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Jordan Bastian, a Senior Infection Preventionist within CloroxPro's Clinical and Scientific Affairs team, recently sat down with Dr. Saskia Popescu, Assistant Professor, Epidemiologist and CloroxPro Spokesperson, to discuss their predictions for the 2023-2024 cold and flu season. Check out the video above or keep reading below to hear their thoughts on what's to come and what precautions we can take to help stop the spread of illness-causing germs.

Please note this is an abridged version of the conversation edited for brevity and clarity.

Jordan Bastian: Hi, I'm Jordan Bastian, Senior Infection Preventionist with Clorox Pro. With me today, I have Saskia Popescu, Assistant Professor and Epidemiologist and CloroxPro Partner, to discuss predictions and best practices to help prevent the spread of illness-causing germs this cold and flu season.

Saskia Popescu: Thanks so much, Jordan. I'm so excited to chat with you today. 

Jordan Bastian: So, to kick it off today, I'd love to pick your brain on what you think cold and flu season will look like this year in the United States based on current data and trends.

Saskia Popescu: I think we're likely in for a moderate flu season. We're getting some really helpful information out of Australia as they're currently heading into their summer, which means they've already experienced their flu season, and what we actually get to see is their experiences through that as a way to predict our own. 

Australians reported that they had a moderate flu season that started a little bit later. They still had surges and spikes, but nowhere near the severity of the 2016 and 2017 flu seasons. So, most likely, what we're going to experience is a moderate flu season with later activity, looking more toward the kind of pre-covid seasonal patterns. 

Jordan Bastian: RSV is another pathogen to keep our eyes on. As you mentioned, Saskia, in the southern hemisphere, what we're seeing out of Australia is they had an uptick in RSV cases, which might signal that we might be seeing some increased cases of RSV as well. Australia also saw that 72% of hospitalizations due to cold and flu or respiratory illness were in children 16 and under, and this was up 24% from last year.

A lot of this has to do with behavior changes as well as relaxed precautions. We know more people are traveling now. We're also seeing more kids returning to school, as well as employees who have been working remotely, spending more time in the office. We also see lower vaccination rates due to vaccine fatigue and hesitancy. Last year, respiratory illness rates were as high as 16%. What I'd like to know now is what some of these best practices are that we could put into place to help protect us and slow the spread of these illness-causing germs.

Saskia Popescu: That's a great question. In addition to ensuring you get your flu shot, we have to talk about different ways to prevent the spread of these germs because we know that cold and flu germs love to lurk on surfaces and commonly shared items. We have to remember that these illness-causing germs require us to take a holistic approach. The first strategy is what I call the bread and butter of infection prevention, and that's hand hygiene. This is a strategy that prevents not just a single infectious disease but is really effective against almost all of them.

We want to ensure that people routinely wash their hands with soap and water. And if you're out and about, alcohol-based hand sanitizer is a great strategy. In addition to hand hygiene, one of the biggest but most neglected ones is routine cleaning and disinfection. We want to make sure that people are routinely cleaning and disinfecting surfaces: desks, computers, countertops, sinks, doorknobs, cell phones, and the one that I always think is neglected: the water bottle.  

Lastly, be mindful of your cough and respiratory etiquette. If you feel an illness coming on, please wear a mask and stay home. But if you feel a sneeze or a cough coming along, that's a great time to use your elbow. 

Jordan Bastian: I have to completely agree with you talking about this holistic approach to cold and flu prevention. I resonate with what you said about hand hygiene. We know that our hands are only as clean as the environment around us. It really speaks to the fact that we're going to need to clean and disinfect the surfaces that are in our environment. I recommend ready-to-use (RTU) disinfectant wipes as a day solution for building occupants and for cleaning staff.

These help to slow the spread or to stop the spread of illness-causing germs that can resign on surfaces and do so in an effective and efficient manner. RTU disinfectant wipes are accessible, easy to use, versatile, and feature fast contact times for multiple viruses. One of the risks of using a disinfectant is for the surface to dry before the contact time elapses. Having a product with a fast contact time is key as we enter into this cold flu season and also beyond, especially for facilities who are looking to combat or stop the spread of multiple viruses in their facilities at any given time.

Saskia Popescu: Absolutely, Jordan; I think that's such an important point because we want to make sure that not only are those disinfecting materials accessible but also that people feel comfortable using them and making sure that they're ready to use and that the contact time isn't really, really high is such a big piece to this.

