Linda Spaulding, RN, CIC, BC, CHEC, CHOP, is an infection prevention consultant and founder of InCo and Associates International, Inc.

Linda Spaulding, RN, BC, CIC, CHEC, CHOP

In fall 2016, I was on my way to work at 8 AM on a Monday when my cell phone rang. It was the surgical department of a 350-bed acute care hospital in Texas where I served as an infection prevention (IP) consultant. They wanted to report that some instruments were used on a patient over the weekend even though the biological indicator failed.

To be of help in an operating room (OR) an IP must grasp 4 key concepts about biological indicators: what a biological indicator is (an indicator that goes into each pack of surgical instruments to determine that each instrument gets sterilized), where it is placed in the instrument pack (in the middle), how it is documented (in a freestanding notebook in the OR), and what to do with a patient who had surgery with potentially nonsterile instruments (notify the infection control department).

Luckily, I knew all these things because I have the experience of being a consultant and working for many hospitals. I reviewed the case, then set up a protocol to monitor the patient for possible infection.

Although that was resolved quickly, what happens if the scenario is more complicated, as it was for me in summer 2019? At 5 pm on a Friday, I received a call moments after I turned off my computer eager to start the weekend.

The surgery department of a 250-bed acute care hospital in Washington needed my help because they had experienced problems during the week with wet packs (packages or containers that hold surgical instruments that become moist after sterilization is completed). They were frustrated because they couldn’t figure out why.

I was told they had already reviewed all documentation showing that staff members followed policies and procedures. Because there was a record of staff who had signed off indicating that the sterilizer trap was cleaned twice a day, they didn’t suspect that was the problem. Meanwhile, they called the sterilizer company to come troubleshoot the issue. However, the staff wondered if there was something else they should do.

I thought about factors that could lead to wet packs and asked:

“Has the trap of the sterilizer been cleaned?” Their response: “Yes. We have staff documenting that it is cleaned and checked every morning.”

“Were the packs overloaded?” Their response: “No.”

“Is there a problem with the function of the sterilizer?” Their response: “The vendor is coming to check this.”

“Is there a problem with how packs are stored post sterilization?” Their response: “We don’t think so.”

I decided to go to the OR to verify and validate everything I had been told. I reviewed the department’s practices to see if I could determine the problem and work with the department to develop an action plan. I did a quick walk-through of the area to look for anything that might be causing the problem but found nothing. So I decided to look at the documentation for each sterilizer, paying close attention to the sterilizer for which the problem packs were processed.

The staff had documented that all Bowie-Dick, biological, and chemical indicators had passed inspection.

I thought, “What should I do next? Do I know what I’m looking for? Do I know the sterilizer in question needs to be put out of service until the issue is identified and corrected?” I felt pressure because having 1 sterilizer down might mean canceling some surgical procedures.

I scanned the checklist to ensure that the trap had been emptied at the beginning of the shift each day and that someone had signed the form verifying that the sterilizer trap had been cleaned every day per hospital policy. I asked the sterilizer technician to remove the trap. Inside I found a sticker that had a date of a week and a half earlier, which caused the wet packs.

Essentially, personnel were falsely documenting that they had cleaned the trap when it had not been cleaned appropriately for a few days. I told the staff that they must not only run their fingers through the trap to clean it but also look inside because a sticker that is stuck in the trap will not come out with a finger swipe. Management of the department took disciplinary action. (I do not know what that included.)

These 2 scenarios are examples of why IPs must verify and validate everything they are told. Many IPs have a misconception that the surgical suite is the cleanest and most sterile area in the hospital. Because of this, many IPs trust that everyone working in the OR knows what they are doing and often shy away from going into the OR because they do not have a comfort level in their knowledge of OR practices.

Many IPs spend most of their time on the computer developing policies and procedures, submitting data to the National Healthcare Safety Network, reviewing charts for patient infections, developing education programs, attending meetings, and putting out fires. This leaves little time to learn about infection prevention in the OR.

Yet there may be many issues related to infection prevention in the OR that staff in the area do not see. They have worked in the area for so long that their ability to identify incorrect practices decreases because what they see every day appears normal to them. For this reason, it is crucial that IPs make regular rounds in the surgical suite as well as perform direct observation of cases and observation of the cleaning, disinfection, and sterilization processing areas.

