Rebecca Leach, RN, BSN, MPH, CIC

The topic of appropriate personal protective equipment (PPE) is continuously in the media and trade articles thanks to the COVID-19 pandemic. PPE supply and use is a daily topic for those who work in infection prevention and one of the main tools used to prevent the spread of infection in healthcare facilities. The use of N95 respirators, and their equivalent, is currently a subset of the PPE focus that has many facilities scrambling to provide the best PPE available to staff and keep their stock in hand. 

Respiratory protection programs mandated by the Occupational Safety and Health Association (OSHA) include the process of training, providing medical clearance, and fit testing for respirator use in healthcare facilities. These programs are often run by an occupational or employee health department in collaboration with safety, emergency management, infection prevention, and human resources. Several requirements include ensuring that health care providers (HCP) know how to use respirators, how to don and doff appropriately, when to use the respirator, and how to maintain their PPE to maximize the lifespan of that respirator. 

Traditionally, these are accomplished via an annual fit test through occupational health, which is done for HCPs who may have contact with infectious agents that require airborne precautions (ie, tuberculosis, measles, chicken pox). 

Typically, the fit testing depends on the annual anniversary of hire date, department-specific dates for testing, or some other pre-determined timeframe to have staff come through on a scheduled basis so as to not overwhelm the occupational health department. In a pandemic situation of a respiratory illness, when many staff members need to have quick access to appropriate respirators, the process for fit testing has to change to a different model of operationalization.

Just-in-time (JIT) fit testing allows a healthcare organization to offer evaluation, training, and fitting of HCPs during rapid intervals, as needed, based on specific patient care assignments. Many institutions have JIT fit testing as part of their plans for pandemic influenza or Ebola preparations. In order to implement JIT programs, many key components need to be considered. Also, in March 2020, OSHA issued a temporary guidance that allows healthcare facilities to suspend annual fit testing due to shortages, as long as staff have a prior fit test with the same model respirator.

 This allows for JIT fit testing to be accomplished for staff in a rapid pace needed to keep up with patient care needs.

Another way to better implement JIT fit testing is to utilize qualitative test methods versus quantitative. The more commonly used qualitative method involves the use of a sweet, saccharin solution sprayed into a hood while the HCP wears the respirator. If the HCP can taste the sweet solution, then essentially, they fail the fit test for that respirator. 

Quantitative fit testing involves modifying the respirator to allow access for a sampling port, therefore damaging the respirator so that it cannot be used after the fit test. Again, in recognition of PPE shortages (so glaringly revealed during the COVID-19 pandemic), OSHA recommended using qualitative fit testing over quantitative to conserve respirators and making JIT more feasible. OSHA did so in the same March 2020 temporary guidance.

Occupational health programs historically control the fit testing process. However, in an emergency situation, occupational health would likely not have the capacity to offer JIT fit testing at all times for HCPs, therefore a cadre of staff need to be trained into the roles and assigned a schedule to have the service available 24/7. 

Occupational health departments can train staff, make sure they are certified to teach the process, thereby making a labor pool of fit testers available in the facility for the times and days needed. Often in pandemics-and, again, as we’ve seen recently with COVID-19-job roles need to be adjusted, so there may be staff from low work-load areas that comprise the JIT fit testing team. 

Having this resource staffed consistently meets the needs of HCPs and can reduce the anxiety about finding the appropriate size mask in a moment. Another method of training staff for fit testing that has been shown to be effective is through a video.

 If occupational health is not available, or there are a large number of locations and staff that need training, having a video option for training with a competency would be a reasonable alternative. 

Part of the JIT process needs to include a tracking mechanism for staff. Having a searchable database of all the sizes that staff have fitted would be a helpful tool. Along with a database that is kept by the JIT program staff, develop a way for staff to also track their own mask types and sizes that they can fit. This can be accomplished by having a sticker or badge accessory so that staff will always have it written on their badges and available whenever at the facility. During pandemic situations, the usual masks that an organization uses for annual fit testing and patient care may not be available, so new products will be brought in regularly as alternatives. Having a log of which sizes work for HCPs and also a document that shows comparable products that tend to be similar in size is helpful as well to decrease guessing and wasting masks that may not fit staff.  