Jordan Bastian: Great. Well, thank you so much, Saskia! It has been a pleasure talking with you today. And thank you for sharing your insights and predictions for this upcoming cold and flu season. We wish you the best. Hope you stay safe and healthy.

Saskia Popescu: You too, Jordan. Thanks so much for having me!

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Last week, our Clinical and Scientific Affairs Specialist, Erin McLean, sat down with Dr. Saskia Popescu, Assistant Professor, Epidemiologist and CloroxPro Spokesperson, to discuss this year’s APIC conference ahead of the event next week. See what they had to say about key topics they expect to be covered, tips for those attending for the first time and more.

Please note: this is an abridged version edited for brevity and clarity. View the full conversation below.  

Erin McLean: I’m Dr. Erin McLean and I am a Clinical and Scientific Affairs Specialist at CloroxPro. Today, I'm here with Dr. Saskia Popescu, Assistant Professor, Epidemiologist and CloroxPro Spokesperson to chat all things APIC, particularly pertaining to the hot topics we think will be discussed at this year’s APIC conference.

Saskia Popescu: Thank you so much for having me, Erin! As an Infection Preventionist and Epidemiologist, APIC is one of my favorite events of the year — it is an exciting opportunity for us to discuss what we've experienced in the last year, share pros and cons, successes and challenges and tricks of the trade.

EM: Absolutely. I’m super excited. I wanted to start by picking your brain on what you think are going to be some hot topics at this year's conference, particularly pertaining to environmental disinfection and why.

SP: I think the first one is emerging pathogens. A lot of us are tired of emerging pathogens since we're on year four with COVID-19 and now we're dealing with a lot of Candida auris (C. auris). While this is not a novel pathogen, it is being discussed a lot because it's challenging for disinfection and diagnostics. I also think pathogens like Mpox and even Marburg, which was recently added to the EPA's emerging pathogen list, are going to be big topics too. This is because it speaks to how the realm of infection prevention is evolving and how it's getting a little bit more complicated.

How we handle healthcare worker burnout will be important, as well. As Infection Preventionists, this involves how we manage getting people to stay vigilant with their cleaning and disinfection, even if they're tired, especially as the healthcare industry continues to struggle with staff turnover.

EM: I could not agree with you more. I think given staffing challenges and gaps in training, I do expect there to be a lot of discussion or educational sessions around being more efficient. How can we be more efficient as IPs such as, selecting the right disinfectants to use. You want something to be efficacious without compromising the integrity of equipment.

Now that we've covered what we expect to be the hot topics, are there any topics that were not covered on the program that you were surprised by, especially as an IP and Epidemiologist?

SP: It's a great question, and there were a few that I expected to see more of. You mentioned one right away, training gaps. We’re seeing some changeover in the workforce, so how do we keep competencies up to date, especially when we are dealing with pathogens that might require specific disinfection and cleaning products like C. auris?

I also was surprised to not see more about infectious diseases we face and how they impact processes and require us to stay cognizant and up to date on infection prevention protocols and engage with frontline staff.

And another thing that really struck my mind was, how are we doing rounding in terms of cleaning and disinfection?  Rounding is the bread and butter of infection control. We love doing isolation precaution rounding and hand hygiene, but what about cleaning and disinfection? What's the best way to do that?

After so many years of talking only about COVID-19, one of the big challenges is keeping staff engaged and having those conversations about protocols they may not feel are important. In this vein, I was hoping to see more about how we keep staff informed, engaged and educated. Not by putting things on a bulletin board, but getting them to be champions of these topics.

EM: Those are great adds. We understand there are numerous topics to discuss at APIC, and it’s hard to cover it all in a short window. There is never enough time to do everything we want to do, which brings me to my next question. Do you have any pieces of advice for people attending on how to navigate a conference of this epic magnitude, particularly for people like me who are first time attendees?

SP: The first would be to take notes because as much as you think you're going to remember things, there are long days, and you are a sponge absorbing all the information.  

The other piece would be to plan ahead. I call it the amusement park experience, where you want to pick your favorite rides first. But, also, try to go outside of your bubble — see a lecture on something that maybe you don't know a lot about. Even if it's not your favorite one, it may capture your attention or inspire you to start something new at work.

