I know what you’re thinking. I don’t often get into arguments with my disinfectant wipes. But it’s quite possible your equipment might.

Surface compatibility

Just because it’s an EPA-approved disinfectant with the dentistry required EPA registered TB, Hep B, and HIV kill claim doesn’t necessarily mean it’s “approved” by your equipment. Manufacturers are starting to put recommended classes of disinfectants in their instructions for use (IFU). Some disinfectants can cause that expensive technology to discolor, crack, or even break.

It’s a delicate dance to look at all your equipment and pick the best product based on varying recommendations. It might have you tempted to have an array of choices for your team. But mixing disinfectants can have detrimental effects on your equipment and patient care.

Equipment

I recently saw a two-year-old X-ray head that was cracking and dropping pieces of plastic onto patients like flakes of dandruff on a black shirt. After some investigation, it was determined that the office had a habit of using whatever disinfectant was on sale. While this might seem like a great way to save money, it turned into an expensive lesson in chemistry.

Choosing one compatible disinfectant and sticking with it has many benefits, but the first one is preserving the longevity of your equipment. If, through your investigation of IFUs, you determine it’s time to switch products, be sure to give your equipment a light soap and water bath to remove the residue that each product leaves behind. Otherwise, you could end up with an unplanned purchase.

Patient care

Recently, my husband had to have surgery. As we traversed the hospital from radiology to hematology to the surgeon’s consult area, I noticed each unit had a different disinfectant wipe. I couldn’t help but wonder if everyone in the hospital knew each product’s kill time, proper PPE, and surface compatibility. I started to get concerned about infection control compliance across departments.

Imagine how confusing it would be to go from one operatory or even one office to another to find different products with varying kill times. Not only could this slow down care if a clinician took the time to read the proper use of the product, but imagine they didn’t, and the operatory wasn’t properly disinfected.

Loyalty has its perks.

We are all looking for ways to make our day a little bit easier. Choosing to work with a company that has a wide portfolio of compatible disinfectants can give you leverage to take advantage of sales, perks, and bonus deals—saving you money, prolonging the life of your equipment, and eliminating team confusion that can lead to infection control breaches.

A Centers for Disease Control and Prevention (CDC) report published in 2010 found that ASC lapses in infection control were common. Of 68 ASCs, most (67.6%) had at least one infection control finding. Common findings included using single-dose vials for more than one patient (28.1%), equipment reprocessing failures (28.4%), and blood glucose monitoring equipment failures (46.3%).²

In June of 2015, the Center for Medicare and Medicaid Services (CMS) released an update to the Ambulatory Surgical Center Infection Control Surveyor Worksheet (ICSW), which is used by federal and sometimes state surveyors to determine infection control program compliance as pertains to the Conditions for Coverage (CfC) requirements.³ As part of the survey requirements, ASCs must have both an explicit infection control program and documentation that the program follows nationally recognized infection control guidelines. Most, if not all, facilities refer to this document as their “infection control plan.” The aim of this document is to walk through some of the essential pieces of an ASC infection control plan and thus help the facility to plan to succeed both in any potential infection control survey and at preventing infections related to procedures performed within their walls.

Risk Assessment

A risk assessment is a companion document to the infection control plan. It should identify risks specific to the facility to allocate infection prevention resources appropriately and to inform planned activities under the infection control program. A facility should perform a risk assessment at least annually and consider:

• Community (rural/urban, potential natural disasters),
• Population (age demographics, characteristics, available health statistics),
• Facility/utility (age of building, HVAC considerations, connections with other buildings, any potential construction projects),
• Staff competencies,
• Services and procedures offered (treatments, procedure types, pharmaceutical/compounding considerations, infections likely to occur, low-vs.-high volume procedures),
• Patient care/Infection Control Practices (Personal Protective Equipment (PPE), Isolation, Hand Hygiene, Injection Safety)
• Staff Immunity (New hire health screening and annual vaccination program)
• Medical Devices (Selection, cleaning/disinfection/sterilization, water reservoirs, handling and storage)
• Facility Type (orthopedic, dental, etc.)
• Patient Safety (Healthcare-associated infection surveillance and trending, requirement for day-of-procedure screening, other quality outcomes trending)⁴

A risk assessment may also be considered any time a facility makes a major change – things that may prompt additional risks (and therefore an additional risk assessment) include but are not limited to adding a building, service line, or procedure type.

