We have all experienced that feeling of disgust from seeing a mess left behind in a shared space. Whether at a restaurant, office (I’m looking at you, microwave), or even your own home, nobody wants to be left with the mess. Now imagine beyond the crumbs, trash, and sicky soda residue down to a microscopic level and the invisible host of germs that was left behind as well. It is true for anyone: where we go our germs follow. However, the potential spread of these germs is up to us. Action on each of our parts can and should be taken to avoid spreading germs.
Leave No Trace
Growing up hiking and camping in the Idaho wilderness I learned at a young age the concept “leave no trace.” Similar principles as those I learned to protect natural spaces can be followed to protect and preserve our safety in shared spaces from cold and flu-causing germs:
- Plan ahead, be prepared, and ask for cleaning and disinfecting products in your workspaces. As you enter a shared space, consider how you might minimize your impact on others. Avoid bringing unwanted germs into shared spaces by staying home when feeling sick or experiencing symptoms of illness. Additionally, ensure you are well equipped with supplies to help you minimize the spread of germs. This includes having hand sanitizer, tissues, and cleaning and disinfecting products, like wipes, available to be used on hard non-porous surfaces throughout your workday. This might involve asking your facility manager or custodian to supply these items in the breakroom or conference rooms.
- Dispose of trash and disinfect your spaces to prevent the spread of germs. Regularly assess your space and remove any garbage that may have accumulated. Don’t be that person with the pile of used tissues on their desk. Promptly deposit used tissues and other waste in the trash can. After tossing your trash, be sure to use hand sanitizer and disinfecting wipes to clean your space. This helps you to avoid taking those germs with you and possibly contaminating another area.
- Be considerate of others and clean or disinfect shared spaces after use. Not all shared spaces are created equal. If working near others, be respectful of their space. Consider wearing a mask as appropriate and following guidance for masking and social distancing. Practice respiratory etiquette like coughing or sneezing into our elbow or tissue. Prepare the space for the next user by using disinfecting wipes on high touch surface and other shared items. Be sure to leave the space better than you found it.
- Give others the benefit of the doubt. Understand that it takes a group effort and for everyone working together to create a safer environment. It’s going to take supporting each other for positive change to occur and even then, it will take time.
As cold and flu season approaches let’s do our part to keep healthy by maintaining cleanliness in our shared spaces. To help in this effort, place signage such as the Cold and Flu Prevention Quick Tips around shared spaces to serve as a reminder of practices that help stop the spread of cold and flu viruses. Likewise, partner with your facility manager or custodian to make sure disinfecting wipes and hand sanitizer are available in conference rooms, break areas, and other common spaces. Offices or desk clusters should also have cleaning wipes nearby and readily available. If you find yourself in need, speak up so you can have the right tools to be safe. Remember, it is a shared responsibility to safeguard our spaces and leave no trace to help keep germs at bay.
Infection preventionists “raced” to Indianapolis, Indiana to attend the Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference which was held in-person for the first time since 2019. The conference was abuzz as 2,800 infection preventionists (IPs) celebrated being able to see each other’s masked faces in person once again. For many attendees, the conference was the first time out of their bubble since the COVID-19 pandemic began. An additional 1,500 attendees were able to join and participate virtually. The conference featured stellar keynote speakers, an impressive exhibitor hall, and many knowledgeable session presenters. One of these was Clorox Healthcare’s own infection preventionist, Doe Kley, who shared cleaning and disinfection essentials for long-term care settings.
This year APIC celebrated its 50th Anniversary. Founded in 1972, APIC was organized to bring professionals together, create opportunities to collaborate and network, provide education, and to drive guidance for best practices in infection prevention and control. This year’s APIC conference delivered and will continue to drive forward the important work of creating a safer world well into the future.
New Attendees from Clorox Healthcare
In attendance at this year’s APIC conference for the first time were two Research and Development (R&D) Scientists from Clorox Healthcare; Fanny Frausto Arellano, Ph.D. and Camile Dematos Gomes. Fanny is a lab chemist focused on formulation development for cleaning and disinfection products and Camile is heavily involved in product and process development with expertise in disinfecting wipes. For a new and fresh perspective of the APIC conference, I asked these two R&D scientists to share a bit about their experiences, including their thoughts and insights.
Question: As a first-time APIC Conference attendee, what was your overall impression?
Camile: The conference was comprised of some of the brightest and most passionate minds in the field of infection prevention. Everyone I spoke with was knowledgeable and experienced but still came with the desire and eagerness to learn more. It was encouraging to see how we, as an industry, are working together to provide solutions to achieve the same goal of creating a healthier, safer lives for all.