I also think this is a great opportunity to ask yourself as both an infection preventionist and part of a larger team and industry, where do I want to be in the next six months to year to five years? What programs in my hospital org do I need to improve on? There might be a talk that can give you the answer or at the very least, an opportunity to talk with other infection preventionists, who have experienced something similar or have similar goals.

Use this as an opportunity for growth and development.

EM: I love that. I definitely took notes on what you said as a first-time attendee, I appreciate the advice! With these last few moments, I do want to talk about key takeaways.

Are there any overarching takeaways you think people will or should walk away with this year?

SP: Since we could sit here and talk for hours about them, I’ll only name a couple. As discussed, emerging pathogens — Mpox, C. auris, fungal meningitis — as we are facing these at an increased rate, but also how can we maintain readiness while still conquering challenges like healthcare-associated infections?

Another piece is managing outbreaks. How do we handle evolving requirements in an increasingly complex world? Infection prevention is only getting bigger and more complicated. Therefore, innovation complexities and being ready for the next infectious disease challenge will be a big piece.

Lastly, how do we ensure that our healthcare workers are protected and safe, but also engaged within our teams? How do we move forward within the industry? It’s important to acknowledge not only burnout within healthcare but also within infection prevention teams because we’ve been through a lot the last few years.

EM: I think if people can walk away with those takeaways, it will be an amazing conference. Thank you again for sharing that and thank you again for your time today and giving us your insight into the conference.  

The past two years of battling against the COVID-19 pandemic has weighed heavily on healthcare workers and infection preventionists. While our attention has focused so much on COVID-19, there is a continued need to find a sustainable approach that allows infection preventionists and healthcare facilities to address healthcare-associated infections (HAIs).

According to the Centers for Disease Control and Prevention (CDC) on any given day, one in thirty-one hospitalized people will have at least one HAI. This number is likely underrepresented, as some HAIs are not reportable or identified properly. Coupled with the ever-changing threat of antimicrobial resistance (AMR), it is critical that healthcare facilities target their infection prevention measures to address all relevant pathogens.

During the first few months of the pandemic, we were trying to put out the fire that was COVID-19. Guidance changed in waves and we were trying our best to simply stay afloat. Slowly, we started to notice trends – patients hospitalized with COVID-19 were often given or required antibiotics and/or had prolonged hospital stays. From central-line associated bloodstream infections to drug-resistant urinary tract infections, it became apparent that hospitalized COVID-19 patients faced a real risk of HAIs and multi-drug resistant organisms (MDROs).

In my experience, HAI prevention has always been a hurdle and the COVID-19 pandemic only exacerbated this issue. From ensuring proper protocols are followed to making sure personal protective equipment (PPE) is worn, to ensuring proper and effective cleaning and disinfection. While the focus for COVID-19 has moved to a more holistic approach that still incorporates daily cleaning and disinfecting, the over-correction we saw with COVID-19 prevention initially trickled into healthcare. While we now know that COVID-19 is primarily spread through shared air, cleaning and disinfection remains important as part of the holistic prevention strategy.

However, the amount of attention put on enhanced cleaning in the early days of the pandemic can send the wrong message about the importance of this prevention strategy across the board. There are many times we absolutely need to perform enhanced cleaning and disinfection — consider C. diff or a hardier organism, like a highly resistant C. auris. Both require us to ensure the products being used are effective and we’re properly following contact time directions. Just because COVID-19 may not require enhanced cleaning and disinfection, which is a good thing, doesn’t mean that other organisms are going to let up also. As a result, now more than ever, we are working to re-align healthcare and infection prevention efforts to include a sustainable approach that allows us to focus on COVID-19 in addition to the daily threat of HAIs.

Too often the daily cleaning and disinfection is forgotten in the hectic world of healthcare. Running a million miles a minute, it can seem like there is no time for the cleaning of a bed-side table or knobs of medical equipment. These though, are the times and situations we must continue to be vigilant. In fact, each year in the United States, there are 2.8 million antibiotic resistant infections and as a result, 35,000 people die – we can’t afford to forget about MDROs, even if we’re in the midst of a pandemic. For example, healthcare continuously struggles to contain HAIs. In fact, much of the progress we’ve been working towards with HAIs has plateaued and slowed during the COVID-19 pandemic. While we’ve made some gains in reducing C. diff, we still struggle to bring these preventable infections to zero. C. diff, in particular, is preventable by both proper antibiotic use and proper infection prevention efforts including cleaning and disinfecting and use of PPE. Cleaning and disinfection, both routine and in high-risk situations, is one of the most basic forms of infection prevention we can undertake.