Occupational Health

Staff training is key to a successful infection control program – everything can be perfect on paper, but if employees are not aware of policies and procedures, lapses are all but guaranteed. According to the CMS ICSW, facilities can be cited at the condition-level if infection control training is completely absent. Ideally, all staff should be trained on hire and annually on the IC program.

Vaccinations are essential to prevent healthcare workers in all settings. Vaccinations recommended by the CDC for healthcare works include COVID-19, chickenpox (varicella), influenza, Hepatitis B, meningococcal, measles, mumps, and rubella (MMR), and tetanus, diptheria, and pertussis (Tdap).  Healthcare workers may also be recommended to be up to date on human papillomavirus(HPV) or shingles (varicella) vaccines depending on their age or other factors.⁵

All newly hired healthcare personnel should be screened for tuberculosis (TB), and the local health department should be notified if TB disease is suspected. Annual TB testing for healthcare staff is not recommended unless there is a known exposure or a significant likelihood of exposure – something that can be addressed in a facility’s annual risk assessment. TB screening and testing includes a baseline individual TB risk assessment, a TB symptom evaluation, and a TB test (this is more commonly a blood draw but may also be a two-step TB skin test.) Although annual screening for TB is not required, annual TB education is – TB infection control and education materials can be found on the CDC website.⁶

Standard Precautions are a set of principles that prevent infections anywhere healthcare is provided, and includes a facility’s hand hygiene program, PPE use whenever there is a potential for exposure to infectious material, respiratory hygiene and cough etiquette, patient placement/cohorting, environmental infection prevention (cleaning, disinfection, and sterilization), laundry handling, safe injection practices, and sharp safety. Current guidelines for all these topics can also be obtained directly from the CDC.

The bloodborne pathogens (BBP) exposure control plan and needlestick prevention efforts should also be part of the infection control plan. Employers are required by OSHA to update this plan annually and it should be included or referenced by the infection control plan. The BBP exposure control standard set forth by OSHA requires the use of standard precautions, engineering controls like sharps disposal containers and safer medical devices, work practice controls, adequate PPE availability, provision of both hepatitis B vaccines and post-exposure evaluations and follow up after any potential BBP exposure incident, labels and signs to communicate hazards, regular training on the plan, and record maintenance to include medical and training records as well as a sharps injury log.⁷

Environmental Cleaning

A facility should have a cleaning schedule that includes detailed written policies and procedures for routine cleaning and disinfection of environmental surfaces, including identification of responsible personnel, frequency, and chemicals to be used. Every employee who cleans and disinfects patient care areas should be trained on cleaning procedures on hire (prior to performing environmental cleaning and disinfection), annually, and whenever there is a change in policy or procedure. The facility should routinely audit adherence to these policies and procedures, including compliance with manufacturer instructions for use (IFU) regarding contact/wet/kill time for any chemicals used and compatibility with any medical devices or surfaces these chemicals are used on. Something to consider when choosing disinfectants is ease-of-use—is it ready to use, like a pre-saturated wipe, or will staff have to mix it carefully and discard solution daily?

A note regarding environmental cleaning in ASCs specifically: the clinical administration of the facility may contract out environmental services, especially if the center is not a part of a larger health system. This can sometimes lead to a disconnect between clinical and environmental services (EVS) staff – even if an EVS staff is contracted, the facility will still be responsible for approving procedures such as cleaning schedules and products used and should have oversight of the EVS process regardless of whether staff is employed directly by the facility or contracted to clean after hours.

