing in the amount of research in the field (partly helped by COVID-19, of course, but not only).

So now the real work begins: HEH programs need to be analyzed globally, tools for improvement need to be developed and implemented, and facilities need to understand the value of investing in a field that traditionally was one of the first places they would cut budgets. Globally, of course, it is still early days: Quality is generally low, and there is virtually everything left to do. Although, in some ways, that is intimidating, it also means that every effort we make will likely have a measurable impact. Measuring improvement is much more complicated when the level of quality in a field is already quite high. This means that whatever you can do in your facilities, even on a ward level, will positively impact staff and patients.

If HEH is the “Cinderella of infection control,” then Professor Dancer is certainly its fairy godmother, and it’s time to go to the ball. If you want an excellent overview of the history of the field, then you can read her synopsis “Hospital Cleaning: Past, Present, and Future” 

I look forward to going on this journey with 

’s readers and am excited to be part of a field whose time has come.

Feel free to email me at Alexandra.peters@unige.ch.

This new column, Clean Hospital with Alexandra Peters, PhD, explores advancements in health care environmental hygiene, highlighting its growing recognition as a key component of infection prevention and honoring pioneers like Professor Stephanie Dancer.

The Evolution of Health Care Environmental Hygiene: A Long Overdue Shift in Infection Control

Candida auris in maryland

That nursing facilities in certain areas experience more outbreaks of 

 raises the question of why this happens. Though C auris is rare in the United States, it is commonly found in long-term care facilities and is more prevalent in socioeconomically disadvantaged regions. A study titled "

and Neighborhood Socioeconomic Vulnerability in Maryland" was presented at IDWeek 2023 in Boston, Massachusetts, and it sheds light on this issue.

 cases in Maryland between June 2019 and December 2021, finding that patients frequently lived in disadvantaged neighborhoods with elevated crowding, uninsured populations, and diverse racial backgrounds. These factors may contribute to the spread of C auris, with 30% of affected nursing facilities located in socioeconomically disadvantaged areas.

To find out more about the study’s findings, 

) spoke with Lauren Leigh Smith, MD, MAS, assistant professor, University of Maryland, Baltimore, Maryland, about the poster presentation she gave at IDWeek. 

“We looked at the neighborhoods where patients lived and the neighborhoods where nursing facilities were, “Smith said. The reason why we chose to look at neighborhoods is because you can get a lot of different information about the environment that patients live in, and how that can contribute to illness overall. So, we looked at something called a vulnerability index.”

Leigh then said that they also looked at an area deprivation index. “What that does is it builds upon information that is built into the US Census. It takes that information and looks at different variables of the neighborhood that a patient lives in. For instance, it'll look at things like poverty, housing, racial, and ethnic minority status, and then it'll give you a risk, a score. And you can see how vulnerable that community is compared to other communities in the nation or the state.”

Then Leigh and the other investigators were trying to get a better understanding of the nursing homes in the state of Maryland. “When we talk about vulnerability indices, we're really trying to get a better understanding of how disadvantaged neighborhoods are and how vulnerable the people in these neighborhoods are. Originally, the big indices that we use are something called the social vulnerability index. And that's put out by the CDC, and it looks at different domains. And really what it was used for was to help emergency response planners and public health officials map and plan communities that likely need more support.”

Click here for more coverage of IDWeek 2023.

A study in Maryland from June 2019 to December 2021 analyzed 140 Candida auris cases, revealing that patients often resided in disadvantaged neighborhoods with higher crowding, uninsured rates, and racial diversity. ICT speaks to the lead author. 


Examining Vulnerability Factors in Patients With Candida auris in Maryland

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