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Cleaning Up the Mess: Could a New Type of Patient Bath Basin Turn the Tide of HAIs?

Recommendations for COVID-19 vaccine administration are 

. The fear of vaccine-related myocarditis is driving the withdrawal of recommendations. However, this fear stems from both a distortion of scientific data and the forgetting of pandemic history.
 
We must not develop monocular vision and focus solely on myocarditis when assessing the risks and benefits of childhood COVID-19 vaccination. Vaccines have also been shown to reduce the incidence 

, it is “generally mild with rare cases of left ventricular dysfunction, heart failure, and arrhythmias.”

Let’s also remember that cases of myocarditis were appearing in 

 were reported to have cardiac magnetic resonance (CMR) findings consistent with myocarditis, and 2 of these cases had mild symptoms. 

And, on September 8, 2020, an article in 

 raised the question of whether COVID-19 is not primarily a heart and vascular disease. All of this occurred before any COVID-19 vaccine was available.

Researchers from Heidelberg University, Germany

, reported that the incidence of myocarditis after COVID-19 infections varies between 2.3% and 5.0

 found the incidence of symptomatic myocarditis after a positive SARS-CoV-2 test was 0.31% (31 per 10,000). When subclinical disease was added, the incidence increased to 2.3% (230 per 10,000). 

 it was stated that the incidence of postvaccination myocarditis in children is 6 to 8 per 10,000. I feel many interpreted these statistics as applying to all children. However, this high rate may apply only to a subset of young post-pubescent males; even in that group, the quoted incidence appears high. The 

American College of Cardiology determined

 the rate of vaccine-associated myocarditis for males between the ages of 12 and 24 years to be 1.07 per 10,000. In a meta-analysis published in 

, Watanabe and colleagues reported that, among children aged 5 to 11 years, the rate of postvaccine myocarditis was 1.8 per million (0.018 per 10,000).

Unfortunately, misinformation regarding the rate of vaccination-induced myocarditis in relation to infections is rampant. I feel this is due in part to a report from Florida’s Surgeon General, Joseph Ladapo, MD, PhD. 

 that his final report regarding cardiac-related deaths in young men is reported to have omitted information, which “showed that catching COVID-19 could increase the chances of a cardiac-related death much more than getting the vaccine.” The report was 

also based on a minimal number of deaths, 20

, which allowed biases to easily alter the results.

Even in the highest-risk vaccination group, young postpubescent males, the data make a compelling argument that the rate of myocarditis from COVID-19 infections is higher than from vaccination.

the current FDA head of the Center for Biologics Evaluation and Research

, "The incidence of myocarditis found for young men after SARS-CoV-2 infection is larger than what we found for myocarditis following COVID-19 vaccination." There were, however, a few caveats.In the paper, 

 that infection rates for vaccinations were found to be higher in individuals under the age of 40 after receiving the second dose of the Moderna COVID-19 Vaccine. It should also be noted that the data used in this analysis is from the Moderna Spikevax vaccine and has a higher dosage than Moderna’s mNEXSPIKE vaccine, which is available this year for those under the age of 65.

Most studies have found that the greatest risk of post-vaccination myocarditis is after the second dose of an mRNA vaccine. 

, reported the odds ratio (person-years of follow-up) of developing myocarditis after the second dose of an mRNA vaccine is 2.86 for the Pfizer vaccine and 6.10 for the Moderna (Spikevax) vaccine.The odds ratios are lower for the first, and third doses of the vaccine. For comparison, 

 a hazard ratio (risk) for patients (mean age of 56.1 years) developing myocarditis after infection of 5.16.

 the risk of myocarditis in young males aged 12 to 19 years to have a range of 1/2562 to 1/9442.The authors also discussed the analysis by 

, which found that when all ages are considered, the incidence of myocarditis after infection was at least 4 times larger than after vaccination with a first or second mRNA dose. For those under 40, the second dose of the Moderna (Spikevax) vaccine had a larger incidence of myocarditis than after infection. As stated above, Moderna is currently distributing a new vaccine for younger patients, mNEXSPIKE, which has a lower antigen dosage.

Drs Knudsen and Prasad also expressed concern about bias in studies examining the incidence of myocarditis after infection, as most studies rely on documented infections with a positive COVID-19 test, which may result in an undercount of cases. Although this may be true, I do not feel this would meaningfully bias Panton, et al’s findings. 

 reported that “Meta-analyses and studies of large cohorts have shown that around 20–40% of individuals infected with SARS-CoV-2 have asymptomatic disease.” Thus, even if one includes asymptomatic infections, the data still support the conclusion that myocarditis after COVID-19 infection has a higher incidence than after COVID-19 vaccination.

