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

 runs from March 13 to March 19 this year, but infection preventionists (IPs) keep patient safety in mind all year round. Andrea Blyth-Cheggour, BSN, RN, CIC, is the director of infection prevention at Tallahassee Memorial Hospital. “One of my main duties in keeping patients safe is performing regular hand hygiene observations,” she tells 

). “Our IP team converses with all nursing units daily to ensure any required transmission-based precautions are in place as well as answer any questions or concerns.”

While they do regular rounds, Blyth-Cheggour says IPs also audit all indwelling devices, such as catheters and central lines, and IPs will also advocate for early removal of the lines to avoid infection. “I’m a member of a patient safety committee, which meets bimonthly bringing various service line leaders around the table to show how we’re keeping our patients safe,” Blyth-Cheggour says.

IPs know they are doing their job when they walk into a unit and hear, “Oh no, here she/he comes again.” Every IP knows this means the staff know who they are and that they are looking for flaws in infection prevention practices.

The backgrounds for the majority of individuals who practice as IPs are as follows: 

Source: Linda Spaulding, RN-BC, CIC, CHEC, CHOP

The data were collected from a 2017 mega-survey by the Association for Professionals in Infection Control and Epidemiology (APIC). A study in the 

, an APIC publication, says 4079 of 13,050 active APIC members (31%) participated in the survey.

According to the data, the primary job activity for IPs with a nursing background (97.9%; n = 2434) is preventing and controlling the transmission of infectious agents or health care–associated infections. For IPs who previously worked as laboratory scientists (97.5%; n = 307), it is the interpretation of surveillance data. For IPs with a public health background (96.1%; n = 136), the main duties include management and communication, ie, 

These numbers are due for an update because so many changes have occurred in the infection prevention and control profession since 2017. But it is believed the majority of IPs are still nurses.

IPs play multiple roles, including the following: 

The ability to be an excellent IP requires lifelong learning and taking the initiative to grow professionally. IPs must have the ability to think quickly on their feet and adjust to an ever-changing environment of new resistant organisms, epidemics, pandemics, antibiotic shortages, and never-ending regulations from the Centers for Medicare & Medicaid Services (CMS), accreditation bodies such as DNV Healthcare or the Joint Commission, and the Occupational Safety and Health Administration (OSHA).

“Infection preventionists form the backbone of risk mitigation efforts around the country, but because their goal is to prevent something from happening, it’s harder to see what they do,” APIC’s 2020 president Connie Steed, MSN, RN, CIC, FAPIC, said in an APIC news release in September 2020. “COVID-19 has shown the world how crucial IPs are in keeping our 

The IP role involves not only patient safety, but also employee safety, and that includes educating hesitant health care workers about the safety and efficacy of the COVID-19 vaccines.

“COVID-19 has also shown most of the world the importance of vaccination,” says Blyth-Cheggour. “In my view, making COVID-19 vaccines mandatory (with minimal exceptions) is the only way to ensure patient and colleague safety. Health care workers need to trust the science showing these vaccines are effective in preventing the spread of COVID-19. Many vaccinations (hepatitis B, MMR, varicella, annual influenza) or proof of immunity are required for employment at many facilities so what is wrong with one more?”

IPs need to earn the trust and respect of all hospital stakeholders from the C-suite to the environmental service (EVS) workers and everyone in between, including the general public.

IPs also play a large role in education, from an IP’s the first day on the job with new hire orientation, to an IP’s last day on the job. IPs work in hospitals, ambulatory care centers, dental offices, surgical centers, urgent care centers, clinics, physician offices, home health care, nursing homes, assisted living facilities, restaurants, corporations, cruise ships, and even movie sets.

They must stay current on all the changes related to the area they are working or consulting in. Their schedule can range from 4 hours a day to 24/7. IPs do their job because they believe no one should acquire an infection regardless of where they are cared for.

Connie Henry, BSN, RNC, has been a nurse for 35 years, working in the areas of obstetrics, neonatal care, and infection prevention and control. “As an IP, I make rounds on my designated areas to act as a resource for clinical staff and to re-enforce hand hygiene,” she tells 

®. “I attend the patient safety, quality, and reliability council meetings to be the IP liaison for the different projects. I am also a member of the [the quality assurance and patient improvement] community for rehab and home health.”

The COVID-19 pandemic has strengthened the ability of the IP to keep everyone—patients, visitors, staff, and vendors—safe as they enter health care facilities around the world.

