Global Patients, Local Risks: Why Medical Tourism Demands Infection Preventionists’ Attention

Heather Stoltzfus, MPH, RN, CIC, at APIC25!

As global health care becomes increasingly interconnected, infection preventionists (IPs) must broaden their scope beyond local facilities. At the Association of Professionals of Infection Control and Epidemiology (APIC) Conference and Expo, held in Phoenix, Arizona, from June 16 to 18, 2025, Heather Stoltzfus, MPH, RN, CIC, tackles the growing phenomenon of medical tourism, a topic that may seem distant to some but has urgent relevance for US-based health care professionals.

“Patients return home with complications, infections, or exposures we’re not always prepared to handle,” she says. Drawing on her experience with Global Healthcare Accreditation, Stoltzfus aims to equip infection prevention and control (IPC) personnel with the tools and insights they need to respond to this complex, global challenge.

In this interview with Infection Control Today^® (ICT^®), Stoltzfus, who is also an ICT’s editorial advisory board member, describes what she will discuss in her presentation.

ICT: Heather, your session at APIC 2025 focuses on medical tourism, a subject that many infection preventionists may not directly deal with. What led you to take on this topic?

Heather Stoltzfus, MPH, RN, CIC: Medical tourism, also known as medical travel, refers to individuals crossing borders to receive health care. That could be cosmetic procedures, dental surgery, fertility treatments, or even major surgeries like joint replacements. What inspired me to focus on this is how often these patients return to US facilities post-op, sometimes with complications, infections, or exposures that US-based providers may not be fully prepared to handle. As IPs, we need to be prepared for that. On the other hand, we should also be part of improving the global systems these patients are entering.

ICT: That’s fascinating and probably unexpected for a lot of people. What are the key points you want attendees to walk away with?

HS: First, medical tourism is not inherently negative. It’s often driven by cost, access, and patient autonomy. But there are risks, especially related to infection prevention and control. In my session, we’ll look at real case studies, including outbreaks of multidrug-resistant organisms and surgical site infections that resulted from poor sterilization or inadequate IPC protocols in medical travel destinations.

Second, I want people to understand our role: Even if you're not working at a destination hospital, you might receive patients who have traveled. You need to know how to assess risk, what questions to ask, and how to respond if something goes wrong.

ICT: You’re also the Director of IPC for Global Healthcare Accreditation (GHA). How does that experience inform this work?

HS: At GHA, I helped develop the IPC standards used in their accreditation of medical travel programs. One of the challenges is that regulations and infection control practices vary widely around the world. There are many excellent international facilities, but there's also a lack of consistent accountability in others.

Accreditation helps establish trust. When a facility is accredited not only for its clinical services but also for its IPC practices, it gives patients and referring physicians confidence. That’s one of the long-term solutions I’ll be advocating for in my session: promoting international IPC standards in the global health travel industry.

ICT: Can you give us a preview of one of the case studies or outbreaks you’ll be discussing?

HS: Absolutely. One of the cases we’ll look at involves patients who traveled to a specific country for cosmetic surgery and returned with rapidly growing nontuberculous mycobacterial infections. These cases were difficult to diagnose and treat, and they required multiple rounds of antibiotics and sometimes surgery to manage. What we learned was that basic sterilization procedures weren’t being followed in the facility they visited.

These stories are not meant to scare people away from medical travel. They’re meant to highlight how critical infection prevention is, no matter where care is delivered.

ICT: You mentioned earlier that patients traveling for care might not always volunteer that information. What do you recommend IPC personnel do?

HS: Great question. One thing we can do right away is ensure our intake teams are instructed to ask about recent international travel for medical purposes, just like we would for infectious disease exposures. Was the surgery recent? What country? What kind of procedure? Was there any follow-up care?

Another piece is education: Helping our teams understand that a patient returning from medical travel isn’t just a clinical challenge—it’s a potential IPC concern. We also need to be prepared to screen, monitor, and intervene.

ICT: What do you see as the biggest challenge facing IPs this year?

HS: It’s the politicization of public health and the defunding of our programs. At both local and national levels, we’re seeing freezes in hiring, pauses in funding, and regulatory uncertainty. The momentum we had post-COVID-19 for infection prevention is fading, and that’s concerning. But we’ve been here before, and public health professionals are resilient. If we stay united and informed, we will continue to advance. We will persevere.

ICT: What are you most looking forward to at APIC 2025?

HS: The people. Truly. The energy of being in the same room with so many colleagues who live and breathe infection prevention is incredible. Some I collaborate with virtually year-round, and APIC is the one time we all come together. It’s reinvigorating. Especially during such a tough year, it helps to be reminded you’re not alone.

ICT: Any final words for your fellow IPs?

HS: Just this: keep asking questions, keep building connections, and don’t underestimate the global impact of your work. Whether you're in a hospital, clinic, or public health department, infection prevention is borderless, and so is your influence.