The second Sunday of every October marks the first day of Sterile Processing Week, running this year from October 10 through 16. As is the case every year, well-planned, meaningful, and memorable events should properly celebrate the vital contributions of our nation’s quality-focused professionals in the sterile processing (SP) field who promote patient safety and positive patient outcomes.

The International Association of Healthcare Central Service Materiel Management (IAHCSMM) has always viewed SP professionals as crucial contributors to patient care, not unlike frontline caregivers. The association also knows that, unfortunately, some facilities still don’t give members of the SP department (SPD) the acknowledgment and appreciation they deserve. In some cases, facility executives may not be aware of Sterile Processing Week because SP leadership hasn’t taken the time to inform them; perhaps, the leadership has never taken the time to meet with those in the C-suite to help explain the difficult and crucial processes that take place within the walls of the SPD—and how those processes affect patient outcomes.

Some SP professionals themselves, in fact, may be unaware that there’s an entire week dedicated to them and their discipline. Some may be new to the profession, and others may not 

have had the opportunity to read IAHCSMM’s many articles, tips, and tributes for them each year. Even some who are aware of the dedicated week each October may lack a celebratory spirit if their SP leaders and interdisciplinary colleagues fail to acknowledge their profession and the hard work it requires. Ultimately, one key point remains: This yearly honorary week should never be overlooked. Regardless of their title or tenure, every SP professional should be recognized for their hard work and dedication to quality customer service and patient safety.

Managers who haven’t already begun their Sterile Processing Week planning still have time to create thoughtful and successful events to honor their teams and get other disciplines involved.

Although celebrating within the department’s walls is a good approach, casting a wider net can yield even more success. In many facilities, SP professionals remain the “unsung heroes,” primarily because members of other health care disciplines often lack understanding of what SP entails and how challenging the jobs are. Sterile Processing Week presents a perfect opportunity to invite other health care professionals to tour the department and see for themselves what it takes to process instruments; they can ask questions and even participate in or contribute to some education. Drawing other disciplines into Sterile Processing Week festivities isn’t just good for SP professionals’ morale; it also can help set the stage for improved interdisciplinary communication and teamwork.

It’s prudent to invite professionals from the surgical services department and other departments the SPD serves to planned Sterile Processing Week events, but it’s equally important to include the facility’s infection preventionists (IPs). IPs are integral members of the extended SPD team and can be among the department’s biggest supporters. SP leaders who haven’t yet forged an effective relationship with their IPs should start establishing a more productive partnership now, before the official Sterile Processing Week kickoff, then carry that momentum into the weeks, months, and years ahead.

Prior to the week’s official start, consider setting up a meeting with the IPs to discuss the SPD’s challenges, successes, and goals, and then work collaboratively to help best address them. Is the SP team operating at a staffing deficiency? Is your instrument inventory poorly matched with the facility’s surgical and procedural volume? Is your processing equipment frequently on the fritz and unable to meet the load demands? Are the standards in the SPD outdated (or missing altogether)? Are continuing education and certification efforts falling short? When IPs are apprised of the struggles SP professionals face, they can help SP leadership build a stronger case with the surgical services department and with facility executives by using essential data to drive positive change.

SP leaders can take a further step by asking their IPs to help honor the week and the SP team by drafting a brief statement about the department’s critical importance to infection prevention and patient safety. They can also assist in sharing impressive SPD-related statistics such as low error rates, the number of instrument sets processed this year so far, and how the department has worked to curtail immediate-use steam sterilization. In addition, they can promote the merits of certification and ongoing education. This information could then be shared with the human resources or public relations teams for inclusion in the facility’s newsletter, or perhaps even shared with local media as a way to educate the general public on the SPD’s essential contributions to patient safety. Asking IPs to participate in a Sterile Processing Week educational session is another great way to strengthen the bond between the 2 disciplines.

Don’t forget the organization’s senior executives, either. These individuals may have only a vague understanding of instrument processing and the importance of SP professionals. They often aren’t aware of the extent of the SPD’s contributions, successes, and sacrifices—and it’s up to SP leaders to show them.

It’s helpful to invite these senior executives “to observe the intricate sequential workflow processes that must be followed to promote positive quality outcomes and patient safety—being sure to explain the steps and processes along the way,” IAHCSMM’s immediate past president, Brian Reynolds, CRCST, CIS, CER, CHL, explained. Reynolds, assistant chief of sterile processing services for the West Palm Beach VA Medical Center in Florida, also stressed the importance of detailing the future goals and objectives of the SPD that align with the health care organization’s mission, vision, and values.

Nearly every year,IAHCSMM hears from SP professionals who lament that limited budgets lead their facilities and managers to overlook Sterile Processing Week. IAHCSMM consistently reminds all SP professionals that some of the best ways to honor the profession and those who are in it require little or no outlay of capital.