What falls under an IP’s purview can include the following:

cleaning of equipment between patient use;

monitoring for the presence of multidrug-resistant organisms-

policy changes to mitigate risk of infection;

which patients need isolation and when they can be removed from isolation;

monitoring processes in all departments from the C-suite to EVS;

how vendor products are stored before delivery and how to reprocess them after delivery;

reviewing loaner instruments or equipment;

monitoring construction to prevent the spread of infectious diseases;

how sterile supplies are processed and stored;

what to do if sterile parameters are not met or if non-sterile instruments are used on a surgical case; and

monitoring how outside laundry companies process health care laundry. Does the contractor laundry service use the correct water temperatures and appropriate detergent? Is linen stored and transported to the facility in the proper way to prevent contamination in transport?

This list can go on depending on the area of the IP’s expertise.

, patients and health care workers might want to pause and thank an IP for the work he or she is doing. Let them know how important their jobs are and that society in general is aware of the mental and physical strain that COVID-19 pandemic has posed.

For IPs, it’s just part of the job description: keeping patients and health care professionals safe.

Articles

The ability to be an excellent infection preventionist requires lifelong learning and taking the initiative to grow professionally.

Despite Little Interaction With Patients, IPs Play Huge Role in Keeping Them Safe

Last week the Centers for Disease Control and Prevention (CDC) changed the 

, shortening the recommended isolation time for health care workers exposed to COVID-19 in high-risk situations from 10 to 7 days.

It’s not a surprise that the CDC came out with this new guidance. I would have been surprised if it didn’t. Health care workers, like the general public, who are asymptomatic after 7 days are probably not going to spread the virus to others, at least according to the what we currently know. The CDC constantly gets new data and adjusts its guidance accordingly.

That is why many people in the general public are upset; the recommendations change frequently. The public needs to understand that the CDC does not know anything about new variants, such as Omicron, until 

. That can take weeks to months. The CDC wants to be sure it gets it as right as possible.

The public just wants to know everything NOW. That will never happen. Currently, and in the coming days, people are going to be amazed at how many COVID-19 cases there are and they are going to blame the scientists, medical experts, and the CDC.

There are 2 reasons and 2 reasons alone we are still dealing with COVID-19.

First and most importantly is the great number of UNVACCINATED around the world. Our issue in the US is the UNVACCINATED. The unvaccinated are incubators of the virus and that improves COVID-19’s ability to mutate and cause more variants.

The second issue is so many countries still do not have access to the vaccine. That has to change. And all of this is on the backs of the medical professionals who are trying to keep people alive and the message that the unvaccinated are giving them is “we don’t care if nurses, doctors, and first responders die, just take care of us when we get sick and save our lives.”

The people who are vaccinated and boosted are so appreciated. And they will probably live if they get a breakthrough case. But in the meantime, many health care workers are getting death threats from the unvaccinated, which is ridiculous. I was at a store with a friend yesterday and we were doubled masked because most people did not have on a mask in a county that has the highest level of cases right now.

We were laughed at and made fun of. We will be here after the holidays. How many of them will be sick? Many health care workers are 

. But we have taken oaths to protect and do no harm hence we will continue to try to keep people alive who threaten and laugh at us.

Many health care workers are just tired and fed up. But we have taken oaths to protect and do no harm hence we will continue to try to keep people alive who threaten and laugh at us.

Viewpoint: Unvaccinated ‘Thank’ Health Care Workers with Mockery, Death Threats

For over a year and a half, health care workers have been very verbal that they are on the brink of collapse. I don’t know why people aren’t listening. Everyone is ignoring the 

 that not every health care worker can take care of COVID-19 patients.

They have to have specific training in intensive care. There are not that many nurses with that training because hospitals have always run lean on staff and relied on staff picking up overtime to cover sick calls and vacations. There is no one left to cover sick calls and vacations now. There are no vacations for nurses and doctors. There are no Christmas celebrations or New Year celebrations for these workers.

While the general public go about their daily lives with no mask and those who are not vaccinated, they are telling each and every one of those nurses and doctors: “We don’t know you. We don’t care about you. Just be there to care for me when I get COVID-19 so I don’t die. And if I die, I don’t care if you got COVID-19 from me and die because I don’t know you, so I don’t care if you die.”