As stated by 

 “Myocarditis following SARS-CoV-2 vaccination is rare, more frequently reported in males under 30 years, and is generally associated with a favorable prognosis. Despite this, the benefits of vaccination continue to outweigh the risks.”

An interesting question is whether, because the incidence of myocarditis is highest after the second dose of the vaccine, giving the first and second doses in early childhood would decrease the risk of myocarditis in young post-pubescent males.

The overall findings strongly support that COVID-19 vaccinations are safer than contracting an infection. The available data makes a compelling argument for everyone, not just those over the age of 65 or those with risk factors, but for all individuals aged 6 months and older to receive this year’s updated COVID-19 booster. This is of utmost importance in children where the first exposure to a virus should be in a vaccine and not an infection.

Fear of vaccine-related myocarditis is narrowing guidance, but the evidence is clear: COVID-19 infection triggers more myocarditis than vaccination, early doses cut pediatric long COVID, and myocarditis appeared in 2020—before vaccines existed. This piece restores the full risk–benefit picture.

Beyond the Myocarditis Headlines: What the Data and Our Memory Say About COVID-19 Shots for Kids

 helps educate readers about existing and emerging pathogens of clinical importance in health care facilities today. Each column explores the 

's etiology, the infections it can cause, the modes of transmission, and ways to fight its spread. The pathogen profiles will span bacterial, viral, fungal, and parasitic species. We encourage you to use 

 as a teaching tool to help educate health care personnel and start a dialogue about microbiology-related imperatives.

The Bug of the Month helps educate readers about existing and emerging pathogens that are clinically important in today's health care facilities. 

Bug of the Month: I'm Older Than Empires

Let’s face it—Infection prevention can be serious business. From health care-associated infections to hand hygiene adherence and everything in between, your daily work keeps patients safe and hospitals running. But who says we can’t have a little fun along the way?

Whether you're a word nerd, a crossword connoisseur, or just someone who loves a good challenge, we’ve got something for you: The very first 

! It’s your chance to test your infection prevention IQ, unwind from your day, and maybe even pick up a new acronym or 2! 

This puzzle is packed with clues covering all things infection prevention—sterile processing, isolation precautions, antimicrobial stewardship, and yes, even a little personal protection equipment fashion. It's a fun, brain-boosting way to review key terms, share a laugh with your team, and maybe even spark a few debates over whether “contact time” really deserves 9 across.

No need for scrubs or gloves—just grab a pen, pull up a chair, and dive in.

Download the crossword now and challenge your colleagues.


See who finishes first, who gets stumped by “biofilm,” and who’s secretly a puzzle prodigy. Bonus points if you print it out for the break room!

Let’s connect through a bit of competition—and remind ourselves that even in a world of compliance checklists and policy updates, there’s always room for a little play.

Because at the end of the day, staying sharp helps us stay safe—and there’s no better way to do that than with a few clever clues and a well-earned smile.

Check out our first IPC Crossword Challenge.

Infection Prevention Connection: An IPC Crossword Challenge

Amanda Heitman, BSN, RN, CNOR, blends clinical practice and education to advance infection prevention in surgery, emphasizing preparation, innovation, and tailored care for patients with heightened infection risk.

Championing Surgical Safety: A Perioperative Nurse’s Perspective on Infection Prevention

Amanda Heitman, BSN, RN, CNOR, a seasoned perioperative nurse with over 2 decades of experience, and a member of 

has dedicated her career to advancing patient safety and surgical excellence. With a background in surgical services education and leadership, she founded Periop Anew, a consulting and education company focused on perioperative quality and safety. Her work extends across clinical practice, teaching, and advocacy, including her role as the clinical administrator of the AORN’s Periop 101 course, and she was a candidate for the national Association for periOperative Registered Nurses (AORN) Board of Directors.

Heitman’s approach to infection prevention is rooted in hands-on practice and education. In her current hospital role, she not only supervises surgical services but remains active in patient care, scrubbing and circulating to maintain strong clinical ties. She emphasizes preparation, environmental control, instrument inspection, and constant vigilance during procedures to minimize infection risks. Her attention to aseptic technique and surgical timing aligns with current best practices for reducing surgical site infections.

“As a perioperative nurse, my number one priority is my patient,” Heitman told 

“I strive to make sure I'm instilling best practices through education when I'm training folks, either on the floor in my own practices or in the classroom with nurses who are learning how to be in the operating room when I'm educating them. Infection prevention is a key concern in our operating rooms because the risk is always potentially going to be there, but what interventions that we implement can really help reduce that risk?”

