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Shared Accountability: A Strategy to Reduce Infection Risk

Common sense dictates that limiting surgical patients' exposure to any reservoir that could harbor pathogenic organisms could help prevent surgical site infections (SSIs). Wearing proper surgical attire is a cornerstone of SSI prevention, yet there has been strident disagreement on some of the finer points of surgical attire and its impact on SSI rates.

Surgical Attire Debate Continues as Experts Weigh the Evidence

'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

In modern health care, infection control and prevention are at the heart of patient care. Every healthcare professional understands the importance of stringent measures to prevent health care-associated infections (HAIs) and reduce antimicrobial resistance. Yet, one crucial area often remains overlooked: hospital environmental hygiene. This critical facet of infection prevention profoundly impacts patient safety and the well-being of health care workers and the broader community.

, an International Centre of Excellence in Public Health, is dedicated to addressing this gap by promoting high standards of hospital environmental hygiene. Here is why infection control and prevention personnel need to know about Clean Hospitals and participate in the global awareness campaign, Clean Hospitals Day.

“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,” 

, Clean Hospitals scientific lead and an 

 is an international initiative focused on improving health care environmental hygiene to safeguard patients, health care workers, and the environment. Rooted in public health excellence, Clean Hospitals takes a transdisciplinary approach to promoting a hygienic environment in health care settings. The organization brings together industry, academia, hospitals, governmental bodies, and key stakeholders to collaborate and raise industry standards in hospital hygiene.

The core values of Clean Hospitals are integrity, sharing, transparency, and respect. These values guide their actions and commitment to improving patient safety and protecting health care workers. By elevating hospital hygiene standards worldwide, Clean Hospitals aims to reduce the spread of infections, enhance safety, and protect public health.

“However, only talking about environmental hygiene to other experts about the challenges is not enough,” Didier 

Pittet, MD, MS, CBE, the hospital epidemiologist and director of the infection control programme and World Health Organization Collaborating Centre on Patient Safety, told 

. “We need to sensitize [hospitals] to the importance of health care environmental hygiene. There are too many hospitals around the world that I have visited where it's just left like this: either it's a private company will [do the cleaning], and sometimes that [should be] a professional’s work. Cleaning a hospital is not cleaning a hotel [because] patients are coming to the hospitals. Environmental protection in a hotel or at home has nothing to do with environmental protection in a hospital or in a long-term care facility, even where many people are living today. So, this is an important problem. And we want to address it with my friends and colleagues from around the world [at the conference]. Again, in a public/private/partnership and academic action that we all want to carry over.”

The Importance of Hospital Environmental Hygiene

Although often underfunded and understudied, hospital environmental hygiene is crucial in preventing HAIs and combating antimicrobial resistance. Numerous studies have shown that a clean hospital environment reduces infection rates. Effective hygiene practices can significantly lower the risk of pathogen transmission from surfaces and instruments to air and water quality. This is vital for patient care, staff safety, and public health.

Moreover, hospital hygiene has a broader impact beyond the hospital walls. Proper waste management, air quality control, and sustainable practices also benefit the surrounding community and the environment. Clean Hospitals recognizes this and strives to make healthcare facilities safer and more sustainable through evidence-based practices.

“Everyone is a puzzle, and environmental hygiene is a puzzle,” 

, who works at the University of Geneva Hospitals & Faculty of Medicine in Geneva, Switzerland, told 

. “We need to emphasize its importance to people.”

The mission of Clean Hospitals is to increase awareness and lead a global shift in environmental hygiene culture. This includes developing and promoting best practices for hospital hygiene, advocating for sustainable products and services, and enhancing corporate social responsibility within the health care industry. Clean Hospitals connects stakeholders and experts worldwide, aiming to raise standards and bring visibility to the often-overlooked role of environmental hygiene in patient care.

Clean Hospitals' ultimate vision is to become the leading voice in health care environmental hygiene, making hospitals cleaner, safer, and more sustainable. Through its work, the organization seeks to protect patients, health care workers, and the environment by reducing HAIs and antimicrobial resistance.

Clean Hospitals Day, launched in 2019, is a global campaign to raise awareness of the importance of health care environmental hygiene. This awareness day celebrates the hard work and dedication of environmental service workers, hospital management, healthcare workers, and partners who produce the products, education, and technologies essential to maintaining a clean health care environment.

Clean Hospitals Day aims to increase global visibility and recognition of health care environmental hygiene’s role in patient safety. It is a call to action for infection control and prevention personnel to join Clean Hospitals in celebrating and empowering those who work tirelessly to improve hospital hygiene every day.

Clean Hospitals Day is for everyone involved in hospital hygiene, from environmental service workers to health care providers and management. It is also for patients most vulnerable to infections resulting from poor hospital hygiene. By participating in this campaign, health care workers can help raise awareness of the importance of hospital hygiene and promote better practices within their institutions.

