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1rem

 hand hygiene page examines the practice of hand hygiene, from the proper methods to adherence among hospital staff. Will greater recognition of hand hygiene’s importance in curbing the spread of infections translate into better adherence among hospital staff and the public? This page features videos that demonstrate exactly how to conduct hand hygiene properly, articles recapping peer-reviewed literature on the latest advances in monitoring and adherence, as well as the popular "Bug of the Month" feature. 

Use this handout to explain the basics of why infection prevention and control and antimicrobial stewardship are essential and how the 2 fields must have a unified approach to patient and staff safety


Strengthening Defenses: Integrating Infection Control With Antimicrobial Stewardship

The Bug of the Month helps educate readers about existing and emerging pathogens that are clinically important in today's health care facilities. 

Bug of the Month: Fearing My Unpleasant High-Pitched Whine

Clean Hospitals promotes global healthcare environmental hygiene, reducing infections and antimicrobial resistance. Join the movement to improve patient safety and staff protection through Clean Hospitals Day.


The Critical Role of Clean Hospitals in Infection Control: Why You Should Join the Initiative

Enjoy this first installment of The Long-Term Care Chronicles With Robbie Hilliard, MSN, RN CIC, a column about managing special infection control situations in the long-term care patient population. This installment is about when 2 experts conflict about best care.

The Long-Term Care Chronicles: The Great Mitigators

Infection Control Today® speaks with the 2023 Infection Control Today’s Educator of the Year Award™ winner, Sharon Ward-Fore, MS, MT,(ASCP), CIC, FAPIC

About the Infection Control Today's Educator of the Year Award

Health care workers must stay vigilant against rare pathogens. Saskia v. Popescu, PhD, MPH, MA, FAPIC, an expert in infection prevention, 

Saskia v. Popescu, PhD, Discusses How to Prepare for Rare Infectious Diseases

Because the landscape of infectious diseases is constantly evolving, health care workers (HCWs) should be aware of the possibility of rare, yet equally significant, pathogens. HCWs should be aware of the critical importance of robust infection prevention measures, including accurate diagnostics, isolation protocols, and stringent disinfection practices, in mitigating the spread of such infections.

) spoke with Saskia v. Popescu, PhD, MPH, MA, FAPIC, assistant professor at the

University of Maryland School of Medicine in Baltimore, Maryland, and a member of 

Popescu discussed multidrug-resistant organisms like 

and other emerging infectious diseases not endemic or typically seen in the US, like SARS-CoV-1, Ebola, Nipah virus, Hendra virus, Marburg virus, and others.

She emphasizes that infection prevention health care workers should know about these diseases, including infection preventionists, environmental hygienists, and sterile processing personnel. “The tough part is that if we only stuck to one disease, we'd be doing our staff a disservice. And even if the likelihood of the Nipah virus showing up in your hospital is extremely low, I would rather we talk about it and have plans for response because it's actually a very manageable disease. From an [infection control and prevention] perspective, we can easily put those protocols in place. Even with Ebola, it is much more complicated to handle, but we have protocols and a tiered hospital system within the universe. But we have to make sure people know about it; we have to make sure they have the resources to adequately respond and communicate it.”

 where she goes to get the latest information on rare diseases and infectious diseases in general. She said she goes to 

, “This is a free online information service about outbreaks that are reported globally,” Popescu said. She also reads 

, and the social media from those sources.

Popescu said that training teams on recognizing and handling rare diseases should be addressed at the highest level, such as for Ebola, because it requires a high level of infection control processes. “If you can train your teams and make them comfortable with those processes, comfortable with the protocols, the donning and doffing and knowing what to do, or at least where to find the resources. [Ebola] is a nice top to your level of readiness, that anything else will probably not be as burdensome because even when we look at novel respiratory pathogens like COVID-19, [which] is not the same level of PPE because Ebola is so infectious, that you have to be very, very careful, you have to have the designated donning and doffing rooms, and going in and out.”

She continued, “The PPE is very exhausting and hot. It's very time-consuming. So, I use Ebola as a gold standard for if we can do [follow those high-level processes]. And it involves so much in terms of engineering controls, cleaning, disinfection, waste management…PPE, just communication, everything, then everything else will just be either a little bit less or different in a way that [the team] will know what to do, essentially. I like using Ebola as a metric.”