Heitman identifies a growing interest in innovative infection prevention methods. These include the use of chlorhexidine-based irrigation products to reduce antibiotic resistance, enhanced recovery after surgery (ERAS) protocols that help shorten hospital stays, and advanced wound therapies such as fish-scale-based dressings and compact wound vacuum systems. These tools, she notes, empower perioperative staff to improve patient outcomes and encourage engagement through continued learning.

Looking ahead, Heitman advocates for greater exploration of how newer medications—particularly those with infection-related side effects—impact surgical patients. She believes health care professionals must be better prepared to address these risks proactively, adjusting protocols as necessary. She calls for 

to explore these emerging concerns, especially as medication regimens and surgical risks continue to evolve. For Heitman, continuous education and innovation remain key pillars in safeguarding patient health in the operating room.

Amanda Heitman, BSN, RN, CNOR, a perioperative nurse with over 20 years' experience and member of Infection Control Today® Editorial Advisory Board, has dedicated her career to patient safety and surgical excellence. Learn more about her path to where she is now. 

Video Series

Update: Norovirus is spreading this winter, with nearly 100 outbreaks reported in early December 2024. To protect themselves, hand hygiene is vital; however, is alcohol hand sanitizer effective? 

, or the stomach flu, consists of viruses that irritate and inflame the stomach and intestine linings. Highly contagious, norovirus can cause days of nausea, vomiting, diarrhea, and fever, resulting in severe dehydration, reduced nutrient absorption, and even death.

Norovirus causes an estimated 685 million cases of acute gastroenteritis worldwide each year, according to the 

. This includes 200 million cases of children, resulting in 50,000 deaths. The virus is responsible for at least 

of all gastroenteritis outbreaks and is estimated to total $60 billion in health care costs and lost productivity worldwide. And while respiratory virus season is slowing down, norovirus numbers remain in the wrong direction. Statistics from 15 states participating in the

 reported 1,208 outbreaks from August 1, 2023, to April 9, 2024, compared with 986 during the same period last year.

Unlike enveloped respiratory viruses such as influenza, respiratory syncytial virus, and SARS-CoV-2, which are transmitted by airborne particles, Norovirus usually spreads from direct contact with infected fecal matter, vomit, or person or surface. Also, unlike most respiratory viruses, norovirus can live on surfaces, still infecting people, for up to 

Many people, including those in health care, believe alcohol-based hand rub (ABHR) is the answer. Yet scientific research proved long ago it is not. Having worked for 25-plus years developing ABHR formulas, I can attest that ABHR has its place in health care settings, especially in fighting many respiratory viruses such as SARS-CoV-2. However, ABHR is useless against norovirus, making health care professionals more likely to contract the virus. This raises the question: If ABHR is ineffective against norovirus, why do so many health care facilities continue to use it for that purpose?

The Q&A below closely examines why ABHR doesn’t work against norovirus and why remaining dependent on ABHR facilitates the spread of the virus and lowers hand hygiene compliance rates.

 We have heard from many sources—including the CDC—that ABHR is ineffective against norovirus and can exacerbate its spread. Why?

 making it hardy and more resistant to pH and temperature changes and some disinfectants—including alcohol. ABHR cannot kill norovirus because the alcohol, regardless of percentage, cannot penetrate the capsid, the protein shell of a virus particle surrounding its nucleic acid. In contrast, SARS-CoV-2 is an enveloped virus with a fragile covering easily penetrated by alcohol sanitizers. The confusion comes in because the average person often does not know the difference between nonenveloped and enveloped viruses. The emphasis on ABHR during the COVID-19 pandemic further advanced the misinformation that ABHR works against all viruses.

Q. Is the finding that ABHR does not work against Norovirus new?

 showed that ABHR is ineffective against norovirus and could potentially increase the risk of an outbreak of highly contagious diseases—including norovirus—in health care settings. Two years later, the 

 stated that ABHR is “useless” against norovirus.

Lee-Ann Jaykus, PhD, a respected researcher and professor at North Carolina State University, definitively told 

 that hand sanitizers will not inactivate norovirus. Aron Hall, DVM, MSPH, Dipl ACVPM, the CDC’s Norovirus expert, told

 that ABHR is “ineffective against the virus” and that “soap and water can wash it away, but it takes really hot water to kill it.” This means the virus is not killed by warm water. Last year, senior 

 contributor Bruce Y. Lee quoted Hall: “Alcohol gels won’t kill the virus. Even if you were to use so much hand sanitizer on your hands that you felt like you were wearing hand sanitizer mittens, the live virus could still remain on your hands.” Further, while proper handwashing removes norovirus,

show most health care workers wash their hands properly less than 50% of the time.