Heartfelt words of appreciation from their bosses, interdepartmental colleagues, and top-level executives typically matter more than, say, pizza parties or celebratory trinkets—which are nice add-ons if budgets allow but certainly aren’t a requirement. SP managers should consider carving out time to personally thank each employee for their specific contributions, recognize their strengths and growth areas, and share how they contributed to the team’s success. Leaders can also discuss career ladder opportunities with each employee and initiate a plan to help put them on the path to professional growth.

Other low-cost ways to honor the SP team include hosting departmental tours and fun in-department educational offerings such as vendor-led in-services or trivia-style games that the SP team and other health care professionals who visit the department during SP Week can participate in to broaden their knowledge. Ideally, managers will plan 1 event per shift for every day of SP Week.

Above all, SP leaders should work to remind their technicians and educators that they are valued, appreciated, supported, and heard—not just during Sterile Processing Week, but every day of the year.

IAHCSMM has created a number of free Sterile Processing Week templates and celebration materials (including posters, thank-you cards, certificates of excellence, and Sterile Processing Week departmental tour invitation letters) that can be customized, downloaded/printed, and easily posted/shared. Visit 

https://www.iahcsmm.org/about/sp-week.html

. Note: Templates will be updated for 2021 in the coming weeks.

JULIE E. WILLIAMSON is the communications director/editor for the International Association of Healthcare Central Service Materiel Management, an Infection Control Today® Strategic Alliance Partner.

Articles

Infection preventionists are integral members of the extended sterile processing department team and can be among the department’s biggest supporters.

Celebrate the Critical Role of the Sterile Processing Profession in Infection Prevention

The importance of ventilation in health care and non–health care settings has become evident amid the COVID-19 pandemic. Decreased performance of health care facility heating, ventilation, and air conditioning (HVAC) systems, including filter inefficiencies, improper installation, and poor maintenance, can contribute to the spread of health care-associated infections (HAIs), according to various research findings. Infection preventionists (IPs) who have a basic understanding of ventilation systems and associated risks might feel more confident and comfortable collaborating with architects, facility designers, and engineers. COVID-19 is 1 of many diseases transmitted from a respiratory source.

How does air play a role in disease transmission? The aerosolized transmission of disease happens through droplet and airborne means.

 Droplet transmission of disease can occur when 

bacteria or viruses travel on relatively large respiratory particles that people sneeze, cough, or exhale through talking, singing, or shouting. These droplets travel short distances (usually less than 6 ft) before settling and can be loaded with infectious particles. Infectious particles that contact a person’s eyes, nose, or mouth can cause infection. If they fall on surfaces, they can be transferred onto the hand of someone who unknowingly rubs their eyes, nose, or mouth, causing possible self-contamination.

Airborne transmission is defined as infections transmitted through exposure to infectious, pathogen-containing, small droplets and particles suspended in the air over long distances that can persist in the air for long times.

 The main differences between these 2 transmission types come down to particle size and distance traveled: Droplets are thought to be larger and don’t travel as far; aerosols are smaller and can travel quite a distance. The Centers for Disease Control and Prevention (CDC) recommended isolation precautions for diseases like measles or chicken pox, which are airborne, and mumps, which is transmitted by droplet.

 IPs understand the importance of these precautions but may know less about how these measures work to protect patients and staff.

“The importance of good air quality in controlling and preventing airborne infections in health care facilities cannot be overemphasized,” wrote Anjali Joseph, PhD, the director of research at the Center for Health Design, a company that plans health care facilities, in a 2006 study. “Providing clean filtered air and effectively controlling indoor air pollution through ventilation are 2 key aspects of maintaining good air quality.”

Knowing how important air quality and ventilation are, IPs might better converse with health care architects, designers, and facilities groups if they understand the basics of clean, filtered air and ventilation. Basic terms include the following:

Filtration refers to controlling air quality at the source and is defined as the physical removal of particulates from the air, a key step toward achieving acceptable indoor air quality by removing contaminants.

Filters that are 90% efficient are sufficient for most patient care areas in ambulatory care facilities and hospitals, including the operating room.

High-efficiency particulate air (HEPA) filters should be used for special care areas of the hospital such as surgical areas, burn units, and protective environments for patients who are immunocompromised.

HEPA filters are required to be 99.97% efficient for removing particles 0.3 μm or larger (eg, COVID-19 = 0.06-0.2 μm; measles = 0.2 μm; 

 = 1.0 μm). This means for every 10,000 particles sized 0.3 μm in diameter, HEPA filters only allow 3 particles to pass through.

The principle of Brownian motion applies to HEPA filters for particles less than 0.3 μm. These smaller particles bounce off other molecules when they collide and move in random patterns. They hit the HEPA filter fibers and get stuck. So HEPA filters actually better capture these smaller particles.

Ventilation guidelines are defined in terms of air volume per minute per occupant. They assume that the people in the room and their activities are responsible for most of the contaminants in the space.

Supply vents are where conditioned air blows into the room, usually from the ceiling; return vents (exhaust) pull the room air in, usually near the floor.

Most ventilation rates for health care facilities are stated as room air changes per hour (ACH). ACH refers to the number of times that air gets replaced in each room every hour, mixing in outside air to dilute microbial contamination.

