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 health care-acquired infections (HAIs) page presents updates on the latest techniques and strategies in the never-ending battle between infection preventionists and HAIs. Focusing on the latest in medical literature, we also present perspectives from the top infection preventionists and other medical experts in the country about how to put the growing knowledge of HAIs into use in the everyday world of infection prevention. Articles and videos often focus on methods to contain and control pathogens and multidrug-resistant organisms from spreading within the health care system.

In this Hot Topics in IPC, Saskia v. Popescu, PhD, MPH, MA, CIC, FAPIC, discusses COVID-19 vaccines and boosters, Legionella infections from transplants, and hospital leadership.

Hot Topics in IPC: COVID-19 Updated Booster, Legionella Infections, and Hospital Leadership

Plague doctors' historical attire was an early form of PPE. While modern PPE has improved, the quest for better, more comfortable protection continues as we aim for a future where health care workers can provide care confidently.

Protecting HCWs: Plague Doctor's Masks to the Personal Protective Equipment of Tomorrow

The "Strategies to Prevent Catheter-Associated Urinary Tract Infections" document has been updated by the Compendium of Strategies to Prevent Health Care-Associated Infections. It is sponsored by the Society for Healthcare Epidemiology and developed by over 100 experts from various organizations.


Guidance for Preventing CAUTIs: Insights from the 2022 Compendium Update

September is Sepsis Awareness Month, and a recently published study examines what patients and health care workers know—and fear—about sepsis. 


Results of a 2023 State of Sepsis Awareness Survey

Here you will see where to nominate an exceptional infection control and prevention educator for the Infection Control Today®’s Educator of the Year Award™.

Infection Control Today's Educator of the Year Award Nomination Form

The Association for the Health Care Environment (AHE) Exchange Conference & Solution Center brings together individuals who are passionate about environmental hygiene in the health care industry. Doe Kley, MPH, RN, T-CHEST, LTC-CIP, CIC, Infection Prevention Fellow for Clorox Healthcare, and adjunct lecturer for the department of education and human ecology at The Ohio State University at the conference and shared valuable insights with 

) about her presentation and 2 sessions she found valuable. The AHE was held in Dallas, Texas, from July 31 to August 2, 2023.

: Please summarize your AHE presentation?

Doe Kley, MPH, RN, T-CHEST, LTC-CIP, CIC:

 The presentation that I gave at AHE was titled “Deepening Your Understanding of Environmentally Spread Emerging Pathogens.” As the title implies, this talk was specific to those emerging pathogens that have the potential to be spread by contaminated surfaces—albeit some more than others. This talk was inspired by the events of the past few years. The 21st century has been impacted by emerging infectious diseases on an unprecedented scale.

I started this talk with a little background into the problem, primarily why we are seeing an increase in novel pathogens (eg, climate change and urbanization). I then reviewed some of the challenges associated with these pathogens, particularly as they relate to environmental services [EVS], including things like our general lack of preparedness, limited treatment options, a tendency to cause outbreaks, and cleaning and disinfecting against pathogens. Because it can be quite complex, I reviewed the EPA’s viral emerging pathogen policy, including a comprehensive overview of EPA’s List Q.

I also reviewed several selected emerging pathogens. These included 

], carbapenem-resistant organisms, hemorrhagic viral fevers, and seasonal respiratory pathogens. Since we went several years with a nearly nonexistent influenza season, these seasonal pathogens are reemerging. Last year’s influenza season started and peaked a few months earlier than usual. However, the experts at BlueDot Global Surveillance believe that the timing of these seasonal pathogens is progressing back to prepandemic patterns.

Finally, I provided the participants with several resources, including pathogen education sheets on the pathogens I addressed, a cleaning frequency risk assessment, and an emerging pathogen checklist for EVS leaders.

: What are you most excited about at this year’s AHE meeting?

 I was excited to see several IPs [infection preventionists] attending the conference along with their EVS teams. Every IP should attend the AHE conference at least once in their career and, better yet, attend with your EVS manager. Another thing that was great is that I am seeing more EVS leaders bringing their supervisors, leads, and even frontline workers to the conference with them.

