Infection Prevention in the Spotlight

Doe Kley, RN, MPH, T-CHEST, LTC-CIP, CIC, national director, The Clorox Company, noted several important topics that should be top of mind for infection preventionists today. She said, “Monitoring changes with federal legislation given the new Administration. Some examples include:

“Budget cuts to the CDC’s National Healthcare Safety Network (NHSN) have impacted the healthcare-associated infection (HAI) tracking system. NHSN serves as a repository of HAI data used for benchmarking and payor determination. The Centers for Medicare and Medicaid (CMS) and other payors use these data to determine incentives (or penalties) for performance. Additionally, members of the public may use the data to select among available providers through hospitalcompare.gov.

“Grant cuts. These funds reach beyond research and include things like CDCs Project Firstline and the status of antimicrobial resistance through reports such as the CDC’s Antimicrobial Threats Reports.

“The recent proposal to eliminate the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) that provides advice and guidance to Health and Human Services (HHS) and CDC on infection control practices and strategies for the surveillance, prevention, and control of healthcare-associated infections (HAIs), antimicrobial resistance, and adverse events in US healthcare settings. IPs, public health, and clinicians rely heavily on these guidance documents in their day-to-day work.”

She added that emerging and high consequence infectious diseases such as Candida auris, avian influenza (e.g., H5N1), and measles pose significant threats. Along with other countries, the U.S. was caught off guard by the COVID-19 pandemic. These emerging and re-emerging pathogens and infectious diseases could escalate at any time. It is essential that we remain continuously prepared for the next potential threat.

Further, Kley added, “The COVID-19 pandemic resulted in an influx of new IPs. We need to double-down on efforts to provide education for these novice IPs.”

Benjamin D. Galvan, MPH, MLS (ASCP), CIC, CPH, is a board-certified Director of Infection Prevention with HCA Florida Brandon Hospital, a part of HCA Florida Healthcare’s West Florida Division. Galvan told HPN, “Infection preventionists have really been focused the last few years on getting ‘back-to-basics’ especially after the COVID-19 pandemic caused a mass exodus of experienced healthcare workers. As the healthcare workforce has begun to re-stabilize, at top of mind is moving on from a ‘back-to-basics’ mindset to developing our current caregivers into seasoned clinicians that can critically weave in basic infection prevention practices into all patient care.”

Resources in today’s climate

Peter Graves, BSN, RN, CNOR, Infection Prevention Consultants, and Maureen Spencer, M. Ed., BSN, RN, CIC, FAPIC, Infection Prevention Consultants, were interviewed together, live on site in Boston at AORN2025.

When asked where to best find resources in today’s political and ever-changing environment, Graves said, “My bias, of course, comes from being a perioperative nurse, so I always go back to what I call the “source of truth,” which, for me, is AORN’s guidelines. AORN has over 15 different guidelines focused on infection prevention—not just in the OR, but also for sterile processing, pre-op, and post-op areas. If you're looking for evidence-based recommendations and best practices, AORN is where to go.”

Spencer largely agreed. She said, “I recommend that IPs join AORN so they can access the e-guidelines. Even if they’re not nurses—and might not feel they can join—I believe there’s a membership category for non-nurses. At the very least, ask your OR director, who is likely to have access, to get you the infection control-related guidelines. They're evidence-based, so you’ll get the latest research and supporting articles.”

Further, she added, “I subscribe to journals like JAMA, New England Journal of Medicine, Surgical Infections, APIC, AJIC, and more—they send me updates daily. When I find something that’s really important for IPs, I share it on LinkedIn since they’re often too busy to stay on top of it all. As consultants, we have the flexibility to help in that way.”

“You can also go to the CDC’s website for updates,” Spencer noted. “We don’t rely on WHO as much—mostly CDC, American College of Surgeons, and sometimes other associations depending on the topic. For instance, I’m currently researching disinfection recommendations for percutaneous ultrasound probes. For that, I’m reviewing guidance from various specialty groups like SGNA for endoscopy. And with AI tools like ChatGPT, you can just ask about an issue and get references instantly. That’s huge.”

