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Elias Coury, MPH, BHSc, is the market director of quality, risk, accreditation, and infection control at Havasu Regional Medical Center and Valley View Medical Center. Elias works daily with medical staff, nursing, support services, and senior leadership to implement quality, safety, and service strategies.

Elias has presented at the SHEA conference on reducing NV-HAP. He is also an active member of the APIC Phoenix Chapter and previously served as its membership secretary.

NV-HAP significantly contributes to increased sepsis, mortality, and length of stay, negatively affecting hospital metrics, finances, and patient outcomes, underscoring the importance of targeted prevention strategies.


Addressing Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP): Impact on Sepsis, Mortality, and Hospital Metrics

's) Editorial Board members—a diverse group of professionals dedicated to advancing infection prevention and control practices. This series highlights each member's unique expertise and contributions to the field.

From groundbreaking research to innovative strategies, these experts are at the forefront of enhancing health care safety. Join us as we learn their insights, experiences, and visions for the future, providing valuable knowledge and inspiration to elevate infection control protocols.

In this installment, we hear from Tabrikah Mohammed, MSc, BSN, CIC, CPHQ, FAPIC, senior infection control officer, MSc, BSN, TQM, CIC, CPHQ, FAPIC. 

Tabrikah Mohammed, MSc, BSN, CIC, CPHQ, FAPIC, is an accomplished nursing professional with a diverse educational background and vast experience in infection control. She obtained a bachelor of nursing degree from Sharjah University in 2011 and a master of health care administration from the Royal College of Surgeon Ireland in 2013.

Tabrikah has furthered her expertise by obtaining certification as a CIC in 2018 and a CPHQ in 2021. She is also the founder of the IPQ Academy, where she imparts her knowledge and experience to other health care professionals. As the cofounder, head of the scientific committee, and infection control expert at the 

Middle East North Africa Federation for Hospital Sterilization Sciences

 (MENA FHSS), she has significantly contributed to the healthcare sector.

Emirates Infection Prevention and Sterilization Society

 (EIPSS), a nonprofit organization dedicated to advancing knowledge in infection prevention and sterilization practices in the United Arab Emirates. EIPSS operates under the 

Currently, Tabrikah serves as a senior infection control officer in 

, where she applies her skills and knowledge to ensure the safety of patients and healthcare workers. She is also a member of the 2023 editorial advisory board for 

, a testament to her reputation as an expert in infection control.

Tabrikah's contributions to infection control have been recognized through several awards, including the 

IP Idol from Certification Board of Infection Control and Epidemiology, Inc

 by Saudi Society for Infection Prevention and Control in 2023. She is also an international speaker at various conferences and conducts workshops.

Tabrikah sees these topics as trending right now:

These programs aim to optimize the use of antibiotics to combat antibiotic resistance. They involve the proper selection, dosage, and duration of antibiotic treatment to minimize resistance and adverse effects.

: Real-time data and advanced analytics track infection trends and outbreaks within healthcare facilities, allowing quicker and more effective responses.

Artificial intelligence and machine learning

: These technologies are applied to predict outbreaks and optimize infection control strategies.

Personal Protective Equipment (PPE) Innovation

: PPE is continually being innovated, with improvements in comfort, durability, and protection levels. Reusable PPE is also being developed to address supply chain issues and sustainability concerns.

Infection Control in Nonhospital Settings

: Infection prevention in long-term care facilities has become a major focus, particularly due to residents' vulnerability to infections like COVID-19 and influenza.

: There’s increased attention to infection prevention in schools, workplaces, and other community settings.

: Online platforms for infection prevention training have expanded, making education more accessible and scalable.

: There’s a growing emphasis on interprofessional education and collaboration in infection prevention, recognizing that effective infection control requires teamwork across various healthcare disciplines.

: Educating patients and their families on infection prevention practices, such as hand hygiene and recognizing signs of infection, is becoming more prevalent.

: There is a trend towards involving patients in their care, including infection prevention measures, to improve outcomes.

: There is an increasing focus on sustainable practices in infection prevention, such as reducing single-use plastics and developing environmentally friendly disinfectants.