As for sessions, 2 stood out to me. The first was a session presented by the CDC titled “The Role of Environmental Services in Controlling Outbreaks of High-Impact Pathogens.” This presentation piggybacked nicely on the one I gave. The CDC presenters reminded us that cleaning and disinfection are part of standard precautions.

I also appreciated how the presenters helped participants understand the importance of communication between EVS and IPs, particularly during outbreaks or other emergency situations, such as the presence of an emerging pathogen. They also made this session interactive with “what would you do” scenarios leveraging a real-life outbreak of carbapenem-resistant 

The second session was titled “From Survival Mode to Flourishing.” In this highly motivating talk, Benjamin Kenyon, an EVS supervisor in upstate New York, shared ideas for EVS leaders to move outside of their status quo comfort zone to establish a highly engaged team

 Mr Kenyon was very much about having the frontline workers be part of the solution to whatever problem is being faced. He also discussed standardization quite a bit, ranging from EVS cart setup to cleaning processes. Another area that is ripe for standardization is product. For example, why have EVS use one bleach manufacturer’s product for 

rooms and terminal cleans while clinical staff use a different manufacturer’s bleach wipes? Wouldn’t it be easier and make more sense to educate everyone [on] the same product, same instructions for use, and same contact time?

ICT: Anything else you would like to add?

 Every IP should consider attending the AHE conference. They do such a great job with the program, ranging from the quality of speakers to the exhibit hall to the fun activities. By attending this conference, IPs will gain an appreciation for the EVS profession that they otherwise may never have.

This interview has been edited for length and clarity. You can watch the video to see the entire interview.

Doe Kley, MPH, RN, T-CHEST, LTC-CIP, CIC, speaks to Infection Control Today about her presentation and other exceptional presentations at the Association for the Health Care Environment (AHE) Exchange Conference & Solution Center 

Environmental Spread of Emerging Pathogens: AHE Conference Discussion

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 

Reaching for zero infections in orthopedic operating rooms led one facility to find a visible-light continuous environmental disinfection system. Recently, to find out how the system works and the results of the study that examined the system, 

 spoke with Cliff Yahnke, PhD, chief scientist and head of clinical affairs for Indigo-Clean and Kenall Manufacturing; and Lynnelle Murrell, RN, BSN, CIC, director, infection prevention and control, Maury Regional Medical Center.

“Indigo-Clean, a continuous environmental disinfection technology, uses visible light to safely and continuously kill harmful viruses and bacteria within the environment while also providing ambient illumination within the space,” states the 

. “Indigo-Clean is a technology integrated into light fixtures, which install easily into the ceiling of any hospital room, classroom, or office space to bolster your current cleaning protocols.”

Murrell explained, “With our patient population and orthopedic surgeries, we have found that you] have to keep doing the [infection prevention] bundle; you can't just let one part of what prevents infection. While the lights are there, they're constant. And I'll go on a little rabbit trail to say we've even checked in their efficacy a couple of times, to make sure that they are still those in the room as they should….But you have to keep going back as far as the human element and mak[e] sure that we are doing all the basic things [like] we are wearing our surgical attire.”

Yahnke added, “Where Lynette and I ended up [in] the first phase of our research, we've started to look at other questions that we can answer in the operating room, specifically how, or what the benefit of the lights might be a real-time intraoperatively while the patient is on the table. And so we've done a pilot study looking at, essentially, the transmission of organisms within the room, from when the room is prepped to when the patient is brought in and prepared for anesthesia. And we specifically use a technique called wholesale genomic analysis to fingerprint various strains of organisms. And this was a pilot study that was done at the University of Iowa; it was published by AORN [Association of periOperative Registered Nurses Conference] in 2020. We have a full-blown randomized study going on at a major school right now; hopefully, that'll be ready to publish here in the very near future. But the idea is that it highlights the benefits of this unique technology, which is that it can be used while people are in the room. And you know, that also highlights one of the common misconceptions of the technology is that people apply standard metrics that they use for ultraviolet light, for example, which is, you know, kind of log kill or the amount of kill in a very short period of time. Whereas we asked the more medically relevant questions, such as reduction of post-operative infection and intraoperative transmission. And we find that those questions resonate with medical professionals because that's how they view things. People realize there are organisms contaminated throughout the hospital. And that, of course, reducing organisms is a good thing. But it doesn't necessarily answer the medical question: does this benefit the patient in any way? And that's what we're trying to focus on with our research.” 