Clorox’s Kley added two cents as well. Her go-to resources are:

• CDC’s evidence-based guidelines.
• Guidance and best practices from professional organizations such as:
  • Association for Professionals in Infection Control & Epidemiology (APIC)
  • Society for Healthcare Epidemiology of America (SHEA)
  • Association for Perioperative Registered Nurses (AORN)
  • Association for the Healthcare Environment (AHE)

She added, “I encourage IPs to attend and network at their local APIC chapter meetings as well as the national conference held every June. In fact, I will be co-presenting with Dr. Mariana Torres from BlueDot (a company that uses artificial intelligence to conduct global infection surveillance) at this year’s APIC conference on high-priority pathogens.”

Further, “Trusted vendors who are experts in their respective fields,” Kley said. “IPs don’t have to reinvent the wheel. Many vendors provide valuable resources, including educational content and protocols at no extra cost.”

HCA’s Galvan largely agreed. He said, “What initially comes to mind is APIC, our professional organization that has a ton of resources available from the APIC text, educational webinars, conferences, and many more downloadable resources. Beyond that, we have local APIC chapters that can provide a network of other local infection preventionists and public health leaders that serve as resources as well. Of course, the CDC provides many guidelines and other resources that are essential for IPs in their day-to-day work. IPs may also look to other professional organizations like SHEA, IDSA, AORN, and so on thathave a multitude of guidelines or best practice documents related to particular areas of practice.”

Post-COVID landscape for IP

When asked about the landscape for IP post-COVID, Clorox’s Kley noted, “In addition to managing staffing shortages and burnout in remaining staff, there is a need for the newer IPs who came onboard during the pandemic to get back to basics. While our attention was on COVID, infection prevention and control (IPC) practices may have drifted, resulting in regulatory compliance issues and HAI increases.”

Galvan commented on the role of infection prevention in hospitals. He said, “I believe the biggest change, at least in my career, has been a greater acceptance and collaboration with infection prevention. I think the COVID pandemic highlighted the critical importance of infection preventionists as clinical collaborators that bring an evidence-based, common-sense perspective to all types of complex situations in healthcare.”

OR and IP Collaboration

Graves said, “Many IPs don’t come from a clinical background. It’s critical that they partner with OR clinicians to understand how to integrate guidelines into actual practice.”

Spencer, agreeing, continued, “Data drives your program. Take, for example, the NHSN study on antimicrobial resistance a few years ago. It analyzed HAIs over a span of years, and for the first time, SSIs became the most common, accounting for 40%—up from the low 30s previously. It’s easier to manage CLABSIs, CAUTIs, and VAPs because they’re often in the ICU and protocols can be applied consistently. But SSIs require a full team approach. IPs can’t do it alone. The OR director can’t do it alone.”

“It involves the entire continuum: pre-op holding, intra-op, post-op in PACU, the nursing unit, and even home care,” she added. “That’s a challenge, especially for IPs who don’t have a strong relationship with the OR. When we lecture to OR directors, we suggest they give IPs—especially those from public health backgrounds—the same orientation they give to new OR nurses.”

Spencer also explained that AORN has videos of procedures, toolkits, checklists, and PowerPoint presentations, and that if IPs are AORN members, they have access to all of this important material to help them.

Graves jumped back in and added, “From our recent lectures and events, what’s clear is that there's a real hunger for knowledge. You have to leave the office, put on scrubs, and go into the OR. Observe. Work with your team. That’s how we model best practices and collaborate to reduce infections. Whether you’re in a critical access hospital or a large teaching facility, collaboration between IPs and surgical staff is key. Reducing SSIs—making them a ‘never event,’ as Maureen often says—has to be the goal. Don’t accept even one infection. When one occurs, go straight to the root cause.”

“Every facility has internal resources and external ones through professional organizations. Use them—not just for patient safety, but to improve your facility overall,” Spencer chimed in.