Infection Prevention in Nonhospital Settings:

There is a growing focus on infection prevention in long-term care facilities, outpatient clinics, and community settings. Tailored infection control measures are being developed for these environments.

Telehealth services have expanded significantly, reducing the need for in-person visits and thereby lowering the risk of infection transmission. Remote monitoring of patients helps in managing infections and chronic conditions more effectively.

could focus on a range of timely and impactful topics. Here are her suggestions:

1. Emerging Infectious Diseases and Global Threats

 Coverage of the latest research and developments regarding new viruses or bacteria, particularly those with pandemic potential.

 Updates on global efforts to prevent and control infectious diseases, including responses to outbreaks and lessons learned from recent events.

 New technologies, treatments, and policies to mitigate the rise of drug-resistant infections.

 Strategies for improving AMR monitoring in healthcare settings.

3. Infection Control in Special Populations

 Best practices for preventing infections in nursing homes and other long-term care settings.

 Specialized approaches to infection control in pediatric units.

4. Health Care-Associated Infections (HAIs)

 Latest strategies, protocols, and technologies for preventing HAIs, with a focus on surgical site infections, catheter-associated infections, and ventilator-associated pneumonia.

 Case studies and lessons learned from recent HAI outbreaks.

5. Environmental Hygiene and Disinfection

 New products, technologies, and practices in environmental cleaning and disinfection.

Role of air quality in infection control:

 Research on the impact of ventilation and air purification in preventing the spread of infections.

 Strategies for healthcare professionals to address vaccine hesitancy and counter misinformation.

 Updates on new vaccines and vaccine delivery methods.

7. Technology and Digital Health in Infection Control

AI and machine learning in infection prevention:

 How artificial intelligence predicts and prevents outbreaks in healthcare settings.

 The role of telehealth in infection control, especially in managing patients with infectious diseases remotely.

 How the pandemic has changed infection control practices permanently.

 Future-proofing infection control protocols.

9. Infection Control in Nonhospital Settings

Infection prevention in outpatient clinics:

 Best practices for clinics, dental offices, and other non-hospital healthcare settings.

 Strategies for preventing infections in schools and workplaces, especially with the increasing focus on respiratory illnesses.

Continuing education for healthcare workers:

 New programs, tools, and certifications in infection prevention.

 How to involve patients and their families in infection prevention efforts.

Meet the experts shaping infection prevention: Infection Control Today's Editorial Board members share insights, experiences, and cutting-edge strategies to enhance health care safety and quality. Meet Tabrikah Mohammed, MSc, BSN, CIC, CPHQ, FAPIC.

Meet Infection Control Today's Editorial Board Member: Tabrikah Mohammed, MSc, BSN, CIC, CPHQ, FAPIC

Henry Spratt, Editorial Advisory Board member video

From groundbreaking research to innovative strategies, these experts are at the forefront of enhancing health care safety. Join us as we learn their insights, experiences, and visions for the future, providing valuable knowledge and inspiration to elevate infection control protocols. 

In this installment, we hear from Henry Spratt, Jr, PhD. Spratt is the senior microbiologist and professor at the University of Tennessee in Chattanooga and has dedicated over 3 decades to the study of microbiology, particularly in environmental settings. 

Initially focusing on wetland microbiology and bioremediation, Spratt’s research contributed significantly to understanding how microbes in wetlands can be harnessed to clean up toxic environments, such as those affected by acid mine drainage. However, his career took a pivotal turn about 20 years ago when he began collaborating with David Levine, PhD, DPT, MPH, FAPTA, a physical therapist and another member of 

's Editorial Advisory Board, leading Spratt into the realm of health care-related microbiology.

This collaboration began with a study of the microbial environment in physical therapy clinics, leading to their first published paper a decade ago. The success of this research prompted their university to establish the Clinical Infectious Disease Control Research Group in 2015. This interdisciplinary group has since been instrumental in monitoring environmental contamination in various health care settings, including inpatient and outpatient clinics, veterinary clinics, and long-term care facilities.