It’s not so simple though to reiterate the importance of doing the cleaning and disinfection, but also consider several factors – like correct product selection for the organism. C. diff is a prime example of why we work to ensure there are enhanced cleaning and disinfection protocols. We want to ensure staff have easy access to a sporicidal or bleach-based product but are also aware of how to properly use the product and follow contact times appropriately. It can be helpful to incorporate reminders of proper use or effective products on isolation signage. Such efforts reduce the risk of exposure to seasonal organisms like influenza and norovirus, but also MDROs and those we often see in hospitalized patients causing infections.

Unfortunately, I have seen HAIs that occurred as a result of poor cleaning and disinfection, which led to further antibiotic use, longer hospital stays, and a transition to an MDRO, underscoring the importance of this basic infection prevention effort. As the world tries to normalize post-pandemic, the role of cleaning and disinfection has increased in importance. Our ability to maintain continued efforts and follow protocols will make the difference between infections in patients and staff alike, but also the future of antimicrobial resistance. Now is the time to build up the infection prevention toolbox with everything from appropriate products for the task at hand to education resources to the most effective cleaning and disinfecting protocols — all things you can find on cloroxhealthcare.com

COVID-19 has suddenly and dramatically shifted infection prevention efforts in places from the home to public spaces, workplaces and businesses large and small. Many of these new behaviors are things that should have been common practice in pre-pandemic times. The efforts have been shown to be hugely beneficial not only in the fight against COVID-19, but also against other respiratory viruses, like influenza, which is at a record low this year.

Now as we look towards wide-spread vaccinations and re-openings, the question is what infection prevention strategies need to remain post-pandemic, and when COVID-19 cases become less common, what new behaviors will we keep?

Wearing Masks

Masks are now an integrated part of our lives – expected across our daily activities – whether you’re running errands, waiting in line, dropping off the kids – don’t forget your mask.  A public health intervention has never been so prevalent across the majority of the U.S. 

Staying power?

We may move away from behaviors and protocols around masking, but there are fundamental infection prevention behaviors that should stay.

Disinfecting Surfaces

One of the earliest measures was cleaning and disinfection. With any new pathogen, especially a respiratory one where we know fomites (i.e. objects or materials which are likely to carry infection) can play a role, routine cleaning and disinfection is pivotal. Early on we saw consumers wiping down everything that entered their home and spaces they interacted with, including groceries, mail, handles, desks, and packages.

Staying power?

While cleaning and disinfecting have a place, we learned that SARS-CoV-2, the virus that causes COVID-19, is not predominantly transmitted by infected surfaces or objects, unlike other common respiratory pathogens like respiratory syncytial virus (RSV) or influenza. It can and does spread this way, but not as frequently as through respiratory inhalation.

It is important that we continue to practice routine cleaning and disinfection and emphasize that it is one part of a holistic infection prevention strategy. COVID-19 after all, is not the only infectious disease we live with and cleaning and disinfection should be a standard part of our lives.

We can expect to see business take a proactive role in maintaining these efforts by implementing a variety of new disinfection practices, such as leveraging electrostatic technology like the Clorox® Total 360® ProPack Electrostatic Sprayer to disinfect airport terminals or hospitals, handing out hand sanitizers or disinfecting wipes to passengers when they board aircraft or customers when they enter a store, or having restaurant personnel slow the seating process to allow time for all surfaces to be cleaned and disinfected between guests.

Avoiding the Indoors

As we continue to learn more from transmission data, it is now known that clustered outbreaks can occur when people interact together indoors even with masks. This has put an unprecedented spotlight on the health of our indoor environments. There is now enormous emphasis on indoor protocols, including social distancing and air ventilation. These are not new areas of study for epidemiologists, but because of COVID-19, social distancing and air ventilation in public spaces have become priorities in infection prevention among consumers.

Staying Power?

Staying away from indoor situations may not be practical for many in their everyday lives, and may not be broadly beneficial for public health, education or small business impact.  Like masking, protocols for reduced capacity in indoor settings like restaurants will gradually fade.

Instead we’ll see continual investments in infection prevention efforts like hand hygiene, routine cleaning and disinfecting protocols and staying home when sick. From plexiglass partitions to marked indicators for physical distancing, we’ve seen a lot of emphasis on infection prevention during this pandemic.