Cleaning, Disinfection, and Sterilization

Another major consideration anywhere that surgical procedures are performed is the cleaning, disinfection, or sterilization of surgical instruments and other medical devices. The facility should be well-versed in the Spaulding classification, manufacturer IFUs for any instruments and reprocessing equipment, and be able to identify which instruments are cleaned and reprocessed, and which are single use. The facility should not be reprocessing any single use devices – something that in 2022, The Joint Commission noted that it was seeing with more frequency.⁸

The facility should be able to speak to whether reprocessing occurs on-site or off-site. If instruments are transported off-site to be reprocessed, the facility should still have detailed procedures for instrument cleaning and packing for transport.

All instruments should be cleaned and inspected for visual debris before being packaged for sterilization – if an instrument is not clean, it can’t be sterilized. The facility should also have chemical or biological indicators to verify that sterilization is being performed adequately as well as a tracking system to recall instruments that have been reprocessed inadequately – that may be due to a failed indicator, but instruments may also be recalled due to improper storage or compromised packaging.

Immediate-use steam sterilization (IUSS), if performed, should not be relied upon – and implants, post-procedure decontamination of potential prion disease (e.g. Creutzfeldt-Jakob disease) cases, devices that have not been validated for specific cycle employed, or single-use devices should never be processed using IUSS. Using IUSS on a routine basis can result in a citation for deficient practice.³

High-level disinfection (HLD) performed in the facility must also be pre-cleaned according to manufacturer instructions or, if they are not provided, evidence-based guidelines prior to high-level disinfection. Much like sterilization, if an item is not clean, it cannot be disinfected.

Chemicals used for HLD should be prepared, tested, and replaced according to manufacturer IFUs and proper documentation of this process should be kept in a log. Once disinfected, the items should be allowed to dry and stored in a designated clean area to prevent contamination.

Conclusions

This is a ton of information, and it’s only the tip of the iceberg. Why does it matter? A recent report in the Journal of Infection Control and Hospital Epidemiology (ICHE) looked at 4,045 ambulatory surgery centers and found that their SSI rates ranged from 0.0%-3.2% for common procedures, mirroring hospital SSI rates.⁹ The same report came to the conclusion that these rates may be underestimated as often, they are calculated using traditional hospital-based surveillance (and some patients may develop an infection but never return to the hospital.)

Developing a comprehensive infection control program, risk assessment, and plan in an ambulatory surgery setting is no small undertaking. Fortunately, there are many resources available from organizations like the Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Administration (OSHA), and the Association for Professionals in Infection Control and Epidemiology (APIC). Even with these resources, as more care shifts to the outpatient setting, infection prevention becomes more complicated and more important. Facilities should have an infectious disease-trained medical director or infection preventionist to assist in developing and employing their program. There are consultants available to help with this kind of work, but it is also worth the investment to train an employ a staff person to be in the ASC and responsible for the infection control program as well.

Infections can happen anywhere, and planning for an adequate infection control program helps to prevent them – and to save lives.

To more fully understand the challenges of infection prevention in this setting, PDI Clinical Science Liaison, Amanda Thornton, RN, MSN, CIC, VA-BC, sat down with Emma Parsons, BSN, RN, CTSS, owner and Director of Nursing of Sequoia Behavioral Health (3) an inpatient residential behavioral health program located in Mesa, Arizona, to tackle the topic

Emma Parsons, BSN, RN, CTSS, Sequoia Behavioral Health

Q. Thanks for joining us today to discuss infection control in behavioral health settings.  Can you tell us a little about your facility and the types of patients you serve?

Parsons: Thank you for having me today!  Sequoia Behavioral Health is an inpatient 30-day residential treatment program that helps individuals experiencing a wide variety of mental health disorders including addictions and psychiatric disorders.

Q. What types of issues do your client’s typically experience?

Parsons: Clients at Sequoia Behavioral Health typically are suffering from psychiatric disorders. We often see people with depressive disorders, anxiety disorders, complex PSTD, mood disorders, sleep disorders, personality disorders, and substance abuse disorders. We apply a trauma-informed care model, meaning that we require our staff to be extremely knowledgeable about how traumatic experiences impact an individual’s mental health and wellbeing, and our treatment interventions are based on this foundational component.

Q. Your facility is inpatient, meaning the people you are treating stay at the facility.  This must pose some infection control challenges that are different from what most people think of when they think of mental health treatment- such as outpatient therapy.  What are some of the infection control challenges you face within your facility?