Some individuals believe that just because a disease usually is only found in a foreign country, that doesn’t negate that HCWs should be prepared for any disease that shows up at their facility. “There's a sense of saying this disease isn't something we have seen in the US,” Popescu said. “But that doesn't mean we're not preparing for it is a better strategy because I don't want people to ever live in a state of fear. I also don't want us to ever be so complacent that we're not preparing ourselves.”

(Quotes have been edited for clarity. Watch the entire video for more of Popescu’s advice.)

Health care workers must stay vigilant against rare pathogens. Saskia v. Popescu, PhD, MPH, MA, FAPIC, an expert in infection prevention, emphasizes the importance of robust measures and preparedness.

The Role of Hospital Beds in Clostridioides difficile Transmission: Insights from a Retrospective Study

), Lucy S. Witt, MD, the lead author, shared insights into her groundbreaking study on 

 transmission. She is an assistant professor of medicine and infectious diseases at the Emory University School of Medicine, a hospital epidemiologist at Emory Johns Creek Hospital, and the newest member of 

, titled "The role of the hospital bed in hospital-onset 

, a retrospective study with mediation analysis,” published in 

Infection Control & Hospital Epidemiology

, investigates the significant role hospital beds play in 

 acquisition. Witt explains the study's methodology, findings, and the crucial interaction between beds and rooms. The exclusive interview sheds light on key insights for infection prevention personnel, emphasizing the importance of addressing various touchpoints and hand hygiene in health care environments to curb 

’s listeners the title and some background, how it came about, and what the findings were.

 So myself, along with colleagues at Emory, recently published a study on 

. We were looking at whether the bed itself was important to the transmission of 

 in a hospital because it's…been shown in multiple studies that being in a hospital room where a patient had previously had 

, likely puts subsequent patients at risk for acquisition as well. But exactly what part of the hospital room was playing a role hadn't been understood.

We used available technology at the time, which tracked the beds in our hospital, and each bed had 1 mattress, so we could tell you where that bed and that mattress were at any time and could follow those beds and mattresses and see how much of a role the actual bed played, as opposed to the room played in the acquisition of hospital-onset 

We employed a more complicated biostatistical analysis called mediation and interaction analysis, where we looked at the bed playing a role and the room playing a role. How much is the interaction between the bed and the room together playing a role? And how much do they play a role individually? What we really found is that both the beds in the room play a role in putting patients at risk for hospital-onset 

, but there is an interaction between them.

If you are in both a bed that held a patient who previously had 

 and a room that held a patient that previously had 

, it's really that interaction in the bed in the room is really important to future patients’ risk.

: What is the interaction? Is it because of where it's at? Is it not? Is it because it's not being cleaned properly?

 We don't know; our study did not do swabs of bedrails, light bulbs, light switches, or patient care equipment. So, I can't say for sure, but from prior studies looking at like [adenosine triphosphate] fluorescent markers on health care workers’ hands, there's probably some healthcare worker hands transmitting spores, maybe some inadequate cleaning, as well as interactions between the surfaces themselves. If the bed hits the wall, you know, does a little bit of spore get on the wall? It's complicated and not completely figured out yet. But anyone who works in health care can kind of imagine the different routes that contaminate a bed and a room and make it [riskier] to be in a contaminated bed and room.

: What do you want infection prevention personnel to learn from your study?

 My study, in conjunction with other studies, even looking at other infectious pathogens that are hospital-based problems, I'm thinking 

 that there's so much interaction between the health care environment and the patient that health care workers participate in that patients participate in, your patients are out of bed touching things, health care workers are in the room helping their patients, and that all of those touches are potential contaminations. And I think we, as a group, and we, like the infection prevention world, have been so focused on clean-in and clean-out. These hard stops are easy to see and track and intervene on. 

It's becoming more and more obvious that we need to make sure we're focusing on all the 5 moments that the [World Health Organization] has highlighted. When we're interacting with patients, make sure that hands are being cleaned every time you go from surface to body or body to a surface, not just focusing on clean-in, clean-out, [but] focusing on cleaning our hands during all interactions with patients and surfaces in their rooms. And really understanding what is a sterile site? What's a nonsterile site, and what's an in-between site, and then what's a dirty site? And [then] making sure that we wash our hands, use hand sanitizer, use gloves, use gowns at the appropriate place in our care of patients.