Awareness Around Infections

Our awareness of infectious disease and the importance of general infection prevention including hand hygiene and routine cleaning and disinfection.

Early on, the focus was on staying home, masking or staying six feet apart. It was quickly realized that wasn’t enough. COVID-19 prevention requires multiple intervention strategies. Increasing emphasis on all the infection prevention behaviors – masking, physical distancing, hand hygiene, cleaning and disinfection, and avoiding indoor spaces with those outside your household - is what prevents the spread of COVID-19. No single layer of prevention is perfect, but together, they can significantly reduce risk. We know that now.

Staying power?

Using a holistic approach to reducing infectious diseases, whether they be COVID-19 or any other, is one that has definite staying power. While the protocols may change, the holistic nature of infection control will remain the same. Infection prevention efforts are front and center now, not only for infection preventionists like me, but to each and every one of us. We have a real opportunity to change how we treat infections in our everyday life even beyond COVID-19.

For the latest information on COVID-19 and variants, visit our CloroxPro COVID-19 Hub.

Dr. Saskia v. Popescu is a paid consultant for Clorox Healthcare.

Originally published by Healthcare Facilities Today

The outbreak of COVID-19 has been a wake-up call for public health and healthcare officials alike. This respiratory disease, caused by a coronavirus, SARS-CoV-2, is a reminder of the importance of infection prevention efforts and the need for continued vigilance.

While the overall risk for contracting COVID-19 in the United States is low, it’s important to not discount that this current influenza season is quite severe, and that flu is a much more likely threat. Attention has mostly been focused on this new outbreak, but millions of Americans have already been battling respiratory illnesses and influenza for weeks. Based off preliminary data, the U.S. Centers for Disease Control and Prevention (CDC) is estimating that for the 2019/2020 flu season (October 1, 2019–February 15, 2020), there have been between 29–41 million flu illnesses and between 16,000 and 41,000 flu-related deaths. 

The spread of both COVID-19 and flu-related illnesses remind us of the critical role of infection prevention. Everything from vaccines to personal protective equipment (PPE) to hand hygiene and environmental disinfection, play a vital role in helping prevent the spread of infections. It’s easy to view flu and even COVID-19 prevention in the context of only PPE, but we can’t discount the critical role of environmental bioburden.

When people with respiratory infections cough or sneeze, the infectious droplets land on surfaces and objects, which contaminates them. These respiratory viruses, especially coronaviruses, are not environmentally hardy, meaning they are easy to kill via standard disinfection practices with EPA-registered disinfectants for enveloped viruses.

However, the challenge is if too much of the attention is on PPE, some may neglect the environmental component to disease prevention. When infected people fail to wash their hands or cover their cough, the environmental disinfection component to infection prevention is the stopgap, making it imperative to preventing the spread of infection. 

In fact, the CDC guidance for SARS-CoV-2 notes that “products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2. If there are no available EPA-registered products that have an approved emerging viral pathogen claim for SARS-CoV-2, products with label claims against human coronaviruses should be used according to label instructions.”

There are several products with EPA-approved emerging viral pathogen claims that are available for surface disinfection against SARS-CoV-2, including Clorox Healthcare® Bleach Germicidal Wipes.

What we can take away from these recommendations and the concerns regarding respiratory illnesses, including both COVID-19 and the flu, is that disinfection remains a critical component to infection prevention and we already have the tools to combat such respiratory viruses.

Hospitals and healthcare facilities are working to ensure they are ready for possible patients with respiratory illnesses and part of these measures include ensuring the right products are available, training staff to use products currently, and monitoring environmental disinfection compliance.

From cleaning high-touch surfaces and workstations to using dedicated medical equipment, environmental infection prevention is a foundational piece to disease control. Shortages of PPE is a concern during this respiratory virus season and while hospital supply chains work to acquire adequate supplies, this is the time to hone in on environmental measures. 

Just like our practices during flu season, we can ensure routine cleaning is being done in high-risk areas like emergency department waiting areas. Rounding and asking staff (both clinical and environmental services) their processes is helpful to engage that reminder of environmental cleanliness during respiratory virus season.

CDC guidance pushes us to also execute routine environmental cleaning and disinfection for patients in isolation, so now is the time we ensure those practices are as efficient and effective as possible. Make sure privacy curtains are laundered appropriately to avoid contamination — linens play a bit role in environmental infection control! 

