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As Coronavirus Spreads, Mask Manufacturers Can’t Keep Up

Respiratory Pathogens on the Outer Surface of Used Medical Masks May Result in Self-Contamination

Patients rarely question sterilization protocols at the dentist, yet it is essential for safety. The Clean Bite explores why asking matters, what to look for, and how to start the conversation confidently.

Why You Should Always Ask About Sterilization at the Dentist

When an unclear airborne isolation order disrupted patient care, one infection preventionist had to unravel entrenched practices and prioritize safety, communication, and staff trust.

A Tuberculosis Mystery and the Infection Preventionist's Dilemma: The Case Study

A silent invader lurks in health care settings, exploiting human oversights to spread. Discover how vigilance, hand hygiene, and disinfection can stop infections before they begin.

A Day in the Life of a Pathogen: From Your Hands to Stethoscopes and Beyond

Norovirus and avian influenza outbreaks require infection preventionists to enhance hygiene, train staff, implement PPE use, and ensure effective disinfection to protect health care workers, patients, and facilities.

Winter Strategies for Infection Preventionists in Managing Recent Norovirus and Avian Influenza Outbreaks

Read about the CDC’s Health Advisory. The advisory emphasizes the significance of early detection, infection control measures, and interdisciplinary collaboration to reduce risks, guarantee timely treatment, and prevent further spread.

CDC Issues H5N1 Health Advisory: Infection Preventionists Urged to Strengthen Avian Influenza Surveillance and Response

, Ambassador Deborah Birx, MD, a prominent figure during the early days of the COVID-19 pandemic, shares insights on collaboration, innovation, and the need for change in public health practices. While discussing the challenges and opportunities faced during the pandemic, Birx emphasizes the importance of community engagement, real-time communication, and adapting to the unique needs of each community.

Birx highlights the remarkable collaboration and coordination that took place at various levels of government and among international organizations during the pandemic. She acknowledges the crucial role played by federal, state, and local governments in working together to find innovative solutions to combat the virus.

“I almost feel like the book that needs to be written and that I would love to have time to write is the positive, clear evidence base of how people work together to innovate and save lives,” Birx explained. “And it goes not only across the federal government, but the communications that [were] set up to constantly interact with the states, at the mayor level, and at the [federal] government level, allowed us to bring forward solutions because people all across the country are having breakthroughs. And it allowed us to then communicate that out in real time.”

Birx also commends the health care sector for its cooperation, particularly among hospitals. Hospitals put aside competition and established a system to match patients with specific needs to available resources, ensuring the efficient allocation of medical care.

Moreover, she expresses gratitude towards the private sector for their rapid response and innovation in developing tests, monoclonal antibodies, antivirals, and vaccines within a short timeframe. “There wasn't one thing that I asked the private sector to do that they didn't do, in real-time, at risk, not knowing if [the federal government agencies] were going to [pay them]. We made no payment promises to most of these organizations, particularly the test developers. And they had a meeting that first week of March [2020] when I came in, and I had tests across every platform in every platform made across the United States within weeks, and then I had antigen tests within months. That's amazing. These groups never get credit for that.”

Dr. Birx advocates for a data-driven approach to public health, emphasizing the importance of using data for action. Drawing parallels with the success of controlling HIV, she suggests that daily warnings should be sent out to those at risk based on real-time hospitalization and mortality data. This approach aims to empower individuals with information and guide them towards taking necessary precautions.

To rebuild trust in public health, Birx emphasizes the need for federal agencies, such as the CDC, to engage with communities at the grassroots level. She believes that federal institutions, especially the CDC, should be on the ground, listening to and understanding the challenges faced by Americans.

She underscores the importance of adapting guidance to meet the unique needs and situations of each community, promoting dialogue, and allowing questions and answers to bridge the gap between public health experts and the public.

“For years, CDC has withdrawn from the community and engagement at the community level, Birx said. “What do I mean by that? They're not in the trenches with the people with what they're going through in the reality of their lives and what they're confronting. And it's different in different areas of America. But [the CDC] should be on the ground, working at the community level, at the local level, at the state level, to understand the lives of Americans and what they need. Because to rebuild trust, people have to see you. They have to understand that you're going to listen and that you're going to act on the information they have given you. And they see the CDC and our public health system as divorced from the reality of their lives.”

