A disinfectant dispenser that delivers the wrong concentration, shared equipment without clear cleaning responsibility, or restricted areas inaccessible to environmental services can expose gaps in environmental hygiene programs. In this interview with Infection Control Today® (ICT®), Doe Kley, MPH, RN, T-CHEST, LTC-CIP, CIC, discusses disinfectant efficacy, practical cleaning challenges, and shared accountability. Drawing on research and infection prevention experience, she emphasizes that everyday practices matter in addressing antimicrobial resistance. “Everyone has a role in preventing transmission,” Kley says. “Effective environmental hygiene isn't a supporting role in this fight - it's a frontline intervention.”ICT: You open by saying the post-antimicrobial era "isn't coming, it's here." For someone outside health care, what does that look like day-to-day? And what convinced you that it's already happening rather than a future risk?Doe Kley, MPH, RN, T-CHEST, LTC-CIP, CIC, infection prevention fellow of clinical and scientific affairs for Clorox Purell ProCare: That's the CDC's language, not mine—and I use it because the data backs it up. You know, resistance is rising faster than we can answer it. In the last decade, only about 22 new antibiotics reached the market. In contrast, up to 50 new drugs are coming out each year for things like diabetes, depression, and even weight loss. Meanwhile, antibiotic resistance climbed nearly 40% between 2018 and 2023. Did you know that in the US, 1 in 7 bacterial infections is now resistant, costing about 48,000 lives and $5.7 billion a year? And what’s scarier is that by the year 2050, experts predict that AMR [antimicrobial resistance] will kill more people than all cancers combined.But what convinced me isn't the projection of AMR; it's the history. Methicillin came into widespread use in 1959, and the first resistant [Staphylococcus] appeared in 1960, just 1 year later. Consider that bacteria reproduce roughly every 20 minutes, whereas we humans only reproduce maybe twice in a lifetime. This replication speed is directly tied to how quickly antimicrobial resistance can emerge and spread. The math was never in our favor. What's at stake isn't just treating infections; it's whether surgery, transplants, and chemotherapy remain safe to perform.ICT: Most people hear "antibiotic resistance" and think about overprescribing. You argue that the hospital environment itself is half the story. How did you come to that view, and what do surfaces and shared equipment contribute that prescribing habits can't explain?DK: So antibiotic stewardship is essential, but it's only part of the solution, and here's what gets missed: Resistant organisms don't just live and replicate inside the patient’s body; they live and replicate on surfaces. For perspective, a 2024 Rutala study found that 65% of resident rooms and half of common areas in long-term care facilities were positive for at least one MDRO [multidrug resistant organism]. Another 2024 study found that within just 4 hours of disinfection, Candida auris had already recontaminated 20% of surfaces. And the consequence is measurable: Being admitted to a room previously occupied by someone who harbored an MDRO raises the risk of acquiring that same organism by 1.5 to 3.5 times.Prescribing habits can't explain that. What prescribing also can't explain is gene sharing. While these organisms sit in the environment, they trade resistance genes with unrelated bacterial species. So, the environment isn't just a reservoir; it's where resistance spreads and evolves.Disinfectant #1 had no Klebsiella claim, and while disinfectant #2 (a ready-to-use sporicidal) had a Klebsiella claim, it did not have an NDM-1-specific claim. And that's the moment. People pause because neither disinfectant has the resistant strain on its label.That pause is the whole lesson. You don't need an NDM-1-specific claim. The claim for the susceptible strain covers the resistant one. And the sporicidal wipe wins on every other dimension too: broader spectrum, faster contact time, and no risk for dilution error.Audiences respond well because it's not abstract; they see the consequence play out. In the first path, the next patient admitted to the room acquires the NDM-1 pathogen. In the second path, the patient goes home in just 3 days with no complications. When participants make the choice themselves, it lands differently than when they are told the principle.ICT: You recommend a sporicidal disinfectant for every discharge clean, not just isolation rooms. That's a real workflow shift. How do you make that case to a skeptical hospital leader, and what evidence moves them?DK: I would start by defining the problem, which, in this case, is that we simply don’t know. Meaning, we don’t always know what pathogens a patient may have been harboring. We only apply enhanced measures when we're aware a patient is carrying something, but all too often we are not aware until sometime later, and the damage is already done. In the scenario I used in this presentation, the patient wasn't even on contact precautions until the culture came back on the day of discharge. And that's not unusual.To convince my leadership, I would lean into the available evidence. I would point to the plethora