Moreover, beyond educating staff on the proper screening and isolation for those with respiratory symptoms, we can also remind them about the power of a single disinfecting wipe and that cleaning is not limited to what is done by environmental services staff.

I always encourage frontline staff to grab a disinfecting wipe and wipe down their work areas as a routine practice to end their shift. Desks, keyboards, counters and phones are all high-touch items that can act as transmission mechanisms for respiratory viruses. Waiting rooms can easily be neglected, so it’s important to make sure there cleaning of high-touch surfaces. More so, don’t forget routinely remove those objects that can’t be cleaned, like magazines. 

Environmental disinfection is a key part of preventing both influenza and even COVID-19. We all have a role in prevention and with the right products and training, it is possible for everyone to take responsibility and play their part. Practice makes perfect and given the severe flu season and potential spread of SARS-Cov-2, now is the time for facilities to focus on environmental disinfection efforts to ensure preparedness and effectiveness against such respiratory viruses. 

For the latest information on COVID-19 and variants, visit our CloroxPro COVID-19 Hub.

Dr. Saskia v. Popescu is a paid consultant for Clorox Healthcare.

In the ever-changing world of healthcare and infection prevention, there’s always a hot topic or new approach to an old problem. 2020 is sure to keep us on our toes with increasing emerging infectious disease threats like COVID-19 caused by the virus SARS-CoV-2, growing antimicrobial resistance, and the expansion of medical care and procedures to outpatient settings.

As an infection preventionist (IP), below are some themes I anticipate will be critical for infection prevention and environmental hygiene in 2020:

Tackling emerging antimicrobial-resistant organisms

As antimicrobial-resistant organisms such as Candida auris (C. auris) emerge, hospitals and healthcare facilities must develop strategies for rapid detection, isolation, and prevention, including effective environmental disinfection. This year will be one in which the industry must work to understand new and emerging resistant organisms. While these pathogens challenge antimicrobial response efforts, they will also require IPC to adapt through foundational disinfection practices. As antimicrobial-resistant organisms become more prolific and common in U.S. hospitals, guidance will come from the U.S. Centers for Disease Control and Prevention (CDC) and researchers. For example, with C. auris, the CDC has published a list of Environmental Protection Agency (EPA)–registered hospital-grade disinfectants effective against C. auris, including Clorox Healthcare® Hydrogen Peroxide Cleaner Disinfectants, and if none of these products is available, the EPA recommends using an EPA-registered hospital-grade disinfectant effective against Clostridioides difficile spores. In conclusion, it is vital that healthcare facilities engage in enhanced cleaning or stay aware of additional measures that the CDC is suggesting to stop the spread of pathogens that contribute to antimicrobial resistance.

Implementing infection prevention programs in outpatient settings

Today’s healthcare practice is increasingly pushing procedures to outpatient centers. However, it is critical that these types of facilities also have strong infection control programs akin to those found in acute-care facilities. Regulatory oversight is beginning to look at this issue and requirements are changing, which means facilities need to establish plans to incorporate infection prevention processes, such as staff training, into these previously overlooked outpatient settings. Routine rounding, risk assessments, and even staff surveys can help identify those opportunities to improve patient and healthcare safety in these unique healthcare environments. Outpatient settings need to take infection control just as seriously as their acute-care counterparts.

Investing in preparedness

From the recent COVID-19 outbreak in China to the Ebola outbreak in the Democratic Republic of Congo in 2019, emerging infectious diseases are increasingly becoming a part of the infection prevention playbook. In the U.S., the funding for the tiered hospital approach to special pathogens is set to expire, which means hospitals will have to start investing in preparedness. The tiered hospital approach was set into place following the 2014 Dallas Ebola cluster to ensure there were designated hospitals with enhanced measures to treat patients with special pathogens, like Ebola or SARS-CoV. This includes all preparedness measures, from personal protective equipment to environmental disinfection in areas where a patient with an infectious disease might be. Infection prevention programs play a critical role in preparing for future outbreaks, like COVID-19, and that means considering screening practices in triage and the importance of the i3 strategy (identify, isolate, and inform). Given the current outbreaks across the world, these topics have to be re-addressed in 2020.