Fanny: The conference was great and provided me an opportunity to better understand the wants, needs, and challenges facing the IP community. The conference shared the latest research and industry information with conference goers.
Question: As an R&D scientist, did you have any big “aha” moments?
Camile: The process of how IPs and facilities select cleaning and disinfection products stood out to me. I came to recognize that evaluating products for potential use in a hospital or clinic is extensive and complicated. A better understanding of how IPs look at products, the metrics used to evaluate them, and why this is important, has helped me realize opportunities for future R&D work to support equipment and device compatibility.
Fanny: I learned that even with a big push from IPs, it may still take facilities a long time to fully implement a new cleaning and disinfection product. I heard from IPs the need for products that are easy to use, surface compatible, and affordable. While these attributes are ideal, it’s important for IPs to understand the consideration and possible tradeoffs involved. For example, it may be possible to have better surface compatibility, but this may lengthen contact times.
Question: What were some major themes you noticed throughout APIC 2022?
- The need to simplify infection prevention guidance and processes for IPs and healthcare staff.
- More enhanced training and support needed to IPs.
- Greater focus on setting and working towards achieving long-term progress and results.
- Staff are tired, over-worked, and understaffed but still accomplishing great work.
- Need to focus on making up for lost progress and gaining more traction against rising HAIs.
Question: What is one big takeaway about Infection Prevention that we can all remember?
Camile: We must strive to make the right thing to do the easy thing to do.
Fanny: Wash your hands, disinfect surfaces, and don’t touch your face!
Infection preventionists have the difficult job of juggling many responsibilities and areas of expertise. The APIC conference demonstrated the incredible efforts of IPs and gave our scientists a glimpse into the challenges they as well as opportunities for the future. Congratulations to the APIC organization on a successful event this year and thanks to you, IPs, for the incredible work that you do. As a proud platinum plus sponsor of APIC, we at Clorox Healthcare look forward to continuing to support and help move the needle towards better healthcare outcomes and a safer future.
Updated on 8/18/2022
For more information on monkeypox and to learn how to use CloroxPro and Clorox Healthcare products that have demonstrated effectiveness against viruses similar to the monkeypox virus, please reference our FAQs and monkeypox pathogen education sheet.
Monkeypox: A Global Outbreak
Monkeypox has recently become a trending topic in the news and on social media. The Centers for Disease Control and Prevention (CDC) recently reported more than 13,000 monkeypox cases in the U.S., with cases confirmed in nearly every state.1 As the monkeypox situation worsens and cases continue to grow globally, the World Health Organization has declared monkeypox a public health emergency of international concern.
Monkeypox, historically a rare disease, is an example of an emerging viral pathogen (EVP). While it does not spread as easily as some other respiratory viral pathogens, the sudden appearance of monkeypox in several non-endemic countries suggests that there may have been undetected transmission for some time.2 Close contact with an infected animal, human, or materials contaminated with the virus can lead to spread.3 Though most cases of monkeypox are mild, the illness and symptoms can last 2-4 weeks and include fever, headache, swollen lymph nodes, back pain, muscle aches, and fatigue followed by a rash.4
Combating New Threats
In the case with monkeypox and other new and emerging threats, the CDC provides guidance and recommendations for infection prevention and control. Familiar practices are still effective against monkeypox: isolation of a sick individual, hand hygiene, wearing personal protective equipment (PPE) like gloves and masks, and performing routine cleaning and disinfection of environmental surfaces.
To support environmental surface disinfection, the Environmental Protection Agency (EPA) has activated its EVP Policy for monkeypox. This means that product manufacturers can make off-label claims about a disinfectant’s effectiveness against monkeypox. This same approach was used during the COVID-19 pandemic with SARS-CoV-2. The EPA has also created List Q to address and provide additional cleaning and disinfection guidance emerging viral pathogens.
EPA List Q
The EPA has provided guidance for disinfecting against EVPs in the form of a new web tool know as EPA List Q. Unique from other lists that the EPA has published to address individual pathogens, List Q allows users to search all products eligible for use against any of the three main categories of EVPs based on difficulty to inactivate. The categories are as follows:5
- Tier 1: Enveloped viruses. These are the easiest to inactivate. When disinfectants damage their lipid envelope, the virus is no longer infectious. Examples of enveloped viruses include influenza, SARS-CoV-2, as well as monkeypox viruses.
- Tier 2: Large, nonenveloped viruses. These are encased in protein capsids that make them more difficult to inactivate compared to enveloped viruses. Examples include norovirus, which causes common food-borne gastrointestinal illnesses on cruise ships.
