The hospital discipline of infection control was established in the 1950s

Since then, the specialty requirements and duties have gone through many changes. 

® asked 2 infection preventionists—a veteran and a novice—about the changes they have seen in the profession and how infection preventionists of different experience levels view the profession and each other.

The Veteran—Technology Reshapes the Profession

By LaTitia Houston, MPH, BSN, RN, MT, CIC

As an infection preventionist (IP) during the “digital transition age,” I have seen many changes and uncertainties introduced. IP staff used to be comprised mainly of nurses who were no longer at the bedside, and in the beginning of my career around 20 years ago, local and national government required little detailed reporting. The clinical staff—nurses and physicians alike—were confident in the care provided despite any health care–acquired infections (HAIs) that patients developed. Finally, the patients were satisfied to have been successfully treated with few complications.

But the birth of technology changed the face of infection prevention by requiring the demographics of the profession to change. In the past, nursing staff who were ready to exit the bedside and wanted to coast out of the clinical life were replaced with nonclinical staff eager to provide statistics on performance of the nursing staff.

Once I entered the field of IP around 2012, national data requirements were robust, paper charts were fading, and electronic medical records were becoming the new norm. Health care organizations began requesting detailed reporting of not only the safety of patients, but also the quality of care they were receiving. My nursing skills and knowledge were still a plus, but these changes required more. IP now required staff who could handle statistics, analytics, and information technology.

Organizations took notice and acted, realizing the demand for infection prevention was increasing. The job descriptions were broadened to allow others with varying backgrounds to succeed as IPs. Nurses were always welcome, but now public health personnel, laboratory technicians, sanitary specialists, and other fields experts were entering the industry as IPs.

However, this merge was awkward at first. Nursing staff were always considered clinical; everyone else was considered nonclinical and data driven. As a nurse with a master’s degree in public health and 15 years of laboratory bench work, and now an IP, I was able to see all sides. My public health colleagues were able to calculate, format reports from trends, and identify gaps in surveillance data. They were able to communicate these gaps to their laboratory colleagues, who were able to speak on the susceptibility and origin of microbes. And this information was helpful for the nursing staff to visualize how transmission occurred.

This transition would not have happened if medicine did not become digitized. The organizations’ acknowledgement brought the boosting of skills to infection prevention and also allowed the implementation of new initiatives, closing the electronic gaps within infection prevention. We all became experts, “superusers and trainers,” with electronic medical record systems. The CDC

 on how to report and identify infections that were required for reporting, and local and state governments visited or provided webinars or on-site courses pertaining to electronic data reporting of communicable diseases.

Among the many things that changed during the fusion of generations in IP, the introduction of technology stands out the most. Before this transition, the local and national governments required little reporting.

The days of lab results found on the printer the next morning and faxing information to the state and local governments are now things of the past. We now send scripted emails or fax directly from the electronic medical records to the different governing bodies. The introduction of electronic medical records and data-mining programs was the beginning of where we are today.

This change started a chain reaction. IP nurses quoting evidence-based practice was no longer a statement; it was now able to be measured. Reports can be generated to capture the reason a patient was admitted, what happened during the time of the admission, surgeries, procedures, laboratory results, and discharge information. IP, clinical and nonclinical, validate and communicate whether evidence-based practices were implemented during patient care.

Before 20124, infection data reporting was voluntary for all hospitals nationally. Required infections were reported to the state and local governments, such as sexually transmitted diseases and hepatitis. The infection data were not related to the performance of care. Hospital staff were educated on the basics of hand hygiene and environmental cleanliness. The information provided was about communicable diseases and diseases within the surrounding community, and then these data were sent on a spreadsheet or a laboratory report by fax to the state and local governments. This was the life of an IP.

The initial transition was not very receptive to that nurse coasting from bedside to easy exit. Being an IP now required nurses to monitor the practices of their previous coworkers. Gone were the days of educating peers voluntarily on how infections from one patient affected another patient or how a patient who was admitted to the hospital for a broken leg did not get a urinary tract infection “just because”; IPs were now required to educate, observe, and validate evidence-based practices.

By 2015, many states required hospitals to report communicable diseases, and the federal government, along with state and local governments, required hospitals to report HAIs to the CDC’s National Healthcare Safety Network.

 Technology enabled efficient capture of these data.

