Tori Whitacre Martonicz, MA, is the lead editor of 

.  She has been a writer and editor for over 30 years and has an MA and BA in English Composition/Literature from the University of Akron in Akron, OH. She lives in Ohio with her husband, Eric; son, Drake; 2 tiny dogs, Selena Brigid Sophia and Doctor Danger Dog; and a big black cat, Freya. She loves reading, writing, gardening, and spending time with her loved ones. 

Contact her through her email: tmartonicz@mjhlifesciences.com.

When surgical site infections began rising due to anastomotic leaks and incidental colon lacerations, perioperative nurses took action. Claudia Chanes, MSN-Ed, RN, CNOR, who spoke with ICT, and Zebina Sonia Roger, BSN, BS, RN, MT(ASCP), CIC, FAPIC, GB, shared that strengthened nursing advocacy and updated evidence-based practices led to significant reductions in infection rates among patients undergoing colon and abdominal hysterectomy. At the Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo 2025, held in Boston, Massachusetts, April 5 to 8, they presented a poster titled “Advocacy Reduces Infection Related to Anastomotic Leaks and Incidental Lacerations.”

Nursing Advocacy and Evidence-Based Practice Cut SSI Rates in Colon and Hysterectomy Surgeries

At AORN 2025, nurses shared how strengthened advocacy and updated evidence-based protocols significantly reduced surgical site infections in colon and hysterectomy cases. By reinforcing antimicrobial stewardship, interdisciplinary communication, and colorectal prevention bundles, systemic inflammatory response syndrome (SIRS) declined significantly, underscoring the measurable impact of perioperative nursing leadership on patient safety.

When surgical site infections began rising due to anastomotic leaks and incidental colon lacerations, perioperative nurses took action. Claudia Chanes, MSN-Ed, RN, CNOR, who spoke with 

; and Zebina Sonia Roger, BSN, BS, RN, MT(ASCP), CIC, FAPIC, GB, shared that strengthened nursing advocacy and updated evidence-based practices led to significant reductions in infection rates among patients undergoing colon and abdominal hysterectomy. At the Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo 2025, held in Boston, Massachusetts, April 5 to 8, they presented a poster titled “Advocacy Reduces Infection Related to Anastomotic Leaks and Incidental Lacerations.”

This poster presents a quality improvement project focused on reducing surgical site infections (SSIs) in patients undergoing colon and abdominal hysterectomy surgeries by strengthening nursing advocacy and implementing the latest evidence-based practices (EBP). The project was driven by an observed increase in SSIs related to anastomotic leaks and incidental colon lacerations. The goal was to evaluate how adopting updated EBP guidelines and improving interdisciplinary communication could positively impact patient outcomes.

“As nurses, one of our roles is to advocate,” Chanes told 

. “So, this is what we did with that project. The most important thing is recommendations that adjust antimicrobials and antibiotics, and, if the patient has [a surgical site infection (SSI)], any complication that requires continuous antimicrobial therapy, per the infection control document. The other thing that we encourage is a big project. It's a multidisciplinary team to prevent SSI malfunction.”

The initiative involved collaboration among infection prevention leaders, surgical educators, gynecologists, and colorectal and general surgeons. Education sessions were provided to the surgical services team, and current evidence-based practice (EBP) literature addressing SSI prevention in colorectal and abdominal procedures was shared.

Key recommendations included strict adherence to colorectal prevention bundles, reinforcement of anastomotic integrity, use of fluorescence angiography to assess tissue perfusion, application of surgical sealants, and consistent use of enhanced recovery after surgery (ERAS) protocols. For hysterectomy cases, recommendations emphasized antimicrobial stewardship with infectious disease consultation, multidisciplinary perioperative planning, awareness of prior surgical complications, and vigilant intraoperative communication.

Approximately 400 colorectal and 250 hysterectomy cases were included in the evaluation. Outcome data were collected using National Healthcare Safety Network (NHSN) criteria. The standardized infection ratio (SIR) showed improvement following implementation of these strategies. In FY22, colon surgeries had an SIR of 0.850, and abdominal hysterectomies had an SIR of 1.800. By FY23, the SIR decreased to 0.335 for colon surgeries and 1.110 for hysterectomies, representing substantial reductions.