This is the message being sent to health care workers. States are calling out the national guard again including states that have never done that in the past. They will not have a Christmas or New Years this year again. But families will gather and celebrate, and many will visit these health care workers after these celebrations. Many people will die from heart attacks and strokes after the holidays because there are no health care workers to care for them when they go to the hospital with no hospital beds because they are taken up by COVID-19 patients.

Many cancer patients will die because there is no one to give them their cancer treatment. Small children will die because their parents did not protect them from getting COVID-19 or 

 because they just wanted to go out among people they don’t know who have COVID-19 and their babies got infected.

People need to realize that health care workers are not omnipotent. They are human and mistakes will happen when someone hasn’t slept for days on end and has been pushed to their limit daily. The health care system can collapse. And I’m not sure that would even make people get vaccinated, stay home, and wear masks.

There are too many who are self-centered. “I don’t watch the news people. I don’t want to hear the bad news. I don’t believe anything in the news reports. I just want to do what I want to do when I want to do it.”

I feel disaster coming our way. I think we are about to experience something that will knock the breath out of people very soon. It will be up to the public when enough is enough and if it doesn't happen soon this virus will kill so many more people that it will put fear in people.

There is no one left to cover sick calls and vacations now. There are no vacations for nurses and doctors. There are no Christmas celebrations or New Year celebrations for these workers.

Viewpoint: Health Care System on Verge of Collapse

The public needs to pay attention to what is happening with COVID-19. So many people have said “COVID is almost over. We can return to life as it used to be.” Nothing could be further from the truth. The way I see it we are still in the middle of potentially the worse pandemic in history. We see large numbers of the Delta variant and now Omicron is on Delta’s heels. It’s likely we may see two highly contagious COVID-19 variants hitting and spreading rapidly at the same time.

It does not appear the unvaccinated are going to change their minds at this point and the vaccinated think they don’t need, or they don’t want, to wear masks and social distance anymore. This is verified by the number of people in public without a mask on just pretending nothing is going on.

Numbers of COVID-19 cases and deaths continue to rise. We have high numbers of cases of COVID-19 currently in some states and now Omicron is positioned to maybe double the numbers. Just how high of a COVID-19 rate can we get before the health care system crashes? I believe that we will end up with over 1 million individuals dying of COVID-19 and that is very sad.

The only thing infection preventionists can do at this point is keep the hospital decision makers up to date daily on what variant is being seen in their area and how fast it is growing. I predict that soon after Christmas we may see percentage rates of COVID-19 go up to 20% or greater in many states.

People are gathering for the holidays this year acting like COVID-19 is gone. It’s sad that so many people have to experience having COVID-19, but I’ve witnessed even after having COVID-19 and being very sick that people still do not protect themselves against getting COVID-19 a second time.

I don’t think we will ever have an answer as to why this is and hence COVID-19 will continue, and the incubators (people who get COVID-19) will continue to create variants until many more die. I don’t think we are close to ridding COVID-19 from our midst. I think we are almost halfway through the pandemic.

I predict this will be the longest pandemic in history driven by people who just don’t want to understand or don’t want to know what is happening.

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

The only thing infection preventionists can do at this point is keep the hospital decision makers up to date daily on what variant is being seen in their area and how fast it is growing.

Viewpoint: We’re Not Even Halfway Through the COVID-19 Pandemic

COVID-19 rocked the world of health care so much that the system turned not only to the government but also to private industry for help. Many businesses wanted to contribute in some way with the cleaning and disinfecting of products, masks, and other personal protective equipment (PPE). Bars started making hand sanitizers when there was a shortage. Oil companies in Texas supplied barrels of hand sanitizer to rural critical access hospitals, which could have harmed health care workers. Storing 50 gallons of hand sanitizer in a hallway rather than in a fire-rated cabinet could cause it to explode under certain conditions because of the amount of alcohol it contains. It is unclear whether hospitals were checking the ingredients of the hand sanitizer that had been donated to them. As months went by, the US Food and Drug Administration (FDA) banned some hand sanitizers because they contained toxic chemicals, such as methanol/1-propanol, or because the alcohol level was found to be too low to be effective.

However, the overarching question remains: How does a hospital, nursing home, or surgical center decide what infection prevention products they need to invest in to improve or maintain patient safety? More products than ever are being promoted as a way to decrease infection rates within health care settings since the arrival of COVID-19. Some products have been approved under the FDA’s Emergency Use Authorization (EUA). Under an EUA, “the FDA allows the use of unapproved medical products or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.”