IPs were asked to not only know how to prevent infections, but also to know technology and how to present the data and report the data to the different entities. This change, again, was a challenge for those IPs who were from the bedside. But this opened the doors of infection prevention to public health and laboratory staff.

, “Over time, the tracking of HAIs became more regulated. State governments were passing legislation mandating public reporting of select HAIs, thereby forcing IP programs to focus efforts on those particular HAIs that were publicly reported.

The new face of infection prevention is still being molded. Currently, there are more demands from the government

, which require more data, more prevention knowledge, and always the improvement of patient care. Organizations will continue to review the needs required to meet these constant demands, and infection prevention requires a multidisciplinary staff for it to be successful.

The Novice—Positive Collaboration Around New Ideas

I am coming from the perspective of someone who is new to the field or learning. People like me—internal medicine residents working in the intensive care unit or the emergency department—were on the front lines during the COVID-19 pandemic.

My peers and I have a firsthand perspective on what something like COVID-19 can do to the health care system, having seen the tsunami it caused, how important infection control is, and how dangerous infection control gone wrong can be if we do not get things right. The new generation of infection preventionists (IPs) bring that perspective and voice to the table, and people, at least during my training, have been receptive to both. Being extra careful is important for everyone—our patients, frontline workers, other people involved in patient care, hospital staff, and providers.

The other thing about the newer generation of IPs is that we question older literature and demand that benefits be shown for certain interventions like contact isolation, contact gowns, etc; we also question the old guidelines and verify that there are benefits to patients.

Overall, I have not encountered much pushback from the older generation of IPs. In fact, people often welcome new perspectives—for example, newer data showing unnecessary isolation leads to worse patient outcomes, which was part of my residency training, and the perspective that isolations lead to worse outcomes, which is something that I have even seen.

Things evolved as my training progressed; for example, understanding the clinical perspective of “Does this patient actually have this disease?” is something that I have seen IPs work hard on—even involving clinicians if they’re not physician IPs—to help sort out the question. Questioning has only become more important with COVID-19 and the complexities of trying to figure it out.

The science has changed so much in terms of a positive test not necessarily indicating a patient has a disease, and we have seen that with COVID-19: Patients can have very low-level viral shedding for months after the illness, and that does not necessarily mean they are infectious and need treated as such.

You need nuanced clinical decisions; you must look at the patient as a whole. You must look at their symptoms and what is happening with them rather than not just saying, “This is what the patient has, so now we have to do this.” I have seen nuanced clinical decision-making go beyond COVID-19 to infections like methicillin-resistant 

 (MRSA); from institution to institution, what clinicians do varies, but the question is, “Do they actually have a wound that is purely related, or is it that they had a positive MRSA swab at some point 10 years ago?”—followed by making more nuanced decisions.

I have seen the process change. I have been trained to think, “Even if they do have MRSA, is this something that is infectious to other people? Does it need to be isolated?” Many people can have a trace positive but not need to be isolated.

 you need to think, “Does this patient have diarrhea? Does this patient even need to be tested for 

 or isolated?” You also need to consider the hospital reimbursement side of things. I am learning more about hospital reimbursement as I get through training, and that pressure to accurately classify and diagnose patients is even more intense when there is a financial penalty for misclassifying someone.

There is mixed literature for MRSA around whether you need to wear a contact gown. In some hospitals like where I did my residency, enough literature exists to make health care workers (HCWs) comfortable to say that for people with MRSA, if no pus is coming out the wound, you do not need to wear a gown because it does not help anything, and the gown is an environmental cost. Seeing HCWs with a contact gown is stigmatizing to the patient, and it decreases the amount of time that physicians and nurses spend in the room with the patient. The risks outweigh the benefits of isolation at that point.

The holistic approach is something that I was glad to see and that I hope to see more of in the future. Everyone I have encountered, at least on the clinical side or the physician-led scientists, is very happy to embrace new ideas, including holistic ones; the data were not there in the past to back up holistic approaches. For example, today less is more in terms of isolation (or isolating when only clinically relevant). The science also was not there in terms of more accurate testing for viral pathogens, and nor was polymerase chain reaction testing that has exploded. As that science has started to catch up, everyone is really excited about making infection prevention and control more precise.