: What surprised you from the results of your study?

 I was surprised at how much the interaction between the room and the bed was important. At the beginning of the study, I thought that the bed itself was going to be of the utmost importance, and that was one of the reasons this was undertaken. It was right around the time that our health care system just happened to replace all the mattresses. There had been national reports given to the [Federal Drug Administration] that there had been leakage through mattress covers of human material, so not necessarily transmission of a pathogen through a mattress. But just this concept that we all assumed that mattress covers were impermeable, and it turns out they weren't. So, it was just a lucky coincidence that we happened to have replaced these new mattresses, and this concern for mattresses, and could track them.

Because of those reports about the seepage, I said, “I wonder if beds are really the important part.” And again, a lot of our patients are bed-bound; they might be soiling in their beds. It made sense to me that, okay, the bed could be the smoking gun for the transmission of 

. I was surprised at how important the room turned out to be. It reiterated to me again that it's the other surfaces in health care interactions [that] are super important. We need to be doing a good job of cleaning our hands and protecting cross-transmission from surfaces to patients and patients to surfaces.

: Do you have anything else you'd like to add?

we're seeing across the country. It's going to be interesting to see what effect this has on 

 is making us rethink what cleaning products should be the everyday cleaning products in our hospitals, how we should disinfect rooms, and how we prevent contamination. I suspect that that's going to have a further effect on 

 since some of the products overlap in terms of being able to kill 

, which some basic products [that] many hospitals used for disinfection and decontamination would not necessarily kill 

. So, I think it's going to be interesting to see what the future holds as we all ramp up to try to prevent further spread of 

A study led by Lucy S. Witt, MD, investigates hospital bed's role in C difficile transmission, emphasizing room interactions and infection prevention.

The Role of Hospital Beds in Clostridioides difficile Transmission: Insights From a Retrospective Study

interview on chikungunya. What it is about. 

Chikungunya

As tropical viruses show up more often in the United States, 

) wanted to get more information about one virus in particular: the chikungunya. To learn more, ICT spoke with Thomas Rademacher, MD, PhD, cofounder of Emergex, who has served as CEO since the company's formation. He is also an emeritus professor of Molecular Medicine at University College London.

Rademacher explains the virus, related viruses, and how Emergex recently signed a contract with the UK Department of Health and Social Care to advance a CD8 T cell-based vaccine candidate against chikungunya.

 that has gained increasing attention in recent years due to its rapid spread and debilitating effects on individuals. This infectious disease is primarily transmitted to humans through the bite of infected 

Aedes mosquitoes, primarily Aedes aegypti and Aedes albopictus

. Chikungunya is characterized by a sudden onset of high fever, severe joint pain, and a range of other influenza-like symptoms, making it challenging to diagnose accurately. While it is not typically fatal, the acute phase of the illness can be extremely distressing and incapacitating, often leaving individuals bedridden for weeks.

The name "chikungunya" is derived from the 

, meaning "to become contorted," which aptly describes the painful joint deformities that can result from the infection.

“Therefore, to generate types of vaccines that will have broad specificity will cross-react, but we're acting with more than one because it's just not practical,” Rademacher said. “If people go to endemic regions where mosquitoes are, you don't know what you're going to get there….The idea here is to use chikungunya as sort of a prototype and develop a vaccine against that. But the hope is, of course, that vaccine will cover other members of the chikungunya family.” 

As tropical viruses increase in the US, Infection Control Today wanted to learn more about chikungunya. Here is what we learned.

Video Series

Chikungunya: What Is it, Why Is it Dangerous, and What Is Being Done to Help?  

As students return to school, a crucial question arises: Should they be required to wear masks? The answer to this question, like many aspects of the COVID-19 pandemic, is complex and depends on various factors.

) spoke with Ambassador Deborah Birx, MD, a highly respected American physician and public health expert who has played a pivotal role in the field of global health and infectious diseases. Throughout her distinguished career, Birx has made significant contributions to the fight against HIV/AIDS and has been at the forefront of the response to the COVID-19 pandemic. In 2020, during the outbreak of the COVID-19 pandemic, Birx was appointed as the White House Coronavirus Response Coordinator on the US Coronavirus Task Force. In this role, she played a key part in guiding the nation's response to the pandemic, providing valuable insights and data-driven recommendations to mitigate the virus spread

The effectiveness of vaccines in providing long-term protection against infection is limited. Additionally, natural immunity acquired through previous infection also wanes relatively quickly. This raises concerns about the vulnerability of children under 18 in the school system, where close contact and the exchange of saliva are common occurrences. However, now “we have tools to treat people who are at risk,” Birx told 

. “ And we have tools in the vaccines to ensure that the teachers who are vulnerable are actively immunized so that we don't have to worry about if they get infected [that] they're at risk.”