Yahnke and Murrell also discussed the system’s effect against SARS-CoV-2. “The other piece of research, which is incredibly relevant to our time here, is effectiveness against SARS-CoV-2 and other enveloped viruses, and historically visible light was just considered effective against viruses,” Yahnke said. “But we answered that question in a way that no one had before. It's ineffective against non-enveloped viruses, such as norovirus. Still, it turns out that enveloped viruses, such as SARS-CoV-2 and influenza A, have this fatty lipid layer surrounding the inner contents of the virus. And that fatty lipid layer has the hydrocarbons required to absorb the visible light to create the oxidative reaction, which then can disassociate the organism. I traveled in the middle of this entire pandemic in the fall of 2020, to Mount Sinai in New York, where we did this research with Adolfo Garcia-Sastre, PhD, [Professor in the Department of Microbiology and Director of the 

Global Health and Emerging Pathogens Institute

 of Icahn School of Medicine at Mount Sinai in New York] who is world-renowned in this subject. And the results were revolutionary for our field. It was published in 

. It gives you some indication as to the importance and significance of the results. And again, it shows the fact that this visible light, even in very low dose situations, can be very effective against these types of viruses.”

Visible-light continuous environmental disinfection system reduces microbial contamination and surgical site infections, as noted in an AJIC study. Experts explain the study and the technology.


Visible-Light Continuous Environmental Disinfection System Reduces Pathogens

Adverse Events toolkits by the Department of Health and Human Services Office of Inspector General are designed to aid health care professionals and decision-makers in preventing harm to patients in hospitals, nursing homes, and other inpatient settings. Lee Adler, DO, infectious disease specialist, AdventHealth System; and Amy Ashcraft, MPA, a deputy regional inspector general with the Department of Health and Human Services Office of Inspector General (OIG) spoke with 

)about the Adverse Events Toolkits recently published by the OIG.

Ashcraft provides insight into the inspiration behind the creation of the toolkits. “As an oversight agency for the Department of Health and Human Services, we have responsibilities for both Medicare and Medicaid programs, and ensuring that patients are receiving safe care and effective care is a huge priority for the OIG. We're invested in this topic area; we've been doing work on patient safety for over 15 years and have produced almost 20 reports on the topic. And when we talk about adverse events, I want to clarify…that we are talking about all causes of harm, we don't focus on a specific list. And we include both preventable and nonpreventable events that may be important to some of your viewers.”

Ashcraft continued, “As we've been doing this work, we found that patient harm is commonplace in every inpatient setting. And the rates range from 13 to 46%, depending on the setting that you look at. I wanted to tell you about our most recent report, which we released in May 2022. It was the seventh medical record review looking at a national incidence rate of patient harm. And we found that about a quarter (1 in 4) of Medicare patients experience harm during hospital stays, and almost half of those were preventable.”

 viewers that infections “were the smallest category of types of events that we've looked at and comprise about 11% of the adverse events. The most common ones were respiratory infections, surgical site infections, and thrush. And in terms of why it's important, it's imperative that hospitals and other health care settings monitor their rates of adverse events and patient harm. And we released these toolkits because we wanted to share what we've learned conducting this work so that others can build upon it.”

The toolkits should not be considered perpetual. “It's important for those who read the document to understand that [the toolkits were created and written at a certain] point in time because evidence and practices change and what was not preventable,” Adler said. “In the past, for instance, central line infections [were considered nonpreventable but] are now considered preventable. Also, sepsis says another indication of where they were using lots of fluid years ago in as part of the best practices, and now we are very careful and how much fluid we give a patient not to overload them. If anybody's going to use this toolkit, they need to look at the latest guidance, whether it's the CDC guides, NHSN, or the Infectious Disease Society. And it's important that this is a document and appointed time that each time it's used [the information] needs to be updated.”

The toolkits were created with the help of many experts from many different fields of study to get the best practices. Ashcraft explains, “These [toolkits] represent numerous hours of research and case-specific conversations. It's a living document. And for each study, we would revisit the basic guidance document and add to it considering anything that has changed and the recommended practices over the intervening years or that are specific to a set setting that we're looking at. And get input from our panel of physicians; we had 6 high-level physicians with a range of specializations, including infectious disease, cardiology, surgery, neurology, and orthopedics. I could go on, but we tried to cover a wide range of specializations. And whenever we didn't have the specialization that we needed, Dr. Adler would go out and find someone that would help us to make sure we got the most accurate information for people working in that field. And then, in addition to that, as we were manually reviewing cases, we would come together weekly and talk about those cases.”