Similarly, working with logistics support to review the options available for respirators, tracking usage and days on hand, projecting volumes, estimating how a surge of a certain percentage would impact supply, and reporting those data regularly creates a successful program. Other supplies needed for JIT include the hoods or test kit components and the saccharin or bitter testing solution. During pandemics, these supplies can also be in high demand and integrating those into the tracking helps prevent any unforeseen delays in JIT testing. 

Part of the JIT process is to prioritize or delineate the HCPs who would need to use respirators. This can be accomplished by looking at job roles and departments that would interact with patients who require airborne precautions and tasks that are done by the various job roles. Cross training staff, such as having nurses perform phlebotomy or administer nebulizing treatments, can limit staff who need to interact with patients in airborne precautions when PPE are in demand. 

Also, adjust when some processes should be implemented. For instance, only have the room cleaned by housekeeping after discharge. In addition, wait the allotted time for appropriate air exchanges in the room so that environmental services staff won’t need to don N95 respirators to perform their duties. Also, cohort patients and staff so that the JIT fit testing can be focused on that select group who will have the most need.

The use of JIT fit testing is essential to providing HCPs with the appropriate PPE during outbreaks, pandemics, and emergent respiratory illness disasters. Part of the planning for emergency preparedness can involve developing JIT guidelines and program guidance so that can be used in training and be available when the next outbreak occurs. Currently, many organizations are using JIT testing as part of their response to the COVID-19 pandemic. Documentation of operations of those programs will be key and any lessons learned from current experiences can be utilized for future planning.

Rebecca Leach, RN, BSN, MPH, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a regular contributor to Infection Control Today®, currently works at a healthcare system in Phoenix that includes 5 hospitals and more than 100 outpatient treatment centers.

1.      US Department of Labor, Occupational Safety and Health Administration. Temporary enforcement guidance-healthcare respiratory protection annual fit-testing for N95 filtering facepieces during the COVID-19 outbreak. 

https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit

2.     Harper et al. Comparison of three respirator user training methods. 

Articles

Just-in-time (JIT) fit testing allows a healthcare organization to offer evaluation, training, and fitting of HCPs during rapid intervals, as needed, based on specific patient care assignments. 

Just-in-Time Fit Testing Allows for Rapid Response During Pandemics Like COVID-19

Throughout the evolution of antimicrobial stewardship (AMS) programs in healthcare, the role of the infection preventionist (IP) has not been clearly defined. AMS programs are an effort to coordinate the activities of pharmacy, providers, nursing, infection prevention, and administrators to align policy and practice around antimicrobial prescribing in ways that are optimal for patient care and appropriate for maintaining proper use to help alleviate the burden of antimicrobial resistance and other potential negative outcomes that can result in patient harm. 

Those harms have long been noted. The continued misuse of antimicrobials is driving up the resistance of numerous types of pathogens and prodding the US Centers for Disease control and Prevention (CDC), the World Health Organization (WHO), and other national and international health authorities to focus more on AMS programs.

The IP has always been called on as a partner and collaborator of AMS programs, as the goals of AMS dovetail with many of the goals of IP programs. However, depending on many factors, how involved the IP is in the program varies from facility to facility.

In some facilities, the IP is seen as the champion for the AMS program and would be instrumental in getting the program started and building support to move forward with the effort. Commonly the IP is the chair or co-chair of the committee. Pharmacy representatives are also usually a co-chair, as well as perhaps infectious disease physicians. 

The specialty of an infectious disease pharmacist is not available in many settings, therefore the leadership of the committee often has a learning curve about the principles and concepts of AMS and how that could be implemented in their organization. IP is a useful partner in the establishment of new committees and initiatives, as much of the work of an IP involves gathering stakeholders, researching best practices, and working with a multidisciplinary team to reach mutual objectives. Also, the IP often has relationships with the various groups involved in AMS committees, so they are a good resource to bring those parties together. However, IPs are not the expert in prescribing and administering antimicrobials, so the knowledge of providers and pharmacists is essential in taking the core concepts and then translating them into operational models for the organization.

Numerous professional societies have seen the need for the promotion of AMS activities and have developed toolkits, training courses, online resources, and professional education that is available for practitioners who are new to the concepts or need some help in developing AMS programs in their facilities. The Joint Commission and other accrediting bodies have included AMS programs in requirements for survey. The CDC included AMS programs in its 2019 Conditions of Participation. Based on data from the CDC, these efforts have increased the percentage of hospitals with active AMS programs from 41% in 2018 to 85% in 2018.