Peak efficiency for particle removal in an airborne infection isolation room (AIIR) occurs between 12 and 15 ACH, per CDC guidelines.

Ventilation rates vary with different patient care areas of a health care facility. Look at the most recent edition of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 170, Ventilation of Health Care Facilities, which is now integrated into the Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities.

ASHRAE Standard 170 speaks to the removal of airborne pathogens through a combination of filtration, direct exhaust of contaminated air, and dilution through introduction of outdoor air. Most IPs are familiar with ASHRAE and FGI. These resources are highly recommended and often consulted, especially when renovation and construction are planned for a facility.

Be aware that the Joint Commission, through its Environment of Care standards, also audits ventilation systems for appropriate pressure relationships, air exchange rates, and filtration efficiencies because it views the proper design and maintenance of isolation rooms as vitally important in preventing the transmission of disease through the air for patients, staff, and visitors.

Interestingly, studies have found that ASHRAE 170 2008 and the 2005 CDC guidelines recommendations for minimum ventilation rates of 12 ACH for hospital insolation rooms are not necessarily the optimum ACH to control infection transmission. Increasing ventilation airflow rate dilutes concentrations but does not increase ventilation effectiveness. The results of a study by Memarzadeh and Xusuggest that the most important contributing factor to contaminant transmission in an AIIR is the path between the patient and the exhaust, not the ACH.

 When this path is disrupted by airstreams, the contaminants can move to other to places in the room. If this path is not disrupted, then the contaminant is not likely to migrate, so changing the number of air exchanges does nothing for ventilation effectiveness.

This is why thoughtful ventilation design and placement of exhaust and supply vents in relation to patient placement in the room are important. Simply introducing extra amounts of outdoor air hoping to dilute the room air may not be effective in providing protection from airborne infection because it does not increase ventilation effectiveness. It is very important to not block the path to the exhaust and returns.

Humidity is defined as the concentration of water vapor present in the air.

The recommended relative humidity range for hospitals is between 40% and 60% (also check local standards). The minimum relative humidity level for an operating room should be 20% and the maximum level should be 60%, per ASHRAE Standard 170-2017, Ventilation of Health Care Facilities.

Relative humidity greater than 60% can promote growth of fungus.

Humidity control allows patients and health care workers to breathe easily, avoiding dryness of the respiratory tracts and reducing the amount of airborne dust in closed spaces.

According to Stephanie Taylor, MD, an infection prevention consultant at Harvard Medical School, “At low relative humidity, indoor air was strongly associated with higher infection rates. When we dry the air out, droplets and skin flakes carrying viruses and bacteria are launched into the air, traveling far and over long periods of time.…In addition to this increased exposure to infectious particles, the dry air also harms our natural immune barriers which protect us from infections.”

Ideal humidity conditions can also improve working conditions for health care workers and help medical electrical equipment operate properly by reducing static electricity (Figure 1 demonstrates the relationship between microorganisms and humidity.)

Room pressurization involves technology that controls movement of air contaminants by causing drafts between spaces, usually rooms and hallways. Pressurization can be positive or negative.

In health care, certain rooms are positively or negatively pressurized with respect to surrounding areas.

Negative pressure (depressurized) means airflow into the room.

AIIRs are set at negative pressure with respect to adjacent areas to prevent airborne microorganisms in the room from entering hallways, corridors, and other areas.

AIIRs provide negative pressure in the room (so that air flows under the door gap into the room), with an airflow rate of 6 to 12 ACH (6 ACH for existing structures; 12 ACH for new construction or renovation) and direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before returning to circulation.

Positive pressure means air flows out of the room (pressurized).

Protective environment rooms, used to protect neutropenic patients, are set at positive pressure to keep airborne pathogens in adjacent spaces or corridors from coming into and contaminating the airspace.

The 2014 FGI Guidelines/Standard 170-2013 provides lists of rooms that should be positively or negatively pressurized with respect to surrounding areas. (Figure 2.)

•	Self-closing doors are mandatory for both of these areas to help maintain the correct pressure differential.
•	Variable pressure rooms (rooms where the ventilation can be manually switched between positive and negative pressure) are no longer permitted in new construction or renovation, and their use in existing facilities has been discouraged because of difficulties in assuring the proper pressure differential, especially for the negative pressure setting, and the potential for error associated with switching the pressure differentials for the room. Continued use of existing variable pressure rooms depends on collaboration between engineering and infection control. Both positive- and negative-pressure rooms should be maintained according to specific engineering specifications.


•	ASHRAE Standard 170, Ventilation of Health Care Facilities, requires each isolation room to have a permanently installed visual device or mechanism to constantly monitor the air pressure differential of the room when occupied by a patient who requires isolation. The CDC states that airflow direction should be maintained and verified, preferably daily, even when the room is unoccupied, using either a visual means of indication (eg, smoke tubes and flutter strips) or manometers.