The key question is whether masks should be mandatory for students. The consensus is that vulnerable children should wear masks during waves or surges of COVID-19 cases. The decision should be informed by local data and community circumstances. Well-fitted masks, including N95s, offer a level of protection that is especially crucial for vulnerable children.

Furthermore, it's important to foster understanding among students and their families. Rather than assuming that mask-wearing is a political statement, it should be seen as a matter of personal safety and consideration for others. “I have a great respect for people who proactively mitigate during a surge…to protect their family members. And we should see that as a point of personal empowerment and respect for others, particularly that they may have people at home at risk,” Birx said.

Timely communication from public health agencies, like the CDC, is crucial. They must provide specific, localized guidelines based on the status of the virus in each community. This information empowers individuals to make informed decisions about their safety.

It's important not to underestimate BA.2.86 potential impact. This variant, while a distant relative of Omicron, carries mutations that make it just as concerning in terms of its ability to infect individuals and potentially evade immunity. 

Global surveillance efforts are designed to identify and study variants that pose a risk to public health. If a variant is identified as potentially problematic, action should be taken promptly. This includes developing and producing updated vaccines if necessary. The mRNA vaccine technology allows for rapid adjustments to vaccines, ensuring that we can stay ahead of evolving variants.

Ambassador Deborah Birx, MD, discusses whether students should be required to wear masks to protect themselves and others and what the public should know about the newest COVID-19 variant, B.A.2.86.

Fall 2023: Mask Mandates for Students Amidst COVID-19 and Latest Variant Concerns

What concerns do Americans have about hospitalization? A recent survey’s focus was to understand the perspectives, feelings, concerns, and level of knowledge of risks associated with hospitalization in the United States from both medical and nonmedical individuals.

Greg Bullington, CEO and cofounder, and Christine Chen, vice president of marketing, Magnolia Medical Technologies, Inc., discussed with 

“State of Hospitalized Patient Care in the U.S. 2023,” 

examines how much individuals understand and worry about these hospital risks, including antibiotic stewardship and hospital-acquired infections.

“We wanted to start broadly to understand just what the level of knowledge and understanding of various types of risks within the hospital environment look like, really, as a baseline, it's our intent to continue this research,” Bullington told 

. We think there are many important gaps in knowledge and education as it relates to risks associated with a host of factors…. We wanted to calibrate and understand the level of knowledge, concern, and fear amongst the general population and those [who] serve in medically related occupations, including physicians.”

Overall, the main concern of the survey’s participants is the financial implications of hospitalization. “We've all heard stories of how significant the burden can become for folks [who] end up with prolonged hospital stays. So, that was not necessarily a surprise. But as it related to the risk of hospital-acquired infections and antibiotic use, there [were] interesting data and [many] interesting responses. About 75% of the respondents, 3 out of 4, stated they were concerned and believed that health care providers must be more cautious when prescribing antibiotics. The concerns around antibiotic resistance release seem to be generally well understood. But not surprisingly, the bifurcation between the general population and then those employed and medically related occupations, there was a much higher acuity and understanding within the medical profession group than the general population.”

Chen said she was surprised by the number of individuals affected by sepsis. “Either they had been diagnosed with sepsis, or a family or loved one had been diagnosed and cared for sepsis. The other interesting finding from the survey was that individuals who had been directly impacted by sepsis were much more aware of consumer rights when it came to issues associated with antimicrobial resistance and antibiotic-resistant bacteria. And there needed to be more caution and focus on the unnecessary prescribing of antibiotics. The other piece that I thought was super interesting about this patient population was that not only were they more of an aware consumer, but they had the highest level of awareness [regarding] when it came to the impact of inaccurate results. So, these respondents are 45% more aware that inaccurate blood culture results can lead to the unnecessary administration of antibiotics compared to those individuals [who] had not had a diagnosis.”