Graves, commenting on the show, said, “At AORN this year, what really stood out was the attention on infection prevention in the OR. The average OR nurse spends 70–80% of their day focused on this. A lot of the products here may not be labeled directly as ‘infection prevention,’ but they are—surgical drapes, UV systems, hand hygiene tools, gowns. It’s a common theme.”

Technology advancements

When it comes to new technology, Clorox’s Kley has a warning: “Technology isn’t always the best solution. I prefer to start by analyzing the existing process and making necessary improvements before implementing technology as the solution. It’s also important for IPs to scrutinize the evidence. Is the potential technology proven to reduce pathogen transmission or to reduce HAIs outside of a simulated testing environment? We also must be cognizant of ‘shiny new object syndrome.’ The last thing we want is expensive technology to be left unused, sitting in a closet somewhere. Especially given that healthcare facilities are still rebounding financially from the pandemic. Operating margins, while improving, remain below pre-pandemic levels. Sometimes, simple is best. For example, ready-to-use cleaning and disinfecting products. My motto is, ‘make the right thing to do the easy thing to do.’”

Yet, she sees promise for technology, nonetheless. She said, “In terms of innovation, whole genome sequencing (WGS) - which has only come about in the past few years - holds great promise for busy IPs. WGS helps us to better understand how microorganisms move through a facility. WGS can be used to detect and investigate outbreaks, including those which previously may have gone undetected. Reflecting on my time as a frontline infection preventionist, I can only imagine how many outbreaks went unnoticed. Looking ahead, I anticipate that the use of WGS will become more prevalent at the individual facility level.

“Finally, on my watch list is artificial intelligence (AI), as it may have potential to assist IPs with various tasks including infection surveillance. It may even help to identify patients at risk for infection so that the healthcare team can proactively intervene.”

HCA’s Galvan commented on technology as well. He said, “I believe many hospitals are starting to investigate the application of artificial intelligence, which is very exciting to me. A lot of infection preventionists often get ‘stuck’ at their desks conducting necessary computer work like surveillance, data management, presentation building, and so on that could potentially be accomplished down the road with AI. I can’t wait to see what advancements are coming down the line as less time at the computer means more time interacting with our fellow caregivers and patients.”

At AORN2025, Graves noted, “AI isn’t fully integrated yet, but it's coming. Some really interesting technologies are being introduced—like automated instrument tray assembly. If trays are complete, OR nurses don’t have to leave the room to grab missing tools, which helps keep the door closed and preserve air quality. That real-time data is essential. If you can’t measure it, you can’t manage it. There are also AI and UV technologies. But one area we need to focus more on is door discipline in the OR. Laminar airflow is outdated. Newer options, like temperature-controlled airflow, use physics to push contaminated air down and out. With traditional laminar flow, any disruption—lights, bodies, warm air—can cause turbulence that compromises the sterile field.”

Spencer added, “We’ve done full-day workshops on this at APIC. Not every OR will use the same tech. But if you're rebuilding or renovating OR suites, consider newer systems like those from Avidicare in Sweden. There are also portable systems that combine UV disinfection with HEPA filtration—great for areas like PACUs, emergency rooms, or nurses' stations. Some facilities use dry hydrogen peroxide, which is non-toxic and effective for air disinfection. AORN now recommends forming air quality management teams, just like we do for water. They also advise that any SSI investigation include an assessment of OR air quality. That’s where the field is headed.”

“And remember, you don’t need to reinvent the wheel,” Graves commented. “Hospitals often think their problems are unique, but most of us are dealing with the same issues. Go back to the data. Go back to the evidence.”

Spencer agreed, and explained, “Peter and I lecture on a bundled, foundational approach to SSI reduction. Start with a safe OR environment. We conduct surveys looking at the whole picture—pre-op, intra-op, and post-op—using AORN guidelines.

“Second, prepare patients properly: pre-op showers (with clear instructions), screening and decolonizing MRSA carriers, addressing risk factors like smoking and weight.

“Then, in surgery: use alcohol-based skin preps. Stop using antibiotics in irrigation—they don’t work. Use antiseptics instead.