These actions can help IPs identify any practices or shortcuts staff are taking that may contribute to decreased patient safety.

For instance, a vendor for a particular instrument might accompany the surgeons in the OR to teach them about the instrument during the procedure. But earlier in the day, the IP saw the vendor walking in the hallway in the same scrubs now being worn in the OR. In addition, the IP can tell the scrubs aren’t hospital scrubs because they are a different color. Although the OR staff should have noticed, in the rush to get the case under way, they missed it. A fresh set of eyes can help identify issues that others may overlook.

Because IPs are familiar with areas such as biological and chemical indicator documentation, they should begin there. Ask staff to show how they document the indicators and where the records are kept. From there, see if there is documentation for every pack.

Next, expand upon that knowledge by studying what it means if there is a failed indicator. What is the proper action staff should take? As IPs make rounds, they should strike up a conversation with OR staff and have them explain what they would do if there is an indicator failure and then compare that response to the hospital policy. If there are discrepancies, talk with the manager and determine if there was a misunderstanding. This may also alert the manager that the staff could use a policy refresher. Working side by side with OR staff and learning the ropes will benefit the IP, putting another level of patient safety in place.

Another way for IPs to learn more about surgical cases and decontamination processes is to review the DNV Accreditation Standards and/or the Joint Commission accreditation standards.

The IP’s role is to be the verifier and validator of the OR and decontamination policies and procedures. Therefore, IPs need to observe practices in these areas to ensure all policies, procedures, standards, and guidelines are being followed. This can be accomplished through collaboration with OR managers and staff. The IP should also be a member of the surgical committee.

IPs should be notified of the following: failure of a Bowie-Dick test, problems with wet packs as indicated by biological or chemical indicators, or concern about unsterile instruments in the surgical suite and whether they were used on a patient. If any of these incidents occur, an IP can properly monitor a patient or group of patients for a surgical site infection.

The IP and surgical department need to catch near misses and put corrective action plans in place.

Infection prevention cannot be entirely learned in the OR, but continuing education will help IPs become experts in the surgical suite.

The many references that IPs should obtain include the following:

Association of periOperative Registered Nurses standards

Association for the Advancement of Medical Instrumentation standards⁴

Disinfection & Sterilization, a website maintained by William A. Rutala, PhD, MPH

 published by the International Association of Healthcare Central Service Materiel Management

Centers for Disease Control and Prevention standards for prevention of surgical site infections⁷

These references will provide IPs with a strong knowledge base, allowing a complete review of surgical suites and decontamination/sterilization areas to assist in preventing poor practices and increasing patient safety.

By understanding the information in these references, the IP will be able to verify and validate proper practices in these areas. IPs must remember that practices are as good as people are taught. Proper training is the responsibility of the facility and the IP, who should take advantage of all opportunities to improve their knowledge. 

LINDA SPAULDING, RN, CIC, BC, CHEC, CHOP, is an infection prevention consultant and founder of InCo and Associates International, Inc.

National Center for Immunization and Respiratory Diseases (NCIRD). CDC. Updated July 6, 2020. Accessed August 23,2021. https://www.cdc.gov/ncird/index.html

1918 pandemic (H1N1 virus). CDC. Updated March 20, 2019. Accessed August 24, 2021. https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html

Past pandemics. CDC August 10, 2018. Accessed August 20, 2021, 

https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html

2020-2021 flu season summary. CDC. Updated July 22, 2021. Accessed August 19, 2021. https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm

How the flu virus can change: “drift” and “shift.” CDC. Updated October 15, 2019. Accessed August 20, 2021. https://www.cdc.gov/flu/about/viruses/change.htm

Influenza vaccine for the 2021-2022 season. United States Food and Drug Administration. Updated September 2, 2021. Accessed August 19, 2021, https://www.fda.gov/vaccines-blood-biologics/lot-release/influenza-vaccine-2021-2022-season

Frequently asked influenza (flu) questions: 2021-2022 season. CDC. Updated September 1, 2021. Accessed August 23, 2021. https://cdc.gov/flu/season/faq-flu-season-2021-2022.htm

Articles

Many infection preventionists trust that everyone working in the operating room knows what they are doing and many times shy away from going into the OR. That's a mistake.

