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Gary S. Marshall, MD; Shanna M. Barton, MD; Theresa M. Fiorito, MD

Patient, Provider, and Caregiver Connection™: Prevention and Control of Meningococcal Disease — Individualizing Vaccine Recommendations in Adolescent Populations

personal protective equipment page offers written and video content on the proper use and—during the time of COVID-19 surges—reuse of PPE, including masks, respirators, gloves, gowns, face shields, goggles, and more. What are the proper donning and doffing methods? How long can PPE be extended? How are these items decontaminated? What comprises proper fit testing? Our experts will tell you.

Learn about the new Recertification option for the a-IPC certification, and the APIC's Emerging Infectious Diseases Task Force, and the Mpox Playbook. 

Recertification Options for a-IPC, APIC's Emerging Infectious Diseases Task Force and Mpox Playbook

As influenza and COVID-19 circulate in long-term care facilities, prompt testing, isolation precautions, and antiviral treatments are crucial for preventing outbreaks and protecting vulnerable residents.

An Ounce of Prevention: Managing Influenza and COVID-19 in Long-Term Care 

Infection control policies significantly impact laboratory billing, from coding and documentation to reimbursement rates. Labs must adapt to remain compliant, streamline billing, and ensure accurate compensation.

How Infection Control Policies Shape Laboratory Billing: Compliance, Reimbursement, and Coding Updates

Take 5 minutes to catch up on Infection Control Today’s highlights for the week ending September 6, 2024.

Weekly Rounds: UV-C Disinfecting Ultrasound Probes, Reducing C difficile Testing, and More


The FDA's 21 CFR Part 820 and ISO 13485 are crucial in regulating medical device quality systems. Harmonizing these standards by 2026 will streamline compliance, improve patient access to devices, and align US regulations with global practices.

Implementing FDA 21 CFR Part 820 & ISO 13485 on Quality System Regulation

Meet Matt Pullen, MD, ICT EAB Member

'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.

This installment is from Matthew Pullen, MD.

I am Dr Matthew Pullen at the University of Minnesota. I am an infectious disease physician and assistant professor of infectious diseases and international medicine. I've been asked to talk about my journey into health care and infection prevention and the trends I want to see in infection prevention in 

. So, as far as getting into medicine, [it is] something I always wanted to do, even when I was a little kid. My parents always had 

s around our house. I remember that, in kindergarten, there was an early 3D rendering of a bacteriophage on the cover. And I drew that in my journal in kindergarten and loved it. I thought it was the coolest thing ever. I just always loved anything about viruses and bacteria.

Going into later years, in high school, I [was] still interested in it, volunteered in clinics and hospitals when I could, [then] continued doing that in college. Then [I] got into genetic research at college, under the mentorship of Dr Margaret Kovac, who was just a wonderful geneticist at the University of Tennessee in Chattanooga.

From there, I interned as an intern geneticist with the Federal Bureau of Investigation (FBI) at the FBI Academy. I stayed on there for a bit, doing genetics work in the Counterterrorism Support and Forensic Research Unit. Most of my work was related to mitochondrial DNA using technologies that, at the time, were ahead of the market, so things that weren't available to anyone else that today—it was long enough ago—that today they would be massively outdated and slow and useless, but in 2006 they were cutting-edge.

After that, I was still trying to decide if I wanted to do research or clinical medicine. I decided my heart was still in clinical medicine, so I applied to medical school. While doing that, I took a research position at Vanderbilt University, working in a lab that specialized in the genetics of the circadian rhythm. So, I kept one foot in the genetics world.

It took 2 cycles, but [I] got into medical school at the University of Tennessee in Memphis. I had a great education there, stayed there for my internal medicine residency, and got a phenomenal clinical education. Then, after that, it was time to apply for a fellowship in infectious diseases. I wanted to learn some aspects of international health during my fellowship training, and Minnesota has a very strong track record for that. They have a core research group that is doing a lot of work in Uganda.