On April 11, 2020, the FDA issued an EUA for decontaminating compatible N95 or N95-equivalent respirators using Advanced Sterilization Products STERRAD Sterilization Systems, enabling health care facilities to conserve their supply of respirators during the COVID-19 pandemic.

 This EUA came with specific instructions on how masks were to be handled. There was only 1 company that was paid $400 million to offer their services to hospitals. It is yet to be determined whether this process posed any harm to health care workers.

 The outstanding question is: Will the reprocessing of N95 masks receive full FDA approval post COVID-19?

The contact tracing of thousands to millions of people throughout the country went from a discussion to a reality almost overnight. No one, except the Centers for Disease Control and Prevention, had experience in contact tracing millions of people. Health care systems scrambled to develop a system to contract trace employees who developed a COVID-19 infection and who may have exposed patients or other coworkers. The number of patients in the emergency department waiting for an intensive care unit (ICU) bed were tracked daily. Many contact tracing companies appeared on the market.

Many hospital infection preventionists (IPs) and employee health or human resource departments utilized Microsoft Excel to track all health care exposures as well as patient and family member exposures. This is a very inefficient use of time. This is an area that IT departments should assess post COVID-19 to develop or purchase a system that will help IPs collect and analyze data during an outbreak or pandemic. This should become part of emergency preparedness programs. Look at technology for improving infection prevention programs and patient safety that hospitals can vet and implement when COVID-19 recedes. Products that can clean the air in buildings, protect staff, and improve cleaning and maintenance of medical equipment and the environment.

One such product is a real-time tracking system for medical equipment. Real-time tracking systems can alert staff when they are using equipment that has not been cleaned prior to another use. It will give the department responsible for cleaning this equipment information related to where dirty equipment is located, giving them the ability to retrieve the dirty equipment and clean it. Technology leverages the ability to track equipment, monitor availability of equipment, hand hygiene adherence, contact tracing, and environmental cleaning techniques. Currently, with the pandemic, the health care industry has had to deal with an exponential demand for resources, overcrowding, and increased lack of good quality PPE, as well as a lack of ventilators and extracorporeal membrane oxygenation machines. Having a real-time tracking system would enable facilities to locate available equipment, noting whether the equipment is being used in a quarantine room and where the equipment has been. It will give facilities the ability to determine if the equipment needs to be cleaned at the point of use or changed out for anything from filter changes to other internal parts that need to be cleaned or sterilized to maintain their safety. Real-time tracking helps to optimize resources by creating a more streamlined workflow during a time of massive stress and usage of critical equipment.

Environmental monitoring is crucial. Monitoring and recording temperatures, humidity, and air pressure needs to be done in patient rooms, surgical suites, and sterile processing areas. During the pandemic, many clinics or areas of facilities that closed could have benefited from the ability to monitor temperatures and environmental conditions that fell outside of safe ranges.

Real-time monitoring alerts staff that immediate action is necessary. Clinics that closed during the pandemic that did not have alert systems found themselves spending thousands of dollars remodeling and disposing or reprocessing patient care products because temperature and humidity levels were not maintained during closure, which led to mold growth. Things like proper storage of vaccines and lab specimens need to be continuously recorded and tracked remotely to reduce the likelihood of decreasing patient and employee safety.

 This is an investment health care professionals have talked about for years, but now we see this is necessary for the future of quality health care to survive.

The ViSi mobile system is a newer system that has been available for some time but has received more publicity in light of COVID-19. For years, patient monitoring was done by Episodic Vital Sign Collection, which, unlike Continuous Vital Sign Monitoring (cVSM), cannot provide a continuous comprehensive view of a patient’s physiologic status, which prevents early intervention when a patient is deteriorating. Systems like ViSi Mobil give clinicians a constant stream of data to help identify early signs of deterioration, which could help prevent adverse events. These systems monitor SpO2, respiratory rate, heart rate, skin temperature, and continuous noninvasive blood pressure readings for ambulatory patients. Up to 75% of adverse events and preventable deaths occur outside of the ICU, where cVSM is not currently used.

These systems empower clinicians to detect early signs of deterioration in virtually all care settings, saving lives and decreasing the need for rapid response calls. A study review of 849 patients in a 32-bed orthopedic, orthopedic-spine, and trauma general care unit showed that, by using the ViSi mobile system, there was a significant reduction in risk of developing complications, fewer transfers to the ICU, and increased adherence using the system by staff.