One role that IPs bring to AMS is to provide outcomes data related to multidrug-resistant organisms and negative patient outcomes, such as healthcare-onset 

occurrences. Along with providing data, IPs often perform case review of healthcare facility infections and potential impacts that antimicrobial use may have had in those cases. When doing case reviews, it is important that the IP alone is not looking at the prescribing, as a joint review with pharmacy or infectious disease physicians can provide a deeper insight into the selection based on patient diagnosis. 

As AMS programs become more established, the role of the IP can move away from the leader of the group and take on other duties in order to innovate the program and bring other related concepts to the team. Staff and patient education are a huge part of what an IP does on a daily basis. Often frontline staff are not aware of the AMS activities in their facility and how they can contribute to the program. 

This is an opportunity for the IP to develop educational programs and share with staff about AMS and how it impacts their work, and vice versa. Nurses in particular can also be a vital part of AMS work, as they are interacting with the patients, assessing signs and symptoms, and communicating with providers routinely. By providing some insight into the concepts of AMS at the facility, the nurses can act as an advocate from the patients with providers and also educate patients on why antibiotics may not be necessary or why a certain medication is not appropriate.

IPs can also help educate patients. Often we hear of patients going to the physician and expecting to walk out of the office with something tangible, so a prescription for an antimicrobial may be given to ensure patient satisfaction. IPs can partner with providers in the inpatient and outpatient arenas to teach patients about when an antimicrobial is needed, and when other alternatives should be used. Scripting can be developed so that a consistent message is sent to the patient from the moment they walk in the door, get checked in, and get called back for the initial assessment to when the provider sees them. 

Diagnostic stewardship is becoming the new hot topic, which is a perfect companion to AMS activities. IPs have been looking at diagnostic stewardship for many years, focusing on educating about the signs and symptoms associated with urinary tract infections or 

, and providing guidance on appropriate testing. 

These activities can be overseen by the AMS committee and policy and procedures can be established, utilizing electronic medical records and other platforms, to set up criteria that make clinical sense when ordering tests. For instance, pan culturing is still commonly seen in healthcare systems and should be considered a possible inappropriate use of resources that can potentially lead to inaccurate interpretation of test results if the full clinical picture of the patient is not considered.

Though CMS and some medical associations want outpatient, non-acute healthcare facilities to have robust AMS programs, there still exists a gap in the implementation of AMS in settings such as primary care offices, long-term care facilities, acute rehabs, behavioral health settings, dental clinics, and pediatric offices. IPs in these settings may have to be the champion to initiate AMS programs. There are resources for outpatient settings available, however the oversight that is seen in hospitals is not the same and can be a barrier to support, as there are many other competing priorities. This is where the IP can leverage expertise in developing that burning platform, call to action, and determine and engage those stakeholders within their organization who can help drive change.

AMS and IP programs are strong partners in the work to decrease multidrug-resistance and promote positive patient outcomes. IPs can bring their perspective and strengths to the AMS program and offer ways to bring the work to the bedside and engage the partnerships that already exist to make AMS programs successful.

Rebecca Leach, RN, BSN, MPH, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a regular contributor to Infection Control Today, currently works at a healthcare system in Phoenix that includes 5 hospitals and more than 100 outpatient treatment centers.

1.    Centers for Disease Control & Prevention. Antibiotic resistance & patient safety portal. CDC wesite. 

Infectoin preventionists's can bring their perspective and strengths to the antimicrobial stewardship (AMS) program and offer ways to bring the work to the bedside and engage the partnerships that already exist to make AMS programs successful.

Go Team! IPs and Antimicrobial Stewardship Programs Take On Superbugs 

As the science behind the transmission of microbes on hospital surfaces becomes clearer, an appreciation of environmental services (EVS) departments grows stronger. At least 25% of surfaces in a patient room are contaminated with pathogens, which can then be transmitted to the patient.

A study by Cohen et al found that patients have 5 to 6 times increased odds of acquiring an infection when they were placed in a contaminated room.

