Tori Whitacre Martonicz is the editor of 

.  She has been a writer and editor for over 30 years, and she has an MA and BA in English Composition/Literature from the University of Akron in Akron, OH. She lives in Ohio with her husband; son; 2 tiny dogs, Selena Brigid Sophia and Doctor Danger Dog; and a big black cat, Freya. She loves reading, writing, gardening, and spending time with her loved ones.

Tori Whitacre Martonicz

Vaccines for COVID-19, but what about the next pandemic? 

COVID-19 is not going away, and it is the latest in the world’s pandemics. Undoubtedly, another one will come, and what can scientists and medical professionals do to prepare vaccines for the next pandemic?

Seth Lederman, MD, the CEO of Tonix Pharmaceuticals, a biopharmaceutical company developing new vaccines for COVID-19, smallpox, and mpox (previously known as “monkeypox”), answered that question for 

). He is well versed in vaccine creation, and his research led to the discovery of the CD40 ligand and its role in T-cell helper function.

: In a new age of pandemics, how can we wage a smarter defense?

 Our daily news is crowded with updates on overlapping health emergencies in America. Researchers are modeling a winter COVID-19 wave fueled by 

more than 100 locations where it is not endemic

. There is no shortage of speculation about the next pandemic, and we still can’t shake COVID-19. If sluggish uptake of new boosters continues, projections suggest the United States could average 

As we look ahead to the next public health threat, there’s a great deal that we’ve learned since SARS-CoV-2 swept the world almost 3 years ago. Indeed, we also have lessons dating back to the fight against HIV/AIDS, which is when my work in molecular virology began. It’s a mix of hard-earned reality about immunity, vaccines, and long-term consequences we would be foolish to ignore.

: Why isn’t immunity easier to achieve?

 There are 2 primary ways our immune systems protect us—antibodies and T cells—and the most effective vaccines rely on both. Our first-generation mRNA vaccines recruit antibodies to ward off COVID-19 infection, but only for a few months. The problem is we need T cells to achieve more durable protection, recognize variants, and block forward transmission. Hence, the pandemic is not over, hundreds of Americans are still dying every day, and the virus continues to strike with more 

immune-evasive variants constantly gaining ground

. Our “whack-a-mole” approach has given way to a motley soup of variants spreading exponentially 

We all may have pandemic fatigue, yet SARS-CoV-2 is still busy mutating. People keeping up with the guidelines have now had at least 4 shots since vaccines became available. And even the well-vaccinated are getting infected and reinfected. While current COVID-19 vaccines gave us breathing room and saved many lives, they have not landed a definitive knock-out punch. If we continue relying on perpetual boosters, we will remain in a forever war against COVID-19. If we instead apply our ingenuity and resources to make better vaccines, we can truly end this pandemic—and critically, build the platforms that prepare us for the next one.

: What do we need vaccines to do to better protect those who receive them?

 We must be smarter about the limitations of some vaccines. For instance, the World Health Organization has warned our 

,” in part because it doesn’t block forward transmission. Similarly, it was premature to stop developing more robust COVID-19 vaccines after releasing mRNA shots. But it’s not too late to send COVID-19 into retreat. The possibilities include live-virus vaccines like the ones that eradicated smallpox and protect us from measles, mumps, and rubella; intranasal and oral delivery routes are also being considered. One promising technology is a “chimeric” approach combining a SARS-CoV-2 antigen to target the spike protein with a live-virus backbone that produces T-cell immunity.

What matters most is following the science further. There is 

, either from natural infection or current vaccines. In fact, contracting COVID-19 confers only short-term immunity to those individuals who recover, similar to the protective benefits from current vaccines. This is why we see people getting second and third cases of COVID-19 only weeks after their last bout. The bottom line is to battle any virus successfully, we need vaccines that do 3 things: block forward transmission, provide long-term protection, and protect more broadly against variants.

 Complacency has unrelenting long-term consequences. The history of HIV/AIDS is replete with the tragic results of inaction. We’ve 

, yet outbreaks are surging because countries like ours largely ignored the potential threat, just as we did with Ebola and Zika. And now we have a trailing epidemic of long COVID-19, 

. As many as 23 million people in the US are suffering from long COVID-19, a number that potentially increases with every COVID-19 infection.