Parsons: Indeed, inpatient care is vastly different from an outpatient clinic (which we also have),and requires a holistic approach that includes a solid infection control program that prevents the transmission of diseases.  Inpatient infection control for a behavioral health program can be just as rigorous if not more so than other inpatient settings, and we have a federal and state code of regulations we must follow.  Populations experiencing behavioral health challenges pose some of the highest risks for acquiring infections, especially infections like HIV, tuberculosis, and sexually transmitted infections. Our clients are especially vulnerable to infection due to the challenges that they face in their daily lives. For example, a person experiencing major depressive disorder often experiences major difficulty with keeping themselves or their environments clean as a result of their condition. We also see secondary infections like pneumonia or infected wounds as a result of an individual’s inability to care for themselves. For individuals with drug addiction, exposure to hepatitis C or HIV is commonplace, and immunosuppressed patients pose unique challenges. We truly have to prioritize infection control from the time the client admits and even after they discharge with us. Another real challenge is that anytime you have a lot of people living in close quarters together in a congregate living setting, there is risk for passing infections around, especially during flu and cold season.

Q. What things do you do to help protect your patients?

Parsons: At Sequoia we have screening assessments that we complete on admission, as well as ongoing surveillance for any suspected infections.  We also have a rigorous cleaning and disinfecting program, which requires healthcare grade disinfectants as well as a frequent cleaning schedule.  We employ a trained and certified Infection Preventionist to oversee our infection control program and all its components.

Q. When you say ‘Healthcare grade disinfectant’ what do you mean by that?

Parsons: My Infection Preventionist could explain it better, but it basically means you must use an EPA approved disinfectant that is appropriate for inpatient healthcare facilities (4).  This is usually stronger than the average disinfectant you find in the isles of the grocery store. The disinfectant we use here has to kill all kinds of pathogens including bloodborne pathogens like HIV and Hepatitis-B but it also must kill pathogens that are frequently associated with healthcare infections, like MRSA and VRE.  And of course, it has to kill COVID, Influenza, and other respiratory pathogens.

Q. What is the disinfectant you use?

Parsons: We use PDI’s Super Sani-Cloth wipes (The “Purple-top”), as well as their bleach wipe.  We find that Super-Sani is a great product because it is easy and quick to use, has a lot of pathogen kill-claims, and does not have a bad or lingering smell.  Even the bleach product smells clean – kind of like when you go to a swimming pool.  We also use their Easy Screen product to clean anything digital, like phones and tablets, which we find to be very helpful, especially for when we complete neurofeedback with clients.

Q. What is neurofeedback?

Parsons: Neurofeedback is essentially an electroencephalogram which reads the brain waves of the client and evaluates how their performance may be impacting their mental health. Observing how the activity in the brain changes based on positive or negative feedback allows you to gain control of stress responses you might have thought weren’t in your control. The EEG software reads your brainwaves and then provides audio and visual feedback so your brain can better understand how it is functioning.  Neurofeedback is associated with dramatic positive real-life outcomes. In the context of substance abuse, studies have shown that more sessions of neurofeedback therapy lead to considerably fewer overdose deaths (5).

Q. What other challenges have you faced in relation to infection control?

Parsons: Since our inpatient setting is home-like, we must maintain a quality oversight program that routinely cleans and disinfects shared items and spaces, as well as upholstery and furniture.  It is important to maintain the comfortable home-like setting in our facility for the comfort of our clients, but we also have to ensure that we are providing care in a clean and sanitary environment.  That is a hard balancing act.

Q. Mental health is so important, do you find that there is less stigma now for people to get help than there was in the past?

Parsons: Yes and no.  Even ten years ago there was more stigma and fear for people who were seeking mental health treatment that they would not be able to be treated, or would be terrified of involuntary hospitalization. But more and more people are seeing and realizing through public health campaigns and facilities like ours that there is no reason not to address and treat your mental health problems anymore, and you do not have to suffer in silence. Our program takes anyone from across the United States, and most often times insurance will pay for the treatment, whereas in the past they did not always cover it. On the other hand, there is still a lot of fear, especially in our communities, of people experiencing mental health crises. One of the missions of Sequoia Behavioral Health is community integration and public education. Healing occurs in community, not in solitude.