This Way to the OR, Infection Preventionists

I reached out to people in different disciplines, settings, and states. I wanted to know what lessons we’ve learned from the carnage caused by COVID-19 at various types of health care facilities, from acute care hospitals to long-term care facilities (LTCFs).

I had to do this because one thing that will haunt me and many health care personnel forever is that so many people died without a family member at their bedside.

So many families will suffer forever knowing that they were not with their mother, father, brother, sister, grandparent, or child when that loved one died. This is not right, and we need to do better.
We need to take this experience that we've had with COVID-19 and make sure we develop ways to prevent anyone from dying alone or with the only connection to family being an iPad or a cell phone on their pillow.
We are better than this.
Where there is discussion and empathy, there is a solution to never letting this happen again. So, I reached out.
I spoke to a member of a purchasing department (sometimes called supply chain). I spoke to an infection preventionist (IP) in a pediatric acute care facility.
I talked to the director of quality and infection control in Port Angeles, Washington, as well as an administrator from Palolo Chinese Home in Honolulu, Hawaii.
They shared their stories.



RHONDA BOWEN, CIC, CPPS, CPHQ, CPHRM
INFECTION PREVENTIONIST
Olympic Medical Center in Port Angeles, Washington


Bowen has 15 years of experience in quality, patient safety, and patient experience evidence-based practices and is proactive with risk assessments and process improvement for quality and infection prevention. She is a certified infection preventionist who takes patient safety to heart. I met Bowen a few years ago when she was preparing her hospital for its Certification in Infection Prevention (CIP). Bowen is the director of safety and infection prevention and control. Olympic Medical Center holds the designation of CIP. This is a certification designated for the top hospitals in the United States, which few had been able to obtain. The certification is bestowed by DNV GL Healthcare, an independent foundation based in Cincinnati, Ohio, that accredits acute care and critical access hospitals. I asked Bowen how the hospital certification better prepared Olympic Medical Center for this pandemic.
“I think we have done well during COVID-19 because of our ability to work together within our organization and with our community partners, such as our local and neighboring public health teams and health care providers/clinics,” Bowen said. “Because of CIP, infection prevention and control is solidly integrated throughout our organization. CIP keeps us continuously focused on improvement and all things infection control, from hand hygiene and personal protective equipment [PPE] to antimicrobial stewardship, emergency management, and cleaning and disinfection. Incident command/senior leadership has led the way and been able to rapidly deploy and obtain resources when and where needed. Strong communication efforts, including multiple forums, communication tools, and just-in-time training have been effective in sharing the constantly evolving information and processes to our staff and patients. I think the most important thing for IPs to focus on is communication and rounding. You are a partner in staff and patient safety—a conduit of knowledge and empowerment. Continue building relationships by taking time every day to talk with staff at all organizational levels. Listen to their questions, concerns, and ideas. Assess how you can share or clarify information such as the disease/issue (to the best of our current knowledge), transmission, precautions, and effective cleaning processes, or just reassurance that they are doing what they are doing exactly right and thank them. And finally, for future pandemics…a healthy stock of PPE and essential cleaning supplies!”



DARIN YOSHIMOTO
LONG-TERM CARE FACILITY ADMINISTRATOR,
PALOLO CHINESE HOME
Honolulu, Hawaii


Yoshimoto has worked in the health care industry for more than 15 years, holding various positions, such as director of rehabilitation, activity, social services, and now administrator at a long-term care facility (LTCF) for the past 8 years. Because of his varied experience, he has been able to guide Palolo Chinese Home through the COVID-19 crisis. He wanted to share his thoughts on what he has learned.
“Infection control practices are a vital part of nursing facilities’ operations and procedures. Having a solid infection control program and plan, consistent implementation, and daily practice for all types of infection concerns is instrumental in facilities being prepared for any sort of new pandemic or infection influx.
“At this time most infection dangers will likely fall into already known categories for risks of spreading and exposure. Having strong practices in place best prepares facilities from the start to protect all individuals, whether it is from known dangers or a new pandemic, while the world needs time to learn and understand the infectious dangers.
“In the end, with COVID-19, the mitigation and protection strategies are known, although some are more commonly in practice than others.
“As we learned more about the COVID-19 virus, it was a matter of putting multiple strategies in place to defend ourselves against this new threat. We understood and practiced contact precautions, droplet precautions, proper use of PPE, and hand hygiene.
“With COVID-19, and its highly infectious nature, we also learned the level to which we must adapt procedures and be flexible to quickly implement new strategies as more knowledge is gained of new pandemic issues. We needed to incorporate social distancing, stringent mask wearing at all times for both residents and staff, and screening strategies in addition to what we were already doing. As this pandemic spread, COVID-19 taught valuable lessons: (1) the importance of having a strong infection control program and practices, and (2) the effectiveness of practices when implemented properly and consistently.”