Birx's comments provide valuable information on the importance of working together, being creative, relying on data, and involving the community in public health efforts. Her suggestion to regain trust by connecting with people and adjusting to their requirements serves as a strong reminder of how these principles can help combat pandemics.


Deborah Birx, MD, discusses the significance of collaboration, innovation, data-driven decision-making, and community engagement in public health. Her insights underscore the need for trust-building and adaptability in pandemic response.

Video Series

Rebuilding Trust in Public Health: Continuing a Conversation with Deborah Birx, MD

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

) 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

How often do we hear, “I have the stomach flu!”? While norovirus is not related to the influenza virus, it does cause millions of people to sicken yearly. It is the number 1 cause of foodborne illness and is extremely infectious. The number of cases of norovirus has been much lower in the last few years because of the COVID-19 pandemic precautions. Do the experts believe this year will be the same? Or with “pandemic fatigue,” will the number rise?

With the norovirus season in full swing, 

) spoke with Chip Manuel, PhD, Food Safety Science Advisor, and Megan DiGiorgio, MSN, RN, CIC, FAPIC, infection prevention senior clinical manager, both with GOJO Industries, about this norovirus season for both food service providers and health care providers.

In this first installment, Manuel and DiGiorgio cover what norovirus is and whether they believe that norovirus will be worse this season or not, and how much that will be affected by the COVID-19 pandemic. They also discuss what precautions are taken and which oes are too often overlooked.

When asked about what he sees in the norovirus season we are in, Manuel answered, “We're seeing a major relaxation of a lot of these COVID-19 pandemic-related practices. So think isolation, social distance masking. Many people have pandemic fatigue, and they're just dropping many of their hygiene practices. They're dropping their guard. That can allow for a lot of other viruses to come in and cause a surge. The other thing that's important to remember is that during the pandemic, especially at the height of the pandemic, norovirus case has dropped off to historic lows.”

“But if we look at this slice of US data, there are around 900 deaths per year, around 100,000 hospitalizations, 465,000 ER visits, mostly in young children,” DiGiorgio told 

 in this exclusive interview. “Then there are about 2.2 million outpatient clinic visits, mostly in young children. But this is a big burden to society and health care facilities. It's not something that should be ignored. With many diseases, we tend to worry about the very young and the very old. In the case of norovirus, we worry most about kids under the age of 5 and adults that are over the age of 85 because they're more likely to seek health care as a result of their infection.”

DiGiorgio continued, “When we talk about people over the age of 85, we think about long-term care facilities, and over half of the outbreaks that are reported in the US are in long-term care facilities; it's a unique setting; it tends to have an older population as we know, many comorbidities, immunodeficiency, as well as close shared quarters. This is their home; it's not like a hospital where they're staying for a few days. They often share bathroom facilities; they're eating together. It's tough to do isolation the same way in a long-term care facility as it is in a hospital. The situation in long-term care promotes transmission.”

, showing an increase in norovirus outbreaks. Manuel said that data reports confirmed cases (as defined as when an individual goes to hospital or doctor and is diagnosed with norovirus) from the 14 participating states. There is typically a lag while the data is curated. The higher cases reported are happening in the UK as well; their norovirus cases are up about one-third higher than normal this time of yeaThis is part 1 of 2. Part 2 can be found 

r, mostly in those 65 years and older. More information is here: 

Natioal norovirus and rotavirus report, week 3 report: data up to week 1 (8 January 2023) - GOV.UK (www.gov.uk)

This is part 1 of 2. Part 2 can be found 

(Quotes have been lightly edited for clarity.)

Are norovirus cases going to skyrocket, or will the pandemic slowdown of this infectious disease continue?


Norovirus: What Experts Say About the 2022-2023 Season

At the start of the COVID-19 pandemic, questions asked among environmental hygiene personnel were “Did the CDC and the EPA give enough guidance on how to use the proper cleaners? Were the disinfectants they recommended safe? Or were they dangerous and ineffective if not used correctly and with the proper personal protective equipment (PPE)?”