In 2019, the Centers for Disease Control and Prevention (CDC) solicited feedback regarding expanding its surveillance protocols to include hospital onset bacteremia (HOB). ⁴ A HOB is defined as a first positive blood culture for a noncommensal organism on or after day 3 of hospitalization plus receipt of a new antimicrobial. ⁵   The scope would include “all bloodstream infections that develop in patients following hospital admission.  Although this scope would be wider than Central Line-associated Bloodstream Infection (CLABSI) surveillance, CLABSI surveillance could be incorporated as a subset of HOB surveillance.” ⁴ The template for this surveillance module has been described in a recent article in Infection Control and Hospital Epidemiology. ⁵ Further actions towards the adoption of such a measure was presumably stalled with the onset of the pandemic, but as we turn the page to a “new normal” it would not be surprising to see this surveillance measure deployed and potentially ultimately serve as an additional measure for the Centers for Medicare and Medicaid Services (CMS) to use “in its public reporting and payment programs.”. ⁴ A recent analysis of over 9.2. million admissions across 267 hospitals demonstrated the feasibility of benchmarking facilities with this metric and future adoption as a new CMS reportable measure of healthcare quality seems likely. ⁵

The rationale for deploying such a metric is readily apparent and arguably logical. This measure seems highly conducive to electronic surveillance, CLABSIs can remain a subset of these infections and the simplification and standardization may theoretically level the playing field between facilities. ^5,6 Counter arguments to this proposed measure may include a disconnect between surveillance and clinically relevant definitions. In a recent report, hypothetical HOB scenarios were posed to infectious disease physicians for assessment of preventability. While 44% of the scenarios were indeterminable, 27% were deemed to be preventable while 29% were assessed as not being preventable. ⁷ It is an imperfect measure in that in an ideal (yet unrealized) world, the majority of HOBs would be preventable and there would be no differentiation between surveillance criteria and clinical diagnosis.

Surveillance for hospital onset bacteremia is expanding beyond the central venous catheter and specific pathogens. We can’t midline our way out of this and it is time to expand our prevention strategies to address all vascular access devices.

All vascular access devices (VAD) bypass the human body’s natural defense of the skin and as such the same risk mitigation strategies for preventing infection (e.g. hand hygiene, skin antisepsis prior to insertion, aseptic non-touch technique, etc) should be deployed. Similarly, needless connectors (NC) of VAD need to be disinfected prior to each access.⁸ While some recent studies have shown that VAD alternatives to central venous catheters may have a lower risk of infection, that risk is not zero and may come at the price of mechanical complications. ^9-12 Although passive disinfection of NC may be a useful adjunct for all VAD, most recommendations favor active, physical scrubbing the hub. ^8,13 A recent study showed scrubbing the hub with swabs was more effective than scrubbing with an alcohol based cap and that a majority of staff preferred the shorter scrub and dry time of Prevantics® Device Swab. ¹⁴

To compound the difficulty, many of the physical structures are older and contain carpeted hallways and other soft surfaces that are easily contaminated. What can the Infection Preventionist do to help mitigate the infection risks within LTC? Let’s look at a few important points to remember when approaching the environment of care.

Establishing Cleaning and Disinfection Practices

Perhaps the first thing to establish when thinking about a long-term care setting is cleaning and disinfection practices that are thorough, effective, and efficient. Many studies show that environmental services staff (EVS) wipe down only 50% or less of surfaces (1). Visual inspections and rounds are not enough by themselves to ensure quality oversight.

The CDC states that for surfaces to be cleaned appropriately there should be a consistent pattern for the cleaning of rooms and shared equipment, as well as clearly established assignments of who is to clean what (2). Also, following the same pattern, every time makes it easier to ensure consistent cleaning. Quality monitoring can be improved with the use of a checklist or other audit tools. Including the EVS staff in quality oversight and the use of these tools allows them to feel a sense of shared responsibility and gives them feedback which increases engagement and motivation.