Q. Since ABHR is ineffective against norovirus, what infection prevention protocols must health care facilities follow when a patient is discovered to have norovirus, and are there any complications with the protocol that must be considered?

 Any individual showing norovirus symptoms needs to be immediately isolated, and health care workers must switch from ABHR to hand washing with soap and water. Unfortunately, however, there are significant drawbacks to this protocol. For one, it is too little too late since by the time a patient is diagnosed with Norovirus, it has already spread to the entire ward and even the whole facility by staff still using ABHR. Further, handwashing does not kill the virus and only removes it if handwashing is done correctly. To kill the virus requires a water temperature of 140 

F (60 °C), which is far too hot for human hands. In addition, the absence of a nearby water source and time constraints can make handwashing between interactions difficult in a busy health care environment and lead to lower hand hygiene adherence.

Q. Does ABHR cause other health concerns directly related to the spread of norovirus?

 Yes. ABHR can dissolve the lipid level, 

 that protects the skin and causing dermal damage to hands and even eczema; the same is true of too much handwashing. This skin damage makes people more vulnerable to norovirus.

Q. How can ABHR misuse negatively impact health care hand hygiene adherence?

A. Dermal damage makes skin sensitive, so those with dermal issues wash their hands less frequently, linked to decreased

. In May 2023, the World Health Organization (WHO) conducted its 

 on hand hygiene in health care settings and found, “Average hand hygiene [adherence] without specific improvement interventions remains around 40%. In critical care areas, such as intensive care units, average [adherence] levels are around 60%.” These low scores have spawned a new industry that measures and reports on hand hygiene adherence.

Q. If ABHR is ineffective against norovirus and causes dermal damage to the skin, why do health care facilities and workers continue to use it?

 In many cases, even health care personnel do not understand the difference between enveloped and nonenveloped viruses. Add to this that the CDC, WHO, other respected health agencies, and powerful ABHR manufacturers have spent years and millions of dollars promoting ABHR. Understandably, this promotion skyrocketed during the COVID-19 pandemic, leaving many people convinced ABHR is the answer for preventing all types of viruses, although this is not the case. The only way to rectify this is to help spread the word that ABHR fights respiratory viruses but does 

 work against norovirus; ABHR encourages the spread of norovirus through a false sense of security and dermal damage that discourages proper hand hygiene.

Q. Are there any solutions other than thorough handwashing that can be used against norovirus?

. Yes. Hypochlorous acid (HOCl). The human immune system produces HOCI to kill invasive organisms and fight infection. White blood cells create HOCl in humans to defend against infection, bacteria, and general illness. It works by breaking down the cell walls of pathogens and killing them. Outside the body, HOCl is made using electrolysis to break down a simple saltwater solution.

 in the United Kingdom and Europe. US studies show that HOCl

 inactivates both enveloped and nonenveloped viruses

. HOCl contains no alcohol, benzalkonium chloride, hydrogen peroxide, or other chemicals. It is so safe that it is used in products such as wound care and eyecare formulas and is approved by the 

 as a nonrinse sanitizer for meat, poultry, fish, vegetables, and fruits.

Q. Are all HOCl products the same in terms of effectiveness against norovirus?

 No, not all HOCl-based products are equal. They differ in their percentage of HOCl and free available chlorine, shelf lives that can vary from days to years, and pH ranges from acidic to alkaline, making some inadvisable for use on the skin. In 

, Cleveland Clinic dermatologist Shilpi Khetarpal, MD, advised verifying that a product with HOCl is billed for skin care before use.

The best HOCl antimicrobial spray for hand hygiene use on the skin contains stabilized HOCl (S-HOCl). This stabilized formulation has all the attributes of HOCl plus additional benefits that make it exceptionally well-suited for hand hygiene.

S-HOCl is hypoallergenic with a neutral pH, making it safe for use on skin, a feature few HOCl solutions can match. The best S-HOCl formulas have a 2-year shelf life compared to HOCl’s average 30-day shelf life. It is also advisable to look for an S-HOCl hand hygiene spray that:

Has an antimicrobial designation that has a 510(k) registration

Is accepted by the National Eczema Association

Carries designations from other reputable organizations, verifying it is safe for use on skin.

I am a huge proponent of using ABHR to eliminate bacteria and enveloped viral pathogens, and our company still manufactures it for this reason. However, ABHR will not kill nonenveloped viruses like norovirus, no matter how much you use it. This puts health care staff, patients, and visitors at risk for norovirus every day.