For infection preventionists, the survey points to areas where they can assist with resisting the antibiotic prescription. “Infection preventionists (IP) play an important role in the institution in terms of the prioritization of various techniques and technologies that are evidence-based to minimize the risk of blood culture contamination, which can lead to the misdiagnosis of sepsis. So there is a vital role that the IP community plays within acute care hospitals to help reduce the incidences of false positive results, which significantly reduces the overuse of these powerful, potent antibiotics, which has the cascading effect and impact of helping stave off a lot of the continued pressure that we have from an antibiotic resistance standpoint.”

The financial cost of hospitalization is the most concerning risk for Americans, given the current state of the economy. A survey showed that 55% of respondents are either 'Very' or 'Extremely' fearful about this issue. Additionally, 75% of Americans believe health care providers should be more cautious when prescribing antibiotics. However, there is a significant knowledge gap regarding the risks associated with antimicrobial-resistant bacteria among previously and future hospitalized patients. Therefore, there is a need for more government leadership between health care providers and patients to address this issue.

Regarding infections caused by antimicrobial-resistant bacteria, 52% of respondents are 'Very concerned' or 'Extremely concerned' about the effects on their current or future health. They also agree that more education is needed for patients about this issue. Sepsis is the number one cause of death, readmissions, and costs for US hospitals and is the most feared infection. Nearly half of the survey respondents are either 'Extremely' or 'Very' fearful of sepsis. Additionally, approximately 1/3 of respondents either have had a loved one or have been personally diagnosed with sepsis, making them more knowledgeable about other health care-associated infections.

However, the survey also revealed that approximately 40% of respondents in non-medical related occupations are 'Barely' or 'Not at all' informed about the risk for hospital-acquired infections (HAIs). Nevertheless, 81% of all respondents agree that it is 'Very' or 'Extremely' important to be informed about HAI risk and infection control measures in the hospital if they were to be admitted as a patient.

Finally, 46% of respondents rated the government's performance as either 'Extremely poorly' or 'Poor' when it comes to protecting the health of Americans by addressing preventable medical errors and holding hospitals accountable for key quality measures.

 A recent survey aimed to understand Americans' concerns and knowledge about hospitalization. Infection Control Today speaks to 2 of the authors. 

What Are Patients’ Fears Around Hospitalization? A Survey Found Out 

The COVID-19 Public Health Emergency has been declared over. But that doesn’t mean that COVID-19 and the need for assistance for the effects of COVID-19 are over. Where do we go from here? 

) contacted Deborah Birx, MD, for her input, based on her work with global HIV initiatives. 

Birx is a renowned medical expert and leader with extensive experience in clinical and basic immunology, infectious disease, pandemic preparedness, vaccine research, and global health. She has served the United States as an Army Colonel and has overseen influential programs at the CDC and US Department of State. Birx is a formal Ambassador-at-Large and is currently a Senior Fellow at George W. Bush Institute in Dallas, Texas.

In the discussion, Birx discusses what she thinks the government did right, did wrong, and what still needs to be done going forward. One theme runs through the conversation: “If you give people the information and empower them, they'll make the right decisions, but we're not giving people the information and empowering them to make the right decisions.”

About the Public Health Initiative, Birx remarked, “It doesn't matter if the public health emergency goes away or not. Because we haven't really taken advantage of the public health emergency over the last 2 years to understand and address the gaps that are quite apparent to every American out there.”

About masks, Birx says, “I think the masking issue has demonstrated how important it is in aerosolized respiratory disease and how it may be less important and more droplet transmission that may still be more surface and direct contact with individuals.”

, “I'm going to be very clear: these vaccines were a miracle. They saved literally hundreds of thousands of American lives. But they're not perfect. They're far from perfect. And we have not been clear to the American public about their imperfection. I think because of that, people aren't clear on what these vaccines can do and can't do.”

Birx is optimistic about the world’s ability to handle future pandemics. “All of these things are addressable. We are incredibly smart in the United States and around the globe; we know how to make highly technical things fast. [So,] we need to figure out how we work effectively with communities to give them the information they need to do their own risk-benefit analysis, and [so] they don't feel like the federal government is misleading them with partial truths. There is never a reason to withhold information for fear that the American people will not understand it. That's how you lose the public. And that's been very well demonstrated in COVID-19.”