Once we build a lasting infrastructure for next-generation COVID-19 vaccines and large-scale production, we will have it to defend against other infectious diseases. We may be on the right track with a 2023 federal budget proposal that includes bolstered funding for pandemic preparedness. There’s also the successful elevation of 

the U.S. Department of Health and Human Services Administration for Strategic Preparedness and Response to a standalone agency

 empowered to mobilize against public health emergencies. Along with a recent 

White House executive order to ramp up biodefense

, these steps could significantly increase our capacity for anticipating lethal viruses and deploying life-saving solutions – but only if we leverage the very tough lessons learned from COVID-19.

From more durable COVID-19 vaccines to prevention and treatment for diseases that strike next, it’s time to take urgent action. We need smarter, longer-lasting, and scalable virus-fighting weapons on the front lines for today’s public health crises and those just ahead.

Articles

Vaccines are one of the best weapons scientists have against pandemics. What can scientists and medical professionals do to prepare better vaccines for the next pandemic?  


How We Can Wage a Smarter Defense Against Future Pandemics

To help improve the vital work of those infection preventionists, nurses, and physicians in the infection control field,

searches for interesting, supportive, and innovative products. These are this month's picks.

Hibiclens Antimicrobial Hand Soap System by GP PRO

This soap system combines the effectiveness of Hibiclens’ FDA-approved chlorhexidine gluconate (CHG) 4% solution with GP PRO’s hand soap dispenser. The result is a system that helps improve hand hygiene adherence in the health care environment.

The Hibiclens Antimicrobial Hand Soap System by GP PRO features Hibiclens’ CHG 4% solution inside GP PRO’s automated touchless hand soap dispenser. As part of infection prevention bundles for patient bathing, Hibiclens has demonstrated in study after study that it helps prevent methicillin-resistant 

. Best of all, it is gentle on sensitive skin. The GP PRO is a touchless technology, which reduces cross-contamination and eliminates the potential for hands carrying pathogens from one place to another.

One review of Hibiclens Antimicrobial Hand Soap System comes from Paulina Rodriguez, BSN, RN, an infection preventionist in Abilene, Texas, who shared the following: “My nurses regularly use Hibiclens for handwashing because they know how effective it is at providing a deep and lasting clean, and they love how gentle it is on their skin. Making it available in a touchless dispenser at handwashing stations throughout the health care setting will encourage heightened use, improve overall hand hygiene, and reduce transmission of microorganisms. This is the kind of solution that has the potential to dramatically and positively affect hand hygiene [adherence] and influence a reduction in health care–associated infections.”

Wassenburg Medical Dry 320 endoscope drying cabinet

Wassenburg Medical Dry 320 cabinets dry flexible endoscopes in a patented, controlled, and safe storage manner while preserving the endoscopes’ washed and disinfected state for up to 30 days. Because the storage period is extended, the endoscopes may be accessed for use in a more efficient and timely manner. The endoscopes are stored vertically in a hanging position, which allows gravity to assist in the drying process. Vertical hanging for endoscopes is recommended by the manufacturers and complies with recommendations from the European Society of Gastrointestinal Endoscopy-European Society of Gastroenterology Nurses and Associates guideline 939. The Wassenburg Medical Dry 320’s patented pull-down positioning system allows users of all heights to position, connect, and remove endoscopes easily without straining. Overall, the Wassenburg Medical Dry 320 is more economical to run, has a smaller ecological footprint, and is built to last.

With over 40 years of serving the endoscope market, Wassenburg Medical has accessories, endoscope storage, and many other products to meet endoscope disinfecting needs.

Actizone F5 by Solvay is a ready-to-use broad-spectrum disinfectant with 24-hour antimicrobial sanitation for hard surfaces. Actizone F5 is residue free on a variety of surfaces and specifically designed to combine cleaning performance and 1-step disinfection of harmful viruses and bacteria. Actizone F5 kills 99.9% of harmful bacteria and viruses, including 99.9% of all bacteria for 24 hours.

SteriTite containers by Case Medical, Inc, are rigid, reusable sterilization containers proven to be more safe, efficient, cost-effective, and sustainable. Already competitively priced, the SteriTite container is designed for durability and continuous use and is virtually repair and replacement free. Cleared by the FDA, the SteriTite system with MediTray inserts has the Conformité Européenne marking for all methods of sterilization.

The SteriTite sterilization containers are constructed of anodized aluminum, platinum-cured silicone, and passivated stainless steel hardware. Because of this, they are less likely to have performance issues that could lead to unsuitably processed devices and operating room interruptions.