The Importance of Cleaning Schedules

With increasing efforts to provide person-centric facilities such as the “Eden Alternative” approach (3), it has never been more important to consider the relevance of cleaning schedules that revolve around the residents’ needs and are appropriate for the ongoing activities. For example, mopping the activities room when bingo is being played or cleaning the dining room during mealtime is not a person-centered approach.

Cleaning of residents’ rooms can be particularly challenging, especially if the resident is resistant to the efforts of the EVS staff due to dementia, paranoia, or other issues such as hoarding.  Striking a balance between the resident’s rights and the importance of environmental cleanliness is key and should be a part of the resident’s care plan through a multidisciplinary team.

How often to clean and what to clean can sometimes be confusing in LTC.  The Association for Professionals in Infection Control and Epidemiology (APIC) recommends the following  (4):

1. Establish a schedule for ALL surfaces to be cleaned routinely using an EPA-approved hospital-grade disinfectant.
2. Clean spills and hard surfaces as needed in-between the routine cleaning.
3. Vacuum all carpets daily.
4. Clean high-touch surfaces daily and more often during outbreak situations.
5. Use a horizontal wet dusting technique vs dry dusting.
6. Use all disinfectants according to their instructions for use, including the recommended contact times.

While cleaning and disinfection can often be a tedious task, studies show that the environment and survival of pathogens on surfaces contribute to healthcare-associated infections (HAI’s) (5). Some pathogens can survive on surfaces for weeks or even months, still posing a threat of infection. A decline in the available number of trained EVS staff during and throughout the pandemic made it even more challenging for LTC facilities to protect their residents.

To truly mitigate this risk however, institutions cannot rely on just one method or approach to environmental decontamination. Rather, a layered approach must be considered as the new “gold standard” which would include an environmental cleaning program with proven practices to reduce the transmission of organisms, a robust hand hygiene program for both staff, patients, and visitors, the use of appropriate disinfectants, and the inclusion of new novel approaches such as UV technology which show proven reduction in organisms on treated surfaces (7). By utilizing the layered approach as the new standard of care, facilities are helping to decrease the risk of healthcare associated infections (HAI’s) in the LTC setting that come from a contaminated environment.

As we follow the risks of vascular access “from vein to care and maintain,” the skin and its organisms present numerous opportunities to serve as potential sources of infection.  Ensuring optimal disinfection of the patient’s skin prior to inserting any vascular access device is crucial to reduce insertion-related infection risks.  That means starting with clean skin and applying the antiseptic according to manufacturer’s recommendations.

When selecting the most appropriate product, CDC’s Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011) preferentially recommends 0.5% chlorhexidine gluconate (CHG) prior to insertion of central venous catheters and arterial catheters as well as during dressing changes.  At the time of the publication, the CDC left the choice for peripheral IV insertion much broader.

Since that time, the Infusion Nurses Society (INS) released two revisions to its Infusion Therapy Standards of Practice guidelines in 2016 and 2021.  The 2021 INS guidelines recommend the use of an alcohol-based chlorhexidine solution for ALL vascular access devices unless there is a contraindication.  These same recommendations are made when performing skin antisepsis during dressing changes.  CHG is included as a consideration in other standards as well, with consideration given to daily CHG bathing for ICU patients with central lines as well as application of CHG over vascular access dressing and tubing 6 inches from the patient’s body. These treatments are intended to help decrease the bioburden on the patient’s skin and vascular access devices.

A final, crucial step to infection prevention is hub hygiene.  Thorough disinfection of the needleless connector prior to every access is essential to reduce the risk of intraluminal contamination and its contribution to the development of catheter-associated bloodstream infection from any vascular access devices.  This can be achieved through a combination of active as well as passive disinfection; with some promising data regarding incorporating CHG into this step of device care as well.

While there is no “silver bullet” to address and solve the risks of catheter-associated bloodstream infections – being mindful of routes of entry to pathogens and paying close attention to our practices across each step from the moment we approach the bedside can contribute to improving and maintaining favorable outcomes for our patients throughout the continuum of care.