Ashcraft emphasized that these toolkits are only tools. “We're not anticipating that people are going to use this as a cookie-cutter approach. And that's why we made it what we termed a “pick-and-choose” resource. You can take the parts that are useful to your organization and apply them and modify them to what is most appropriate.”

(These quotes have been lightly edited for clarity. To hear the entire discussion, click the video above.)

As an oversight agency for the Department of Health and Human Services, the Office of Inspector General is responsible for ensuring the safety and effectiveness of Medicare and Medicaid programs, with a huge priority being patient care. These toolkits provide additional guidance on how to avoid patient injury. 


OIG's Adverse Events Toolkits: Preventing Patient Harm 

Alexander Sundermann, DrPH, CIC, FAPIC, an assistant professor at the University of Pittsburgh's Division of Infectious Diseases, Center for Genomic Epidemiology, is dedicated to advancing the field of outbreak detection and investigation in health care settings through his research and utilization of whole genome sequencing surveillance. He spoke with 

) on his recognized work presented at the Association for Professionals in Infection Control and Epidemiology (APIC) 

, held in Orlando, Florida, June 26 to 28, 2023.

: Please let us know a little bit about what you're presenting at APIC this year.

:Yeah, so I have 2 talks that I'm giving this year. The first one is titled “empirical methods and genomic epidemiology to improve surveillance of plasmids exchange among health care-associated bacteria.” It's a very long title for a simple topic. Essentially, what this talk investigates is plasmid transmission within hospitals. So normally as infection preventionists, traditionally, we look at bacteria transmission, where, you know, we spread a VRE from one patient to another. But using some genomic techniques, new methods that we're looking into as many of these bacteria have resistance genes and resistance factors that exist in the bacteria as plasmids, and those plasmids can be transferred to different bacteria and different bacterial species. Using genomics, we're able to see how these plasmids carrying resistance are moving around in hospitals, from patient to patient. So that first talk is summarizing a lot of those findings of how frequently does occur and what we can do with them.

Secondly, I'm copresenting with [Janet Glowicz, PhD, RN, MPH, CIC, infection preventionist, CDC, Denton, Texas] on a topic called “Keeping health care linens clean.” Health care linens are known to cause health care outbreaks in the past of molds and bacteria. Jenna, glow X is going through the important factors to look through to keep linens clean across the spectrum of their entire lifespan within the hospital. And then what I'm providing in that talk is published research that we did in the past on an outbreak that we had at our hospital from contaminated linens, and then also the state of contamination of linens across the United States through another study that we did as well. I'm excited to be talking to both of those [presentations].

: Can you tell me a little bit more about the practical applications of those studies and how they can be beneficial for IPs?

: Whenever we think of plasmids, too, there's [many] opportunities for intervening on transmission events. In this current state, we're doing a lot of this work retrospectively, meaning that we've had all these infections that we built up, and we look to see what happened in the past. But going forward, what we're trying to build up is a real-time surveillance program that can look at how plasmids are being transmitted within the hospital. And we're doing that with bacteria at our hospital right now.

From an application perspective, IPs are going to be the ones in the end, to take this type of information of how plasmids and bacteria are being transmitted in the hospital and be the ones doing the interventions to stop that transmission. So doing enhanced cleaning, or audits on a certain unit where we see an increased transmission or investigating devices that we think may be contaminated and causing these transmissions that happened to have plasmids in them as well. So that'll be a big take-home message about the future application.

We can do it within the linen side. There are many take-home messages right away from this talk. Dr. Janet Glowicz provides a lot of recommendations for what IPS can do, how to partner with the health care linen industry, to make sure that the linens are safer than the end in the patients. Giving my experience investigating this large outbreak we had and looking at the experience of others, [the presentation] will give IPs an understanding of where they need to look in the health care laundry facilities and what they should be looking for. And then a better understanding about the level of the degree of burden that this can carry across hospitals and how severe it can be.

