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Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.

The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered.

Environmental disinfection has become the new frontier in the ongoing battle to reduce the risk of health care-associated infections. Evidence demonstrating the persistent contamination of environmental surfaces despite traditional cleaning and disinfection methods has led to the widespread acceptance that there is both a need for reassessing traditional cleaning protocols and for using secondary disinfection technologies. Ultraviolet-C (UV-C) disinfection is one type of no-touch technology shown to be a successful adjunct to manual cleaning in reducing environmental bioburden. The dilemma for the infection preventionist, however, is how to choose the system best suited for their facility among the many UV-C surface disinfection delivery systems available and how to build a case for acquisition to present to the hospital administration/C-suite. This article proposes an approach to these dilemmas based in part on the experience of 2 health care networks.

Background Clostridioides difficile (CDiff) is a common bacterium in 2-5% in the human gut and can develop into a serious gastrointestinal infection after exposure to antibiotic therapy, an unhealthy diet, extended hospitalization and stay in a long-term care facility. Educating the public and children about preventing CDiff is important and engaging children early on is vital to the future of preventing CDiff. CDiff Foundation Junior Infection Fighter Program was introduced to families and their children in fall 2019. Methods The volunteer program was developed for children and teens ages 7 to 14, with the support of their parents/legal guardian. Two events were held in October and December with 8 children in Pennsylvania and 23 children in Michigan. A survey was given to the 23 students, in the age groups 5 to 13 in the second program. Results Students older than 8 years were knowledgeable and responded correctly 100% of the time in pretest and posttest. On average, all students in the age group 5 and older were correct 100% of time to know that bacterial and virus are germs, drinking plenty of water and exercising is important for good health. Knowledge gaps were predominant in the area of dental hygiene, students did not understand the importance of flossing in the age group of 5 to 7. Only 65% students were correct in their pretest survey on dental hygiene questions, post survey there was a 17% improvement in their understanding. 18% of the students thought that sharing cups does not spread germs, postsurvey there was a 4% improvement in their understanding. Conclusions Multi-faceted patient and family program offered by the C Diff Foundation builds awareness and advocacy for C. diff. infection prevention, treatments, clinical trials, antibiotic-resistance, and environmental safety worldwide. Children are our future and it is important that they are informed about infection prevention.

Cross-contamination from inanimate surfaces can play a significant role in intensive care unit (ICU)-acquired colonization and infection. This study assessed an innovative isopropyl alcohol/organofunctional silane solution (IOS) to reduce microbial contamination on inert surfaces in a medical ICU.Baseline adenosine triphosphate bioluminescence testing (ABT)-measurements (N = 200) were obtained on designated inert ICU surfaces followed by IOS treatment. At 1 and 6 weeks, selective surfaces were randomized to either IOS-treated or nontreated controls for comparison using ABT (N = 400) and RODAC colony counts (N = 400). An ABT value of ≤45 relative light units (RLU) was designated as "clean," whereas45 was assessed as "dirty."Mean RLU baseline values ranged from 870.3 (computer keyboard) to 201.6 (bed table), and 97.5% of surfaces were assessed as "dirty." At 6 weeks, the mean RLU of surfaces treated with IOS ranged from 31.7 (physician workstation) to 51.5 (telephone handpiece), whereas values on comparative control surfaces were 717.3 and 643.7, respectively (P.001). Some 95.5% of RODAC cultures from IOS-treated sites at 6 weeks were negative, whereas 90.5% of nontreated sites were culture-positive, yielding multiple isolates including multidrug-resistant gram-positive and gram-negative bacteria.IOS-treated surfaces recorded significantly lower RLU and RODAC colony counts compared with controls (P.001). A single application of IOS resulted in a persistent antimicrobial activity on inert ICU surfaces over the 6-week study interval.