- Tier 3: Small, nonenveloped viruses are the hardest to inactivate. Both their protein capsids and their small size make them less vulnerable to disinfectants compared to other viruses. Examples include adenoviruses, which are thought to be responsible for the recent pediatric hepatitis outbreaks.
Since emerging pathogens may not be listed on a disinfectant product label, List Q can help determine which set of directions to follow to kill the pathogen of interest.5 You can use EPA List Q in a few ways (see image below).
- Search for a product by entering the EPA registration number or name to determine whether the disinfectant product has EVP claims. Since marketed product names can evolve over time, leveraging the EPA registration number is the quickest way to navigate the tool.
- Identify an appropriate disinfectant product by first determining the tier the pathogen of interest falls into, and then selecting “Yes” on the corresponding dropdown.
- Once results are displayed, refer to the column “Follow directions for the following pathogen(s)” to determine what directions on the product label, including contact time, to follow during use.
As a new tool, EPA List Q is evolving and not be inclusive of all products with EVP claims. Those not included, may still be effective against monkeypox or other emerging pathogens. To determine this, review the product’s master label for specific claims or contact the product manufacturer for recommendations.
As the world continues to change and new threats emerge in the future, our vigilance looking for and continuing to follow outlined guidance will provide the means to help combat the spread of illness causing germs, in an effort to keep our communities safer and well.
1. CDC. Monkeypox in the United States. [Internet]. [Cited 2022 May 23]. Available from https://www.cdc.gov/poxvirus/monkeypox/outbreak/us-outbreaks.html
2. World Health Organization (WHO). USA Today, May 30, 2022. [Internet]. [Cited 2022 Jun 3]. Available from https://www.usatoday.com/story/news/nation/2022/05/30/who-not-concerned-global-monkeypox-pandemic/9992496002/
3. CDC. Monkeypox Transmission. [Internet]. [Cited 2022 Jun 3]. Available from https://www.cdc.gov/poxvirus/monkeypox/transmission.html
4. World Health Organization (WHO). Monkeypox Signs and Symptoms. [Internet]. [Cited 2022 Jun 3]. Available from https://www.who.int/news-room/fact-sheets/detail/monkeypox
5. US EPA. Disinfectants for Emerging Viral Pathogens (EVPs): List Q 2022. [Internet]. [Cited 2022 Jun 6]. Available from https://www.epa.gov/pesticide-registration/disinfectants-emerging-viral-pathogens-evps-list-q
With the arrival of spring, I can’t help but think about the freshness, clean and rejuvenation this season seems to bring. This time of year, the cleansing rains always serve as a reminder for me to begin my spring cleaning and start crossing items off my to-do list. Like me, many households and businesses may soon participate in the annual tidying up tradition of spring cleaning. As we begin National Cleaning Week, I thought it fitting to reflect on the past, present, and future of cleaning.
Evolution of Cleaning: From Mummies to Modern Day
It’s hard to imagine living at a time without running water; a time when streets were strewn with garbage, human feces, rodents roamed freely, and people lived in constant fear of catching one of many deadly diseases like smallpox, cholera and yellow fever. That life would be no picnic. Throughout history, the civilizations that thrived have something in common: progress in the realm of cleaning and sanitation. The inhabitants of ancient Egypt made and used crude soap for cleaning. The Romans built bathhouses and had systems to bring in fresh water and remove waste. During the industrial revolution, handwashing was found to lead to better health outcomes as well as the use of antiseptics.1 These and many other advancements have allowed sanitation and cleaning to evolve into what we know today. For us, safe and clean water is available thanks to chlorination and water treatment. We have also gained greater knowledge of infection prevention and the science behind sanitization and disinfection. Through continued innovation cleaning products have even become much safer and effective. While there are still challenges, we are fortunate for those who came before us and paved the way for cleaning so that we can enjoy healthier spaces in our modern day.
Cleaning for Health: The Focus of Today
As germs, including those new and emerging, circulate within our communities, cleaning and disinfection remain a critical line of defense to stop the spread. To protect our health, a high standard of cleanliness must be maintained in the environments where we learn, work and play.
A result of the pandemic is the cleaning industry moving to a “cleaning for health” mentality. Cleaning for health is more than just a catch phrase or simply wiping a surface, instead it describes using both cleaning and disinfecting products and best practices to help reduce the spread of germs and other unwanted matter. The ultimate goal in this is to make shared spaces safer for all people. Smart Disinfection encourages cleaning for health and describes how to do this in a more effective, efficient and safe way.