Why Infection Control Personnel Should Join Clean Hospitals

As infection control and prevention personnel, you safeguard patients and healthcare workers from infections. Clean Hospitals provides a unique opportunity to enhance infection prevention by focusing on environmental hygiene. Here are several reasons why you should consider joining Clean Hospitals:

 Clean Hospitals connects you with leading experts and stakeholders worldwide. This network allows you to share knowledge, exchange best practices, and stay updated on the latest research and innovations in hospital hygiene.

Access to cutting-edge tools and resources:

 Clean Hospitals offers valuable tools, such as the Healthcare Environmental Hygiene Self-Assessment Framework (HEHSAF). This internationally validated tool helps healthcare facilities identify areas for improvement in their hygiene programs, and benchmarks progress over time. Infection control personnel can use these resources to enhance their environmental hygiene protocols and better protect patients and staff.

 A clean hospital environment reduces the risk of HAIs and protects health care workers from infections. By aligning with Clean Hospitals' goals and standards, infection control personnel can impact patient and staff safety, leading to better health outcomes.

 Clean Hospitals champions sustainability in healthcare environmental hygiene. From waste management to air and water control, the organization advocates for practices that protect hospital staff, patients, and the environment. Infection control personnel can be crucial in promoting these sustainable practices within their facilities.

 Participating in Clean Hospitals contributes to a global effort to reduce HAIs and antimicrobial resistance. These are pressing public health challenges that require coordinated international action. Infection control personnel are essential to this effort, and Clean Hospitals provides the platform for making a difference on a global scale.

Join the Movement: Celebrate Clean Hospitals Day 2024

 is an opportunity for infection control and prevention personnel to engage in this global campaign and promote the importance of environmental hygiene in health care settings. You can help raise awareness by downloading campaign materials, sharing them with your colleagues, and promoting better hygiene practices in your institution.

Clean Hospitals Day annually centers around a designated theme, and this year, our focus is on "The 6 Technical Domains of Healthcare Environmental Hygiene." These domains encompass surfaces, air control, water control, device reprocessing and sterilization, laundry, and waste management. It is imperative to recognize that these domains are not only essential but also serve as the foundation for upholding a secure and hygienic health care environment.

“Understanding the 6 technical domains of environmental hygiene is key to developing an improvement strategy for your hospital’s environmental hygiene program,” Peters told 

From social media photo frames and posters to video conferencing backgrounds and fact sheets, 

Clean Hospitals offers a variety of resources

 to help you spread the message. By participating in Clean Hospitals Day, you are celebrating the work of environmental service workers and contributing to the global effort to improve patient safety through better hospital hygiene.

Clean Hospitals is at the forefront of a global movement to improve health care environmental hygiene and reduce HAIs. Infection control and prevention personnel have a vital role to play in this effort. By joining Clean Hospitals and participating in Clean Hospitals Day, you can help raise awareness of the importance of hospital hygiene, promote best practices, and contribute to a healthier, safer health care environment for patients, staff, and the community.

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


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

Despite guidance from the CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommending Enhanced Barrier Precautions (EBP) to contain the spread of multidrug-resistant organisms (MDROs), its adoption in nursing homes has been inconsistent. New research highlights key findings, challenges, and recommendations for improving infection prevention practices.

, the infection preventionist and principal consultant at Mayoryk Consulting Services, and the study's lead author, 

What was the primary motivation or research question that led you to conduct this study, and why do you believe it is important?

 This study aimed to assess the feasibility and acceptability of implementing EBP through a quality improvement (QI) initiative within 4 community-based nursing homes in Maryland. Our study objectives were to describe the elements of a quality improvement (QI) initiative for EBP implementation, assess the effectiveness of a QI initiative for EBP implementation, and assess the acceptability of EBP to health care personnel (HCP) and the barriers and facilitators of EBP for HCP.

Guidance from the CDC and HICPAC has recommended that EBP contain multidrug-resistant organism (MDRO) transmission. Yet, the full adoption of EBP by nursing homes has been variable, and EBP remains a new concept for HCP. Many facilities are beginning implementation in response to CMS requiring it in March 2024. Facilities need to have an evidence-based framework for implementation and evaluate administrative, environmental, HCP, and resident considerations before, during, and after EBP implementation.

: Can you briefly explain the methodology you used in the study and why you chose this approach?

 We randomly staggered the implementation of the QI initiative to optimize EBP implementation in 4 mixed short—and long-stay units within 4 community-based nursing homes in Maryland. The facilities belong to the same independent health care system specializing in postacute care, skilled nursing, and rehabilitation. The study timeline included a 3-month baseline period, a training period, and a 3-month intervention period.

To operationalize EBP into practice, we utilized the 4E process model (engage, educate, execute, evaluate), a Translating Research into Practice (TRiP) model component. This model was chosen because it is well-suited for larger projects that include multiple sites and has been utilized in past health care epidemiology and infection control implementation initiatives.