: Were there any results that surprised you?

Whenever we look at keeping health care linens clean, we did a study of multiple hospitals across the United States, large hospitals, transplant centers, etc. And we measured how clean their linens were using a method that we'll talk about in that [presentation]. And most of these hospitals have high levels of contamination of their clean linens that were being brought into the hospital, showing that [many] of these linens that we think are laundered clean can carry pathogens on them. But from the same perspective, when we looked at our facility when we addressed the problem of the contamination at our laundry facility, we were able to sustain essentially zero contamination of our linens. And that's because the industry is not regulated. The IPs [must] go above and beyond what the current regulations are—or lack of—to make sure that their linens are safe.

On the other side, with our plasma transmission talk, we have a few instances that we'll talk about where we have plasmid with resistance genes, where it went from one species to another species in patients [who] were near each other in the same room. These are cool, interesting incidents where we see transmission where we never think of seeing transmission before across different bacterial species. These are all opportunities for IPs to intervene on.

: Do you have any future research related to these topics planned?

AS: What I alluded to before, at our hospital, every week, we do genomic surveillance of [many] of our bacterial pathogens, where we see transmission happening in real-time because, in all hospitals, we think transmission is underrecognized and undermeasured. What we're going to pivot to as well, because we do this for bacteria, is apply our methods and look for plasmid transmission within our hospital as well. We're building up this analysis plan that hopefully other hospitals can look at and use, and then go to their leadership and say, “Look, this is something that we should probably look into as well and adopt that same methodology because these are all opportunities to increase patient safety to make sure that we're stopping transmission.” The same thing with the health care linen side, I’m advocating for IPs to look out at their health care linens to enhance the safety of those linens as well because there is no regulation. The more we let IPs know about this, that there is a possible issue, the more that field can then further advance as a hot topic within our field. That'll be important looking into the future.

ICT: Do you have any other key messages that you would like attendees to take away from your APIC presentations?

[In] my past, I was an IP at our hospital here as well. And then I deviated and went to the research route. I hope this work inspires IPs to do these types of projects because IPs are going to be the ones who know their hospital. They know how it works and how it moves around. And it's because of that experience that I have that I'm able to do this type of work, where I'm doing research, but applying it to the hospital in real-time. I hope IPs can see that as well and get inspired and bring that back to their hospital to do those types of projects too.

: What are you most excited about APIC this year?

I haven't gone in person since pre-COVID-19. I gave a talk virtually during the 2020 [annual APIC conference]. I'm very excited to see everybody I've ever met virtually online since then. It's been over 3 years. There are many people that I know very well [whom] I've never met in person. I'm excited to see all these IPs, network with them, meet with them.

Alexander Sundermann, DrPH, CIC, FAPIC, discusses his work focused on whole genome sequencing surveillance for outbreak detection and investigation in healthcare settings. 


Incorporating Horizontal Plasmid Transfer Findings in Bacterial Infection Prevention and Control

Implementation science can improve health care quality by incorporating research findings and evidence-based guidelines into routine practice. However, limited studies exist on the barriers and facilitators to implementing updated surgical site infection prevention strategies. An observational study evaluated the implementation of surgical site infection (SSI)-reduction recommendations in real-world settings, highlighting challenges due to inconsistent measurement techniques, definitions, and policies. The authors state that health care organizations should address these issues when implementing evidence-based guidelines.

The “Implementation Challenges to Prevent Infections in Colon Surgeries” study was presented at the 

Association for Professionals in Infection Control and Epidemiology (APIC) 2023 Annual Conference and Exhibition

The authors and presenters were Peter B. Graves, BSN, RN, CNOR, independent perioperative, consultant, speaker, and writer, Clinical Solution, LLC, Corinth, Texas; Maureen P. Spencer, M.Ed, BSN, RN, CIC, FAPIC, infection preventionist consultant, Infection Preventionist Consultants, Halifax, Massachusetts; Lena Camperlengo, DrPH, MPH, RN, Senior Director, Premier, Inc, Ocala, Florida. They spoke with 

) in an in-depth discussion about their presentation.