During residency, I got to work in Kenya, right next door, so I was a little familiar with the region. So, I came here and started working with David Boulware, [MD, MPH, professor of medicine, Division of Infectious Diseases and International Medicine] on cryptococcal meningitis and tuberculosis research and got to spend a little bit of time in Uganda my first year of fellowship. Then, through his mentorship, he got a Fogarty fellowship to the National Institutes of Health and spent a full year living in Uganda researching drug-resistant [tuberculosis]. While there, I got to work a little with Doctors Without Borders. They have an isolation unit in the town that I lived in, so I got to see the inner workings of that.

When I returned to Minnesota, we opened what is now our hospital's regional special pathogens unit. So, I asked to join that team, and I was the first fellow who was crazy enough to decide to join that team. Now, we make it a part of the fellowship program where they can be exposed to it. But we got to do training on infection control for Ebola virus, Lassa, and all kinds of high-complication pathogens that, thankfully, we have not seen here yet. I'm still a member of that team.

Then, ICT asked me to join the Editorial Advisory Board. I have contributed a few pieces and quotes here and there.

As far as trends that I see in infection prevention, one trend that I really like is I think we are taking a much more pragmatic and practical approach to infection prevention. Or most of my medical education, everything has been ramped up to a 10 with infection prevention. You know, every MRSA case is gowns and gloves. Everything is maximum materials being used, and in the last few years, more and more research has come out that's shown maybe we're a little overboard with that. There are questions of whether the MRSA we're seeing is community-acquired or hospital-acquired; it may be where our resources are better spent in the community or on other prevention methods. So, I think that's good. I think being open to changing our way of thinking will help save costs in health care and make these resources more available when needed.

 for the rest of the year, I think that falls into 2 buckets: practical things that we should cover and then pet interests that I think are interesting but are probably not very practical. As far as practical things, I think you like the trends getting into some of the more cutting-edge research on practicality versus utility and efficacy in infection control emerging pathogens as more comes out about 

, and resistant pseudomonas, and things like that. Those are things that day-to-day will be helpful from the less practical but personally interesting side of things would be little pieces on infection control and bioterrorism and biodefense agents, those things that we don't think about often because they're not huge day-to-day concerns. Still, if you're on call when smallpox walks into your ER, you should know how to handle that.

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 Matthew Pullen, MD. 


Meet Matthew Pullen, MD, Infection Control Today's Editorial Advisory Board Member

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

Insights on Double-Gloving with Dr. Hudson Garrett

’s) conversation with Hudson Garrett, PhD, MSN, MPH, MBA, FNP-BC, IP-BC, CPHRM, CIC, CHIPP-B, LTC-CIP, CPPS, CPHQ, CVAHP, FACHDM, FAPIC, FAAPM, FNAP, FACHE, FSHEA, FIDSA, an adjunct assistant professor of medicine in the Division of Infectious Diseases at the University of Louisville School of Medicine, and a professor of emergency medical services and critical care at Phoenix Institute and College, the importance of double-gloving in infection control was emphasized. Garrett highlighted how this simple yet effective practice significantly enhances protection for healthcare workers, especially in high-risk environments such as emergency and critical care settings.

Double-gloving involves wearing 2 layers of gloves, which provides an additional barrier against potential exposure to infectious agents. Garrett pointed out that while single-glove use is standard, the added layer from double-gloving can reduce the risk of glove perforation and contamination during procedures. This is particularly crucial during invasive procedures where the likelihood of exposure to blood-borne pathogens and other infectious materials is higher.

"Everything that we can do to reduce that risk of our own floor as health care providers being introduced into that surgical field is going to be huge, and that starts with surgical hand hygiene,” Garrett said. “It includes our personal protective equipment (PPE) protection and things like gloves. But it also, again, goes an extra layer of protection to make sure that my health care workers are safe too.”