The SteriTite sterilization container is available as a universal system and is compatible with all medical devices and current sterilizers. The containers have a perforated base for all sterilization modalities. For prevacuum steam and Sterizone low-temperature sterilizations, the containers are available with a solid base.

Case Medical, which is FDA registered, was the inaugural recipient and is the most recent recipient of the US Environmental Protection Agency’s Safer Choice Partner of the Year Award.

Hand hygiene is vital to protecting patients and staff from bacteria and viruses that lead to health care–associated infections. With this in mind, BioInteractions has developed a new company and product. The product, called Primel Skin Protection, is a skin-safe antimicrobial spray based on TridAnt technology, a coating for medical devices. Primel stays on the skin for 2 days and safeguards both the user and every surface they touch from harmful microbes using Kill-on-Touch Technology. It uses biocompatible components, absorbs quickly, and does not need water. It is ideal for use in all health care and sanitation environments in addition to anywhere high levels of hand hygiene are needed.

“The launch of Primel represents a paradigm shift in the way we approach patient care,” Arjun Luthra, chairman and CEO of Primel, told 

. “Building on the success of TridAnt, Primel was founded to advance antimicrobial protection in all patient care environments. TridAnt, developed by BioInteractions, is a revolutionary coating technology for medical devices that incorporates active and passive components to create the first truly nonleaching, effective, safe, and durable antimicrobial coating, which lasts for up to 365 days and helps save lives and time needed for medical treatments. The intended end result is improvement in well-being and reduction in risks to both patients and professionals.”

Infection Control Game is a fun simulation board game and video game that can be used for training, exploring, and discussing infection prevention and control. The game was developed by leading National Health Service infection control professionals. It is based on a simulated ward that has a norovirus outbreak, and the game encourages players to make real-world connections while minimizing infection. Infection Control Game challenges players to figure out how to manage infection and encourages teamwork to improve players’ confidence when managing a real-life outbreak. Some of the issues that players will learn about include warning signs of infection, infection prevention methods, managing an outbreak, the importance of timely communication, and multidisciplinary collaboration. It may be used as an informal activity or as part of more formal, structured training. Infection Control Game requires 6 to 14 players but no facilitator. It has a standard 60 minutes of play time, but sessions can be fitted to the allotted time and tailored for the players’ level of knowledge.

Infection Control Today's® Product Locator is a monthly column highlighting some of the latest advanced technology in the infection prevention field.


ICT’s Product Locator: December 2022

Every autumn and winter, the media is filled with infectious disease leaders urging everyone from babies older than 6 months to adults to receive the influenza vaccine. Yet, despite the vaccination campaigns for influenza, COVID-19, and even pneumonia, the rates of vaccinations are still disappointingly low. 

To discuss these rates and ideas on how persuade more people to receive the vaccinations, 

Medical Director for the National Foundation for Infectious Diseases (NFID), 

a professor of infectious disease at Vanderbilt University Medical Center, and an 

 in infectious diseases, about what health care workers can say to address the questions and concerns that patients have about receiving the vaccines.

During the interview, Schaffner also spoke about the data NFID released in October, 2022, that showed that Americans are sharply divided over the influenza vaccination, in spite of experts warning of a potentially severe influenza season ahead. This survey of US adult knowledge, attitudes, and practices toward influenza and pneumococcal disease also revealed: Americans expressed significant concerns about the safety of getting influenza and COVID-19 vaccines at the same time, a growing number of Americans say they will consider masking to fight influenza, and concerning data about intention to vaccinate among individuals at high risk for influenza complications.

The vaccine is made up of fragments of the virus, they can't put themselves together and make a[n influenza] virus in your body and give you influenza.

, Schaffner answers the most common questions about getting the influenza vaccination. “One of the things that cannot happen…is you cannot get [influenza] from the [influenza] vaccine. That's a myth that's out there, and it's remarkably persistent. It doesn't go away. But it's not true. The vaccine is made up of fragments of the virus, they can't put themselves together and make a[n influenza] virus in your body and give you influenza. That's never happened, and it certainly doesn't happen now. So I can reassure them about that."