5.	Temperature is defined as the degree of hotness or coldness measured on a definite scale.
•	In health care, normal operating temperature set points should be maintained based on the existing licensing requirements for the space use and occupancy. Consult FGI for specific guidance.
•	ASHRAE Standard 170 requires temperatures ranging from 68 °F to 75 °F for most patient care areas. Cool temperature standards (68 °F–73 °F [20 °C–23 °C]) are usually related to operating rooms, clean workrooms, and endoscopy suites.
•	Temperatures above about 75 °F (24 °C) appear to universally lower airborne bacterial survival.


•	Virus survival, in general, decreases as temperatures rise. However, many factors, such as humidity, presence of organic matter, and whether they are DNA or RNA viruses, influence survivability. Much more research regarding temperature and its effect on viruses is ongoing.

As the above tutorial indicates, the current information on air in health care and public buildings can be overwhelming. The really heavy engineering and design details of ventilation are best left to the architects, engineers, and the facilities groups. But knowing the basics of air quality and air handling, as well as their relationship to possible disease transmission, could benefit IPs.



SHARON WARD-FORE, MS, MT(ASCP), CIC, FAPIC, is an infection prevention consultant in Chicago, Illinois. She is the Infection prevention adviser for Metrex Infection Prevention/Envista Holdings, an APIC Text clinical editor, and a contributing Editorial Advisory Board member of 

Fernstrom A, Goldblatt M. Aerobiology and its role in the transmission of infectious diseases. 

. Published online January 13, 2021. Accessed May 11, 2021. doi:10.1155/2013/493960

Scientific brief: SARS-CoV-2 transmission. CDC. Updated May 7, 2021. Accessed May 29, 2021. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html

Type and duration of precautions recommended for selected infections and conditions. Centers for Disease Control and Prevention. Updated September 2018. Accessed May 12, 2021. https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/type-duration-precautions.html

Joseph A. Impact of the environment on infections in healthcare facilities. Center for Health Design. July 2006. Accessed May 14, 2021. https://www.healthdesign.org/system/files/Joseph_The_Impact_of_Environment_2006.pdf

Scherzer U, Brown C. Efficiency of HEPA filters. Hamilton Medical. March 18, 2020. Accessed May 14, 2021. https://www.hamilton-medical.com/en_US/E-Learning-and-Education/Knowledge-Base/Knowledge-Base-Detail~2020-03-18~Efficiency-of-HEPA-filters~d5358f88-753e-4644-91c6-5c7b862e941f~.html

Centers for Disease Control and Prevention (CDC) and Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for environmental infection control in healthcare facilities. recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 

American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE). Health care facilities resources. ASHRAE website. https://www.ashrae.org/technical-resources/bookstore/health-care-facilities-resources

Memarzadeh F, Xu W. Role of air changes per hour (ACH) in possible transmission of airborne infections. 

 2012;5:15-28. doi:10.1007/s12273-011-0053-4

Modes of transmission of airborne diseases. Centers for Disease Control and Prevention. 2013. Accessed May 20, 2021. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/air.html#c1

Freda A. Managing operating room temperature and humidity. 

. June 24, 2020. Accessed May 16, 2021.https://www.hfmmagazine.com/articles/3939-managing-operating-room-temperature-and-humidity

Diamond F. Q&A: Hospital airflow plays a crucial role in infection prevention. 

®. Published online June 26, 2020. Accessed May 18, 2021. https://www.infectioncontroltoday.com/view/q-and-a-hospital-airflow-plays-a-crucial-role-in-infection-prevention

Air humidification in hospitals and healthcare structures with the objective of saving energy. Carel Compendium. 2013. Accessed May 20, 2021. https://www.carel.com/documents/10191/0/%2B4000021EN/8ad03ec9-6f9f-4216-8395-b2f95325671f

Guidelines for environmental infection control in health-care facilities. Centers for Disease Control and Prevention. 2003. Accessed May 12, 2021. https://www.cdc.gov/infectioncontrol/pdf/guidelines/environmental-guidelines-P.pdf

Herrick M. Planning and maintaining hospital air isolation rooms. 

 February 1, 2017. Accessed May 25, 2021. https://www.hfmmagazine.com/articles/2671-planning-and-maintaining-hospital-air-isolation-rooms

Tang JW. The effect of environmental parameters on the survival of airborne infectious agents. 

. 2009;6(suppl 6):S737-S746. doi:10.1098/rsif.2009.0227.focus

In the new normal after COVID-19, infection preventionists will need to become more knowledgeable about and involved in the functionality of air ventilation in health care settings. 

What IPs Need to Know About Ventilation

Health care professionals who work at NHs are all too aware of the rates for urinary tract infections (UTIs) and catheter-associated UTIs (CAUTIs) at those institutions, according to study results1 unveiled last month at the APIC annual conference. What they’re not so aware of is how well (or not so well) NH employees practice good hand hygiene and properly don and doff gowns and gloves as ways to lower rates of infection.