Efforts to reduce the incidence of hospital-acquired infection (HAI) remain a significant focus for health care facilities, particularly in this era of drug-resistant organisms. With as many as 1 in every 25 hospitalized patients acquiring an infection, the need to minimize the risk of HAIs is widely recognized as critical. Advances in the fields of biomedical technology, microbiology, pharmacology, and infection control and prevention, among others, have played a tremendous role in these efforts. However, evidence suggests that a key element in this battle against HAIs is missing: collaboration and communication between these groups in health care facilities-particularly in microbiology and infection prevention. The need for collaboration between infection preventionists (IPs) and laboratorians has been addressed in the literature; however, a survey conducted by the APIC and the American Society for Microbiology demonstrated that both IPs and laboratorians feel they lack the tools to engage in this collaboration. This article addresses strategies for a working partnership between IPs and laboratorians and reports 3 case studies on successful collaborations at major medical centers.

Background A growing body of research has demonstrated that manual cleaning and disinfection of the operating room (OR) is suboptimal. Residual environmental contamination may pose an infection risk to the surgical wound. This study evaluates the impact of a visible-light continuous environmental disinfection (CED) system on microbial surface contamination and surgical site infections (SSI) in an OR. Methods Samples from 25 surfaces within 2 contiguous ORs sharing an air supply were obtained after manual cleaning on multiple days before and after a visible-light CED system installation in 1 of the ORs. Samples were incubated and enumerated as total colony-forming units. SSIs in both ORs, and a distant OR, were tracked for 1 year prior to and 1 year after the visible-light CED system installation. Results There was an 81% (P = .017) and 49% (P = .015) reduction in total colony-forming units after the visible-light CED system installation in the OR in which the system was installed, and in the contiguous OR, respectively. In the OR with the visible-light CED system, SSIs decreased from 1.4% in the year prior to installation to 0.4% following installation (P = .029). Conclusions A visible-light CED system, used in conjunction with manual cleaning, resulted in significant reductions in both microbial surface contamination and SSIs in the OR.

Efforts to reduce health care–associated infections (HAIs) have grown in both scale and sophistication over the past few decades; however, the increasing threat of antimicrobial resistance and the impact of new legislation regarding HAIs on health care economics make the fight against them all the more urgent. On-demand polymerase chain reaction (PCR) technology has proven to be a highly effective weapon in this fight, offering the ability to accurately and efficiently identify disease-causing pathogens such that targeted and directed therapy can be initiated at the point of care. As a result, on-demand PCR technology has far-reaching influences on HAI rates, health care outcomes, hospital length of stay, isolation days, patient satisfaction, antibiotic stewardship, and health care economics. The basics of on-demand PCR technology and its potential to impact health care have not been widely incorporated into health care education and enrichment programs for many of those involved in infection control and prevention, however. This article serves as a primer on on-demand PCR technology and its ramifications.

Terminal cleaning in the operating room is a critical step in preventing the transmission of health care-associated pathogens. The persistent disinfectant activity of a novel isopropyl alcohol/organofunctional silane solution (ISO) was evaluated in 4 operating rooms after terminal cleaning. Adenosine triphosphate bioluminescence documented a significant difference (P.048) in surface bioburden on IOS-treated surfaces versus controls. RODAC plate cultures revealed a significant (P.001) reduction in microbial contamination on IOS-treated surfaces compared with controls. Further studies are warranted to validate the persistent disinfectant activity of ISO within selective health care settings.

Surgical wound irrigation has long been debated as a potentially critical intraoperative measure taken to prevent the development of surgical site infection (SSI). Unlike many other SSI prevention efforts, there are no official practice guidelines or recommendations from any major medical group for the practice of surgical irrigation. As a result, practitioner implementation of the 3 major irrigation variables (delivery method, volume, and solution additives) can differ significantly. A focus group of key thought leaders in infection prevention and epidemiology convened recently to address the implications of different surgical irrigation practices. They identified an urgent need for well-designed clinical trials investigating surgical irrigation practices, improved collaboration between surgical personnel and infection preventionists, and examination of existing evidence to standardize irrigation practices. The group agreed that current published data are sufficient to support the elimination of antibiotic solutions for surgical irrigation; the avoidance of surfactants for surgical irrigation; and the use of sterile normal saline, sterile water, and 1 medical device containing a sterile 0.05% chlorhexidine gluconate solution followed by sterile saline. Given the current lack of sufficient evidence identifying ideal delivery method and volume choices, expert opinion must be relied on to guide best practice.