The Face of Clean: Our Future Heroes
Cleaning is something that is done by many people; however, it takes more than just a spray bottle and cloth to be called a cleaner. Professional cleaners, in my opinion, are often unsung heroes in public health work. These trained professionals labor tirelessly and often over evenings, weekends and holidays to ensure the spaces we occupy meet high cleanliness and safety standards. The pandemic reemphasized the importance of cleaning and it’s no surprise that an already massive commercial cleaning industry will continue to grow into the future. In the United States, there were over 1 million janitorial services businesses in 20212 and nearly 2 million cleaning professionals as of May 2020, excluding residential maids and housekeepers.3
The future of cleaning, I hope, will see a greater investment in the training and career growth of these cleaning professionals. The cleaning industry, like the rest of the nation, has not been immune to the current staffing crisis. As businesses experience high levels of turnover, there is a need for quality training to be provided to staff. HealthyClean is a course designed with commercial cleaning professionals in mind and provides the education and training they deserve to help ensure shared spaces are clean and safe.
As we celebrate National Cleaning Week, let’s honor those who dedicate themselves to keeping our spaces clean and seek opportunities to get to know them and offer a heartfelt thank you for all they do.
1. Wilson C. History of cleanliness in health care facilities [Internet]. BootieButler. 2016 [cited 2022 Mar 15]. Available from: http://bootiebutler.com/history-cleanliness-health-care-facilities/
2. Janitorial Services in the US - number of businesses [Internet]. Ibisworld.com. [cited 2022 Mar 15]. Available from: https://www.ibisworld.com/industry-statistics/number-of-businesses/janitorial-services-united-states/
3. Number of employees in cleaning occupations in the U.S. by type 2020 [Internet]. Statista. [cited 2022 Mar 15]. Available from: https://www.statista.com/statistics/324419/employees-in-cleaning-occupations-by-job-type-us/
Healthcare facilities are required to provide a sanitary and safe environment for patients1
The challenges from the pandemic caused priorities to shift temporarily, but it is critical to return attention to cleaning and disinfection practices as part of an active infection prevention program. When performed properly, cleaning and disinfection allows for better patient outcomes by limiting the spread of harmful pathogens from contaminated surfaces and disrupting the chain of infection thus reducing the risk of healthcare-associated infections (HAIs).
Staffing shortages, lack of procedures, and supply issues have put patients at risk
Recent studies have shown that nearly 20% of outpatient facilities lacked procedures to properly perform cleaning and disinfection2. It was also found that deficiencies in healthcare facilities related to standardization of practices and inadequate training led to compliance issues3. Other more recent challenges such as supply and staffing shortages only further complicate an already complex process. It is shortcomings such as these that can lead to process gaps, inefficiencies, and ultimately risk to patients.
Basic strategies for compliance: educate, plan, evaluate, improve
Below are strategies to reinforce the basics of cleaning and disinfection while engaging staff and promoting increased compliance.
- Education & Training
Comprehensive training provides the opportunity for staff to be engaged in the education process, both observing and performing necessary cleaning and disinfecting steps. A vital part of this also includes learning about various cleaning and disinfecting products and their use and application. A demonstration of proficiency should also accompany completed training.
To have a successful program, ensure clear expectations are set. This may include having readily available written policies, procedures, and protocols. All processes must be realistic and achievable while maintaining consistent practices for continuity. Safety should be top of mind and an understanding of potential health hazards, required personal protective equipment (PPE), and instructions for use (IFU) is necessary prior to cleaning and disinfection.
Before cleaning and disinfection are to begin, assess the situation and determine the need and requirement. Decide which cleaner or disinfecting product is appropriate for the setting and/or pathogens (i.e., sporicidal in a C. difficile room) to be rendered safe. Always consider product availability, ease of use, and compatibility before proceeding.
According to the CDC, cleaning procedures should be periodically monitored or assessed to ensure they are consistently and correctly performed4. Monitor cleaning and disinfection by employing various methods of verification including direct observation, visual inspection, use of fluorescent gel, and adenosine triphosphate (ATP) testing. Each of these methods has advantages and disadvantages as shown in Table 1, so it is important to implement several based on the needs of the facility.
- Process Improvement
After gaining a better understanding of the gaps and breakdowns in cleaning and disinfection, process improvement can begin. This should involve reevaluating goals and objectives, pinpointing deficiencies, and then responding by developing a plan and implementing a program or intervention to address any issues. Increased compliance and a robust program will result from ongoing process improvement.
These strategies are key to a successful environmental cleaning and disinfection program. By refocusing on the basics of environmental cleaning and disinfection, healthcare facilities will be able to remain steadfast in providing healthy and safe environments for patients while reducing the risk of HAIs despite current and future challenges.
For more on cleaning and disinfection basics, be sure to view the webinar Bringing it Back to the Basics — Cleaning and Disinfection Tidbits I Wish I’d Known as a Novice IP, part one of the three-part series: Cleaning & Disinfection — From Basics to Innovation.