, “The part that I thought was so important, and that caught the attention of the editors [of] the surgical infection journal, was that nobody's looked at the implementation of the colorectal guidelines. And it's such an important aspect of prevention that we continue to see many infections in that specialty. And we must do better. And one of the things that made this paper so appealing to the surgical infection society was [that] they write the guidelines, have the experts, and still can't seem to get consensus amongst all their providers.”

Camperlengo added, “So we had our study coordinators document or look for documentation. They even went and had interviews with surgeons and anesthesiologists, [and] looked in nursing notes, etc, for documentation. That was that the 7 components, the guideline components, [that] were followed in a high-risk pooling surgery. The first finding was [that] the documentation, often, wasn't there for a handful of these 7 components. They seemed to be always there, and they were near 100% compliance. So we, as co-authors of the study, and designers of the study, had to ask ourselves, how do we bring the rest of these guidelines up to the same [adherence] level as ours [concerning] prophylactic IV antibiotics as well as skin prep?”

Spencer explained the 7 variables, “In November of 2016, the World Health Organization published their first global SSI guidelines. This was fantastic for other countries that have done a lot of work in Asia [because] some of the things in CDC weren't applicable. So this was developed for outside the US, followed by the American College of Surgeons updating their guidelines in early 2017, followed by the Wisconsin guidelines, which I feel are the most comprehensive. But the Department of Public Health commissioned this project to develop their own SSI guidelines for Wisconsin, followed very closely by the CDC update from their guideline back in 1999. So we had to wait till 2017 to get updated guidelines. So that's what we did, we took the 4 of those guidelines, and then pulled out 7 variables.”

Experts discuss how implementation science integrates research findings and evidence-based guidelines into health care services to improve quality and effectiveness.


Implementation Science Help Prevent Infections in Colon Surgeries

Collaboration between departments throughout the health care continuum is vital to eliminate unnecessary bacteriuria treatment and, thus, work towards antimicrobial stewardship. A presentation was given at the Association for Professionals in Infection Control and Epidemiology (APIC) 

, held in Orlando, Florida, June 26 to 28, 2023, about how pharmacists and infection preventionists can work together to tackle this challenge.

The presentation was titled “Reducing Asymptomatic Bacteriuria Treatment–a Collaborative Approach,” and given by Maddison B. Stone, MPH, CIC, LSSGB, senior infection preventionist, JPS Health Network, Fort Worth, Texas; and Jordan M. Chiasson, PharmD, BCIDP, clinical pharmacist - antimicrobial stewardship, JPS Health Network, Fort Worth, Texas. The health care workers spoke with 

: Our presentation here focuses on the collaboration between antimicrobial stewardship as a whole [with] pharmacists and infection prevention. We're focusing on reducing asymptomatic bacteria treatment and we're highlighting some of our successes at our hospital. We hope to share some of our experiences with everyone else so that we can provide a model to help out.

: What do you hope the attendees take away from your presentation?

: Overall, knowing the importance of appropriate versus inappropriate orderings or cultures and knowing that you do have the power to speak up and to disseminate that to provide the use [of antibiotics].

: What is the biggest challenge today for those in the infection prevention and control field?

: Getting those key stakeholders on board and ensuring that all that key information is disseminated down to those frontline staff.

: What are you most excited about this year’s APIC conference?

: I'm excited as a pharmacist, antimicrobial stewardship, probably being one of the minority [of clinicians not directly in infection prevention] here. So it's really great to meet people from all different professions and different walks of life and get some ideas, networking, and see what other programs are doing and bring that back [to my team] and be an advocate for infection prevention because it's important for those who are not in infection prevention to also recognize how important it is. It's super critical to my role in microbial stewardship, and ultimately downstream to patients as a whole. So I'm really excited to learn from the experts.

: What I am most excited about as well is networking and learning [from] all of these wonderful infection preventionists. Everyone has so much to give, and I'm so excited to take all that information back to the team.

A presentation at the APIC 2023 annual conference was about reducing the unnecessary treatment of asymptomatic bacteria, and the presenters shared some of the successful strategies they have implemented at their hospital. 

Pharmacists and Infection Preventionists: Collaboration on Antimicrobial Stewardship

A children's hospital in Virginia reduced central line-associated bloodstream infection (CLABSI) infections to 0 for 332 days. How did they do it?