Schaffner also said to remind the patient “that millions of people have gotten an influenza vaccine.” He said to be make it personal to the patient, “I say, ‘I've been vaccinated, my wife has, everybody in the office has been vaccinated, [and] we want to make sure that this measure of protection is available for every single one of our patients.’ So be very gentle, acknowledge that their concerns are real and common. They feel relaxed, then they can talk with you about it.” Finally, he suggested, “Then bridge back to the patient [by saying], ‘We want to make sure that this measure of protection is available for all the patients who come here.’”

Videos

Reluctance to receive the influenza vaccine continues despite years-long campaigns to increase vaccination rates. William Schaffner, MD, speaks to ICT® about how health care workers can respond to the most common questions and assure of the vaccine’s safety and efficacy. 


How to Address Concerns About the Influenza Vaccine

Findings from a prospective observational study

 on health care workers’ adherence to a novel hand hygiene protocol in the operating theater (OT) were published recently in 

According to Manon D. van Dijk, Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, the Netherlands, and colleagues, this uniform way of observing hand hygiene adherence (HHA) in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, the HHA rate in the OT was below 50% and needed to be addressed in teaching hospitals and among physicians.

Because the Netherlands does not have protocols or observations tools in the OT, witnessing nonsterile health care workers (HCWs) perform HHA proved difficult, and a protocol needed to be created.

“Furthermore, regardless of the department or health care setting, hand hygiene observations are often performed by using the 5 moments of hand hygiene as stated by the World Health Organization (WHO),” the investigators wrote in the study. “These 5 moments are the golden standard and are in general easy to apply on clinical wards where there is a clear distinction between the patient zone and the health care zone. The patient zone includes everything that is attached to the patient or belongs to a specific patient, while everything that is not patient specific is referred to as health care zone. Health care workers should apply hand hygiene when changing from patient zone to health care zone, and vice versa.”

The study included 9 hospitals in the Rotterdam-Rijnmond region. Because these hospitals did not have specific hand hygiene protocols for nonsterile HCWs in the OT, the investigators created one with the hospitals’ input. Once the protocol was agreed upon, an observation tool was developed and tested. Using the tool, investigators calculated HHA rates by type of hospital and HCW.


Written hand hygiene rules specifically for anesthesia and surgery


Visual representation of the OT, divided into 4 hand hygiene areas.

Generally, hand hygiene should be performed when moving from one area to another. Across all hospitals, an average HHA rate of 48.0% (95% CI, 45.2%-61.2%) was observed in OTs. The academic teaching hospital received the lowest score at 23.1% (95% CI, 0.0%-45.8%), and the 2 specialized hospitals scored highest at 64.0% (95% CI, 30.6%-89.8%) and 76.7% (95% CI, 62.8%-84.5%). Interestingly, the average HHA scores from anesthesiologists were the lowest,31.6%, (95% CI, 19.2%-62.4%), whereas OT assistants scored the highest, at 57.4% (95% CI, 50.1%-78.2%).

“Nonetheless, adequate hand hygiene in the OT by nonsterile HCW and surgeons (performing nonsterile actions) is of utmost importance to prevent postoperative wound infections. Considering patients undergoing surgery are vulnerable to infection, exposure to infection risks in the OT should be kept as low as possible,” the authors wrote.

Some strengths of this study included the following: enabling uniform hand hygiene observations from one hospital to another, specifically designed for nonsterile HCW in the OT. This information will help infection preventionists to know which departments need extra assistance. The authors also mention that comparisons between hospitals could lead to friendly competition on which has the higher HHA rate. Competition also increases the rate of HHA in each hospital’s OT. Also, as many HCWs work in more than 1 facility, if the protocols were consistent among all the facilities, then the HCWs’ HHA could remain high because the infection prevention and control policies are the same, and they do not have to remember different policies.

Some limitations of this study included the implementation of COVID-19 infection prevention protocols. Also, because of COVID-19, 3 hospitals were not included in the final study, which did not allow for as many observations of HHA. Finally, because all the observations were only performed in 1 region of 1 country, more testing is needed to assess whether these protocols would function the same way in other countries and in other styles of OTs.

“However,” the investigators noted, “[because] almost all observations in the OT nowadays are still performed by using the 5 moments of hand hygiene of the WHO, we think that our protocol and observation tool could be a valuable addition to the existing literature.”

 Dijk MD van, Breejen MCMW den, Vermeeren JMJJ, Berg S van den, Beeck EF van, Vos MC. Compliance to a novel hand hygiene protocol tailored to non-sterile health care workers in the operating theatre. 