“Close wounds with antimicrobial sutures, seal incisions properly, and consider antimicrobial dressings for those allergic to adhesives.

“Patients are going home during the most vulnerable stage of healing. These protections are critical.

“It’s a seven-step bundle, and you can expand it for specific surgeries—colorectal, OB, cardiac, joints, etc. Think of it like Maslow’s hierarchy of needs. Start with a strong foundation and build up to a zero-infection environment.”

Graves concluded, “These bundles aren’t one-size-fits-all. Tailor them to the procedure and train your teams. Wound care starts before surgery, and recovery planning is just as important. This takes a full team—nutritionists, environmental services, IPs, OR staff, and SPD. SPD and environmental services are often the unsung heroes, but they are absolutely essential to patient safety.”

Closing thoughts

HCA’s Galvan put it well: “Infection prevention is a crucial aspect of healthcare, and I believe patients are more aware when something just ‘doesn’t seem right’ as it relates to their care. While many things have changed over the years since the COVID pandemic, the ‘nuts and bolts’ of infection prevention truly remain the same—actions like hand washing, cleaning our environments, using aseptic technique, wearing gloves, etc. are all still proven best practices when caring for patients, and now more than ever we need to model what good looks like so we can build back our healthcare workforce to what it was before. The evidence shows that the risk of healthcare-associated infections is inversely related to the number of resources provided to infection prevention and infection preventionists in hospitals, highlighting just how important it is for hospitals to buy in.”

Further, he said, “Infection prevention is an exciting and ever-evolving field, and just like other healthcare professions, we are feeling the effects of fewer professionals entering the field. I would encourage anyone interested in making a difference in this vital space to reach out to their local infection prevention leaders in their facilities to find out more about how to enter the field! I have interested and curious professionals reach out to me all the time on LinkedIn asking about what it means to be an infection preventionist and what they can do to pursue IP as a career path, which gives me hope that we can continue to rebuild the infection prevention workforce.”

Clorox’s Kley noted the importance of best practices for IP. She said, “We know that HAIs increase patient pain and suffering, length of stay, and cost. However, robust IPC programs can significantly reduce these risks. Evidence-based IPC practices - including hand hygiene and environmental cleaning and disinfection – break the chain of infection, allowing for safe and high-quality care. Patients should never leave our care sicker than when they arrived. Not only does IPC protect our patients; it also safeguards visitors and staff. Finally, we are living in the beginnings of the post-antimicrobial era, and the antibiotic pipeline is dry. HAIs are one of several drivers of antimicrobial resistance, so prevention is crucial to protect existing antimicrobials for future generations.”

“My final recommendation,” Kley said, “is that IPs should ensure that EVS is testing their dilutable disinfectants for proper concentration.  A recent study found that 90% of hospitals had at least one dispenser delivering lower-than-expected disinfectant concentrations! When disinfectant levels are undetectable or below the expected concentration, there is not enough disinfectant to effectively kill pathogens. Low or undetectable levels of disinfectant can compromise the disinfectant's efficacy and increase the risk of HAIs for both patients and staff.”

As the healthcare industry continues to evolve post-COVID, infection prevention remains an indispensable element of high-quality care. The core principles have not changed but the context in which they are applied has grown more complex. From rebuilding a depleted workforce to staying ahead of emerging threats, the role of infection preventionists has expanded, requiring both clinical expertise and adaptive leadership.

Technology offers promising tools; however, as many experts stressed, these innovations must complement—not replace—fundamental IP practices. Additionally, collaboration between departments, especially between IPs and surgical teams, has proven essential for reducing surgical site infections and fostering a culture of safety and accountability.

In the face of rising antimicrobial resistance and financial constraints, the imperative to invest in infection prevention has never been clearer. As Kley put it, “Patients should never leave our care sicker than when they arrived.” By empowering IPs, equipping them with accurate data, and reinforcing foundational practices with forward-thinking strategies, healthcare facilities can ensure that infection prevention continues to be a major contributor to patient safety and quality care.