In this video, Spratt highlights a critical issue in many health care facilities: the lack of consistent and effective infection prevention practices, particularly in environments where environmental services are outsourced to contractors. His research has revealed concerning levels of contamination in various health care settings, including the presence of multidrug-resistant organisms like Methicillin-resistant 

. Despite these findings, he notes that the response from health care administrators is often inadequate, largely due to constraints imposed by low-bid contracts and high staff turnover among cleaning personnel.

A significant part of Spratt’s work now focuses on advocating for better infection control practices and educating health care professionals about the importance of environmental monitoring. His research group has developed rapid and cost-effective methods for detecting live bacterial contaminants on surfaces, which could revolutionize how health care facilities monitor and manage their environments.

Spratt also discusses the potential of new detection technologies, such as biosensors equipped with aptamers—small pieces of single-stranded DNA that bind to specific bacterial proteins. These sensors could provide instantaneous detection of harmful bacteria in clinical settings, greatly enhancing infection prevention efforts. With continued research and development, these tools could become affordable and widely accessible, even in resource-limited settings.

Spratt’s journey from environmental microbiology to health care-related research underscores the critical need for robust infection prevention practices in health care settings. His work not only highlights the gaps in current practices but also offers innovative solutions that could significantly improve patient safety and outcomes.

Meet the experts shaping infection prevention: Infection Control Today's Editorial Board members share insights, experiences, and cutting-edge strategies to enhance health care safety and quality. Meet Henry Spratt, Jr, PhD. 

Meet Infection Control Today's Editorial Board Member: Henry Spratt, Jr, PhD

Clean Hospitals Day 2024 will soon be upon us! Every year since 2020, the 20th of October has been the designated day for celebrating environmental service workers and management and raising awareness of environmental hygiene in health care facilities worldwide. Clean Hospitals Day coincides with the Association for Professionals in 

Infection Control and Epidemiology’s (APIC’s) International Infection Prevention Week

, and we are proud to partner with them for these significant events. This partnership strengthens our cause and makes us part of a global movement for health care environmental hygiene.

Each year, Clean Hospitals Day focuses on a different theme. This year, we delve into “The 6 Technical Domains of Healthcare Environmental Hygiene.” These domains, including surfaces, air control, water control, device reprocessing and sterilization, laundry, and waste management, are not just crucial, but they are the backbone for maintaining a safe and clean healthcare environment.

 and all the materials available to health care facilities, it's beneficial to provide a detailed understanding of these 6 domains.

It's essential to remember that health care environmental hygiene encompasses both human and technical elements. Both are vital for a robust environmental hygiene program, and neither should be undervalued.

WHO Multimodal Improvement Strategy (MMIS)

, around which the WHO Global Surveys on hand hygiene have been based, almost all the strategy's pillars deal with human elements rather than technical ones.

The MMIS comprises 5 pillars and has been adopted as an implementation strategy for environmental hygiene, especially with the development of the 

Healthcare Environmental Hygiene Self-Assessment Framework (HEHSAF)

 Although other implementation strategies are available, this one has benefited IPC for 2 reasons. First, it is comparatively simple, and second, it has been used in thousands of hospitals worldwide for hand hygiene. Seeing how low the global adherence to environmental hygiene is across resource levels, second, it makes the most sense to approach it in the simplest, most effective way possible.

The 1st in the MMIS element is system change, which focuses on the availability of the necessary products, supplies, and infrastructure to perform environmental hygiene. The second is the training and education needed for a workforce that can perform well and know how their work is essential for patient safety. The third is monitoring and feedback. You can't improve what you can't monitor, and feedback, especially constructive feedback, is critical for staff to adapt to changing environments and improve their behaviors and processes. The 4th is workplace reminders, which include any visible materials concerning safety practices, awareness, education, or any activities or celebrations in healthcare facilities. The 5th is institutional safety climate, which encompasses all qualitative elements of working somewhere. Staff motivation, career advancement, communication, and the team are key elements of a healthcare facility's safety climate. Only the very first element of the MMIS concerns the technical elements of environmental hygiene, so why focus on only this?