) spoke with ArrowClean CEO Rayne Guest, who wrote to the Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) about their suggestions for products to use during the COVID-19 pandemic. Guest said that neither governmental agency has responded to the core questions of the letter or any of the many letters she has written to the agencies on infection prevention topics.

In this exclusive interview, Guest explained that one “main point of the letter is that the EPA and the CDC told everybody that they should be using products that were on their list, which was kind of the holy grail of products that they said were safe and effective for use against COVID[-19]…Most of the products on the list cause respiratory issues, making people more susceptible to getting respiratory illnesses like COVID[-19] on the list. [The guidelines] listed the contact time it took to kill COVID[-19], an enveloped virus that is easy to kill. So [individuals] were only letting a product sit for more than just a spray and wipe. If they were letting it sit for a certain amount of time, they were letting it sit for the amount of time it takes to kill COVID[-19], which is not hard to kill. But the reality is [that] to use a disinfectant properly, you have to let it sit for the proper full contact time for its disinfection claims.”

What Guest wanted to accomplish with her letter to the CDC and the EPA was for the agencies to acknowledge and change their guidelines to the public about what disinfecting products to use and how to use them. She told 

, that the she believes CDC guidelines were “very misleading to the public. [They] went against infection prevention 101 in every way. So it was hard to see their public guidance because it was so fundamentally flawed.”

 that her concerns and questions stem from her 15 years in the infection prevention and control business on the ground up and developing a technology attempting to help fight against infectious diseases and do something good for the environment. The products her company manufactures are not tested on animals.

In the interview, she also described what she considers proper disinfection protocol and how it differs from what the CDC is currently recommending.

“Before COVID came around, you heard the CDC say, 'Look, people need to use a disinfectant with the shortest contact time possible because as a society we're conditioned to spray and wipe, spray a product on a surface and wipe it up,'” Guest said. “Most disinfectants have a 10-minute contact time, meaning you have to let them sit on the surface for 10 minutes to be effective. Most of the products in our homes are this way, and a lot of products in healthcare are this way. During the pandemic, though, none of that guidance was given. [It was as if] they just forgot to tell [the public] about it. The only guidance they said is 'Be sure you follow the manufacturer's instructions.'

"But most [individuals] don't even comprehend the concept that something could take 10 minutes to work on a service. It's not how [companies] market their products and commercials. It's not what we grew up to see. So proper disinfection depends on the product. Some disinfectants are limited spectrum; some are broad spectrum, some are health care grade.”

"[The CDC’s and EPA’s guidance on disinfection products] went against infection prevention 101 in every way."

Guest describes her thoughts on what correct and careful disinfection means to health care professionals: “I would say proper disinfection means you use a health care-grade disinfectant, which is the most effective. It's tested against the toughest gram-negative and gram-positive bacteria. And you choose one that is safest for your patients, for your employees, for your customers, for your staff. And you, hopefully, find one that's cost-effective, and you let it sit for the contact time, preferably the shortest contact time possible. And you follow those instructions. 

"So proper disinfection is following the protocols that the disinfectant was tested to. And in order to do it properly, you want to choose the one with the shortest contact time and is safest for everyone,” Guest said.

 has contacted the CDC and EPA for comment and will post if there is a response.

Have the CDC and EPA given enough correct guidance on how to use cleaning products during the COVID-19 pandemic, or is it “fundamentally flawed”?  


How Dangerous Are Cleaning Products Environmental Hygiene Personnel Use? 

) continues a father's story about how his son survived sepsis after entering through a central line, and the huge toll the experience took, not only on his son, but on his whole family.

David Jordon, BS, key account manager for US hospitals for Covalon Technologies talks to 

 about his family’s story of how sepsis changed their lives. He describes his family’s story of pain, loneliness, and, above all, strength to get through a terrible time in their lives due to their son’s illness. This story is also a tale of dedication, determination, and love.

This installment discusses the resiliency of his son and how it shows in his dedication to keeping himself safe from future sepsis incidents. Jordan describes the hospital stay and the long-term effects on his son and family.