of studies that have demonstrated the risk to the next patient admitted to a room previously occupied by a patient colonized or infected with a drug-resistant or a C difficile infection. These studies have demonstrated that the risk can be up to 3.5 times higher than had the prior occupant not been harboring a drug-resistant pathogen.Another study worth sharing is a 2019 Donskey study, which showed that when bleach replaced the quat for all discharge cleans, C difficile contamination in non-C difficile rooms dropped from 24% to 5%. I would also share this important data that always gets a leader’s attention: the human and financial costs of AMR infections, which are associated with up to 70% higher mortality, up to 24% longer stays, and roughly 29% higher costs. Finally, I would remind the leadership team that cleaning with a sporicidal agent is the highest level of clean you can offer the next patient admitted to a room. Remember, sporicidal disinfectants are considered intermediate-level disinfection—just 1 step below high-level disinfection and 1 step above low-level disinfection. ICT: You shared a personal story that reminded participants not to overlook ancillary departments. Can you reshare that story here for us?Absolutely! At my last hospital, I had wandered down to Radiology, where MRIs are performed. As you know, this is a highly restricted area for safety reasons. You know, those magnets don’t play around! It's so restricted that I asked the radiology manager about cleaning. I learned they didn’t even permit EVS in the space! Rather, the radiology staff, untrained in C&D, were doing the cleaning!Guess how they mopped the floors? They dropped disinfecting wipes on the floor and shuffled around the room with their feet!Obviously, as an IP, this was completely unacceptable, so working together:• We trained EVS staff on MRI safety, • We purchased non-ferrous aluminum cleaning tools that were dedicated to the department, and • We mapped out cleaning responsibilities.The key takeaway from this story is that IPs and EVS must look behind every door in every department!ICT: What's the one thing you'd want every EVS professional to hear from this: what's their role in preserving antibiotics for the next generation?DK: I want them to know how absolutely vital their role is in patient safety. You know, IPs and EVS professionals don't prescribe antibiotics — but they certainly help protect them. Every transmission prevented is potentially a life saved and an antibiotic preserved for someone who'll need it, possibly even years from now. Effective environmental hygiene isn't a supporting role in this fight - it's a frontline intervention working on 2 fronts: preventing infections so fewer antibiotics get used, and containing resistance so it doesn't reach the next patient. (Edited for readability and length)
Sterile Processing's Hidden Patient Safety Risk: When Cognitive Overload Meets Complex WorkSterile processing professionals perform high-stakes work requiring sustained attention to detail, yet burnout, fatigue, interruptions, and cognitive overload receive far less attention in SPD than in many patient-facing areas of health care.Randalyn Harreld, CRCST, CIS, CER, CHL, CSPDT, CASSPT, CLS, AAS, FHSPA, clinical education manager for Steelco Belimed, wants that to change.“This particular topic, I think, is pertinent and is not something that we talk about enough,” Harreld told Infection Control Today® following her presentation at the Southern California Sterile Processing Association chapter meeting in Newport Beach, California. “Because we're such a labor-intensive and hardworking environment, I just felt like it's important to bring it up.” One major concern is interruption.“We say, and I say this all the time, ‘I'm a multitasker, and I can multitask.’ And really, there's a study that talks about how humans, we're not multitasking; we're task switching,” Harreld said.Consider an employee assembling an implant tray with 200 components. After counting 40, the technician is interrupted and later returns to the tray.“You forgot where you were,” Harreld said. “Now we're introducing rework.”But cognitive demands are only increasing.Harreld pointed to the rapidly evolving complexity of medical devices and the IFUs sterile processing professionals must follow. Some instructions she has encountered contain more than 100 steps, while formatting and organization vary considerably among manufacturers.“Just the complexity of the information that we are expected to know is getting harder, is getting faster, is getting more, bigger and longer,” Harreld said. “But how are we making it easier, and are we making it achievable to adhere to?” Harreld would like to see greater standardization of IFUs, comparing the concept with safety data sheets, where information appears in predictable sections.Meanwhile, facilities can address human factors now.Harreld suggested standardized workflows, protected safe zones, micro-rests, staff rotation, technology aids, checklists, better access to IFUs, and reinforced training.“If your staff is tired or burnt out, try to come up with some strategies,” she said. “Really support your team to make sure that they feel like they're getting the relief before you lose them and before you have an injury.”