It is time to adjust and adapt to improve hand hygiene protocol to best protect everyone at your health care facility. It’s time to exchange ABHR for an antimicrobial S-HOCI hand hygiene spray with efficacy against norovirus and all enveloped and nonenveloped viruses that will increase hand hygiene adherence.

Alcohol-based hand sanitizers do not protect against norovirus, a highly contagious virus. Effective alternatives like hypochlorous acid-based sanitizers are crucial for better infection control.


Alcohol-Based Hand Sanitizers Ineffective Against Norovirus: Effective Alternatives and Infection Control Strategies

, norovirus is spreading widely during this winter season, with nearly 100 outbreaks at the beginning of December 2024. What is norovirus, and how can individuals protect themselves? 

First identified by Albert Kapikian and colleagues in Norwalk, Ohio, in 1972, Norovirus continues to cause infections and disease outbreaks in the US over 50 years later.

 It is the most common cause of epidemic gastroenteritis, causing 19 to 21 million cases per year, and is responsible for 2.27 million outpatient visits, 465,000 emergency room trips, 109,000 hospitalizations, and 900 yearly deaths.

 The virus is particularly dangerous in children under 5 years, adults over 85, and immunocompromised people. These groups have a higher risk for severe disease and are responsible for most outpatient or emergency room visits.

Outbreak potential, transmission, and symptoms

Norovirus outbreaks are likely to become more common without definitive public health action such as a widely available vaccine. “People are traveling more, which facilitates the spread of the virus to new areas. Norovirus’ genetic diversity and rapid evolution can lead to the emergence of new strains that may cause more outbreaks. Climate change might also be playing a role in outbreak patterns and where outbreaks happen,” says Raj Dasgupta, MD, FACP, FCCP, FAASM, a board-certified physician in internal medicine, critical care, pulmonology, and sleep medicine and chief medical advisor at Sleep Advisor.

Norovirus has many nicknames, including stomach flu, gastric flu, winter vomiting virus, and the cruise ship virus. But it’s not related to the common flu caused by influenza viruses. There are several strains of the Norovirus, but they all belong to the 

 family, which consists of nonenveloped, positive-sense, single-stranded RNA viruses. They are highly contagious, and 10 viral particles can cause an infection. The primary way the virus spreads is through food-related transmission. Food contaminated by food service workers during preparation is a common source of infection. Outbreaks from eating contaminated fruits and vegetables, as are those from fish and oysters, are common. Person-to-person spread is also possible when droplets from infected people’s vomit or stools infect others. Contaminated surfaces are also part of its spread.

The virus mutates fast, and the CDC has said new strains are responsible for 50% more infections.

 “Norovirus is quite a shape-shifter,” said Dasgupta. This constant evolution means new strains pop up from time to time, which could affect how outbreaks happen and how effective preventive measures are,” he added.

Two people testing positive for the Norovirus is regarded as an outbreak. In the US, there are 2000 outbreaks yearly, most of which occur between November and April.2 Outbreaks have happened in several settings, including health facilities, cruise ships, military barracks, schools, care homes, and resorts. The incubation period for Norovirus is 12 to 48 hours, with 33 hours being the median. 

The most common symptoms are nausea, vomiting, and diarrhea. But people also report body pains, headaches, abdominal pain and cramping, and chills. Fever is a less common symptom that has also been reported. Symptoms last for 1 to 3 days and may resolve on their own. Immunocompromised people, those who recently received transplants, older adults, and neonates have a higher risk of fatal illness and need extra attention.

Prevention and control, trusted methods, and newer options

The mainstay of prevention is proper handwashing. Studies show that washing hands with soap and running water for 20 seconds is the most effective hand hygiene for eliminating the virus.

 Alcohol-based sanitizers are less effective. Though they can reduce the viral count on the hands, they are best used alongside proper handwashing.

Decontamination of surfaces also plays a vital role in infection control. During diarrhea and vomiting episodes, the virus is inadvertently sprayed into the air and on surfaces. Sinks, toilets, beds, chairs, counters, doors, faucet handles, and floors are all potential sources of infection. All potentially contaminated surfaces must be decontaminated, and any items that cannot be decontaminated must be discarded.

 The pathogen can survive on surfaces for 2 weeks. It can also survive freezing temperatures and warm water but dies when exposed to temperatures of 145 degrees Fahrenheit (62.7 degrees Celsius).

Norovirus, discovered in 1972, causes millions of gastroenteritis cases yearly. Learn prevention methods, symptoms, and updates on vaccine development.

Leigh Ann Kelly, BS, RN, CIC

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