Garrett stressed that double-gloving not only protects health care workers but also contributes to patient safety by minimizing the risk of cross-contamination. He advocated for the routine adoption of double-gloving in health care settings where the risk of infection is significant. The practice is especially important in the context of emerging infectious diseases and pandemics, where the safety of health care providers is paramount to maintaining a functional and responsive health care system.

“Keep in mind that the use of gloves, gowns, and other PPE is at the very bottom of our pyramid in terms of infection control interventions, but it is an important part of our sort of tool belt,” Garrett said. “My job is to always make sure, whether I'm working with a perioperative nurse or clinician, a surgeon or another [infection preventionist], that our tool belt is as wide and deep as possible.”

The conversation concluded with a call for more education and training on the benefits of double-gloving, ensuring that health care professionals are fully aware of its importance in infection control and patient safety.

In an ICT® interview, Dr. Hudson Garrett emphasized double-gloving in infection control as crucial for protecting health care workers and patients, especially in high-risk environments.

IP and AMR stewardship to the c-suite

Sometimes, communicating the needs of infection prevention programs to top-level executives is not straightforward. How can we ensure that these programs receive adequate resources and support from high-level decision-makers

Susan Casey Bleasdale, MD, an infectious disease specialist now a chief quality officer, understands the strategies for advocating infection prevention programs to the C-suite and securing effective resource allocation and support.

In the field of infectious disease, you are not limited to 1 organ system. You're looking at the whole patient.

Bleasdale, MD, is the chief quality officer, assistant vice chancellor of quality and patient safety, and medical director of infection prevention and antimicrobial stewardship at the University of Illinois Hospital and Health Sciences System (UIH). She will present “Creating a Business Plan for Infection Prevention and Antimicrobial Stewardship” at the Society of Epidemiology of America in Houston, Texas, held from April 16 to 19, 2024.

“The lead into the topic is ‘show me the money.’ It's also about how teams in infection prevention and antimicrobial stewardship can market their programs before the appropriate support and resources are available. And I'm going to market it to the C suite. And I think that this talk, in particular, I'm giving as someone who's been in both rounds. I have been in infection prevention and antimicrobial stewardship, but I sit now in the C suite myself…I understand what the things that you need to look at when you're looking at dedicating resources and support to a program for your health system or your hospital are to be able to improve quality in some way. And so, the talk is about how you build the resources. And how do you how do you give your pitch to the C suite?”

 then asked Bleasdale how she went from being a doctor to sitting in the C-suite. “I would say because I'm starting in infectious disease, I have an impact on trying to improve the quality of care of my patients. I've been doing infection prevention since I was in training and stewardship…. I've been involved in the work of improving outcomes and the quality of care. [My path] just made sense to expand to be a chief quality officer; there are several infectious disease physicians who are chief quality officers as well because, again, we have an impact. I think the other thing is that in the field of infectious disease, you are not limited to 1 organ system. You're looking at the whole patient.”

Discover strategies for advocating infection prevention programs to the C-suite, ensuring resources, leadership support, and impactful outcomes.

Show Me the Money: Marketing Infection Prevention and Antimicrobial Stewardship to the C-suite

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

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

CDC’s antimicrobial-resistant funding to global and domestic partners—from academic centers to local public health departments. CDC collaborates with partners to develop innovative strategies to slow the spread of AR, improve infection prevention and control, and safeguard individuals. Through CDC's investment, significant progress has occurred in enhancing the US and global capabilities to quickly detect, respond to, and contain existing and emerging AR threats.

Mary Alice Lavin, MJ, BSN, RN, CIC, FAPIC, is an infection control consultant at Hektoen Institute, LLC, Illinois Department of Public Health grantee, and spoke with Infection Control Today about the updated 

Antimicrobial Resistance (AR) Investment Map

She discusses antibacterial resistance and overviews the map and its origins.