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https://www.cdc.gov/hai/state-based/required-to-report-hai-nhsn.html

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https://www.infectioncontroltoday.com/view/tracking-of-healthcare-acquired-infections-continues-to-evolve

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Articles

How do the veteran and the novice infection preventionists work together in the present climate? What do they think are their strengths and their differences as they combine their knowledge in the health care field? Infection Control Today®  asked a veteran and a novice to find out. 

Old Meets New School: The Fusion of Generations in Infection Prevention

Surgical-site infections invariably involve surgeons, operating room (OR) nurses, sterilization of equipment, and so forth. Anesthesiologists, nurse anesthetists, and other anesthesia practitioners also contribute substantially to the transmission of pathogens.

For context, incidences of surgical-site infections differ based on inclusion criteria and lengths of patient follow‑up.

 For example, measured incidences have been 7.7% for inpatient surgery based on 60-day follow-ups,

 5.5% for inpatient surgery based on 30-day follow-ups,

 and 3.7% for inpatient and outpatient hospital surgery using billing codes for diagnosis.

 A randomized trial showed that perioperative transmission of ESKAPE pathogens (

 species) can be reduced, which reduces surgical-site infections.

 Prospective observational study then showed the strategy can be implemented throughout a multidisciplinary surgical suite.

) are combined with feedback to clinicians about intraoperative bacterial transmission.

 as a marker. For example, investigators at Georgetown were sent boxes with swabs, tubes, etc, and once used, they were returned for culturing and analysis.

 The investigators studied the time it took to perform sampling using the kits.8 Anesthesia assistants essentially opened sterile swabs, swabbed anesthesia-machine valves, patient axilla, stopcock lumens, etc.

There were 13 sites per case, 6 at the start and 7 at the end.

Sampling was done for successive cases in the same OR on the same day (“case pairs”)

. An example of transmission within a case was from the nasopharynx of the patient at the start of the case to the anesthesiologist’s hands sometime by the end of the case.

An example of transmission between cases was from the nurse anesthetist’s hands at the start of the first case to the nasopharynx of the second patient (when sampled after induction), observed on the nurse anesthetist’s hands again at end of second case and also on the anesthesia equipment at the end of the second case.

 From the study, sampling time averaged 3.4 minutes at the start of each case and 4.4 minutes at the end of each case—the total significantly briefer than 10 minutes.8 The cases from which sampling is done generally are 3.3 to 4.8 hours long

; therefore, circulating nurses can obtain the samples. If this is done, instead, by anesthesia technicians or infection preventionists, add the time waiting for patient induction and to be present at the end of surgery.

The primary end point of the randomized trial and observational effectiveness study was 

 transmission. For the randomized trial, 19 surgeons and their patients were randomized to usual care or infection-control bundle with feedback.

 Patients with transmission had 6-fold greater risk of surgical-site infection (

= .007). Treatment reduced the incidence of transmission (incidence risk ratio [IRR], 0.56; 

 For the effectiveness study, 804 patients were observed months before and after the infection-control program, including transmission feedback.

Optimization reduced the incidence of transmission (IRR, 0.39; 

 transmission complements reporting of surgical-site infections. Although the incidence of surgical-site infection varies more than 10-fold among surgical procedures,

 consistently there are no covariates for transmission: not the procedure, not surgical duration, not a dirty wound, not patient characteristics.

 transmission is many-fold higher than resulting surgical-site infections. Both factors make feedback about transmission easier to explain (

 transmission, the first decision to make is which ORs to sample. Some fundamental characteristics of surgical suites are relevant.

 Some ORs have many more cases per week than others, principally because some rooms’ cases take much longer than other rooms’ cases.

 Also, surgical specialties are distributed unequally among ORs (eg, rooms used preferentially for one specialty versus another), and average case urgency differs among rooms, as does the American Society of Anesthesiologists’ physical status score.

 From a study of 57 ORs in a large teaching hospital, the 20% of ORs with the most surgical-site infections accounted for 44% of 

 transmission, whereas the 20% with the least infections accounted for 5% of

 The 10% of specialty and OR combinations with the most surgical-site infections accounted for 76%

 transmission, whereas 47% of operating rooms had zero observed infections.

 That latter result is important for purposes of monitoring 

 transmission within and between case pairs. Use your surgical-site infection data—not for regular feedback, but rather, to choose a few specialty-OR combinations to target for monitoring and intervention.

Pathogens likely are transmitted intraoperatively in all ORs.

 What differs are probabilities of transmission resulting in surgical-site infection.