“While awareness of UTI and CAUTI rates is high, process measures like hand hygiene rates and gown/glove use are not evaluated consistently,” state the study investigators, who are from the University of Michigan. “Hand hygiene and use of personal protective equipment have [had] heightened priority during the COVID pandemic. NHs have made significant progress operationalizing many evidence-based infection prevention practices, but gaps exist.”

In Michigan, 56 NHs (of 58 asked) agreed to participate in a 5-year survey in which investigators sought to learn if better relations between NHs and hospitals might help foster better infection prevention in NHs. “A 36-question survey on IPC [infection prevention and control] characteristics was distributed … for [the] years 2018-2020,” the study states. “All surveys were completed prior to March 2020, when the first case of COVID-19 was identified in Michigan. Surveys were completed by IPs, directors of nursing, and/or NH administrators.”

The respondents at 93% of the NHs were aware of their institution’s UTI rates, and 87% were aware of its CAUTI rates. Policies were in place at the NHs regarding catheter insertion and care, as well as other methods to prevent UTI/CAUTI infection. Those methods include hydration, discontinuing the catheter use, stop orders, and electronic alerts.

Staff training at the NHs was uneven, however. “Less than half (44%) were aware of their hand hygiene rates; 35% were aware of gown/glove use,” the study authors state, adding that “100% shared infection data with NH leadership, 69% with bedside nursing staff, and 26% with residents and families.”

Among the study authors is Karen Jones, MPH, RN, CIC, who works in the Department of Internal Medicine at the University of Michigan. She tells 

® that face-to-face meetings between NH and hospital officials were originally supposed to be a major part of the third year of the project. Because of COVID-19, though, those meetings had to be held virtually. The data reported in the APIC conference abstract reflect a 3-year period of surveys. An enrollment year was considered to be from March 1 to February 28.

“Our third year…was challenged due to COVID,” Jones tells 

®. “We anticipate enrolling another cohort of NHs for this project this summer. We had to adjust the planned enrollment year due to the chaos COVID caused. The entire project is 5 years.”

Jones says it was good that the meetings in the third year of the project were held—even if they had to be virtual—because “it was even more important during that time of COVID to build those relationships, to have open lines of communication, especially when it came to things like personal protective equipment allocation, visitation, and staff education. It benefited everyone to have those relationships strengthened during [that] COVID year.” For an additional 1 or 2 years, continues Jones, the team will continue to collect the same kinds of data that were presented at this year’s APIC conference.

Still, Jones and colleagues detected a disturbing trend: Even NHs that had IPs had trouble keeping them.

“The NHs that we surveyed had almost two-thirds of their IPs turn over in the course of just 12 months,” Jones tells 

®. “Keeping someone in that role is very, very important: They need to be properly educated and to have the time not only to get education but [also] to set up their program and properly run it and not to be pulled in many different directions [at once] at work. If they’re an IP, they need to focus on [infection prevention]. They should not also be responsible for all the different tasks in the [facility].”

Jones KM, Mantey J, Mody L. Current practices in infection prevention: a 3-year survey of Michigan nursing homes’ urinary tract infection prevention strategies. Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 28, 2021; remote.

A five-year survey in Michigan seeks to determine if enhanced relationships between nursing homes and hospitals might facilitate better infection prevention in nursing homes.

Stronger Ties With Hospitals Might Help Nursing Homes Fight Infections

The demographic challenges facing the infection prevention field represent an almost existential threat.

 The hard question must be asked: Will the specialty dry up? Despite the crucial role IPs played in helping patients and their fellow health care professionals weather COVID-19 surges, the post–COVID-19 normal might dishearteningly resemble the pre–COVID-19 normal. IPs again may start to feel underappreciated

 while their ranks continue to thin. It’s a situation much on the minds of working IPs,

 including those who are APIC officials, as they lobby US states to mandate that NHs and other long-term care facilities hire full-time IPs, and encourage hospitals to layer the IP career path

—novice, becoming proficient, proficient, and expert—through training programs that are often tied to teaching institutions.

In the meantime, though…there’s the meantime. A study

 unveiled last month at APIC’s annual conference looked at a creative approach to keep infection prevention departments fully staffed while also giving younger health care workers who want to become IPs the training they need.

The infection prevention department at Ascension Texas managed to shore up IP ranks by calling a couple of IPs out of retirement and asking another if she would postpone her retirement during a COVID-19 surge. The 3 IPs helped with remote monitoring, thereby freeing the IPs on site to take a more hands-on approach.

“The [retired] IPs required no onboarding or training due to prior knowledge of surveillance methodology, electronic health records, and surveillance software systems,” writes study author Holly Taylor, MPH, CIC, the infection prevention director at Ascension Texas in the study. “An [as-needed] status was preferred over [full-time] or part-time status by both the IPs and the organization. Full-time IPs reported increased availability for unit-based activities.”