EVS staff in healthcare settings are either employees of the facilities or those working with outside vendors. In either situation, infection preventionists need to understand the competencies and training of the staff who are performing cleaning and disinfection in their facility. IPs should meet with the EVS leadership to review what their competencies and training include, in particular for daily cleaning, terminal cleaning, special isolation rooms (ie, 

or norovirus), and cleaning in procedural areas such as operating rooms (OR), cardiac catheterization labs, or interventional radiology suites. 

The IP can bring the standards and guidance from various national groups as references, such as the US Centers for Disease Control and Prevention (CDC) and the Association of Operating Room Nurses (AORN). The EVS leadership can bring standards from their national organization, such as the Association for the Healthcare Environment (AHE). 

IPs can work with EVS to evaluate and approve the best cleaners and disinfectants that are used in the facility.

Criteria to make the decision include: kill claims, contact time, how the product must be applied (ie, ease of use), personal protective equipment (PPE) that is required of the EVS staff when using, the dilution requirements of the product, whether a rinsing step is needed after application, compatibility of the disinfectants with the surfaces to be cleaned, and cost. Any time there are product changes proposed, the products need to be reviewed and approved through infection prevention. 

EVS should be part of the infection prevention committee of the organization and be included on agenda items as appropriate. The IPs can work with EVS leadership to develop quality assurance metrics that can be measured and reported out on a regular basis at the IP committee meetings. That venue allows for multidisciplinary review and discussion of any concerns or issues with EVS quality metrics or processes that need to be reviewed and implemented. Some ideas for quality measures for EVS include monitoring throughput to ensure that enough time is given for terminal or discharge cleaning; audits of high-touch surfaces being cleaned on a daily basis, terminal cleans utilizing fluorescent gel, or ATP programs; and audits of cleaning in procedural areas. Evaluation of cleaning practices can start at a basic level, depending on the amount of resources available to the EVS program. As hospitals develop and launch these programs and gain resources, the auditing program can expand, in particular when or if there’s a spike in transmission of multidrug-resistant organisms or other hospital-associated infections (HAIs). IP and EVS can develop expectations based on CDC guidance and other industry standards. The CDC has developed an example of these types of auditing programs that are available for IP and EVS programs to use as templates for their own facilties.

IPs can promote collaboration with EVS by attending staff meetings and huddles. IPs can introduce themselves and discuss how EVS contributes to the infection prevention activities of the facility. IPs can also learn from EVS staff about the challenges they face and provide a voice for EVS staff in hospital operations. IPs can provide education on topics of interest to the EVS staff and promote the role the EVS staff play in IP programs. 

New technology has emerged in EVS practices that the IP can assist in reviewing in order to develop a proposal for the organization to adopt the technology. UV disinfection and hydrogen peroxide mist technology are both recent advances to supplement the cleaning and disinfection process for EVS. The IPs at the facility can assist with researching the latest technology, determine what would be the best fit for their organization, and work with EVS leadership to develop proposals for capital purchases and return on investment proposals for these innovative devices and products. 

AHE provides certification in infection prevention. The certification for mastery of infection prevention for environmental services professionals (CMIP) is a national program that promotes the integration of infection prevention into environmental services programs. This program is aimed at EVS leadership. IPs can promote this certification in their organization. For EVS staff, there are education modules available from national organizations, such as APIC and AORN that can be utilized in developing training information that the IP can distribute at the facility based on the needs of the staff. 

The APIC modules include such areas as: basic principles of infection prevention; safe PPE use; chemical safety; and surface disinfection processes. 

These trainings are available in Spanish as well. AORN has modules specific to cleaning in the OR for between case cleaning and terminal cleaning. The CDC offers training for EVS staff on the importance of infection prevention, and also provides posters and print materials. All of these resources are excellent ways to provide information to EVS staff and help them understand their role is integral for infection prevention. 

IPs perform routine rounding in their facilities. EVS leadership can be included in those environmental rounds. A joint checklist can be developed for all areas of the facility that includes items for IPs and EVS to review on the rounds and issues can be discussed at the time of the observations. Construction meetings and rounds should also include EVS for the importance of cleaning during and after the completion of the project. EVS staff are involved in every area of the facility and are a resource that can be trained as covert hand hygiene observers. By including EVS staff in this process, they become eyes for the IP program and will also develop a stronger sense of the importance of hand hygiene and the appropriate times when hand hygiene is needed. 