ANONYMOUS
MANAGER, PURCHASING/
SUPPLY CHAIN DEPARTMENT


She is a registered nurse by trade with over 22 years of experience and manages a purchasing department. She knows the importance of value analysis and how important things like PPE are for frontline workers.
“Promoting better communication to staff throughout the hospital when replacement items are being distributed because the product the staff is used to using is no longer available [was something we learned on the fly]. Communication is important if staff is seeing a different item. If health care workers are used to using particular products, they might feel uncomfortable if they think the replacement items are inferior. Keep staff in the loop that they can expect to see a replacement item until the item they are used to is back in stock.
“Creating backups to the backup [is important, and] having a centralized database on the [specifications] for PPE, hand sanitizers, disinfectant wipes. If the heath care facility has a database of like PPE, then when there is a shortage of products, supply chain can go to see what is on list 2. If list 2 supplies are not available, they can go to list 3, knowing that the quality of the product is the same, it is just going to come from a different vendor. Vetting companies and products ahead of time decreases stress during a pandemic. Hospitals could use their IP department to assist them in reviewing products in advance. With the list of PPE, the company name, contact person, and phone number, product review should be done annually to be sure the list is still accurate, the company is still in business, and the quality of their product has not changed. This could be done by sending a single spreadsheet to the vendors of all their products on your list and asking them if the products still meet standards and are still the quality hospitals prefer.”
“There is a need to reassess the number of airborne isolation rooms the hospital has and [whether there is] a way to rapidly change the ventilation to provide more negative pressure rooms if the need arises. Assess alternatives to N95 masks to increase the numbers and types of masks that will provide the same protection. And there is a need to formalize and clearly define what is considered an aerosol-
generating procedure.
“Infection preventionists need to be at the table when designing and constructing new departments and work environments so airborne infection isolation rooms can be designed to meet the needs of a facility. Infection preventionists should work with industry leaders to identify new and innovative strategies to make standard patient rooms negative pressure that can be easily employed and cost-effective. IPs should work with their purchasing department leaders to identify products on the market that offer the same level of protection as N95 respirators and lobby NIOSH [the National Institute for Occupational Safety and Health] if alternatives are not sufficient.”




If you had asked me 2 to 3 years ago how I think we would have handled a pandemic the magnitude of COVID-19, I would have said it would not go too smoothly.
I have never regretted being right so much.
I anticipated resistance from the general public because people who live in different regions of the country have different beliefs and thought patterns. Some are well-informed, and some are not. Some are followers; some are leaders. However, even in my worst-case imaginings, I would not have guessed it was going to be out of control for so many months.
For years, the federal government provided annual grants to hospitals and state agencies to prepare for any type of emergency, from a plane crash to bioterrorism to a pandemic.
Hospitals practiced drills annually and improved their emergency response plans. We knew who to contact for extra medical equipment. We had been told there were strategic stockpiles of PPE in various regions of the US that would be dispensed to hospitals if they needed it. The missing link was that in many regions of the country, LTCFs and assisted living communities (ALCs) were not included in the drills or in the funding for preparedness. These facilities were left on their own with no professional resources to help them develop a strong emergency preparedness program.
LTCFs and ALCs were set up to fail. Emergency managers in many states worked with acute care and neglected LTCFs. LTCFs were told, “Don’t worry, we will be here for you if something happens.” From my experience working with LTCFs—and I contract with more than 70 of them—this did not prove true when it mattered.
COVID-19 was transmitted among residents and staff of LTCFs, and patients were transferred from acute care hospitals to ill-prepared facilities because acute care ICUs were overwhelmed. LTCFs were not provided education or enough PPE, including N95 masks. Staff were not fit tested or taught how to use N95 masks properly. Staff in LTCFs never had N95 masks in the past because if there was a need for N95 masks that meant the resident had to be transferred to acute care.
They were on their own in many places across the country. Then COVID-19 happened and when they were told to use N95 masks, they couldn’t buy them because acute care was getting them, and they came last. It has been an epic failure on the part of federal, state, local, and facility emergency management programs.
So, as we move forward and out of the COVID-19 pandemic, emergency managers across the county will look at how to make improvements to their programs. Let us do it better next time. Let us take what we have learned and change how we provide health care, so we are better prepared for the next pandemic. Let us come up with ways to prevent people from dying alone. Let us be better prepared to stand on our own and not completely rely on federal, state, and local government. And better prepare all agencies that provide health care to focus on everyone’s preparedness, not just acute care facilities.