CAUTIs were identified using the NHSN criteria. Every CAUTI reviewed and debriefing was performed with the clinical team. An algorithm was developed for the bladderscanner. To encourage removal of urinary catheters a daily review of indications and necessity occurred daily. RESULTS: There was over a 65% reduction in CAUTI in the first 3 Quarters of 2013. There was over a 20% reduction in indwelling urinary catheter days in the first 3 Quarters of 2013. There is an increased awareness of indwelling urinary catheters and CAUTIs in the clinical areas, thus instilling a sense of ownership at the level of the units. LESSON LEARNED: Standardizing practice is the first step, review of each case with the interdisciplinary team in real time provided data and opportunities for improvement. These insights helped our team to adjust practice and drive this process. Awareness was heightened by posting rates of CAUTIs, catheter days, and overall hospital CAUTI rates, thus instilling a sense of ownership on the units. This teamwork promoted enthusiasm and helped us to sustain our drive toward zero.

The role of terminal cleaning is to reduce the risk of microbial contamination within the operating room environment. However, previous studies have suggested that ineffective cleaning processes can results in significant microbial contamination of critical touch surfaces throughout the healthcare environment. The present study assesses the impact of an antimicrobial isopropyl alcohol/organofunctional silane solution (IOS) to reduce microbial contamination over a 6 weeks study period. Residual bioburden was determines using ATP-bioluminescence assay.

BACKGROUND: Surgical site infection (SSI) surveillance data is an essential part of infection control programs. Benchmarking data against the National Nosocomial Infections Surveillance System (NNIS) system has been used since 1999 to evaluate SSI in an orthopedic specialty hospital. The presentation of this data is intended to demonstrate trends and risk factors associated within this patient population. METHODS: NNIS criteria were used to classify SSI in orthopedic surgery as superficial, deep, and organ/space. The infection rates were benchmarked with the NNIS report by stratifying total hips, total knees, spinal fusions, and laminectomies by risk factors 0, 1, 2 and 3 (ASA score, duration of operation, and degree of wound contamination). The expected versus actual number of infections, the infection rate, the standardized infection ratio, and probability value were calculated. RESULTS: From fiscal year (FY) 1999 through FY2004, there were 26,202 orthopedic cases with 229 SSIs (0.9%). In FY2004, data were stratified by type of surgery and showed the following infection rates: total hips, 0.3; total knees, 1.0; laminectomies, 0.9; and spinal fusions, 2.0. The standardized infection ratio (the number of infections divided by the expected number of infections) for each group was 0.2, 0.7, 0.8 and 0.9, respectively. Stratification by risk factors (SIR) for each category demonstrated an increased rate in spinal fusions in patients with greater 2 and 3 risk factors (9.3, as compared to the NNIS threshold of 6.3). An investigation revealed additional risk factors in this group: obesity, diabetes, and allograft implantation. Control measures were implemented and infection rates were reduced. CONCLUSION: SSI surveillance in an orthopedic specialty hospital analyzed over a 6-year period has demonstrated rates below NNIS benchmarking using SIR and probability values. The analysis of data in this manner is useful to detect specific problems and focus investigative activities.

BACKGROUND/OBJECTIVES: Clostridium difficile is emerging as a major nosocomial threat worldwide. The incidence of C.diff-associated diarrhea (CDAD) has increased as well as severity and mortality. In early 2005, at an orthopedic specialty hospital, there was a noticeable increase in the number of Clostridium difficile positive titers reported from the microbiology laboratory. From January through April 2005 there were 28 cases of CDAD identified and 13 (46%) occurred in patients who had been hospitalized for greater than 72 hours, indicating possible healthcare associated infection. Most of the cases appeared to be related to surgical prophylaxis until detailed epidemiologic analysis was completed. A room tracer analysis revealed that the 28 patients had been in 42 rooms This prompted the institution of immediate control measures.