EVS should be included in the plans for a facility’s response for high-consequence diseases, such as Ebola, as well as other emergency preparedness scenarios. EVS needs to be included in the development of organizational plans, serve as subject matter experts in the disposal of biohazardous waste from such events, and participate in tabletops and drills. IPs can assist with the collaboration of EVS into emergency preparedness scenarios by ensuring those questions are asked during the creation of the plans and by interjecting those challenges into exercises that would bring EVS concerns to the forefront. 

Infection preventionists have to be masters at collaboration across departments in order to achieve the goals for their programs. The work of EVS is one of the fundamental cornerstones of infection prevention and IP has the opportunity to connect with their partners in EVS and promote their importance in the organization as a key player in patient safety and the quality agenda. 

Rebbeca Leach has been an infection preventionist since 2010, with a background in nursing and epidemiology. Her interests include social determinants of health and reproductive health. 

New technologies have emerged in EVS practices that infection preventionists can help review before a facility decides to implement.

Infection Preventionists Help Environmental Services Keep It Clean 

Rebecca Leach, RN, BSN, MPH, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a regular contributor to 

currently works at a healthcare system in Phoenix that includes 5 hospitals and more than 100 outpatient treatment centers. She recently spoke to 

about dealing with respiratory illnesses during the flu season, which usually runs from December to March. But this year the flu has struck early and hard. The US Centers for Disease Control and Prevention categorizes flu activity from 1 to 10, with 10 being the highest level. For the week ending December 28, 2019, 34 states and Puerto Rico reached that level. At the same point last year, 9 states had. 

What are the broad strokes when it comes to how infection preventionists should approach respiratory illnesses during the flu season? 

Infection preventionists can advise healthcare workers to get the annual flu vaccine and follow facility-specific policies regarding vaccination for employees. Practice appropriate and effective hand hygiene for every patient, every time. Stay home if you are feeling ill (ie, have fever, diarrhea, rash, or other signs and symptoms of communicable respiratory illness). Screen visitors coming to see your patients for signs and symptoms of flu and invite them to visit another day if they are not feeling well. Place patients in empiric isolation precautions based on your facility-specific policies if they have signs and symptoms of respiratory illness. Wear the appropriate personal protective equipment (PPE) for isolation and standard precautions when caring for patients with the flu or other respiratory illnesses. Be aware of your facility’s seasonal visitor restrictions that may be occurring and be a patient advocate for their health and safety while in your facility. 

: Are providers open to the suggestions that IPs present to them?

For the most part providers are open to the guidance from IPs regarding flu prevention. Now that many organizations have mandatory flu vaccination for employees, it is not as controversial of a topic, but initially there was pushback from staff when organizations started with it several years ago. Anecdotally, with the increase in anti-vaccination, we are seeing a little more of a surge in declinations. 

As far as communicating with employees, that is always a challenge for all IP initiatives, not just flu season. Often the information does not trickle down to frontline staff. We have to use multiple methods of communication, ranging from email, newsletters, signage, meetings and huddles, walking rounds, social media, and committee meetings. It can be daunting, but we also collaborate with partners in occupational health, human resources, and nursing to spread the communication so it’s not just up to the IP for it all. There have been studies on recommendation for IP ratios to bed size. An older report, SENIC [Study on the Efficacy of Nosocomial Infection Control Project] from the [US Centers for Disease Control and Prevention (CDC)], recommended 1 IP to every 250 beds. That is now regarded as way too low based on current job duties and more recent work is suggesting 1:100 occupied beds. 

: How have those IP job duties changed? 

The main influence in changing of job duties has been the mandatory reporting of HAIs [healthcare-associated infections] for state and federal programs such as [Centers for Medicare and Medicaid Services].

Since this initiative, as part of value-based purchasing, surveillance activities have become the majority of the job function for IPs. The time involved in not only the identification of HAIs, vetting them based on NHSN [National Healthcare Safety Network] criteria and then reporting them through the NHSN system, but also then working with local leadership and providers to help explain the background of the reporting requirements and how each facility ranks nationally has taken time away from the IP being in the units and providing education to staff. Since those reporting requirements, more time is devoted to surveillance for those particular HAIs and less time is available for other activities. 

In regard to respiratory illness specifically, focus has been shifted to those reportable HAIs and respiratory illnesses are not considered a priority based on limited time and resources. 

: This sounds like a radical change in job duties. 