® that not only did the retired IPs help with the workload, they also helped ease new IPs into the profession. “When you are a novice coming into infection prevention, there is so much content, so much work. It’s incredibly fast-paced,” she tells 

®. “And we know novice IPs often come in without a lot of support. The attrition rate is pretty high. So even just being able to offload some of those administrative tasks, administrative burden, to help facilitate a [better] learning environment, [was appreciated]. I’ve had feedback from my novice IPs talking about how much [the program] has given them space to learn the profession, develop competency in key areas.”

Experienced IPs also found interacting with the retired IPs to be an educational experience.

“I have one who was an endoscopy manager for an extended period of time,” says Taylor. “She brings just a really invaluable set of skills and level of expertise related to high-level disinfection of endoscopes, and so she has come in to round with folks or get perspectives and give feedback, consult with them, to help prioritize any follow-up actions, and so forth.”

Taylor hopes that the arrangement might be more than a stopgap. Ascension Texas administrators so far have made no indication that they want to end the program even as COVID-19 ebbs.

“I know that they are helping support and work through expanding the staffing complement of my department,” Taylor tells 

®. “I see this as something that they allow me to keep for a while. I have not heard that they have put an end date on it for me at all.” 

Diamond F. Infection preventionists face demographic challenges. 

®. May 11, 2021. Accessed June 14, 2021. https://www.infectioncontroltoday.com/view/infection-
preventionists-face-demographic-challenges

Diamond F. A conversation with Kevin Kavanagh, MD: infection preventionists are underutilized and underappreciated. 

®. December 13, 2019. Accessed June 25, 2021. https://www.infectioncontroltoday.com/view/conversation-
kevin-kavanagh-md-infection-preventionists-are-
underutilized-and-underappreciated

Diamond F. Infection preventionists marginalized in antimicrobial stewardship programs. 

®. January 13, 2020. Accessed June 17, 2021. https://www.infectioncontroltoday.com/view/
infection-preventionists-marginalized-
antimicrobial-stewardship-programs

Diamond F. 2 infection preventionists talk about reenergizing the field. 

®. May 11, 2021. Accessed June 23, 2021. https://www.infectioncontroltoday.com/view/2-infection-
preventionists-talk-about-reenergizing-the-field

Developmental path of the infection preventionist. Association for Professionals in Infection Control and Epidemiology. Updated 2019. Accessed June 20, 2021. 

https://apic.org/professional-practice/roadmap

Taylor H. Use of retired infection preventionists to supplement infection prevention department staffing. Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 28, 2021; remote.

The infection prevention department at Ascension Texas managed to shore up IP ranks by calling a couple of IPs out of retirement and asking another if she would postpone her retirement during a COVID-19 surge.

Calling All (Retired) Infection Preventionists: You’re Needed

One of the bigger challenges during COVID-19 surges for IPs involved keeping tabs on the host of other deadly pathogens that cause health care–acquired infections (HAIs). However, just as the mitigation measures used to fight COVID-19 in the public—hand hygiene, social distancing, wearing a mask—reduced the incidence of influenza in the 2020-2021 flu season to historic lows,

 the measures used to combat COVID-19 in hospitals may have helped reduce incidents of HAIs. Better hand hygiene compliance may have been especially important, according to a study unveiled last month at the APIC annual conference.

According to investigators with Mount Sinai Morningside in New York, the rates of 

 infection (CDI) laboratory-identified events remained about the same in March, April, and May of 2020 as they were during the same 3 months in 2019. Investigators compared the 

 rates per 10,000 patient days for both periods, as well as the number of 

“Additionally, the doctor of pharmacy from our antibiotic stewardship team reviewed all orders for oral vancomycin to determine if empiric CDI treatment was initiated without confirmatory testing,” the study authors state.

Among those authors is Barbara Smith, RN, BSN, MPA, CIC, an infection preventionist at Mount Sinai Morningside. She tells 

® that there was 1 case in 2020 in which the patient who’d been given oral vancomycin did in fact have 

®. “There was another woman who had come in with 

 She was valid to receive that treatment.” Smith said she decided to study incidents of 

 when hospital providers noticed an increase in the number of central line–associated bloodstream infections, although she realized that the increase “was understandable given the crisis situation [with COVID-19] and the condition of the patients.

“You would think that with the amount of antibiotics these COVID-19 patients received that that [the 

 rate] would have gone through the roof, but it didn’t,” Smith added.

Investigators found a minuscule increase in 

 during the 3 months in 2020: 0.48 per 10,000 patient days compared with 0.00 in 2019. In addition, the number of tests rose in 2020 to 17.5 per 10,000 patient days from 15.8 during the 2019 months. In 2020, 3 patients received oral vancomycin.

“We speculate that the lack of an increase in CDI rates may be attributed to increased hand hygiene by staff—compliance increased to 91% in 2020 compared with 83% in 2019—enhanced attention to cleaning and high-level disinfection, and improved adherence to use of personal protective equipment,” the authors concluded.