LINDA SPAULDING, RN, BC, CIC, CHEC, CHOP, is an infection prevention consultant and founder of InCo and Associates International.

One thing that will haunt me and many health care personnel in both acute care and LTCFs forever is that so many people died without a family member at their bedside.

Postcards From the Edge: Lessons Taught by COVID-19

Preventing surgical site infections has long been the goal of hospitals across the United States. Important components for preventing SSIs are:

Implementation of the US Centers for Disease Control and Prevention’s (CDC) 2017 updated guidelines for the prevention of SSIs.

Compliance with recommendations for proper prophylactic antimicrobial use for its efficacy against pathogens causing SSIs for specific procedures.

Self-monitoring of procedure and processes with the surgical suites.

Rounding by the hospital’s infection preventionist.

Following guidelines from credible organizations.

These are the key components to limiting or decreasing SSIs to 0 or as close to 0 as possible. This article will concentrate on surgical rounding by the hospital’s infection preventionist (IP). There are 4 key areas that the IP should focus on: the environment throughout the surgical 

suites, the surgical attire of staff, decontamination and the sterilization processes. New IPs can use this checklist to perform IP rounds in the surgical suite, decontamination areas, and sterile processing area. Included with each question is a rationale that can be used as training for the new IP.Developing well-run, infection-free surgery and post-surgical practices is important in today’s market of reimbursement that rewards good performance.

SSI rates are one of the key safety measures tied to value-based purchasing programs as well as the Afford- able Care Act Hospital Readmissions Reduction Program, in which the Centers for Medicare and Medicaid Services (CMS) will penalize hospitals for readmissions in some situations. To be successful, there must be a multidisciplinary effort that includes the surgical team, decontamination and sterile processing, infection prevention techniques, and training as to the post-op care of the patient and surgical site, as well as environmental services and plant operations.

The provided checklist is only a small sample of items that beginner IPs can utilize when making rounds in the OR, decontamination, and sterilization areas.

It is important for IPs to continue their education around this topic so they can continuously improve on their skills in identifying issues within the OR, decontamination, and sterile processing areas to ensure safety for patients. To learn more, a good resource is the 

1 published by the Inter- national Association of Healthcare Central Service Materiel Management (IAHCSMM) (page numbers in the tables refer to the manual).

Patel SN, Murray-Leonard J, Wilson AP. Laundering of hospital staff uniforms at home. 

Munk S, Johansen C, Stahnke LH, Adler-Nissen J. Microbial survival and odor in laundry. 

Nordstrom JM, Reynolds KA, Gerba CP. Comparison of bacteria on new, disposable, laundered, and unlaundered hospital scrubs. 

New infection preventionists can use this checklist to perform IP rounds in the surgical suite, decontamination areas, and sterile processing area.

Checklists for Infection Preventionists Working in ORs 

Even today, as of this writing and very likely as of your reading, many healthcare facilities in the United States—whether acute care, assisted living, or long-term care—are not equipped to handle a surge in coronavirus disease 2019 (COVID-19) cases, even though the world has wrestled with this history-altering pandemic since last year, and even though systemic problems should be fixed by now, but are not.

Some facilities continue to refine policies, procedures, and protocols for COVID-19. In some instances, healthcare is not succeeding with staff social distancing and proper use of personal protective equipment (PPE) (note: fabric and cloth masks ARE NOT considered PPE and should not be used within a healthcare setting) and proper cleaning of 

. There is still a lack of testing for COVID-19 as well as a lack of PPE and hand sanitizer—the basic items needed to protect healthcare workers and patients.