Surveillance has always been a part of the duties, but the public reporting piece was new. And with that came the pressures that now these infections were tied to hospital reimbursement, which I think many IPs see as both a good thing and a bad thing. It was good because more resources and importance was placed on IP initiatives. However, the pressures to alter data to avoid penalties was felt. The specific HAIs that are federally reported are: catheter-associated urinary tract infections, catheter-associated blood stream infections, 

] blood stream infections, and surgical site infections for colon procedures and total abdominal hysterectomies. 

: You mentioned screening visitors coming to see your patients for signs and symptoms of flu and invite them to visit another day if they are not feeling well. How often do you think this happens in real life? 

Screening of visitors for illness is something that really should be happening year-round, but especially during respiratory season. I think it happens more so in areas like ICU, NICU, and oncology wards because those patients are more high-risk and the nurses say they are doing this already in those areas. Places like a NICU also tend to have strict visitation policies in place already, so it is not much of a change in their practice. 

We have developed scripting for staff to help bring up the subject, just reminding visitors that we want to ensure the safety of their loved one and, if possible, to please visit when they feel better. It is true that some staff are more comfortable with it than others. We cannot force visitors to stay home, but it really is about educating and reducing risk. 

: You said: “Practice appropriate and effective hand hygiene for every patient, every time.” Will this problem ever be solved? 

Hand hygiene is always going to be an issue. There are many reasons why healthcare workers cannot maintain compliance, ranging from time management, lack of sinks, non-effective placement of sanitizers, dermatitis and drying of hands, overuse of gloves, and just plain forgetting. Especially for nurses and aides, there are so many opportunities to perform hand hygiene in a shift, it is just odds that they will not be 100% compliant. 

And for the most part, it’s not an education issue, it really is all those other things. It’s a behavior and culture change. 

There have been some automated tracking systems that provide real-time feedback and data has shown them to be effective to increase compliance. Those systems tend to be cost-prohibitive for most facilities. 

And once those systems are removed, hand hygiene compliance reverts back to prior levels. Having peer-to-peer reminders has also been shown to be effective, however that requires culture shift and breaking down hierarchy within the healthcare system. So, to solve the problem, it really is a multi-dimensional answer and needs constant reinforcement. 

: Are there any healthcare facilities known for setting the bar when it comes to handling respiratory illness?

Since hospital-acquired respiratory illnesses are not a publicly reported infection, it can be hard to know who really is doing it the best because we don’t know what national numbers look like. If something is published it tends to either be a research project or an outbreak response, so just to see on an annual basis what the numbers are of influenza cases acquired in healthcare facilities, there is no data available. 

Johns Hopkins has a nationally known, strong IP program, so often they are a resource. CDC guidelines are the best resource available for IPs at all levels. Also, pediatric hospitals deal more heavily with respiratory illness and can be a good resource for IPs to learn what works, but that would mostly be through networking. 

I would not assume that everyone who works in IP would just know what needs to be done, especially in those small, rural facilities or long-term care. Often the people in those roles have multiple responsibilities, and do not receive formal training in IP and have a lot of on-the-job learning. 

So, if someone is new to their role, they would potentially struggle a bit to find the resources they needed. I would suspect most people would turn to the CDC first, and then APIC [the Association for Professionals in Infection Control and Epidemiology] or their local health departments. 

: Is there anything else you’d like to stress to your peers during respiratory illness season?

Another way IPs can be prepared for respiratory season is to monitor the surveillance data that comes from CDC and local health departments for flu and RSV as a way to help determine when spikes are going to occur. 

Also, it’s very important for staff to have buy-in, so working with bedside staff if you’re going to implement visitor restrictions or anything that would be a new process would help make the program more successful since frontline staff can tell you what is really happening and have ideas on how to improve. 

* This interview was edited for clarity and length. 

Rebecca Leach, RN, BSN, MPH, CIC, speaks to Infection Control Today about dealing with respiratory illnesses during the flu season.

Author | Rebecca Leach, RN, BSN, MPH, CIC

Articles

Just-in-Time Fit Testing Allows for Rapid Response During Pandemics Like COVID-19

Go Team! IPs and Antimicrobial Stewardship Programs Take On Superbugs

Infection Preventionists Help Environmental Services Keep It Clean

Tackling Respiratory Illnesses During the Flu Season Takes Persistence, Time