1. CMS State Operations Manual, Appendix A, 2018 [internet]. Available from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf.
2. Schaefer MK, Jhung M, Dahl M, Schillie S, Simpson C, Llata E, et al. Infection control assessment of ambulatory surgical centers. JAMA. 2010;303(22):2273–9
3. Furlan MCR, Ferreira AM, da Silva Barcelos L, Rigotti MA, de Sousa AFL, Dos Santos Junior AG, et al. Evaluation of disinfection of surfaces at an outpatient unit before and after an intervention program. BMC Infect Dis. 2019;19(1):355.
4. Centers for Disease Control and Prevention. Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html.
About the HICPAC Blog Series
The Healthcare Infection Control Practices Advisory Committee (HICPAC) is a federal committee that provides guidance on infection prevention practices in US to the federal Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) in US healthcare settings. As Infection Preventionists, we are all familiar with the HICPAC guidelines including, but not limited to, the Hand Hygiene and the Environmental Infection Control Guidelines. HICPAC meets several times each year, where among other activities, new guidelines are developed and older guidelines are updated. This blog series will highlight the key discussions at these meetings. Because of the lengthy delay from meeting to posting of the minutes, we hope you will find our HICPAC meeting summary blog posts helpful to keep you informed in a timely manner.
In this review of the meeting held on October 28, 2021, I’ll highlight updates from the Division of Healthcare Quality Promotion (DHQP), Healthcare Personnel Guideline workgroup, and share about a new workgroup coming soon. Meeting topics of interest include the current respiratory infection and influenza (“flu”) situation, refugee health, support for long-term care facilities, and upcoming isolation guideline work.
Although vaccine availability is wider than it ever has been, and the impact and spread of cold and flu are being closely monitored, Denise Cardo, MD and director of the DHQP shared that “as much as we’d like it to be the reality, a return to normal will not be an on/off switch”. This is especially true for healthcare where the situation will largely become facility, season, and situation dependent. Instead, efforts should be focused on making healthcare systems more resilient. “A return to the 2018 normal would be unfortunate instead of moving to a new normal, adopting and learning from the pandemic”.
Michael Bell, Deputy Director of DHQP, provided some health insights about the current refugee crisis in Afghanistan where victims face austere conditions including crowding and low vaccination rates. He emphasized the need for public health interventions such as screening and immunization prior to relocation. It was reported that the Department of Defense (DOD) was able to administer 60 thousand vaccines to refugees at high risk for infection. The crisis which expected to see upwards of 5,000 measles cases, only had 60, providing further evidence of the effectiveness of vaccines and public health.
A brief update was provided by Arjun Srinivasan, MD and Associate Director for DHPQ (and other CDC programs) noting that a host of issues were brought forward by the pandemic particularly in Long-term Care Facilities. To support these types of facilities in the future, millions of dollars are being proposed to assist state health departments with hopes to establish “Nursing Home Strike Teams”. The Long-term Care workgroup is currently resuming work and open to new member participants.
Healthcare Personnel Guidelines Workgroup Update
The Healthcare Personnel Guideline, first written in 1998, addresses health and safety in the workplace for healthcare workers including exposures and illnesses1. Recently, HICPAC published revised guidance for Pertussis, Meningococcal Disease, Diphtheria, and Group A Streptococcus. Further, updates to the following were recently approved by HICPAC with a publish date forthcoming.
- Measles, Varicella, and Rabies (Aug 2021)
- Parvo and Cytomegalovirus (Nov 2021)
Review of S. aureus key questions and literature review is currently underway. Respiratory Viral Pathogens review will be restarting soon and other bloodborne pathogens are on deck.
New HICPAC Workgroup Coming Soon
It was announced that a new workgroup will be forming in the coming months that will focus on reviewing and updating current isolation guidelines for healthcare facilities. This group will be led by Sharon Wright, MD, MPH, and HICPAC member who plans to kick things off reframing how infections are transmitted as well as to integrate learnings from pandemic regarding emerging pathogens.
The October HICPAC meeting provided many valuable updates on the status of important and ongoing work. Be sure to watch for public comment periods on HICPAC guidelines in review. For more information about the meeting, schedule, and for previous minutes visit the HICPAC Meeting webpage. It is my hope that you have found this overview informative and helpful in your practice of infection prevention and control.
1. CDC. (2019). Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control. Retrieved on 5 December 2021 from https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/index.html
Clostridioides difficile, or C. diff, is a bacterium greatly impacting healthcare, causing over half a million infections, 15,000 deaths, and costing health care facilities $1.5 billion each year.1,2 This being C. diff Awareness Month, let’s take the opportunity to learn a bit more about this deadly pathogen, its impact, and what the future may bring.