“Antimicrobial resistance is not new; however, it is a growing concern. Even since the 1950s, or early 60s, when we first had treatments for 

, resistance developed quickly after those treatments became available. And over time, as we've seen different organisms of concern. We use antibiotics, and those germs become resistant. Now, one of the issues is that the germs can share those mechanisms of resistance with each other. And so one mechanism of resistance can then move on to another germ. Now that germ also has that mechanism of resistance, and as that occurs, more germs become resistant, potentially. And once they're resistant, there are fewer options for treatment. It makes it more difficult to treat those individuals. In some cases, unfortunately, there is nothing that can cure those individuals, and the cases are fatal.”

Lavin explains that the “goal of the map is to share the investment being made, certainly in the United States. It's also important to note that the CDC also funds initiatives overseas, and people may question why we are doing that. We know that germs are only a plane away. It's easy for people to travel and bring germs back. We also know that some medical tourism occurs and so people may go to other countries to receive medical care. In other countries, antimicrobials are not as well controlled as they are in the United States. In some countries, you can go into a store and ask for an antibiotic. And you don't need to have a prescription. And so when antibiotics are used more broadly, there's more pressure, and the germs and resistance develop more easily and more frequently. So if you've gone to one of these countries where antibiotics are not controlled, you receive medical care, and, unfortunately, are exposed to one of these germs, you return to the United States. Now that it gets introduced potentially into the health care environment. If people don't practice appropriately, cleaning their hands, using personal protective equipment, such as gowns and gloves, and ensuring instruments are adequately cleaned and disinfected, we shouldn't forget about the investments done overseas.”

These quotes have been edited for clarity.

What is the CDC's Antimicrobial Resistance Funding map? A key opinion leader explains. 

CDC’s Map Shows Antimicrobial Resistance Funding to Global/Local Partners  

The COVID-19 Public Health Emergency has been declared over. But that doesn’t mean that COVID-19 and the need for assistance for the effects of COVID-19 are over. Where do we go from here? 

) contacted Deborah Birx, MD, for her input, based on her work with global HIV initiatives. 

Birx is a renowned medical expert and leader with extensive experience in clinical and basic immunology, infectious disease, pandemic preparedness, vaccine research, and global health. She has served the United States as an Army Colonel and has overseen influential programs at the CDC and US Department of State. Birx is a formal Ambassador-at-Large and is currently a Senior Fellow at George W. Bush Institute in Dallas, Texas.

In the discussion, Birx discusses what she thinks the government did right, did wrong, and what still needs to be done going forward. One theme runs through the conversation: “If you give people the information and empower them, they'll make the right decisions, but we're not giving people the information and empowering them to make the right decisions.”

About the Public Health Initiative, Birx remarked, “It doesn't matter if the public health emergency goes away or not. Because we haven't really taken advantage of the public health emergency over the last 2 years to understand and address the gaps that are quite apparent to every American out there.”

About masks, Birx says, “I think the masking issue has demonstrated how important it is in aerosolized respiratory disease and how it may be less important and more droplet transmission that may still be more surface and direct contact with individuals.”

, “I'm going to be very clear: these vaccines were a miracle. They saved literally hundreds of thousands of American lives. But they're not perfect. They're far from perfect. And we have not been clear to the American public about their imperfection. I think because of that, people aren't clear on what these vaccines can do and can't do.”

Birx is optimistic about the world’s ability to handle future pandemics. “All of these things are addressable. We are incredibly smart in the United States and around the globe; we know how to make highly technical things fast. [So,] we need to figure out how we work effectively with communities to give them the information they need to do their own risk-benefit analysis, and [so] they don't feel like the federal government is misleading them with partial truths. There is never a reason to withhold information for fear that the American people will not understand it. That's how you lose the public. And that's been very well demonstrated in COVID-19.”

(Birx’s quotes are edited for clarity. Listen to the full interview for more of Birx’s views.)

“It doesn't matter if the public health emergency goes away or not. Because we haven't taken advantage of the public health emergency over the last 2 years to understand and address the gaps quite apparent to every American out there.”


ICT Exclusive: Deborah Birx, MD, Discusses the End of the COVID-19 Public Health Emergency

) 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.


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