About the Author: Michelle DeVries MPH, CIC, VA-BC, CPHQ, FAPIC: Michelle has been involved in infection prevention and hospital epidemiology for more than 25 years spanning community, university, and federal healthcare facilities as well as post acute settings. She is passionate about raising awareness around vascular access device complications and devotes her time to education on this topic. She was a reviewer for the 2016 and 2021 INS Infusion Therapy Standards of Practice and is now serving on the committee as an author for the 2024 Standards. She is a Senior Adjunct Research Fellow with AVATAR — the Alliance for Vascular Access Teaching and Research, past director at large with VACC (Vascular Access Certification Corporation), incoming President-Elect of the Association for Vascular Access nationally (2023) and serves as the Senior Infection Control Officer for Methodist Hospitals in Gary, Indiana.

About Stephanie Mayoryk, RN, BSN, CIC: Stephanie is President of Mayoryk Consulting Services LLC. Her previous roles include solid organ transplant nursing at Johns Hopkins, infection preventionist at the Johns Hopkins Hospital and the University of Maryland Medical Center, and leadership positions at the Greater Baltimore Medical Center and most recently Corporate Director of Infection Prevention for the LifeBridge Health System in Baltimore, MD. As a consultant, she spent the past two years on contract and on set supporting film and television studios and productions.

Myth: Labor shortage is the only factor causing an egg shortage.

Fact: Avian influenza or bird flu refers to a virus which can cause diseases in both wild and domesticated bird species.  Starting in 2022 a highly pathogenic avian influenza (HPAI) A(H5) virus was detected in U.S. wild aquatic birds, commercial poultry and backyard or hobbyist flocks. These are the first detections of HPAI A(H5) viruses in the U.S. since 2016 (1).  Unfortunately, they are affecting millions of birds.  All 50 states have had wild birds come back positive for the disease, and so far 47 states have detected the variant and over 57 million domestic poultry affected.

Myth: Avian Influenza can easily jump to humans, causing another global pandemic.

Fact:  The short answer is yes it can jump to humans, however the CDC makes it clear that this is highly unlikely.  Although there have been over 57 million domestic birds affected, there has been only one case of human transmission detected (in the United States) so far (1).

To that end, bird flu viruses do not normally infect humans. However, sporadic human infections with bird flu viruses have occurred.  The CDC has stated that highly pathogenic avian influenza has caused family case clusters in the past, mostly in Southeast Asia, that could be due to human-to-human transmission (2). Should this virus, or another zoonotic influenza virus, gain the ability of sustained human-to-human transmission, an influenza pandemic could result.  Influenza strains that are highly pathogenic could be more deadly than the COVID-19 pandemic.  The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919.  In the United States, it was first identified in military personnel in spring 1918 (3). It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.

Myth: There is not much you can do to protect yourself and your family from potentially being exposed to this virus.

Fact: The CDC has some tips (4):

• The best prevention is to avoid sources of exposure. For persons working with poultry wear protective equipment such as masks and gloves, and practice good hand hygiene.  Hunters who handle wild birds should dress game birds in the field when possible and practice good hygiene to prevent any potential disease spread.
• If you see large amounts of dead or sickly birds in your area do not touch them or pick them up.  You can report it to the CDC by calling 1-866-536-7593.
• Is it safe to eat eggs and chicken? The CDC is stating it is still safe to consume eggs and chicken as long as they are properly prepared. Properly handling and cooking poultry and eggs to an internal temperature of 165˚F kills bacteria and viruses, including bird flu viruses. People should handle raw poultry hygienically and cook all poultry and poultry products (including eggs) all the way before eating.
• If you are a backyard hobbyist with chickens that are sick, and you become sick with symptoms of the flu such as • Fever (Temperature of 100°F [37.8°C] or greater) • Feeling feverish/Chills*• Cough• Sore throat • Difficulty breathing/Shortness of breath • Eye tearing, redness or irritation • Headaches • Runny or stuffy nose• Muscle or body aches • Diarrhea, contact your doctor and you could be prescribed antivirals to help treat the condition.
• Do not touch surfaces that may be contaminated with saliva, mucous, or feces from wild or domestic birds. Human infections with bird flu viruses can happen when enough virus gets into a person’s eyes, nose or mouth, or is inhaled. This can happen when virus is in the air (in droplets or possibly dust) and a person breathes it in, or when a person touches something that has virus on it and then touches their mouth, eyes or nose (4).