Actively fighting flu instead of bracing for impact

Too often, hospitals and health facilities have approached flu season as a “brace for impact” situation, responding to cases and increases in severity as it intensifies. The 2019-2020 flu season is still going strong making it imperative for IPs to continue to actively fight flu through preventative measures instead of being reactionary. Healthcare facilities must focus on working with staff, so they are working proactively on the frontlines to prevent its spread and rapidly identifying and isolating patients with suspected cases. Moreover, for pediatric settings, it is vital to continue to emphasize the importance of hand hygiene and enhanced disinfection as children more often spread respiratory infections through contact.

From the community perspective, in addition to vaccination, we must continue to urge people to stay home when sick, implement correct hand hygiene and regularly clean and disinfect their work areas. Even in the midst of flu season, proactive habits are vital and are as easy as making sure your loved ones are vaccinated (flu shots are still available) or encouraging staff to stay home when sick.

Improving environmental disinfection practices and reducing human error

Environmental services, the primary department responsible for the safety and cleanliness of a hospital or other healthcare facility, are a critical component of infection prevention and healthcare; however, like many things environmental services can be prone to human error. With rising antimicrobial resistance and attention to healthcare transmission dynamics (i.e., studies showing how patients colonized with MRSA, VRE, or C. diff can easily contaminate their rooms), IPs are trying to improve environmental cleaning and disinfection, as well as addressing the human factor components. Technologies, like ready-to-use and no-touch solutions, have the capacity to improve disinfection compliance without relying solely on the capabilities of personnel.

2020 will be a critical year for infection prevention efforts as hospitals prepare for and respond to the COVID-19 outbreak. These efforts go beyond the normal work that focuses on reducing healthcare-associated infections in a growing healthcare environment. A severe flu season and growing concerns for antimicrobial resistance all shape infection prevention efforts and require a holistic approach to reducing the spread of infectious diseases in healthcare.

Dr. Saskia v. Popescu is a paid consultant for Clorox Healthcare.

Originally published by Contagion Infectious Diseases Today.

As we work towards making health care safer and establishing a stronger role for infection control in patient care, the role of bioburden and environmental contamination is a common conversation topic. The US Centers for Disease Control and Prevention (CDC) recently reported that each year roughly 2.8 million Americans are infected with antibiotic-resistant infections, which result in 35,000 associated deaths. Organisms like vancomycin-resistant Enterococci (VRE), drug-resistant Candida, Methicillin-resistant Staphylococcus aureus, are all considered serious threats in the CDC’s 2019 Antibiotic Resistance Threats Report

One conversation that we consistently have in infection prevention is about isolation and screening of patients with multidrug-resistant organisms (MDROs) and/or Clostridioides difficile. What is the role of patients without active infection who are likely just colonized in transmission? Will they shed such organisms and contaminate their environmental surroundings? Such issues are all things that impact isolation and environmental cleaning in health care settings. With this in mind, investigators of a new study, published in Open Forum Infectious Diseases, sought to understand the relationship between environmental contamination and patient colonization with VRE and whether it impacted negative health outcomes. 

To assess this relationship, investigators studied 463 patients in post-acute care in Ann Arbor, Michigan. The patients were assessed from point of enrollment through discharge and then for 6 months. Body and environmental samples were taken at specific temporal intervals to determine patient colonization and environmental contamination, as well as the dynamics of long stays, unplanned hospitalization, and infections which were adjusted for sex/age/race, Charlson’s Comorbidity Index, and physical self-maintenance. 

Understanding the relationship dynamics between patient colonization and environmental contamination for MDROs such as VRE is critical. Not only does it help us to appreciate the transmission dynamics but also alerts us if screening is necessary. Following their analysis, the investigators of this study found that new infection or acquisition of VRE was more likely in patients in contaminated rooms (Odds ratio [OR]: 3.75). The opposite of this relationship was also found; contamination of a room was more likely when the patient had VRE. While this relationship isn’t surprising, it emphasizes the importance of daily environmental cleaning and rapid isolation for those with known VRE infections or colonization.

For those patients or rooms with new VRE acquisition, researchers found that increased length of stay played a critical role (new acquisition OR: of 4.36; new contamination OR: 4.61).

Moreover, contaminated rooms increase the risk for colonization, and both are associated with future adverse health outcomes. New infections were more common in those areas with higher VRE burdens. The authors cite the figures, “15% in the absence of VRE, 20% when following VRE isolation only on the patient or only in the room, and 29% following VRE isolation in both the patient and the room”.

Overall in this study, patients who acquired VRE and became infected with the organism, tended to stay in rooms with VRE contamination. As colonization can increase the risk for future adverse events, the authors emphasized the importance of screening for MDROs on admission.