. 2022;0(0). doi:10.1016/j.jhin.2022.10.009

The study's investigators noted that adequate hand hygiene in the OT by nonsterile health care workers and surgeons is vital to prevent post-operative wound infections. 

Hand Hygiene Adherence in the Operating Theater: Data From the Netherlands

Sharps are needles, syringes, scalpels, or other medical instruments that patients or health care workers use to perform a medical procedure. They typically cause a prick or lacerate the patient’s skin. Sharps are considered biomedical waste and must be carefully handled. 

However, as we find out from a long-time user of sharps, dealing with their disposal is occasionally easier said than done. J. Thomas Dukes, PhD, professor emeritus at the University of Akron, in Akron, Ohio, has lived with Type 1 diabetes (TD1) since 1972, and knows all too well that a place to dispose of sharps is sometimes nonexistent.

For the first day of International Sharps Safety Awareness Month, 

) reached out to Dukes to describe his life with dealing with the challenges of sharps' disposal.

 I was diagnosed with TD1 at 16 in 1972, I was already too well acquainted with sharps. In 1970, after extensive tests, almost all involving blood tests with sharps, I was found to have spherocytosis, resulting in a splenectomy: more sharps!

Then, my grandfather got Type I. He lived with us for a while, and I gave him his shots until he learned to do that himself. Good training for what awaited me!

For over 50 years now, I have lived with sharps in all kinds of forms, including lab and hospital blood tests and routine vaccinations. Of course, my primary experience with sharps comes through daily, multiple injections of life-saving insulin.

I was lucky to come along just after disposable syringes were introduced. (I’ve met a couple of people who came up under the old system of boiling syringes and needles, etc. Ugh.) Of course, the challenges were 2-fold: how to give myself shots discreetly and how to dispose of the syringes and needles.

For many years, I would excuse myself just before a meal with others, “shoot up,” then return. Sometimes I would cap the syringe and throw it in the trash. Other times, I would put it in my pocket—diabetes is a disease of pockets, my friends—take it home, and put it in the trash there. As social rules relaxed, I would shoot up, unobtrusively I hope, at the table, then put the used, capped syringe in my pocket.

This sometimes led to the caps coming off and my getting stuck in the thigh or finger when I took the syringe out of my pocket. Ouch!

About 10 years after I was diagnosed, I was in Chicago, spending a long weekend with a friend. I miscounted my syringes and found myself without any before we were to go off to Saturday night supper, and none could be rescued from the garbage because I bent the needles so they could not be used by others. We went to a drug store, only to be told I could not buy syringes without a prescription. I was in a real jam as home then was West Lafayette, Indiana, where I was in graduate school at Purdue University, almost 3 hours away.

The only thing to do was to go to a hospital emergency department. They would either have to give me a script for the syringes or admit me to give me a shot. Rather than do a lot of paperwork, a wise nurse took me to talk to a resident physician. After the resident asked me several questions related to TD1—and listening to my extended answers—she said, “You either have Type 1, or you are the smartest junkie I’ve ever met.” She gave me the script, we got my bag of syringes, then headed off to a wonderful meal.

I entered another challenge with sharps when home glucose testing became readily available, about 12 years after I was diagnosed with Type 1. We were to use one lancet for every test. They were not major sharps, until, of course, you stuck yourself accidentally with a used one!

As the culture became more conscious about medical waste and the dangers sharps posed to others, I adopted different measures. Rather than buy the pricey sharps disposal boxes, I simply resorted to using old milk jugs, detergent containers, or the plastic boxes the cats’ treats came in. I would screw on the cap of these containers when full and put them in the trash.

Through the years, I have had misadventures. A capped syringe I accidentally left in a sport coat pocket pricked a worker at the dry cleaner. The used, capped syringes, as well as new ones, have fallen out of my pockets to be found—or not—by friends or, if I were walking and one fell out, by a stranger. Syringes have dropped onto the floor from my pocket while I am sitting at a meeting or in a restaurant. I have lost a few syringes that way but not many. I try to keep careful count.

But between using all the syringes and the lancets, I am sure I have lost track of a few. Right now, there is an unrecoverable syringe in the well of the elevator door of my building. Is it one of mine? I don’t know!

When I tried the insulin pump several years ago (disaster), I still had sharps to dispose of. I am about to try the pump again. I don’t know how the new models work, but I suspect sharps are not out of my life.