Becky Lapian, MPH, CIC, infection preventionist Inova Health System; and Allison Barberio, MHSA, CPHQ, quality director, Pediatric Service Line, Inova Health System, Falls Church, Virginia, described how they worked together with other departments throughout the hospital to hit that milestone.

) about their poster presentation at the Association for Professionals in Infection Control and Epidemiology (APIC) 2023 

 and Exhibition, held in Orlando, Florida, June 26 to 28, 2023. Their poster, “One Team Approach: Celebration of 300 Days Without a CLABSI as a Children’s Hospital,” examines how their team collaborated across the hospital to keep CLABSI infections from occurring.

Lapian explained, “Our poster is celebrating our CLABSI reduction efforts within our children's hospital. And just for reference…CLABSIs are detrimental to not just the patient but can be costly to a hospital and a multidisciplinary group, including infection prevention, nursing quality, and medical staff.”

To examine how to prevent CLABSIs throughout the hospital’s departments, Lapian said the various departments “met through harm prevention meanings and infection prevention workgroups to not just talk about benchmarks, like how we're doing compared to other children's hospitals, or other units within our hospital, but also what are our opportunities in terms of how do we continue to reduce harm? And then how do we share our best practices not just within our siloed unit, but also as a hospital? We were able to accomplish 332 days without a CLABSI. And that includes over 10,654 central line days. And what that means is more than 10,000 days, where patients had a central line in place, and 81% decrease in our CLABSI standardized infection ratio, and then a slight increase in our utilization. With this partnership and collaboration, we were happy to help facilitate, [however,] we did not necessarily do the work. We just helped guide the team.”

Barberio agreed saying, “This is an ongoing and continuous effort. It's not something where we meet once a month and discuss it for 60 minutes and move on with our lives. This is something that we're talking about and analyzing every single day in any conversation that it's relevant. So that's how we moved beyond what we consider to be the evidence-based standard because we felt we had high reliability and truly looked at what specific factors were important and were impacting our pediatric and neonatal populations.”

Central line-associated bloodstream infection (CLABSI) can cause harm to patients or even lead to fatalities, while also resulting in additional expenses for hospitals.

Children's Hospital's CLABSI Reduction Efforts Succeed Continuously for 332 Days 

In this second installment of a 3-installment series, 

) speaks with managers at Sage Memorial Hospital, Navajo Health Foundation in Ganado, Arizona, about their infection prevention and control program’s decision to incorporate a UV-C robot. Christian Bigwater, BSBA, director of public relations and marketing; and Tiyarra Wauneka, environmental services supervisor, discuss which 

 they chose, how it has changed their protocols, and the Navajo names they gave their robots and why.

The facility follows its Navajo Nation’s values: “The mission of Sage Memorial Hospital is to provide quality healthcare for the Dine people with respect, unity, beauty, and harmony in honor of K‘é an, the sacredness of life,” according to the 

The first installment of this 3-part series is 

: The one thing about infection prevention and control is that it doesn't stop for borders of any kind. So I know you have those issues, too. You're constantly trying to stop infections from spreading or even starting, and one piece of equipment that you are using in your hospital are they are the robots, the UVC robots. Please explain those a little bit and tell our audience why you chose them and how you use them.

I will give a quick backstory of why we went into getting the UVI robots. When the pandemic started, the Navajo Nation was hit hard with COVID-19. And it wiped out a lot of our community members, unfortunately, because we were not prepared as a nation, for that kind of pandemic. And for those kinds of pathogens to come through our area. And like I said, it was hard to reach out to a lot of those people who are in rural areas. We were one of the many health care facilities in our location that stayed open throughout the entire pandemic. At no point did we close any of our services down; we constantly had a 24/7 emergency room that ran throughout the entire pandemic; there were some other health care facilities around this [time] that had closed for a few days to a few weeks because they were not ready for that kind of pandemic to happen and to give the treatment and the services that they needed.

We saw a high number of cases of COVID-19, come through our emergency department, and we had a lot of staffing [who] contracted COVID-19. On a larger level, our staffing was really affected by it. That's when I came on as a supervisor. I worked closely with our infection preventionists to find ways to take precautions and better approach everything that was happening around us. I looked and researched other bigger facilities down south. So, I contacted one of the banner hospitals in Phoenix, Arizona. I was talking to them, and I said I'm concerned. And I have a couple of questions. What do you guys do differently? We collaborated on our protocols and the things that we did with COVID testing, terminal cleanings, patient discharge, how we were taking care of those things, and what our protocols were.