As always, good hand hygiene practices and paying special attention to a clean and hygienic environment are key ways to prevent any kind of Influenza.  PDI is committed to infection prevention, and has a line of hand hygiene products available) as well as a wide selection of EPA approved disinfection wipes with kill claims for Influenza as well as emerging pathogens of concern.  Don’t you think this is “eggselent” news?

In this interview, Dr. Weber and Benjamin Galvan provide valuable perspectives on preemptive approaches healthcare facilities, medical professionals and consumers can take to prevent and prepare.

Dr. David Jay Weber: Dr. Weber is board certified in Internal Medicine, Infectious Disease, Critical Care Medicine, and Preventive Medicine.  He has been on the faculty of the University of North Carolina at Chapel Hill since 1985 where he is currently the Charles Addison and Elizabeth Ann Sanders Distinguished Professor of Medicine, Pediatrics and Epidemiology in the UNC School of Medicine, and UNC Gillings School of Global Public Health.

He serves as an Associate Chief Medical Officer for UNC Medical Center. He also serves as Medical Director of the Department of Infection Prevention UNC Medical Center. He is the Medical Director of the North Carolina Statewide Infection Control Program (SPICE), a Chair of UNC Biomedical IRB, and serves as the UNC Principle Investigator on the CDC sponsored Duke-UNC Epicenter. Dr. Weber is an Associate Editor of Infection Control Hospital Epidemiology and the Secretary of the SHEA Board. He is the Chair of the NC Health Department’s Tuberculosis Advisory Committee.

Benjamin D. Galvan, MLS (ASCP), CIC, CPH: Benjamin is a board-certified infection preventionist with over 7 years of experience in the acute-care, academic healthcare setting. Recently accepting the Director of Infection Prevention role for HCA Florida South Tampa and West Tampa Hospitals, part of the HCA West Florida Division, Benjamin has demonstrated a passion for infection prevention and patient safety by leveraging interdisciplinary collaboration and performance improvement methodologies to improve health outcomes. In June 2021, Benjamin was awarded the inaugural Emerging Leader in Infection Prevention award by the Association for Professionals in Infection Control and Epidemiology (APIC). In 2015, Benjamin attained his bachelor’s degree in medical laboratory science at Louisiana State University Health Sciences Center and is presently pursuing a master’s degree in Public Health at the University of South Florida.

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• Meets CDC, OSHA and CMS Tag F880 guidelines
• Bactericidal, Fungicidal, Tuberculocidal, Virucidal

However, human error is inevitable in the disinfection process. In fact, studies have shown that approximately 50% of surfaces are missed during manual disinfection leading to the need for additional layers of disinfection to ensure completely clean surfaces. By adding UVC technology to standard disinfection practices, variables related to human error in the cleaning process are reduced.

That’s where the Tru-D UVC disinfection robot steps in. The Tru-D robot is the only UVC device of its kind with patented Sensor360® technology which compensates for room variables such as size, shape and contents by measuring the amount, or dose, of UVC needed to ensure thorough room disinfection. The robot operates from a single position without the need for frequent involvement or movement to multiple placements from staff.

Together, Sani-Cloth® Bleach Germicidal Wipes and the Tru-D UVC disinfection robot provide and enhanced, layered approach to cleaning and disinfection.

Tru-D® UVC Disinfection Robot

• Validated by a number of independent, peer-reviewed studies to eliminate organisms in direct and indirect, shadowed areas
• In activates SARS-CoV-2, diff, MRSA, VRE and other bacteria and viruses
• Single placement positioning allows staff to perform other tasks during the disinfection process
• Tru-Dportal provides visual data, showing hospital staff that a room has been properly disinfected