“One of the things that [my wife and I] decided, as a mom and a dad is he's never going to be in a hospital by himself," Jordan said in the exclusive interview. "We will always be there with him. And so my wife did the first week with him. And, you know, it was incredibly taxing on her to handle nurses, doctors, middle of the night, checks on all his vital signs and things. I mean, you don't get any sleep. And so, she had asked [me] if I could do the last little bit, and I offered and said, 'Yeah.' Fortunately, I was working a job where I could be remote at the time, even though this was pre-COVID. So I would do Zoom meetings from his hospital room, [sitting] next to his bed.  I pulled the last three weeks' shift with him."

In this second installment of 3, Infection Control Today® continues a personal story of how sepsis can enter central lines and how it affects the entire family. 

Sepsis: One Father's Story, Part 2

Infection Control Today has brought its readers many interviews during the year. Here are the top 5 most popular. 

Making Sense of Changing CDC Quarantine Rules for Health Care Workers

Just when should a health care professional return to work after a high-risk COVID-19 exposure? In a Q&A, Sharon Ward-Fore, MS, MT(ASCP), CIC, FAPIC, explains the CDC’s changing recommendations.

Immunity Lessons From COVID-19: Natural Infection vs Vaccination

Investigators have learned invaluable lessons from 2 and a half years of the COVID-19 pandemic, particularly on human immunity. Is natural infection better for long-term protection against COVID-19 or is vaccination? What does the data say?

N95 Respirators Prove Effectively Disinfected With Ultraviolet Radiation

Remembering the COVID-19 pandemic and supply chain issues, investigators study the ehttps://www.infectioncontroltoday.com/view/n95-respirators-prove-effectively-disinfected-ultraviolet-radiationfficacy of reusing N95 FFRs.

 Rapidly Recontaminates Surfaces Around Patients’ Beds Despite Cleaning and Disinfection

Candida auris environmental contamination is unlikely to be adequately controlled because re-contamination occurs within hours after disinfection.

Not 'Just' Sterile Processors: HSPA Talks Industry Changes Ahead of Annual Meeting 

Staff shortages, public recognition, and moving out of the medical field are all issues that the sterile processing industry has faced.

Here are the top 5 video interviews from Infection Control Today for 2022.

Students Helping Students During COVID-19: University Contact-Tracing Program

 was taking hold and spreading exponentially. This terrifying pathogen can cause severe illness and remain on diverse surfaces for an unspecified length of time. While it is a yeast, it behaves like a bacteria, and it spreads easily in the health care setting among vulnerable patients.

Doe Kley, RN, MPH, CIC, T-CHEST, speaks with 

: An Emerging Threat” at The Association for Health Care Environment (AHE) annual conference: : 

AHE Exchange, AHE Conference & Solution Center

,, held on October 3-5, 2022, in Orlando, Florida. 

Kley is the principal infection preventionist for The Clorox Company (health care division), and she also teaches an infection control course for The Ohio State University. She is a registered nurse with an undergrad in microbiology, and she holds a masters degree in public health. She is board certified in infection control and epidemiology with 20 years of hospital infection control experience.

“Unfortunately, while our attention was singularly focused on COVID-19, Candida auris, took full advantage,” Kley tells 

in the exclusive interview. “And it really seems to have gotten a solid foothold in this country. Several of the contributing factors include the PPE [personal protective equipment] and the supply shortages, the staffing challenges, and interruptions to our usual surveillance programs, which help infection preventionists identify pathogens like this early. The pandemic disrupted those things. And, of course, the nature of a COVID-19 infection that's severe enough to land a patient in the hospital is high risk in and of itself for acquiring a pathogen like 

 is, Kley explains that healthy people are at a very low risk of acquiring the pathogen, including health care workers. Cleaning and disinfecting is the key to preventing 

 “But it's an important reminder about the importance of frequent hand hygiene, wearing PPE when it's appropriate, wearing it properly and taking it off properly, and then keeping surfaces clean and disinfected, especially the zone around the patient bed as well as any high touch surfaces. And with this particular pathogen, mobile or portable equipment.”

COVID-19 has not been the only pathogen that has been spreading the last few years. Candida auris has taken a hold, not only in the United States but around the world. Here are the details and how environmental hygiene practices can protect patients in a health care setting. 

Mask Respirator

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