 Many hospitals report surgical-site infections per month in control charts. With 3 years of data, when plotted by OR, there was no paired association with cases per month.

The reason: Although ORs with more overall minutes per case (ie, longer) had greater incidence of infection (

<.001), those ORs had far fewer cases per day (

In other words, the ORs with very long cases (> 4.8 hours) have the greatest incidence of surgical-site infections, yet on many days, have only one case.

 In contrast, the ORs with cases averaging 3.3 to 4.8 hours in length have cases long enough for greater risk of surgical-site infection and usually 2 or 3 cases per day.

 In general, those are the ORs to target to prevent pathogen transmission. Beneficially, when monitoring 

 transmission using the few specialty-OR combinations with the most infections, applying the bundle of infection prevention interventions (

 transmission, the next related question is how many case pairs to sample. From the randomized trial, we have a typical incidence for transmission in the usual care group and a corresponding low incidence achieved with infection prevention bundle and feedback.

 Using those 2 incidences and applying statistical power analysis, the sample size would be 25 case pairs.

 For example, suppose that the targets for infection prevention were the 3 ORs of one specialty.

 Then the cases studied could be the first and second cases of the day in each room for 2 weeks. That would potentially give 30 case pairs, but cases occasionally cancel, all sampling cannot be completed, and so forth. After implementation (

 transmission need not be as large as for the randomized trial and observational study.

 A reasonable choice for feedback is to use culture results from another 75 case pairs.

 This information on sample size helps infection preventionists have context on number of surgical cases for sampling so that they can help the anesthesiologists and nurse anesthetists (and surgeons, OR nurses, and other anesthesia practitioners) know what to change to reduce transmission of the intraoperative bacterial pathogens.

In conclusion, substantial understanding exists about how OR pathogens cause surgical-site infections. It is known that the processes involved include not only contaminated wounds and resistance to otherwise appropriate antibiotics, but also bacterial transmission including the anesthesia environment.

 Feedback to anesthesia practitioners contributes to reduced surgical-site infections because that transmission can be mitigated with basic measures (Table).

 There is considerable understanding of why and how best to use 

 transmission as a marker of transmission for the purpose of feedback.

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Loftus RW, Dexter F, Goodheart MJ, et al. The effect of improving basic preventive measures in the perioperative arena on Staphylococcus aureus transmission and surgical site infections: a randomized clinical trial. 

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Petrosyan Y, Thavorn K, Maclure M, et al. Long-term health outcomes and health system costs associated with surgical site infections: a retrospective cohort study. 

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Dexter F, Epstein RH, Loftus RW. Quantifying and interpreting inequality of surgical site infections among operating rooms. 

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Wall RT, Datta S, Dexter F, et al. Effectiveness and feasibility of an evidence-based intraoperative infection control program targeting improved basic measures; a post-implementation prospective case-cohort study. 

 2022;77:110632. doi:10.1016/j.jclinane.2021.110632

Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management. 

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Dexter F, Elhakim M, Loftus RW, Seering MS, Epstein RH. Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic. 

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Datta S, Dexter F, Ledolter J, Wall RT, Loftus RW. Sample times for surveillance of 

 transmission to monitor effectiveness and provide feedback on intraoperative infection control. 

. 2020;21:100137. doi:10.1016/j.pcorm.2020.100137

Robinson ADM, Dexter F, Renkor V, Reddy S, Loftus RW. Operating room PathTrac analysis of current intraoperative Staphylococcus aureus transmission dynamics. 

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Loftus RW, Dexter F, Robinson ADM. High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. 

. 2018;46(10):1134-1141. doi:10.1016/j.ajic.2018.04.211

Dexter F, Ledolter J, Epstein RH, Loftus RW. Futility of cluster designs at individual hospitals to study surgical site infections and interventions involving the installation of capital equipment in operating rooms. 

. 2020;44(4):82. doi:10.1007/s10916-020-01555-0

Dexter F, Ledolter J, Epstein RH, Loftus RW. Importance of operating room case scheduling on analyses of observed reductions in surgical site infections from the purchase and installation of capital equipment in operating rooms. 

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Dexter F, Ledolter J, Wall RT, Datta S, Loftus RW. Sample sizes for surveillance of 

 transmission to monitor effectiveness and provide feedback on intraoperative infection control including for COVID-19. 