I asked them, “Do you guys use any innovative technology. Is there anything that you guys use differently?” Because at the time, we were using [are called] the Clorox 360 machines, which is an electrostatic sprayer. And I said, “That's the only thing that we've been able to bring into our facility to try and help us provide the disinfection that needs to be done.”

They said, “We've been looking into some UV lightings. We haven't gotten there yet, but we have a company that we're looking into, which is called 

 And I said, “If you can send me whatever you have, I'm more than happy to go look into it and see what they're all about.”

From that point, I made contact with one of the representatives from OhmniClean, and his name was Dan. And we kicked it off, as soon as I made contact with him. And we started talking, I looked [previously] at some other vendors, and he gave me some other vendors with similar products. We did our research and what worked best for our facility, and that's what brought us to using UV lighting. Then I found out that just off the reservation in Gallup, New Mexico is very close to where we live, and there is the Gallup Indian Medical Center. They were implementing the UV robots from OhmniLabs. I asked him, “I'm interested in that same product. Can I come and do an onsite visit, and I want to see what these robots are capable of doing [to see] if they would be something we would be interested in bringing into our facility as well.”

I did that onsite visit, and we saw the robots in action. They use them in their surgical unit. And I was like, this is just a great product. I was blown away by the disinfection efficiency that was provided by it and how simple it was to operate the UV robots because it's a step-by-step protocol that you follow on the screen. And it was, it was easy. And that's what I liked about the OmniLab UV robot. It struck my attention….And, lo and behold, we have 3 robots that we currently use in our facility.

: the UV-C has helped you. Do you have any general idea of how [many health care-acquired infections] you have reduced in your facility?

: Yes, UVC robots have definitely helped us in addition to our protocols currently in place with our standard cleaning. We have various ways that we're trying to test the efficiency of the UVC robots. One of the ways that we've done that is we have a machine from 3M called the ATP Luminator. That's the adenosine triphosphate.

When we run the robots through a room, we will take a swab before and get the reading from it. What the ATP machine does is collect all the bacteria from that surface, and you put it into the machine, and it reflects the light back with whatever bacteria or pathogen is left on that surface. It'll give you a real-time number value of what's there. Our goal is to get anything below 1000 [pathogens]. And so we'll take this swab before we run the UVC. After we've done a standard clean, and we take the number, we'll do our UVC run through with our robots, and then we take another swab again. And that's how we're able to compare how efficiently and how much bacteria and pathogens were taken away from that surface. That's one of the ways that we've been able to measure the efficiency of the UVC robots.

That data will then be provided back to OhmniLabs so that they can use it to their benefit as well and make the needed adjustments to increase their software and to increase their product. I've been working closely with OhmniLabs to get that kind of data for them.

This transcript has been edited for clarity.

Because of the COVID-19 pandemic, the infection prevention field had to think outside the box they were used to. The Navajo Nation was no different. Outside their box, they found UV-C robots.

Video Series

Increasing Infection Prevention in the Navajo Nation With UV-C Robots 

Abdominal hysterectomies are a common surgery, and certain risk factors are associated with the procedure. A recent 

 published in the American Journal of Infection Control, titled “Risk factors for surgical site infection after abdominal hysterectomy, New York State, 2015-2018,” discusses what risk factors lead to the highest number of surgical site infections (SSIs).

Boldt Tserenputsag, DrPH, MPH, director of the data unit, Bureau of Healthcare Epidemiology Infection Control for the New York State Department of Health, and lead author of the study, spoke to 

: Can you give us a summary of the key findings and why they're important?

Okay, so the study we're going to talk about is a report on risk factors associated with surgical site infections following abdominal hysterectomy in New York State between 2015 and 2018. The New York State Department of Health monitors surgical site infections using NHSN, the National Healthcare Safety Network since 2006, and monitors several serious surgeries for wound infections. Abdominal hysterectomy is one of the procedures New York State tracks for wound infections.

Investigators studied the risk factors for surgical site infections after abdominal hysterectomy procedures using NHSN data and diagnosis codes from administrative data.

HAIs

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