From the infection prevention perspective, this reinforces the push to screen patients, even if just in high-risk areas like intensive care and oncology units. This study sheds light on the role of environmental contamination in increasing risk of VRE acquisition by patients and how those patients with VRE can easily contaminate their space.

It is well established that as length of stay increases, so does the risk for infection, so this study further reinforces this point. The symbiotic relationship between environmental contamination and patient colonization or infection is a lesson we must truly listen to and apply to infection control efforts. More prevalent environmental disinfection, screening, and stringent patient isolation are all steps we can take to break the chain of infection. 

Originally published by Contagion Infectious Diseases Today.

Clostridioides difficile (C. diff) is one of the infections that stops people in their tracks, from infection preventionists to providers and nurses alike. Roughly half a million Americans will contract this bacterial infection every year, and 20 percent will relapse after treatment.

Moreover, 1 in 11 people over 65 years of age with healthcare-associated C. diff will die within one month of their diagnosis. Studies have shown that the cost of managing and treating C. diff infections is quite significant at around $18,000.

On top of these startling statistics, C. diff also poses a challenge because the bacterium is particularly environmentally hardy. When it’s in its spore form, it’s quite resistant to disinfectants and ultimately requires bleach-based products. (Clorox has become the strongest tool in our arsenal to combat C. diff.)

Moreover, even alcohol-based hand sanitizers aren’t enough to get rid of the bug, which requires healthcare workers and patients to use soap and water as a way to get the spores off through friction. 

One recent study from the U.K. sought to test the hardiness of C. diff on hospital gowns and stainless steel, and assess the efficacy of disinfectants. Investigators first wanted to evaluate the role of gowns as fomites in C. diff transmission, as there has been suspicion that they could play an active role.

The research team found that when they applied spores in sterilized water at various concentrations to the surgical gown, the number of recovered spores did not increase over time.

This means that any transmission would occur within the first 10 seconds of contact. And since the gowns are capable of trapping these spores it is a critical reminder to only use them once, and discard immediately after use. 

The second part of the study is the one that has gotten more attention. The investigators sought to treat the gowns with a disinfectant to test its efficacy and whether it would help with the bioburden.

The research team found that after being treated with the 1000 ppm chlorine-based disinfectant for 10 minutes, the gowns still were able to pick up and hold the C. diff spores. This concern over resistance sent shockwaves, and many news outlets picked up on this as an indicator of what’s on the horizon. But an issue with the study was exactly what disinfectant was used.

First and foremost, as an infection preventionist and the first to stand on my soapbox to shout about the perils of antimicrobial resistance, I know that the efficacy of our disinfectants will eventually fail.

The issue with this study is that much of the media coverage speaks broadly of a chlorine-based disinfectant, and goes into little detail about exactly what was used. For my infection prevention peers, you know not all disinfectants are alike, and some just weren’t designed for combatting hardier bugs like C. diff. This is the playbook we live by in healthcare. 

The disinfectant the investigators used was sodium dichloroisocyanurate (NaDCC), which is a pretty stable form of chlorine that can disinfect water, as well as surfaces/objects. But it is not a hypochlorite (like bleach).

The issue I have is that hospitals in the U.S. don’t use NaDCC, but rather sodium hypochlorite (NaOCl), as a disinfectant for C. diff. In fact, the investigators even note that higher concentrations of NaDCC are required (1000 ppm for 10 minutes) to truly kill C. diff spores. 

NaDCC is different than bleach, and has a lower pH, meaning that its antimicrobial capabilities are different. There are benefits to NaDCC in that it has a reserve disinfecting capability, but it’s simply not used as a primary cleaner within the U.S. as it requires larger concentrations. Ultimately, the U.S. Centers for Disease Control and Prevention (CDC) recommend bleach, like Clorox.

So although hospitals in the U.K. stopped using bleach years ago, it’s important to note that this study was not carried out with the same disinfectants that we use in the U.S., and comparing them apples to apples would be misleading.

Although this study sheds light on how easily gowns can become contaminated with C. diff spores, the takeaways regarding types of disinfectants should be taken in context.

This study highlights the need to test disinfectants and continuously monitor their efficacy against microorganisms, especially those that are more environmentally hardy.

It should also be a reminder that the variety of disinfectants and biocides being used is likely to show variation in different regions, and those results are not always comparable to other healthcare regions.