. 2020;20:100115. doi:10.1016/j.pcorm.2020.100115

To reduce the risk of surgical-site infection, utilize evidence-based interventions and give feedback to clinicians on bacterial transmission using Staphylococcus aureus as a marker. 


The OR: A Prime Target for Pathogens 

The overriding mission of infection preventionists is to contain and stop the spread of disease. Modern day epidemiology has divided the spread of respiratory diseases into categories of airborne and droplet transmission. This dichotomy, along with 2 standards of prevention, persisted up to the COVID-19 pandemic.

 At the beginning of the pandemic, SARS-CoV-2, the virus that causes COVID-19, was thought to spread primarily by large droplets and environmental surfaces. These droplets should be easy to stop, and initial recommendations were made for contact precautions and wearing of surgical masks.However, surgical masks do not fit tight on one’s face. For droplet spread, they work well, but not for aerosolized particles.

Prior to COVID-19, it was believed that aerosols were composed only of small particles, less than 5 microns in size. Although SARS-CoV-2 is approximately one hundredth of a micron in size,

 the virus is primarily spread by respiratory droplets with an estimated minimal size of 9.3 microns.

 But case reports started to emerge that documented transmission over relatively large distances associated with singing in churches



In October 2020, after an extensive analysis of research, the National Academy of Sciences concluded that aerosolization can occur with particle size up to 100 microns.

 Apparently, just talking could aerosolize SARS-CoV-2. In addition, not only could larger particles aerosolize, but talking, singing, and coughing produce a wide range of particle sizes.

We were not facing a dichotomy in methods of spread; we were facing a continuum. When a patient coughs or talks, some of the particles will aerosolize while others that are large droplets will splatter the environment. If a patient has tonsillitis from group B 

[MRSA]) and coughs, droplets will be propelled into the room. The size of 

 and some of the droplets can be expected to aerosolize. Thus, a surgical mask with gaping holes on the sides may not be protective.

Wu et al

 in 3 hospitals in China. The investigators isolated the bacteria in air and documented spread between wards and hospital corridors, which were at least 10 meters apart. Although many strains of 

 are commensal, the bacterium is just 1 plasmid away from transforming into the superpathogen carbapenem-resistant Enterobacteriaceae.

 One might ask, what could have aerosolized 

 Possibly toilet plumes. This mode of spread has also been postulated for SARS-CoV-2.

Unfortunately, the United States has been slow in adopting policies and standards that adequately prevent airborne spread. In the 19th century, health care and the public were highly resistant to realizing that cholera outbreaks were not primarily spread by foul air (miasma).

 In modern medicine, we are now reluctant to believe how frequently pathogens can become airborne.



The use of more effective personnel protective equipment (PPE) and upgrading ventilation systems in all public indoor venues is of paramount importance. Improvements in ventilation can be accomplished by increasing complete air exchanges with outdoor air or equivalent air exchanges with high-efficiency particulate air filtration and/or UV light sanitization.

Alondra Nelson, head of the Office of Science and Technology Policy and deputy assistant to the president, has stated that upgrading a building’s airflow to 5 air exchanges per hour reduces the risk of airborne disease transmission by 50% or more.

 For health care settings, facilities should have the equivalent of 12 or more complete air exchanges per hour.



In public venues, a proxy for determining safe levels of airflow and air exchanges is the measurement of the carbon dioxide concentration in the air.

Outside air has a carbon dioxide (CO2) concentration of less than 500 ppm. The American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) recommends a steady-state indoor CO2 concentration of 870 ppm.

 The Environmental Protection Agency (EPA) recommends a maximum indoor CO2 level of 1400 ppm.

 A study from Harvard University found large differences in cognition when CO2 levels were raised from 550 ppm to 1400 ppm. However, the Occupational Safety and Health Administration has more relaxed rules, with a maximal allowed average concentration within an 8-hour working period of 5000 ppm.

 Unfortunately, few indoor public venues in the United States meet the ASHRAE or even the EPA-recommended safe levels. Even at levels below 1000 ppm, symptoms of sick building syndrome, such as sore throat and wheezing, can occur.



The appropriate use of PPE has also become controversial, with many health care facilities still focusing on the prevention of large droplet spread. Recently, several large hospitals were removing N95 masks that patients wore into the facility and replacing them with surgical masks. This was reported by Politico to also have occurred at Massachusetts General Hospital, the previous facility of the director of the CDC.