And just when many healthcare facilities thought it couldn’t get any worse, here comes influenza. Flu season on top of COVID-19 will make many hospitals and other healthcare facilities feel as if they’ve been caught in a whirlwind.

No one can really predict what is going to happen, but take heart, because seasoned infection preventionists (IPs) will be ready to accept and take on the challenge of the flu/COVID season. Novice IPs should use all the resources available to them to help them develop strong infection prevention and control programs within their facilities. Seasoned and novice IPs should reach out to websites such as:

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

These organizations will keep IPs up to date on what is happening across the United States and the world so IPs can adjust practices as needed in their facilities.

The wearing of masks and face shields or goggles have become part of healthcare workers’ uniforms. The responsibility of IPs and management continues to be reminding 

 disciplines within the healthcare facility to wear their PPE appropriately and to social distance. All disciplines must work as a cohesive group to remind and protect each other. If you see something, say something. Let coworkers know when they may have breached infection control practices such as forgetting to wash their hands, not wearing PPE properly, or missed opportunities to clean high-touch surfaces. Whether dealing with influenza or COVID-19, practices are the same. The only difference is that COVID-19 is more 

infectious and transmittable and more deadly

As of August 15, the United States has seen a total of 5,285,546 cases of COVID-19, with 167,546 deaths. Data have been collected for 3,924,574 people, but healthcare personnel status was only available for 879,436 (22.4%) individuals. For the 134,397 cases of COVID-19 among healthcare personnel, death status was only available for 93,236 (69.4%). Among the data available for healthcare workers, there have been 

The 2019-2020 US flu season data reported on April 17, 2020, showed that the number of flu illnesses reported were between 39,000,000 and 56,000,000, with between 24,000 and 62,000 flu deaths occurring from October 1, 2019, to 

. This was a total of 7 months. When deaths from influenza are compared with deaths from COVID-19, there have been fewer cases of COVID-19 than influenza, but there have been more than double the number of deaths from COVID-19 than from influenza.

So, what do we know for sure about influenza and COVID-19?

Key to balancing safety and success during influenza season in the middle of a global pandemic:

Educate staff and management about new information that is published by professional organizations and associations. We cannot anticipate what will happen if patients are co-infected with influenza and COVID-19. Monitor reputable sites for guidance.

Utilize other IPs in other facilities for advice if an unusual situation arises.

Utilize local department of health epidemiology branch.

Rounding in all patient care areas and monitor use of PPE/hand hygiene and surface cleaning and disinfecting.

Encourage the buddy system for donning and doffing of PPE.

Hold listening sessions with staff and management to let them express what they see as needs or problems.

Monitoring staff and visitors for symptoms of influenza/COVID-19.

Contract tracing once COVID-19 is identified is a must for COVID-19. US Centers for Disease Control and Prevention (CDC) has good online contact tracing education.

Vaccination to protect against influenza is extremely important. And when the flu is here, there are also a lot of other respiratory viruses circulating. It’s not just influenza A and influenza B that’re seen during flu season. Healthcare professionals only test for the virus that they suspect is going to cause the most deaths for that year. That’s how the government decides what the flu vaccine is going to be. There is still respiratory syncytial virus (RSV) among young kids, and even the elderly.

Infection control personnel really have to monitor closely all respiratory viruses that are out there and be sure to work with management to put in place whatever needs to be put in place. Communicate well with the nursing staff and communicate well with all departments because if environmental services teams see nurses wearing a particular PPE, but they’re not being given it to wear, they’re going to be scared and wondering “why do they get better protection than me?”

IPs need to have all lines of communication open and really work hard at it. This can get very complicated.

LINDA SPAULDING, RN, CIC, BC, CHEC, CHOP, is an infection prevention consultant and founder of InCo and Associates International.

If you see something, say something. Let coworkers know when they may have breached infection control practices such as forgetting to wash their hands, not wearing PPE properly, or missed opportunities to clean a high-touch surfaces.

Linda Spaulding, RN, BC, CIC, CHEC, CHOP

Articles

This Way to the OR, Infection Preventionists

Postcards From the Edge: Lessons Taught by COVID-19

Checklists for Infection Preventionists Working in ORs

Infection Preventionist Guide for Dealing With Flu and COVID-19