To my knowledge, I have never lived in a place where the law required [individuals] like me to keep sharps in certain kinds of containers and dispose of them in certain ways. However, some years ago, a custodian reported me for throwing my capped syringes in the trash. Turns out, the university had rules about such things. Health and Safety began dropping off sharps’ containers, then picking them up and replacing them when I called. This practice was marvelous but stopped with the pandemic. When we went back and I asked for the same thing, I was told I would have to file for formal accommodation, get a doctor’s letter, etc. So, I am back to collecting my capped sharps and lancets, this time in baggies, and bringing them home.

I am very, very lucky to have survived so long with TD1 and with, to date, so few side effects. But when I say sharps are a pain, I don’t mean physically—the shots are nothing, the pricks from blood sugar tests not much worse—but disposing of them systematically for the safety of all can be difficult. I am also conscious that I and millions of others are contributing to medical waste. But given the alternative—

A long-time user of sharps tells of his challenges with and gratitude for sharps. 

International Sharps Safety Awareness Month: One User's Life-Long Experience

 costs billions in financial devastation and untold emotional anguish of patients and their families. However, the numbers of cases continue to rise. What can be done?

In a recent study, “Mitigating hospital-onset Clostridioides difficile: The impact of an optimized environmental hygiene program in eight hospitals,” recently published in the Cambridge University Press, the investigators spotlighted how critical thorough and effective cleaning is on the spread of C difficile, which profoundly difficult to kill. To get an in-depth look at the findings, 2 of the authors answered questions from 

). Philip C. Carling, MD, is the director of infectious diseases and hospital epidemiology at Carney Hospital in the Dorchester area of Boston, Massachusetts; and Russell N. Olmsted, MPH, CIC, serves as the director of infection prevention management for Trinity Health's Integrated Clinical Services headquartered in Livonia, Michigan.

 you conducted on mitigating hospital-onset 

: what did you set out to measure and what were the study findings?

Philip C. Carling, MD and Russell N. Olmsted, MPH, CIC, FAPIC: 

half a million per year, causing 29,000 deaths

, especially among at-risk individuals,and costing more than 

 in excess health care costs. Despite many efforts across the industry, the past 30 years of 

 mitigation efforts have proven ineffective in substantially reducing hospital-onset 

 infections (HO-CDI). We set out to dig deeper on the issue—given the lack of evident solutions.

 bacteria spores are extremely difficult to kill. You must use a sporicide to kill them. However, daily sporicidal use among hospitals—every room, every day—remains low. The primary reason is that many sporicides are too hard on hospital equipment and devices. That changed in 2015 when a highly effective and environmentally-safe daily sporicide came on the market.

Our study was supported by previous research fromShaughnessy MK et al and Kundrapu et al that identified that admission to a room that was previously used to care for a patient with 

 This “room placement” risk factor has also been confirmed by Root ED and most recently by Sood G. These studies shed a light on the role asymptomatic carriers play in transmitting HO-CDI.

 spores can be asymptomatically shed onto surfaces by the preceding room occupant, it makes a strong argument for hospital-wide daily sporicidal cleaning that mitigates risk for placement in any inpatient room that is available.

The objective of our study was to put a spotlight on the critical role of thorough and effective cleaning in decreasing HO-CDI. Specifically, we were looking to objectively quantify the impact of combining daily, hospital-wide sporicidal use with robust training, an evidence-based process, and actionable cleaning data.

The findings were unprecedented. We achieved a sustained 50% decrease in HO-CDI compared to control hospitals. We found that an optimized cleaning process, environmental hygiene monitoring and feedback to environmental services (EVS) staff to optimize cleaning thoroughness was effective in sustainably reducing infection rates. Given our results, it is very likely that implementing such a programmatic intervention could have a significant impact on the way hospitals address HO-CDI mitigation moving forward.

: What methods were used for conducting the study, and how did these methods impact the outcomes?

The study was conducted across 8 hospitals with stable endemic HO-CDI. Following an 18-month preintervention control period, each site implemented a daily hospital-wide sporicidal disinfectant patient zone cleaning, followed by cleaning thoroughness performance feedback using a previously validated process improvement program.

We incorporated the daily use of a sporicide (in every room, every day) that provided effective disinfection and is compatible with a wide range of environmental surfaces. This is important because other historical sporicidal disinfectants like dilute sodium hypochlorite can’t be used daily because they are too harsh on surfaces and finishes.