A nonfitted N95 mask provides 4 times the protection of a surgical mask.

 Despite this, and the much greater infectivity of the Omicron variant, regulatory agencies still have not recommended N95 masks for all health care workers. One can make a strong case for wearing N95 masks when treating all patients with respiratory illnesses and relegating the use of poorly fitting surgical masks to surgery, during which the main concern is preventing secretions from the surgeon from contaminating the surgical site.

Increasing Health Care–Associated Infections



The pandemic has given us new knowledge to transform infection prevention; however, it has also created additional challenges that have exacerbated the epidemic of antibiotic-resistant bacteria.

A recent report from the CDC compared the standardized infection ratios (SIRs) of health care–associated infections from the years 2019 to 2020.

 The CDC observed significant increases in central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections, ventilator-associated events (VAEs), and MRSA infections, but not in select surgical-site infections and 

infections. There was also a 14.2% to 36.4% decrease in the number of reporting hospitals during the pandemic.

Large increases in infections were seen in CLABSIs, VAEs, and MRSA, which experienced a 47.0%, 44.8%, and 33.8% increase, respectively. The SIR for these infections increased to a level between 0.97 and 1.39, effectively wiping out any gains achieved since the 2015 baseline that was set at 1.0.

Prevention of these infections requires trained and experienced staff, along with safe staffing levels. Unfortunately, the pandemic has placed tremendous stress on staff, resulting in extremely high turnover rates at many facilities. As pointed out by Lisa Lockerd Maragakis, MD, MPH, senior director of infection prevention at Johns Hopkins Health System, professor of medicine and epidemiology at Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health, and cochair of the CDC’s Healthcare Infection Control Practices Advisory Committee, during the March 24, 2022, meeting: “One of the main challenges I think that many of us are facing is an almost complete turnover in personal on some of our units.”

A primary factor that has contributed to the emergence of antibiotic-resistant bacteria is the overuse of antibiotics. Unfortunately, the use of telehealth during the pandemic may have promoted antibiotic overuse. Without a physical examination, it is very difficult to determine if an ear, sinus, or throat infection is present. Video color balance, brightness, and fogging make examinations of cavities difficult at best. In addition, testing for Group B

 along with bacterial cultures is not relatively available. Ray et al

 found that antibiotic usage for pediatric direct-to-consumer televisits occurred in 52% of the visits versus 31% for primary care–provider office visits.
 
Concern regarding bacterial coinfections also promotes antibiotic usage. In a review of the literature, Rawson et al found that 8% of patients with COVID-19 developed a bacterial/fungal coinfection compared with 11% of patients without COVID-19. Despite wide empirical administration of broad-spectrum antibiotics in patients with COVID-19, the authors stated there was a paucity of data to support their use.

There is no doubt that infection preventionists have a herculean task before them. They must advocate for more effective and available PPE, better indoor ventilation, and mechanisms to decrease aerosols created by sinks and toilets. Extensive training of new and temporary staff must be implemented regarding empirical antibiotic usage and infectious disease protocols, along with the education of patients and providers regarding the limitations of telehealth.

No one can be expected to accomplish all of this with prepandemic resources. The first step must be to educate hospital administration regarding the resources required to reverse the increasing rates of antibiotic resistance and to improve infection prevention by implementing the knowledge learned during the pandemic. Only then will an optimal safe workplace be created and the safest possible care be provided to patients.

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Allen JG, MacNaughton P, Satish U, Santanam S, Vallarino J, Spengler JD. Associations of cognitive function scores with carbon dioxide, ventilation, and volatile organic compound exposures in office workers: a controlled exposure study of green and conventional office environments. 

The bugs are winning, but only because we are letting them.


Infection Control Today, June 2022, (Vol. 26, No. 5)

Old Meets New School: The Fusion of Generations in Infection Prevention

The OR: A Prime Target for Pathogens

A Pandemic Paradigm Shift in Our Understanding of Transmission

Children 6 Months to 6 Years 1 Step Closer to a COVID-19 Vaccine

Health Care Worker COVID-19 Risk Stemmed From Workplace, Not Community

Despite Safety Alerts, Contaminated Flexible Endoscopes Continue to Put Patients at Risk

The FDA Issues Urgent Warning About Karl Storz Endoscopes Reprocessing Methods

In-Use Disinfectant Bucket Identified as Source of Contamination in Hospital