We performed weekly observations of HCP providing care for residents with chronic wounds, devices, and MDROs. During these observations, data was collected on the types of care performed, hand hygiene, and gown and glove use during high-contact care. We also recorded whether EBP had been correctly implemented for eligible residents and whether PPE was available if required at the point of use.

To assess the adaptive aspects of implementation, mini-interviews were conducted with willing HCPs and infection preventionists (IPs) after the 3-month intervention period. All occupational groups that care for residents on EBP, including registered nurses, nursing assistants, licensed practical nurses, and respiratory therapists, were invited to participate.

: What were the key findings of your study, and how do they contribute to the existing body of knowledge in your field?

 Overall, 1 in 3 nursing home residents met EBP indications. The most common indication (21% of 780 residents) was a history of MDRO colonization. Indwelling medical devices or chronic wounds were present in 14% and 10% of residents, respectively.

Accurate identification of residents meeting the EBP criterion improved significantly from 63% during the baseline period (with over 600 observations) to 99% during the intervention period. Among rooms with residents who met the EBP criterion, the percentage with gowns available at the point of use also increased significantly from 55% at baseline to 100% during the intervention period.

We also noted improved HCP compliance with glove and gown use during high-contact care activities. Glove use increased from 85% at baseline to 97%. Gown use increased from 27% to 78% during the intervention period. All high-contact care activities demonstrated increased glove and gown use from baseline to intervention period. The high-contact care activities with the highest level of glove compliance during the baseline period were wound and device care at 98% and 95%, respectively. The high-contact care activities with the lowest level of gown compliance during the intervention period included resident transfers and linen changes, at 66% and 80%, respectively.

Interviewed staff could identify both facilitators and barriers to EBP implementation. The 2 most frequently mentioned facilitators were the perception that EBP helps to reduce transmission of infectious diseases to other residents, staff, and families (74%) and that clear, simple, and bright signage helps to know when and where EBP can be used (69%). The 2 most frequently mentioned barriers to EBP implementation were that gowns are uncomfortable and hot (43%) and that there needs to be more clarity in knowing when a resident can be placed on EBP instead of contact precautions (34%).

These findings are significant as they demonstrate that HCP can achieve improved adherence with high-contact care activities and correctly identify residents eligible for EBP. However, the results also highlight where additional work is needed, such as improving gown and glove during resident transfers and linen changes and increasing HCP and IP knowledge of when a resident with an MDRO would require Contact Precautions instead of EBP.

: Were there any unexpected research results or challenges you encountered?

 HCPs noted additional facilitators and barriers during post-implementation interviews. These included gown comfort and providing multiple gown options, the preference for more frequent informal education on the unit, EBP signage that was visually different from traditional transmission-based precautions signage, and the need for more frequent trash removal due to increased gown waste. Ensuring these elements are assessed and mitigated may improve future implementations.

: What are your findings' potential implications or applications, and what future research directions do you suggest based on your study?

 Our findings support that the 4E implementation model can successfully be used for EBP implementations and other infection prevention and control interventions in nursing home settings. Though the recent adoption of EBP in CMS regulation may lead to hurried implementations, nursing homes may benefit from a stepwise approach to EBP implementation, including leadership training, environmental assessments, and gap analyses, and frequent HCP and resident/family education. Future EBP implementation efforts should focus on mitigating identified barriers.

Mayoryk S, O’Hara LM, Robinson GL, Lydecker AD, Jacobs Slifka K, Jones H, Roghmann MC. Optimizing the implementation of Enhanced Barrier Precautions in community-based nursing homes. 

. Published online September 20, 2024. doi:10.1016/j.ajic.2024.09.014

Research finds Enhanced Barrier Precautions reduce MDRO transmission in nursing homes, though challenges persist with gown usage, education, and comfort during high-contact care activities.

Study Highlights Successes and Challenges in Implementing Enhanced Barrier Precautions in Nursing Homes

Genomic Surveillance: A New Frontier in Health  Care Outbreak Detection

Health care–associated infections (HAIs) are a persistent challenge in hospitals, leading to significant patient morbidity, mortality, and financial burden on health care systems. Traditionally, infection prevention and control (IPC) departments rely on clinical observation, manual outbreak investigations, and retrospective data analysis to detect and manage outbreaks. However, with advancements in genomic epidemiology, a new approach called genomic surveillance transforms how health care outbreaks are detected and controlled.

Alexander Sundermann, DrPH, CIC, FAPIC, an assistant professor in the Division of Infectious Diseases at the University of Pittsburgh Center for Genomic Epidemiology and a member of 

’s Editorial Advisory Board, discussed a study recently published in 

 that explored the use of genomic surveillance for enhanced health care outbreak detection. This research aims to shift the paradigm from reactive to proactive outbreak management, leveraging real-time genomic data to identify and mitigate outbreaks before they escalate.

According to new research, genomic surveillance is transforming health care-associated infection detection by identifying outbreaks earlier, enabling faster interventions, improving patient outcomes, and reducing costs.

Kelly M. Pyrek

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