This study was the first to monitor the daily, hospital-wide use of a sporicide to evaluate the impact on endemic 

 transmission. Rigorous controls were built into the study design. Many studies over the years have tried to evaluate interventions to mitigate transmission risks for 

. However, these are multi-factorial, making determination of the relative contribution of specific interventions more challenging. This was the first-ever controlled study of a single type of intervention—in this case, optimized environmental hygiene—to decrease endemic transmission of 

: What made the biggest impact in driving the significant reduction in 

The study puts a strong emphasis on standardization of policies and procedures for daily and discharge cleaning and disinfection of health care facilities by EVS technicians with proper training and support. These policies and procedures were based on the Association for the Health Care Environment’s (AHE) 

Practice Guidance for Health Care Environmental Cleaning.

It also revealed the critical role of both the daily use of a sporicide, as well as monitoring and feedback to EVS personnel on how well they are cleaning inpatient rooms and other spaces using a fluorescent marking system that is targeted on frequently touched patient-zone surfaces. Alone, neither one of these interventions would have been able to mitigate HO-CDI to the extent the study found when these interventions were combined.

: Are the findings of this study more or less significant compared to similar studies?

This investigation builds on prior studies that demonstrate the critical role environmental surfaces play in cross transmission of 

 in health care settings. The findings are significant in demonstrating efficacy of an EVS program that highlights the importance of the daily work of EVS personnel to provide a safe, clean environment for patients, other health care personnel and visitors. It also is significant in that it demonstrates efficacy of a sporicidal disinfectant for disinfection of all inpatient rooms, not just those that housed a patient with known acute 

: What are some of the key takeaways for hospitals based on the findings?

The objectively quantified results tell us 2 things. First, they highlight the significant role asymptomatic carriers play in the spread of 

 and the impact daily cleaning can have on controlling environmental contamination from this group. Second, the results underscore the dramatic impact optimized environmental hygiene and the work of EVS professionals can have on reducing transmission. It’s not enough to use a daily sporicide hospital-wide—without also assuring that the cleaning is thorough and consistent. That’s why training and cleaning feedback is so important.

: What significance will this research have in the future mitigation of 

Until now, there has not been a study conducted to this level of rigor, nor that has taken into account newer research on the understanding of the epidemiology of 

 transmission. As discussed in a recent review, this intervention to mitigate HO-CDI is clear cut, and the results are strong enough that hospitals with ongoing endemic HO-CDI cases should consider the relevance of the study to their own institutions.

Shaughnessy MK, et al. Evaluation of hospital room assignment and acquisition of 

Kundrapu S, et al. Skin and environmental contamination in patients diagnosed with 

 infection but not meeting clinical criteria for testing. Infect Control Hosp Epidemiol. 2015 Nov;36(11):1348-50.

Root ED, et al. Investigating the association of room features with health care-facility-onset 

: An exploratory study. Infect Control Hosp Epidemiol. 2021 Jul;42(7):847-852.

 infection (CDI) in a previous room occupant predicts CDI in subsequent room occupants across different hospital settings. Am J Infect Control 2022 Feb 23;S0196-6553(22)00079-7.

AHE. Practice Guidance for Health Care Environmental Cleaning, The Essential Resource for Environmental Cleaning and Disinfection. Available at: 

Practice Guidance for Health Care Environmental Cleaning, 3rd Edition eBook | AHE

Carling, PC. Health care environmental hygiene: New insights and Centers for Disease Control and Prevention guidance. Infect Dis Clin North Am 2021;35:609–629.

Philip C. Carling, MD, is the director of infectious diseases and hospital epidemiology at Carney Hospital in the Dorchester area of Boston, Massachusetts. He teaches and is involved in clinical research at Boston University School of Medicine where he is a professor of clinical medicine. Carling’s research activities have primarily related to developing processes to evaluate and improve patient area surface disinfection cleaning and translational research related to the role of wastewater drains in hospital acquired infections.

Russell N. Olmsted, MPH, CIC, serves as the director of infection prevention management for Trinity Health's Integrated Clinical Services headquartered in Livonia, Michigan. He has over 39 years of experience in the fields of infection prevention and control and health care epidemiology.

Any decrease in the devastation of Clostridioides difficile is welcomed, but an investigative team brought the numbers down by 50%. See what control measures they used.