As we know, health care environmental hygiene is a relatively new field, and its scope has yet to be widely defined. Therefore, delineating the technical domains is essential as a first step and a precursor to analyzing how best to allocate and integrate a workforce in those areas. Of course, each of these domains is a whole field in and of itself… so there is more to come.

I look forward to celebrating Clean Hospitals Day with all of you, a day dedicated to recognizing the efforts of environmental service workers and management and raising awareness of environmental hygiene in health care facilities worldwide. I hope you’ll find the 

useful for your facilities and inspire you to contribute to our shared goal of a clean and safe health care environment!

Feel free to email me at Alexandra.peters@unige.ch.

Clean Hospitals Day 2024 emphasizes health care environmental hygiene, recognizing environmental service workers' efforts across 6 technical domains, enhancing global patient safety and infection prevention.

Celebrate Clean Hospitals Day 2024: Elevating Health Care Environmental Hygiene to Safeguard Patient and Staff Safety Worldwide

Damaged mattresses are common in hospitals and can potentially place patients at increased risk for infection. These are the findings of a 

Infection Control & Hospital Epidemiology

. The investigators assessed the conditions of beds and mattresses in 4 hospitals in midwestern United States. Investigators evaluated 727 beds and mattresses, finding that 523 (72%) had damage, 340 (47%) required mattress cover replacement, and 183 (25%) required replacement of the entire mattress.

“The results of this study reaffirm what previous research has shown–that cleaning methods used at hospitals today are inadequate, potentially endangering patients,” Edmond A. Hooker, MD, DrPH, author of the study and a professor at Xavier University, said in a statement.

For the study, each of the 727 beds and mattresses were examined by opening the mattress, then the mattress core was visually evaluated for evidence for damage. Next an LED light was used to identify smaller punctate defects in the cover. Finally, the bed frames were visually examined for evidence of rust.

The investigators collected data on mattress model, bed model, and mattress date of manufacture (if tag was present). They also noted stains present on the mattress cover (external surface of the bottom cover, inside top of cover, inside of bottom cover), damage to zipper or outside air connections. Punctate defects in cover were found with and without LED light, holes in the fire barrier, foam damage (compression, tearing, or crumbling), damage to inside air connections, unacceptable gel compression (greater than 3.2 cm), and rust visible on bed deck.

The majority of the beds needed a replacement of the entire mattress: 174( 95%) had large staining (greater than 15.2cm) visibly present. Of the remaining mattresses, 6 mattresses had gel failure, and 3 mattresses had no reason recorded. A total of340 covers needed replacement,176 (52%) of which had visible holes or staining of the inside of the cover. The firebarrier had damage in 79 (11%) of the beds. The investigators found beddeck rust on 175 beds (24%) and widespread rust on 65 beds (9%).

Hooker reports in the study that it “showed that most beds (72%) in a hospital system in the midwestern  United States had damage. This research is the first to demonstrate that many of the failed mattresses wereless than 4 years old and that the prevalence of rust on the beddecks was substantial.”

Due to infection risk, the Centers for Disease Control and Prevention, the US Food and Drug Administration, and mattress manufacturers recommend replacement of damaged mattresses and covers. The American Hospital Association states that the life of the mattress is 5 years, and mattress manufacturers maintain that the expected life of the mattress is only 1 to 3 years.

Hooker cited some limitations of the study beginning with where the beds were located. Although hospitals were involved in the study, they were all part of a single health  care system. Second, the beds and mattresses were primarily from a single manufacturer. Fewer than half the 727 mattresses (300, 41%) had tags denoting manufacturing dates. Replacement of the cover in 151 (50%) mattresses was necessary due to damage; 123 (81%) of those mattresses were less than 4 years old. Complete replacement, including cover and core, from damage was necessary in 58 (19%), of which 33 (57%) were less than 4 years old.

Because mattresses are the highest-touch element for a hospitalized patient, the risk of infection is potentially higher with a damaged mattress. The results of this study indicate that regular inspections of all mattresses and bed frames—regardless of age—must be conducted to minimize infection risks for patients. 