Studies have also shown there has been a reduction in nonactionable alarms decreasing alarm fatigue, but there was a nonsignificant reduction in ICU transfers and unplanned deaths.

 If these systems were implemented in health care prior to COVID-19, it would have eased the burden of short staffing in non-ICU patient care areas during the pandemic. In non–COVID-19 times, this system may decrease the need for high-cost monitoring systems in the ICU for some patients. The benefit of this kind of technology is staff do not have to enter the patient isolation room to know what the patient’s vital signs are, thereby saving time and resources, which saves money. Health care would benefit from this type of monitoring system should the country see the rise of a COVID-19 variant that is resistant to the current COVID-19 vaccines. These systems could decrease the times health care workers would have to enter a patient isolation room, which would decrease their exposure to the COVID-19 variant but still provide safe patient care when used correctly.

Ultraviolet C (UVC) radiation is a known disinfectant for air, water, and nonporous surfaces. UVC radiation has effectively been used for decades to reduce the spread of bacteria, such as tuberculosis. For this reason, UVC lamps are often called “germicidal” lamps. UVC radiation has been shown to destroy the outer protein coating of SARS-CoV, which is a different virus from the current SARS-CoV-2. The destruction ultimately leads to inactivation of the virus. UVC radiation may also be effective in inactivating SARS-CoV-2. However, there are limited published data about the wavelength, dose, and duration of UVC radiation required to inactivate SARS-CoV-2. In addition to understanding whether UVC radiation is effective at inactivating a particular virus, there are also limitations to how effective UVC radiation can be at inactivating viruses in general.

UVC radiation can only deactivate a virus if the virus is directly exposed to the radiation. Therefore, the deactivation of viruses on surfaces may not be effective because of blocking of the UV radiation by soil, such as dust, or other contaminants, such as bodily fluids.

Many of the UVC lamps sold for home use are of low dose, so it may take longer exposure to a given surface area to potentially provide effective inactivation of a bacteria or virus. UVC radiation is commonly used inside air ducts to disinfect the air. This is the safest way to employ UVC radiation because direct UVC exposure to human skin or eyes may cause injuries, and installation of UVC within an air duct is less likely to cause exposure to skin and eyes.

Another technology to keep an eye on is antimicrobial scrubs. Currently, there are 2 types on the market. They include antimicrobial fabric and silver-impregnated fabric. Many health care workers are not aware of these new technologies that can provide extra protection.

With the many increases in multidrug-resistant bacteria and viruses, medical personnel can now add an extra protection to their workday. With the addition to the market of Vestex antimicrobial material and X-static silver technology, workers now have options.

Vestex makes antimicrobial scrubs that have been reviewed, assessed, and given a 510K number by the FDA, meaning they are considered a medical device and are safe for use by health care workers. Not only are the scrubs antimicrobial, but they are also fluid resistant and stain resistant, which meets the Occupational Safety and Health Administration regulations for PPE. The FDA is currently reviewing data about whether these scrubs can kill SARS-CoV-2, so health care workers have a decreased chance of taking bacteria and viruses home every day.

These scrubs have proven to reduce 99.99% of methicillin-resistant 

(MRSA) when compared with nonantimicrobial scrubs.

 This material is also used for scrub jackets, lab coats, and T-shirts. Gone are the days of taking scrubs off and throwing them in the trash before entering your home.

Vetting new technology and products is a complicated endeavor that takes hours if not weeks before a decision can be made as to whether to bring products into a health care facility. The COVID-19 pandemic did not give health care the luxury of time. This must be built into any future emergency preparedness programs. Better yet, hospitals and other health care facilities should install robust purchasing and infection prevention departments, so health care professionals will know what they’re using is not only safe, but there are also backups that have been vetted. Staying up-to-date on new technology—whether you invest in it now or not—is important.

FDA hand sanitizer recall list 2021.FDA. Accessed October 25, 2021. 