® that she wanted to make sure there were no mitigating factors, such as a decrease in testing for 

. “Were people not testing the same amount? Maybe the doctors were just starting treatment without testing. But that, too, was not found to be statistically significant,” notes Smith. “The volume of patients tested in 2019 was the same, or similar, as the volume in 2020. We didn’t feel like people were just missing the cases. The [patients] who were diagnosed and who did need treatment were getting it.”

 are put in isolation; they cannot leave their hospital room for anything other than a medical test. “People who are entering the room [of a patient with 

] can use a sanitizer to go in. They do wear full gloves and gowns, which they should be removing before they leave the room. And [they should be] using soap and water when they exit the room,” points out Smith, “because, as you know, the alcohol sanitizers don’t kill the spores. Actually, neither does the soap and water. It just flushes it down the drain.”

Diamond F. CDC’s flu czar says she’s ready for the fall offensive. 

®. June 4, 2021. Accessed June 15, 2021. https://www.infectioncontroltoday.com/view/cdc-s-flu-czar-says-she-s-ready-for-the-fall-offensive

The rates of Clostridioides difficile remained about the same in March, April, May of 2020 as they were during the same 3 months in 2019, according to the study.

Clostridioides difficile Controlled at Hospital During COVID-19 Surge

Momentum has been building for months for the World Health Organization (WHO) to acknowledge that SARS-CoV-2, the virus that causes COVID-19, is spread predominantly through the air. It’s an effort that might profoundly improve resources for infection prevention and, therefore, affect the way infection preventionists (IPs) do their jobs. Since July 2020, leading scientists have been pointing toward and signing open letters

 of the airborne transmission of the disease.

 Recently updated WHO language reflects this evidence. As of April 30, 2021, the WHO updated its guidance advising that the virus can be spread in poorly ventilated and crowded settings…because aerosols remain suspended in the air.

This means that all signs point to the inability to supply safe indoor air as the probable cause of a government shutdown and the transmission mode that some long-term care residents had little hope to avoid. Gone are the days when society accepts pathogens spread from public sewers (typhoid), diseased water (cholera), or poor ventilation (COVID-19). This is a watershed moment for the regulation of indoor air quality (IAQ).

In May 2020, the federal government began releasing payments from the Coronavirus Aid, Relief, and Economic Security Act Provider Relief Fund through the US Department of Health & Human Services (HHS). These funds came in the form of general and targeted distributions that expired June 30, 2021. Therefore, if a facility didn’t make investments with these funds, the hospital or long-term care facility stands to leave money on the table.

It is time to stop spending this money on medical consumables and apply it to a lasting solution. If these consumables are billed elsewhere in the facility’s provider fees, that could be construed as double-dipping.

This practice is not allowed and will result in unused funds. These valuable dollars should be used to make lasting improvements. How the organization allocates the money is important, and flexibility exists in sorting appropriate uses even now.

Timothy Crouch, a principal at the accounting company CliftonLarsonAllen (CLA), has been providing CLA accounting software to help health care providers identify appropriate uses. CLA recognized that many of its clients found it confusing to navigate how these funds can be used. The product they developed assists in tracking expenses and is continually updated by HHS.

The federal funds allocated for pandemic relief resulted in hundreds of thousands, and often millions, of dollars showing up in eligible health care provider accounts. Hospitals, nursing homes, and facilities in between began receiving direct deposits from the federal government. Executives and accountants have been trying to figure out what will be forgiven, what is a loan, and what will need to be returned. These funds provide a resource for moving forward on a solution. If alarm bells are ringing, it might not be too late to capitalize on this money for infection control. CLA is in discussion with IPs to place unused funds under contracts to be used for assessment services and infection control

 The company can offer information on timelines and advise on provider relief funds.

Air management is a broad issue involving many components. Don’t expect to discover a quick, all-in-one fix, and caution other decision makers against such solutions. A sound air management solution will require addressing many pollutants. People spend approximately 90% of their time in enclosed spaces, according to the International WELL Building Institute.

 Inhalation exposure to indoor air contaminants leads to a variety of health problems, such as headaches, asthma, cancer, ischemia, high blood pressure, heart disease, and infections caused by pathogenic viruses similar to SARS-CoV-2.

 Indoor pollutants are about 1000 times more likely to be transmitted to the lungs; thus, indoor air quality management is very important.

 Effective monitoring and proactive precautionary measures can prevent exposure.

The COVID-19 pandemic has spurred groundbreaking technological advances in products. For example, veriDART by SafeTraces leverages patented DNA-tagged tracer particles that safely mimic aerosol mobility and exposure to identify high-risk infection hot spots and transmission routes.

 The tracer can be released at a location mimicking a sick patient and the preceding pathway identified. This is a real-world, data-driven tool for assessment and remediation of infection pathways. In a recent project led by Kevin Grosskopf, PhD, a professor of architecture at the University of Nebraska–Lincoln, the Department of Energy used veriDART to assess and validate ventilation measures in residential care environments.

RHP Risk Management, which specializes in evaluating IAQ, building ventilation, and biological contaminants, currently employs the technology for clients and finds veriDART to be essential in providing validation for environmental controls, according to RHP Risk Management.