History and Etiology
Discovered in 1935, Clostridioides difficile was first isolated and cultured by Hall and O’Toole. Proving to be a difficult process, this earned the microorganism its name difficile, meaning “difficult” in French. Although it was identified in the early 1900s, it wasn’t until 43 years later in 1978 that a connection was made between “the bug” — C. difficile, and what was then referred to as antibiotic-associated diarrhea by Dr. John Bartlett.3 From that point forward, efforts have been made through continued research, improved preventive measures, and advanced treatment methods to combat C. diff infections.
C. diff infections have a classic presentation with frequent watery loose stools — as many as 10–15 times a day — that carry a distinct foul odor. Although anyone can become infected with C. diff, certain individuals are at a higher risk. Highly susceptible persons include the elderly, people with serious underlying illness, or those taking or recently (within 30 days) completed an extended regimen of antibiotics. Antibiotic use is the leading risk factor for C. diff infections.4 Although we are learning more about community acquired incidence, most identified cases are healthcare-associated. C. diff is highly transmissible and has been shown to spread via healthcare workers hands which can pick up the pathogen from contaminated surfaces and medical equipment.5 Spores are also extremely resilient, surviving on surfaces for prolonged periods — up to 5 months, and are resistant to hand sanitizer and many disinfectants.6 For these reasons, C. diff continues to be the most common of all healthcare-associated infections (HAIs) and was labeled an urgent threat by the Centers for Disease Control and Prevention (CDC) in 2019.7
Pandemic Impact on HAI Rates
As the COVID-19 pandemic swept the world in 2020 it brought with it added complexities for healthcare workers and facilities. Hospitals saw an increase in hospitalizations, shortages in healthcare personnel, and limited supplies and resources.8 Unfortunately, this impacted healthcare outcomes and more specifically healthcare-associated infections (HAIs). HAI rates that had been trending down began to rise, losing much of the ground gained over the last decade (Table 1). C. diff rates, which were steadily declining in pre-pandemic years, leveled off without significant change. A rise in cases may have been seen if not for infrequent testing for C. diff during the pandemic. Alternatively, practices like enhanced hand hygiene, environmental cleaning & disinfection, patient isolation, PPE use, and a marked decline in outpatient antibiotic prescribing may have helped reduce rates.9 As we move out of the pandemic, there is much to be done if we are to begin reducing these HAI rates once again.
Combating C. diff: Learnings from the C. diff Conference
The annual International C. diff Conference & Health Expo has once again presented opportunities to learn and share relevant work on the topic of C. diff, including insights into this deadly pathogen and ways to combat it. Below, I share just a few learnings from this year’s conference.
- C. diff infections in 2020 were likely underreported due to decreased testing during the pandemic and because diarrhea is also a common symptom of a COVID-19 infection.
- Electrostatic technology used with a sporicide is an effective and efficient environmental disinfection method against C. diff, especially given the current staffing challenges.
- Recent data shows that C. diff infections are on the rise in the community and no longer just seen as a healthcare-associated outcome.
- Antibiotic stewardship works — and not just for C. diff! Lower resistance rates were found in other pathogens after significant reduction in in antibiotic use.
- The critical need for a multifaceted approach of infection prevention and control is needed against C. diff was reemphasized.
Presentations from the conference will be broadcasted each Tuesday from December 7th, 2021 through January 11th, 2022. For more information and to listen in, visit the C. diff. Spores and More Live Broadcast to Podcast program page.
During this month of awareness, let us acknowledge the problem take deliberate infection prevention steps to help us get back on track against C. diff. For more information on combating C. diff, see our C. diff Prevention Toolkit.
1. CDC. Nearly half a million Americans suffer from C. difficile infections in single year. cdc.gov. 2019 [cited 2021 Nov 4]. Available from: https://www.cdc.gov/hai/dpks/deadly-diarrhea/dpk-deadly-diarrhea.html
2. Zimlichman, E.; Henderson, D.; Tamir, O.; Franz, C.; Song, P.; Yamin, C. K.; Keohane, C.; Denham, C. R.; Bates, D. W. JAMA Intern. Med. 2013, 173 (22), 2039–2046.
3. Heinlen L, Ballard JD. Clostridium difficile infection. Am J Med Sci. 2010;340(3):247–52.
4. CDC. What is C. diff? [Internet]. Cdc.gov. 2021 [cited 2021 Nov 4]. Available from: https://www.cdc.gov/cdiff/what-is.html
5. Landelle C, Verachten M, Legrand P, Girou E, Barbut F, Brun-Buisson C. Contamination of healthcare workers’ hands with Clostridium difficile spores after caring for patients with C. difficile infection. Infect Control Hosp Epidemiol. 2014;35(1):10–5.
6. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6(1):130.
7. CDC. Antibiotic resistance threats in the United States. Cdc.gov. 2019 [cited 2021 Nov 4]. Available from: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
8. Weiner-Lastinger L, et al. The Impact of COVID-19 on HAIs in 2020: Summary of Data Reported to NHSN. ICHE. 2021;1-14.
9. CDC. COVID-19 Impact on HAIs in 2020. cdc.gov. 2021 [cited 2021 Nov 4]. Available from: https://www.cdc.gov/hai/data/portal/covid-impact-hai.html
Hospitals at the Breaking Point
As the Delta variant of SARS-CoV-2 continues to sweep the country, we are seeing peak numbers of cases since the beginning of the pandemic. Hospitals are feeling the weight of this spike as the infected make their way into acute care settings, filling beds. Facilities around the country are experiencing such a demand for healthcare services that it has overwhelmed their ability to provide. Entire healthcare systems and even states have been forced to activate Crisis Standards of Care, which ultimately results in the difficult task of determining who receives care and who does not. The current situation in northern Idaho is a prime example of this as hospitals are at max capacity resulting in patients seeking care across the border in Washington and overwhelming their system.1
The healthcare situation, already bleak, could soon get worse. The unfortunate reality is that SARS-CoV-2 isn’t the only respiratory pathogen currently circulating in our communities. As respiratory illness season knocks at the door, illnesses such as influenza, respiratory syncytial virus (RSV), rhinovirus, and others will add stress on an already strained healthcare infrastructure. We have already seen a glimpse of unusually high numbers of illnesses with the uptick in RSV cases beginning in April 2021 accompanying the relaxation of COVID-19 precautions.2 Health experts fear the reality of a “twindemic” this year with the prediction of a severe flu season and the potential of increased coinfections.3 This all points to the fact that it is likely only going to get worse before it gets better.
Keeping Prepared this Respiratory Illness Season
The past year of the pandemic has taught us how difficult it is for patients to receive the care they need when healthcare facilities face countless challenges including staffing shortages, burnout, and limited resources. As facilities and staff carry on through the difficult circumstances brought about by the pandemic, there is a need to step beyond the singular focus on COVID-19 and proceed with an approach to deal with the countless threats on the horizon. Currently, perceptions on the modes of respiratory virus transmission are shifting, and with that new information there must be a willingness to adapt and prepare with the necessary tools to fight back. More than ever, it is imperative that healthcare workers act as stewards of infection prevention to protect the vulnerable and help stop the spread of respiratory illnesses in healthcare.
In preparation for what could be a long winter ahead, consider adopting the following practices in your facility:
- Monitor the current respiratory illness situation using CDC’s FluView and NREVSS
- Continue to perform extensive screening of staff, patients, and visitors entering a facility to promptly identify suspected illnesses
- Review and become familiar with CDC’s Isolation Precautions for respiratory illnesses
- Ensure cleaning and disinfection is performed regularly with products that are EPA-registered and have appropriate pathogen claims for respiratory viruses
- Consider using no-touch disinfection technology such as an electrostatic device to assist under-resourced staff to quickly and efficiently disinfect exam rooms, patient transport equipment, and large spaces (e.g., waiting rooms)
- Remain current with immunizations including annual flu shots, Pneumovax (<2 yr and >65 yr), and COVID-19 vaccines
- Provide resources for and encourage staff to self-isolate and not come to work when ill (presenteeism)
- And as always, practice good respiratory etiquette and hand hygiene!
While navigating these trying times, we applaud healthcare workers for all their efforts and hope that these suggestions can help ease the burden and lessen the impact felt by the healthcare industry. First and foremost, we want healthcare workers to take care of their own physical and mental well-being so they can continue to care for others. Over the next several months through the respiratory illness season, comfort and safety will come as deliberate efforts are made to help reduce the spread of pathogens and protect the health of patients, staff and loved ones.
For the latest information on COVID-19 and variants, visit our CloroxPro COVID-19 Hub.
1. Baker M. ‘Their Crisis’ is ‘Our Problem’: Washington Grapples with Idaho Covid Cases. The New York Times. 2021 Sep 13 [cited 2021 Sep 24]; Available from: https://www.nytimes.com/2021/09/13/us/coronavirus-hospitals-washington-idaho.html
2. RSV National Trends. Centers for Disease Control and Prevention. 2021 [cited 2021 Sep 24]. Available from: https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html
3. Upcoming Flu Season Will Likely Be Severe. University of Pittsburgh Health Sciences. [cited 2021 Sep 24]. Available from: https://www.upmc.com/media/news/083121-roberts-flucovid-medrxiv
In just a few short weeks we may begin to hear the familiar sounds of rallies on the quad, football games, and parties signaling the return of college students from summer break and the start of another school year. As students come back on campus, beware, unwelcomed guests arrive as well. These dangerous intruders are waiting to be caught, and go by many names including, rhinovirus, influenza, meningitis, and SARS-CoV-2.