Emergency use authorization for vaccines explained. FDA. November 20, 2020. Accessed October 26, 2021. 

https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained

Use the correct cycle and compatible N95 respirators when decontaminating respirators with STERRAD sterilization systems – letter to health care providers. FDA. June 30, 2021. Accessed October 26, 2021. 

https://www.fda.gov/medical-devices/letters-health-care-providers/use-correct-cycle-and-compatible-n95-respirators-when-decontaminating-respirators-sterrad

Hohman M, Dunn L, Nguyen V. ‘It’s dangerous’: is the decontamination of N95 masks hurting health care workers? Today. December 5, 2020. Accessed October 26, 2021. 

https://www.today.com/health/ppe-shortages-does-decontaminating-n95-masks-actually-work-t197417

Contact tracing software. Sourceforge. Accessed October 26,2021. 

https://sourceforge.net/software/contact-tracing/

Thompson, C. Technology applications for infection control. Healthcare Facilities Today. April 30, 2020. Accessed October 26, 2021. 

https://www.healthcarefacilitiestoday.com/posts/Technology-applications-for-infection-control--24210

Conferences. Institute for Healthcare Improvement. Accessed October 26, 2021. 

http://www.ihi.org/education/conferences/APACForum2012/Documents/12_Presentation_Diagnostics_Haraden.pdf

Brown H, Terrence J, Vasquez P, Bates DW, Zimlichman E. Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial. 

. 2014;127(3):226-232. doi:10.1016/j.amjmed.2013.12.004

UV lights and lamps: ultraviolet-c radiation, disinfection, and coronavirus. FDA. February 1, 2021. Accessed October 26, 2021. 

https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/uv-lights-and-lamps-ultraviolet-c-radiation-disinfection-and-coronavirus

Bearman GM, Rosato A, Elam K,. et al. A crossover trial of antimicrobial scrubs to reduce methicillin-resistant Staphylococcus aureus burden on healthcare worker apparel. 

Vetting new technology and products is a complicated endeavor that takes hours if not weeks before a decision can be made as to whether to bring products into a health care facility. The COVID-19 pandemic did not give health care the luxury of time.

Necessity Made COVID-19 the Mother of Inventions

The vaccine protects those who don’t have major underlying health conditions such as diabetes, cancer, and autoimmune diseases. Nonetheless, the season of respiratory tract infections is upon us. Influenza, rhinovirus, respiratory syncytial virus, and pertussis—as well as COVID-19—have begun to attack many individuals across not only the United States but also the entire world. We saw this coming. With the decrease in mask mandates this year, we should not be surprised by an increase in respiratory tract infections, including COVID-19 and influenza, both of which can cause an increase in hospitalization and death.

There are environmental factors at play, from the red tide in Florida to wildfires and poor air quality across the state of California. Many areas throughout the country are dealing with higher-than-normal temperatures. In the coming influenza season, the questions to be answered are whether people will get vaccinated against influenza and whether the heated debates over COVID-19 vaccinations (to mandate or not mandate) will drive more individuals to get their influenza vaccine this year.

When historians talk about the history of influenza, they inevitably bring up the Spanish flu of 1918, which infected approximately 500 million people around the world and killed an estimated 50 million.

 But influenza actually goes back to the ancient Greeks, to the time of Hippocrates in the fifth century BC. Influenza has been around, so to speak, for 2500 years, at least.

Although the illness can strike at any time of year, the typical flu season usually starts in September or October with a peak between December and February. Once an individual has been infected with the virus, viral shedding begins within 24 to 48 hours, and it usually takes about 24 hours before symptoms begin. These can include fever or feeling feverish; a stuffy or runny nose; cough; muscle and body aches; headache; fatigue; and vomiting and diarrhea, which are more typical in children than in adults. Influenza can range from asymptomatic to severe illness. Symptoms of COVID-19 can be similar but take longer after exposure to manifest, usually between 2 and 14 days but typically by day 5.

Each year, state and local health department laboratories submit data to the Centers for Disease Control and Prevention (CDC) about the present year’s influenza cases. The CDC performs genetic and antigenic characterization based on that information. They use these data to compare how similar they are to the current virus in order to target strains in the current vaccine.

There was unusually low influenza activity throughout the 2020-2021 flu season, not only in the United States but also globally. US reports indicated that 1675 (0.2%) of the 818,939 respiratory specimens submitted for testing were positive for an influenza virus. This low level of activity decreased hospitalizations and death compared with previous flu seasons. The number of influenza-associated hospitalizations was the lowest recorded since these data were first collected in 2005. The CDC received 1 report of a pediatric flu death in the 2020-2021 season. The CDC states that “since flu deaths in children became nationally notifiable in 2004, reported flu deaths in children had previously ranged from a low of 37 (during 2011-2012) to a high of 199 (during 2019-2020).” Influenza vaccination also contributed to keeping cases lower, as a record 193.8 million doses of vaccine were administered during 2020-2021.