When it comes to air management, manufacturers have embraced a quote attributed to management expert Peter Drucker: “If you can’t measure it, you can’t improve it.” It is considered a hallmark in business.

Currently, manufacturers are offering assorted air cleaning solutions that include the good, the bad, and the unhealthy. One question to ask prior to purchase: Do these technologies provide integrated monitoring of the air? Without monitoring the air, the application and functionality of the technology are immediately cast into doubt. For example, a UV-C lamp may lack the required exposure time required for disinfection. This is a bit analogous to running a large facility heating and cooling system with a window unit.

Obtaining reliable and tested systems that use high-efficiency particulate air (HEPA) and UV-C technology is one thing; application to achieve functionality (the proper selection of technology) is another. Without the ability to measure air quality, air improvement is subjective.

“In recognizing the nature of the airborne spread of COVID-19, it is paramount to establish and maintain an adequate level of indoor air quality,” Gary Shubinsky, PhD, the president and CEO of LightWave SensorTech LLC, a Chicago, Illinois–based technology company that engineers and manufactures advanced UV systems for IAQ, said in an interview with 

. “The correct path to achieve this level is only via an integrated system of complementary air management technologies, including a combination of airflow management, filtration, purification, and real-time monitoring.”

LightWave’s methodology is correct. A lasting air management solution will require proper engineering and not a pileup approach involving unproven products. One concern is that decision makers will fall into the nearsighted trap of selecting piecemeal products that require frequent maintenance, with inconsistent performance and low reliability. Essentially, the concern is about using a short-term Band-Aid solution for a long-term problem. Little, if any, improvement in the ability to supply healthy indoor air and face seasonal influenza or future pandemics will come of this approach. A holistic integrated IAQ solution, one that is informed and addresses core IAQ problems, is required. An integrated solution implies the use of complementary technologies across building management, and there are several elements involved.

an alignment of heating, ventilation, and air-conditioning system performance with building pressurization;

air filtration requirements and a customizable safe air-purification system; and

a network of air management sensors (differential pressure, carbon monoxide, carbon dioxide, thermal, moisture, and airflow) that supply real-time building analytics.

Combined, these parameters optimize cost, performance efficiency, and infection control for a lasting and consistently healthier quality of life. A solution where air quality can be quantified and improved will provide a healthy environment and a future ventilation solution. The ability to respond to current and future infection control concerns will be addressed, and the improved indoor air quality will be measurable. These solutions are obtainable, and the technology and services exist.

To get to this point, you need to look for a partner that is not just selling a HEPA filter or UV light but will provide a measurable understanding of indoor air quality and thus infection control within a building. 

CEDRIC STEINER is a licensed nursing home administrator in Lancaster County, Pennsylvania, who has a specific interest in addressing infection control in the long-term care setting. Steiner is seeking partners for a webinar that he hopes will promote a holistic approach to indoor air management. Contact him at 

 for integrated solutions and infection control concerns related to indoor air quality.

Morawska L, Milton DK. It is time to address airborne transmission of coronavirus disease 2019 (COVID-19). 

. 2020;71(9):2311-2313. doi:10.1093/cid/ciaa939

van Doremalen N, Morris DH, Holbrook MG, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. April 16, 2020. 

. 2020; 382:1564-1567. doi:10.1056/NEJMc2004973

 Long-distance airborne dispersal of SARS-CoV-2 in COVID-19 wards. 

. 2020;10(1):19589. doi:10.1038/s41598-020-76442-2

Zaatari M, Harmon M. Open letter to address the use of electronic air cleaning equipment in buildings. April 12, 2020. Accessed May 9, 2021. 

https://medium.com/open-letter-to-address-the-use-of-electronic-air/no-to-ionizers-plasma-uvpco-bc1570b2fb9b

Coronavirus disease (COVID-19): how is it transmitted? World Health Organization. December 13, 2020. Updated April 30, 2021. Accessed May 15, 2021. 

https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted

https://www.claconnect.com/directory/c/crouch-timothy

About us: people first places. Accessed June 3, 2021. International WELL Building Institute. https://www.wellcertified.com/about-iwbi/

. 2008;12(2):61-64. doi:10.4103/0019-5278.43262

An integrated air management system requires proper engineering and not a pile-up approach of unproven products. One concern is that decision makers will fall into the nearsighted trap of selecting piecemeal products that require frequent maintenance.

Infection Control Today, July/August 2021 (Vol. 25 No. 6)

Celebrate the Critical Role of the Sterile Processing Profession in Infection Prevention

What IPs Need to Know About Ventilation

Stronger Ties With Hospitals Might Help Nursing Homes Fight Infections

Calling All (Retired) Infection Preventionists: You’re Needed

Clostridioides difficile Controlled at Hospital During COVID-19 Surge

Let Airflow Show Pathogens the Door (or Window or Vent)

College Guidance Counseling: Get the COVID-19 Vaccine

CDC’s Flu Czar Says She’s Ready for the Fall Offensive

How To Reenergize the Fielf

Infection Preventionists Face Demographic Challenges