(Birx’s quotes are edited for clarity. Listen to the full interview for more of Birx’s views.)

“It doesn't matter if the public health emergency goes away or not. Because we haven't taken advantage of the public health emergency over the last 2 years to understand and address the gaps quite apparent to every American out there.”


ICT Exclusive: Deborah Birx, MD, Discusses the End of the COVID-19 Public Health Emergency

) requires the efforts of not just infection preventionists (IPs) and environmental hygiene services (EVS), but also the entire facility or community. What specific measures should IPs and EVS take to address this issue?

), along with our colleague Chris Spivey, editorial director for 

, reached out for answers from Megan Lyman, MD, medical officer, Mycotic Diseases Branch, CDC, and Danielle A. Rankin, PhD, MPH, health scientist, Division of Healthcare Quality and Promotion, Prevention and Response Branch, Antimicrobial-Resistance Team, CDC. 

This installment is the second in a series. The first is 

 in the news, but how do you recognize it? What are the symptoms? What do you see?

 There aren't any specific signs or symptoms for 

, which depends on the body site of where the infections are occurring. However, it's often similar to infections caused by bacteria and viruses. If you have a bloodstream infection, you might have a fever or sepsis. And if you have a wound infection from 

, you might see redness, swelling, and drainage. It's difficult because no symptoms specifically point to 

 [because] it's similar to infections caused by other pathogens.

: What can infection preventionists and environmental hygiene specialists do to help prevent this pathogen?

 There are many different infection control measures that can work and beyond the basics, I want to focus on 2 primary key points that we often recommend to our health care facilities for seeing 

 and 1 of them is admission screening. Admission screening is important because we are able to identify patients or residents coming from long-term care facilities who are, as Megan indicated, asymptomatically colonized with 

If we do asymptomatic colonization, we're able to detect when a patient with 

 is not showing those signs or symptoms. We know that asymptomatic colonization can also lead to a silent spread within a health care facility, often undetected, and so we see these larger outbreaks of 

. When we do admission screening, we're able to have the facility place the patient or resident (depending on what facility type it is), if they screen positive for 

, we recommend that those patients are placed on the appropriate transmission-based precautions. In acute care hospital settings, we recommend that contact precautions, which include gloves and gown, that health care providers ensure they're performing the appropriate hand hygiene, and that they have dedicated patient care equipment.

In nursing homes, that changes a little bit. We have what's called 

, again, includes that glove and gown, but only apply those during high-risk patient care activities such as bathing, changing, or toileting a resident, and hand hygiene. In addition to an admission screen, we recommend infection preventionists and facilities with a case of 

 focus on conducting direct observations of those [basic] control practices. So that includes hand hygiene, personal protective equipment usage, and environmental cleaning. But specifically with hand hygiene, [IPs] want to make sure that they have those direct observations are being done during patient care, so you can then help coach staff, and where there are some opportunities for improvement of when hand hygiene could have occurred to limit the spread from environment to patient. Then for personal protection equipment use, ensuring that donning (or putting on the gown and gloves) is in the proper order and taking off [doffing] is reducing any contamination to the person themselves.

Then specifically with environmental cleaning [for] 

] health care facilities should be using the disinfectants listed on Environmental Protection Agency’s 

 is shown to contaminate the environment and can be difficult to remove without meticulous cleaning efforts.

Because of this, we also recommend that IPs pair up with their environmental services (EVS) management team to conduct direct observations of environmental cleaning, to ensure that from start to finish are hitting all high-touch surfaces. All environmental services staff are moving in a systematic method when they're cleaning the room. Either starting clockwise or counterclockwise in a room and from the outer perimeter and going into the patient zone, typically where the patient or resident bed is. In addition to that, while they're watching those items, make sure that staff are moving from cleaner to dirty surfaces so that they're not cross-contaminating within the room itself. It gets complex, but the direct observations help formulate those opportunities for improvement and one-on-one coaching with those staff members.

To prevent the spread of C auris, the CDC recommends that IPs and environmental hygienists play a critical role. In this interview, the medical scientists clarify what specific actions they should take.


CDC Discusses Candida auris: The Role of Infection Preventionists and EVS Staff

The media has been inundated with inquiries about 

To ensure the accuracy of the information concerning Candida auris, Infection Control Today has spoken with 2 medical scientists from the CDC. 

Hand Hygiene

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