Patients can potentially be at increased risk for infection from damaged hospital mattresses and beds. More diligent and frequent cleaning must be done to keep patients safer.  


Hospital Mattress Failure Is a Potential Threat to Patient Safety 

Mounting evidence is supporting the spread of SARS-CoV-2 in animals. The latest report is from Ontario, Canada, and has added to the 

 that white-tailed deer can become infected with SARS-CoV-2. This report comes on the heels of another 

 documenting spread of the Omicron variant in Staten Island deer. SARS-CoV-2 was 

 to infect white-tailed deer on January 12, 2021. This first report was also from Ontario, Canada. 

 have found SARS-CoV-2 in up to 82.5% of deer (80 of 97 samples) in Iowa; and in 

 in Michigan, Pennsylvania, Illinois, and New York.
 


The recent study from Ontario presents several disturbing findings. The SARS-CoV-2 virus found in the deer was a highly mutated virus, with 49 mutations compared with the closest known strain in humans. This is “suggestive of sustained viral transmission.” In other words, the virus may have found a stable host or reservoir in the white-tailed deer population. The authors also point out that there are significant human-to-deer interfaces, along with interfaces with other wildlife.
 
The authors believe the newly detected Ontario white-tailed deer virus (Ontario WTD) may have its distant ancestor from a lineage identified in Michigan. Thus, the Ontario WTD likely represents a case of spread from humans to deer.

Of concern is that the authors also presented information that supports a case of deer-to-human spread of this highly divergent variant. The human case had “highly similar mutations” as the Ontario WTD virus, occurred in the same region as the infected animals, and the patient also had known close contact with white-tailed deer.
 


 animal SARS-CoV-2 infections and the possibility of animal hosts on August 5, 2021. Spread of the virus in animal hosts was 1 of mechanisms of virus evolution, which was 

 by the United Kingdom’s Scientific Advisory Group for Emergencies (SAGE).

We cannot assume that white-tailed deer are the only animal hosts (or virus reservoirs) or that deer were exposed directly from humans. There could be an intermediate host. Dogs, cats, bears, gorillas, baboons, snow leopards, minks, and rodents 

 in the emergence of the Omicron variant (this variant carries 7 out of the 7 mutations that promote transmission in rodents).
 
There are several important lessons here:
1. The virus is spreading easily outdoors among deer. The same should be true with mankind. Droplet spread can still occur outdoors if you are within 6 feet of someone.
2. An animal host all but guarantees that herd immunity in humans will not eradicate the virus.
3. The variants arising in animals will have no regard for the lethality in humans. Thus, increases and decreases in the variant’s human case fatality rate will be random. The virus does not need humans to live and evolve.
 
Above all, the report by Bradley Pickering et al underscores the importance of 

, the idea that animals and mankind live in the same biosphere and you cannot optimally promote health in mankind without also addressing the health and spread of disease in animals. It is unlikely we can stop the emergence of future dangerous variants by vaccinating all of mankind. We must also address the health of animals and modify how we interact with domesticated and wild species.

The virus may have found yet another stable host in the white-tailed deer population. 

Mutated SARS-CoV-2 Detected in White-Tailed Deer in Ontario

’s wide-ranging coverage of the infection prevention and control world. Everything from interviews with known opinion leaders to the news that infection preventionists and other health care professionals can use on their jobs.

1. Pandemic Places Importance of Preventing Environmental Infection at Center Stage

IPs can provide valuable input on construction projects, water safety, and ventilation.

Rethinking the application of air disinfection in the era of COVID-19.

3. Second Booster Shot Authorized by FDA for Patients 50 and Over

The dose is half the antigen amount for adults but with similar amount of titers..

4. The IP Relationship With Clinical Staff Is a Critical Partnership

The COVID-19 pandemic strengthened the relationship between infection preventionists and clinicians, but how can both parties ensure continued collaboration?

5. Bug of the Month: I'm Mostly Harmless, Until I Contaminate Your Food

Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in healthcare facilities today.

Take 5 minutes to catch up on Infection Control Today’s highlights for the week ending April 1. 

Elias Coury, MPH, BHSc

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