Burden of Disease
As students cram into classrooms and lecture halls, share food and drinks, live in close quarters, and participate in various social activities, it is no surprise that pathogens are quick to spread and may cause infection at college and universities1. COVID-19 demonstrated this as campuses were often hit the hardest. The reality is, well before the pandemic, institutions of higher education were unnecessarily burdened with high rates of illness.
In 2019, nearly 46% of college students reported experiencing cold, flu, or upper respiratory illness at some point during the academic year2. Now with lower COVID-19 rates, precautions lessening, and immune systems out of practice, there are rising concerns over the real likelihood that more frequent and severe infections may occur this year3.
There is a silver lining to the COVID-19 pandemic: the spotlight is now on health at institutions of higher education, making them more aware, equipped, and in a better place to address the spread of infection. It is their opportunity and responsibility to be prepared and to take a proactive approach to help keep these pathogens at bay. The following are recommendations to help create a safer and healthier campus this upcoming year.
Develop Robust Plans and Protocols
In response to a global pandemic, institutions were forced to dust off plans they were hoping to never use. In many cases, guidance had to be quickly adopted or even created from scratch. As a sliver of “normal” appears and the hustle and bustle of campus returns, now is the time to ensure the ability to manage and respond to any pathogens threatening campus health.
I recommend that before this school year starts, every institution should:
- Evaluate current health and safety policies and response plans to determine any gaps.
- Establish new protocols for mitigation and revise any outdated guidance.
- Incorporate insights and lessons learned from the pandemic.
- Lean on relationships with local public health to adopt evidence-based practices.
The pandemic made clear the need to quickly identify health threats so that an appropriate and timely response can occur. As testing capability increased with new laboratories and technology, so did the ability to detect and prevent COVID-19 infections. If we aim to prevent the transmission of illness as the school year begins, similar methods of surveillance must be in place to detect infections.
To implement an effective surveillance strategy:
- Establish a process to monitor the campus population for common illnesses, not just COVID-19.
- Provide campus members with education and resources about diagnostic testing.
- Engage campus health services and local public health officials to monitor disease trends and identify potential outbreaks.
- Be prepared to initiate plans and mitigation strategies based on new data.
Wearing a mask in public, although not fun, proved to be an effective intervention in slowing the spread of COVID-194. Likewise, other measures such as providing disinfecting wipes in shared spaces, setting up hand sanitizer stations, and implementing physical distancing markers, were taken to stop the spread of pathogens at colleges and universities. These interventions accompanied by other activities are necessary to decrease the spread of campus pathogens.
To complete your infection prevention strategy:
- Provide resources to encourage the sick to self-isolate away from campus.
- Maintain sufficient supply levels of hand sanitizer and disinfectant wipes for campus use.
- Ensure custodial staff have the proper training and tools to perform cleaning and disinfection of spaces and surfaces effectively and regularly.
- Consider adopting new technology, such as electrostatic sprayers, to increase cleaning and disinfection efficiency and enhance safety in shared spaces.
- Promote vaccinations and safe health practices.
If we want to hear the happy sounds of a buzzing campus this year, a critical look at past, present, and future practices must occur as school begins. These recommendations, when applied, will increase the capacity of institutions of higher education and likewise K-12 Schools, to successfully mitigate the spread of illness. As a result, we can feel confident knowing students and campuses are supported in their academic development and ambitions.
- Shah M, Ferra G, Fitzgerald S, Barreira PJ, Sabeti PC, Colubri A. Containing the spread of infectious disease on college campuses. bioRxiv. 2020. Available from: http://dx.doi.org/10.1101/2020.07.31.20166348
- American College Health Association. American College Health Association - National College Health Assessment (ACHA-NCHA-II). Reference Group Data Report, Spring 2019.
- Consumer news. As COVID rules ease, common colds rebound across America [Internet]. Consumer Health News | HealthDay. 2021 [cited 2021 Jul 12]. Available from: https://consumer.healthday.com/6-24-as-covid-rules-recede-common-colds-rebound-across-america-2653478411.html
- Brooks JT, Butler JC. Effectiveness of mask wearing to control community spread of SARS-CoV-2. JAMA. 2021;325(10):998–9.