What happens when we expect public health to respond immediately after years of inconsistent investment?For Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation, the current Cyclospora outbreak illustrates a much larger problem."It's about speed. It's about capacity," Castrucci told Infection Control Today®. "You can't underinvest in public health and then expect it to have a fast and swift response."In a wide-ranging conversation with ICT Lead Editor Tori Whitacre Martonicz, MA, Castrucci discusses foodborne disease surveillance, workforce capacity, misinformation, declining institutional trust, science communication, and why public health funding cannot follow a boom-and-bust cycle.He also argues that rebuilding trust will require more than telling Americans to "trust the science." Public health professionals must communicate plainly, listen empathetically, build relationships before emergencies occur, and show people how public health affects their everyday lives.Perhaps his simplest explanation came from his daughter:"A pediatrician helps one person at a time. My dad helps everybody all the time."
Reusable lead aprons have long been viewed as essential radiation protection for clinicians, but infection prevention experts say they may also represent an overlooked environmental hygiene challenge.During a recent Infection Control Today and Diagnostic Imaging roundtable, experts from infection prevention, perioperative services, and radiology discussed why lead garments often escape the scrutiny applied to other reusable equipment despite being used every day in patient care environments. Moderator Tori Whitacre Martonicz, MA, opened the discussion by asking whether reusable lead aprons have simply been overlooked rather than proven to be low risk. That question shaped a conversation focused on contamination, inconsistent cleaning practices, and the need for clearer guidance.Peter Graves, BSN, RN, CNOR, argued that lead garments should not be dismissed simply because they are covered by sterile gowns during procedures."We don't go back and culture the lead ever," Graves said. "When we think about radiation-attenuating devices, lead actually functions much like PPE."Several panelists pointed to the absence of standardized cleaning protocols as a significant barrier. Jill Holdsworth explained that organizations may document cleaning activities, but there is often little consistency in how those garments are actually disinfected.Justin McKay said ATP testing has proven to be one of the most effective ways to demonstrate the problem. In one comparison, he found lead garments in an operating room to be far more contaminated than a gas pump handle."When infection prevention sees the data, they say, 'We cannot ignore this,'" McKay said.The discussion also addressed practical challenges, including uncertainty about which disinfectants are compatible with lead garments, conflicting manufacturer recommendations, and questions over whether individual clinicians or hospitals are responsible for maintaining embroidered personal garments.Brenna Doran, PhD, MA, ACC, CIC, AL-CIP, suggested that hospitals would benefit from a practical implementation guide."I would love there to be a playbook that IPs can go to," she said. "It's so much easier to do something someone else has done successfully than to create the wheel on our own."The panel concluded that addressing lead garment hygiene will require multidisciplinary collaboration and standardized protocols. As hospitals continue to strengthen environmental hygiene programs, experts believe reusable lead aprons should no longer be an infection prevention blind spot.
New research presented at AIDS 2026 demonstrates that HIV treatment continues to evolve, with growing evidence supporting both simplified 2-drug regimens and long-acting injectable therapies designed to improve adherence and quality of life.Jean van Wyk, MD, chief medical officer at ViiV Healthcare, discussed with Infection Control Today®, said the expanding treatment landscape gives people living with HIV more choices than ever before."The important thing is clear communication and joint decision making," van Wyk said. "It's not for the physician to just decide what's best for the person sitting in front of them. It has to be a joint decision on what suits that person best."Among the studies presented was new data from the Long-Acting Treatment in Adolescents (LATA) trial, which found superior outcomes for long-acting injectable therapy compared with daily oral treatment in adolescents living with HIV."Adherence is a real issue in adolescents," van Wyk said. "That's why long-acting injectables are a really good option for adolescents."He explained that injectable therapy removes the challenge of remembering to take a daily pill, while clinic-administered treatment results in consistently high adherence rates.Long-acting treatment may also help reduce HIV-related stigma because patients no longer need to keep medications at home or take pills every day.Beyond long-acting therapy, van Wyk highlighted the VOGUE study comparing the 2-drug regimen Dovato with the 3-drug regimen Biktarvy. The findings demonstrated comparable efficacy while potentially reducing patients' lifetime exposure to medications.Despite these advances, van Wyk emphasized that significant challenges remain."We have great options, but why is it that between a quarter and a third of people around the globe do not have virologic suppression?" he said. "There's clearly a big unmet medical need still."Looking ahead, he remains optimistic that continued innovation, broader access to treatment, and stronger collaboration will help advance the global HIV response."The whole model needs to be rethought," van Wyk said. "It is possible, and I'm always an optimist. I know we will get there. We just have to all work together."