Influenza viruses constantly change, so vaccines must change annually to keep people safe and protect them from life-threatening symptoms. During the past flu season (2020-2021), the dominant viruses reported were influenza A (61.4%) and influenza B (38.6%). Most cases of influenza A were of the H3N2 strain, which comprised 52.5% of cases. Sixty percent of cases of the influenza B virus were of the Victoria lineage— B/Victoria/2/87—1 of the 2 major hemagglutinin (HA) lineages of influenza B virus. The other is the Yamagata lineage (B/Yamagata/16/88).

There were also 5 cases of influenza reported that spreads in pigs and not people. This is known as a variant influenza virus. Those infected reported that they had had direct exposure to pigs or lived on a property where pigs were housed. There was no person-to-person spread of this variant influenza. These types of influenza variants are rare. Since 2005, a total of 489 variant influenza virus infections have been identified in the United States.

After spending the last 2 years hearing so much about the COVID-19 variants, people may ask more questions about influenza variants this year. So let’s look at how and why influenza viruses are constantly changing, which leads to the need for annual vaccinations. The more information we have in our knowledge toolkits, the better prepared we will be when unusual and unexpected questions arise. Most people know the signs and symptoms of influenza, but how many know why this constant change in virus happens?

Influenza viruses change in 2 different ways. The first is antigenic drift. This is when small changes or mutations occur in the virus’ genes that lead to a change in the surface proteins of the virus, HA and neuraminidase (NA). These virus proteins are antigens.

 Antigens are recognized by our immune system and trigger an immune response, which produces antibodies that block an infection. As the virus replicates, antigenic drift occurs. Influenza vaccines are designed to target an influenza virus’ HA surface proteins or antigens. Small changes to the antigenic drift can accumulate over time and result in viruses that are different. When the antigenic drift happens, the body’s immune system may not recognize and prevent illness caused by the new influenza virus. This makes individuals more susceptible to influenza infection again. The virus has changed enough that your existing antibodies won’t attack the newer influenza viruses. This is the primary reason the vaccine must be updated each year.

The second type of change is known as the antigenic shift. The is an abrupt major change in an influenza A virus resulting in a new HA or new HA and NA proteins in the viruses. A shift can result in a new influenza A subtype in humans, such as when an influenza virus from an animal population can infect humans. This occurred in 2009 when the H1N1 virus with genes from North American swine, Eurasian swine, humans, and birds infected people and quickly spread, causing a pandemic.

When a shift happens, most people have little to no immunity against the virus. Antigenic shifts occur less frequently than antigenic drifts.

Four pandemics have been caused by influenza in the past 100 years. A pandemic happens when a nonhuman influenza virus changes, making it more easily transmitted from person to person. Past pandemics occurred in:

By now, you may be thinking that this all sounds like COVID-19, and you would be correct. The more COVID-19 mutates and develops new variants, the less likely it is that the current vaccines will remain as effective. Influenza has already proved in the previous pandemics that viruses are very effective at adapting, and millions of human incubators are all they need. For 2021-2022, the FDA’s Vaccines and Related Biological Products Advisory Committeemade recommendations for egg-based, cell-based, and recombinant influenza vaccines, as listed below

US quadrivalent formulations of egg-based influenza vaccines should contain the following:

A/Victoria/2570/2019 (H1N1) pdm09-like virus

A/Cambodia/e0826360/2020 (H3N2)-like virus

B/Washington/02/2019-like virus (B/Victoria lineage)

B/Phuket/3073/2013-like virus (B/Yamagata lineage)

US quadrivalent cell- or recombinant-based vaccines should contain the following:

A/Wisconsin/588/2019 (H1N1) pdm09-like virus

Now, as data are submitted, the CDC will determine how close of a match these vaccines were and how much coverage individuals will need to protect them from influenza. This determines how bad of a flu season the CDC expects to see. The agency then shares its information with state and local officials so proper mitigation processes can be recommended to the general population.

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

CONNIE HENRY, BSN, RNC, has been a nurse for 35 years, working in the areas of obstetrics, neonatal care, and infection prevention and control.

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

The season of respiratory tract infections is upon us. Influenza, rhinovirus, respiratory syncytial virus, and pertussis—as well as COVID-19—once again are attacking many individuals across the US and worldwide.