The project highlights the critical role of nursing advocacy in ensuring adherence to evidence-based protocols, strengthening communication among perioperative staff, and promoting ongoing surveillance of SSI data. Preventing postoperative infections requires sustained commitment to guideline compliance, continuous education, and structured monitoring. While the study did not measure the exact number of surgeries that followed each EBP intervention, the observed improvement in infection rates suggests that coordinated practice change can meaningfully enhance patient safety and surgical outcomes.

Videos

The Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo 2026 is coming up soon. It will be held in New Orleans, Louisiana, from April 11 to 14. To give a taste of what will be available, Infection Control Today®  is publishing the as-yet unposted interviews from 2025. This interview is on a poster titled “Advocacy Reduces Infection Related to Anastomotic Leaks and Incidental Lacerations.”


Conversations with the President: HSPA President, Arlene Bush, CRCST, CER, CIS, CHL, SME, DSMD, CRMST

Sterile processing is often discussed only when something goes wrong. A tray defect. A missing instrument. A delayed case. But in this wide-ranging conversation with 

, Arlene Bush, CRCST, CER, CIS, CHL, SME, DSMD, CRMST, the current president of Healthcare Sterile Processing Association (HSPA), makes a different case for 2026. If the field wants retention, resilience, and safer outcomes, it must start recognizing what works and how often.

Bush is nearing the end of her presidency, calling it “a true labor of love,” and reflecting on what she has learned from serving the association, working with industry partners, and supporting her chapter network. Even with only “a couple of more months” left in her term, she remains focused on momentum: expanding education, strengthening certification, and pushing leadership to recognize sterile processing as the high-skill patient safety discipline it is.

World Federation for Hospital Sterilisation Sciences

 Congress in Hong Kong, where she said it was valuable “to sit at the table with other industry leaders who have input on sterile processing globally.” What stood out was not just innovation, but how different the practice looks outside the US. “The US has the [Food and Drug Administration],” she said. “I think some people forget that.”

She also pointed to rapid product evolution, including “new robotic stuff,” and “new shorter biologicals,” emphasizing how cycle times that were once “hours long are no longer so.” For sterile processing teams under constant pressure, getting time back matters, but Bush grounded the conversation in the core mission: “to deliver safe, sterile equipment to every patient every time.”

The Case for Celebrating Throughput, Not Just Defects

One of Bush’s biggest themes was morale, and how sterile processing measures itself. “No one talks about the 2000 trays you did last week,” when everything went right, she said. “They talk about the one tray that was [wrong].” Her goal for 2026 is to shift that mindset and make throughput visible.

Bush described reviewing department totals and being surprised by the volume, even during the holidays. What mattered to her was not just the number of surgeries, but the instrumentation processed “with little to no defects.” Her challenge to leaders is practical: “It’s hard to change a number you can’t see.”

Certification Growth, and Why Membership Matters

Bush highlighted growth in certification as a marker of the field’s professionalization. “We’re like 67,000 [or] 68,000 certificate holders,” she said, noting that about “28,000 are actual members.” She encouraged certificants to consider membership, pointing out that for “the extra $10” members can vote and access reduced pricing and benefits.

She also previewed changes to certification requirements and urged technicians to follow HSPA town halls and podcasts for the most current updates. Her message was clear: Education is not optional in a field where standards, device design, and instructions for use (IFUs) are constantly changing.

IFUs Must Be Achievable, and Staff Need Real Access

Bush repeatedly returned to a point that other infection control and prevention personnel hear in different forms across the hospital: Policies and instructions only work if they can be followed. “It needs to be achievable,” she said. “It needs to be interpretable, and it needs to be effective.” When IFUs are unrealistic, she encouraged technicians to call manufacturers directly. “This is the way you wrote this IFU; it can’t work that way,” she said, adding that some vendors change and others refuse.

She also underscored how access affects adherence, sharing her own experience as a late-night technician who “never got access to the [Association for the Advancement of Medical Instrumentation (AAMI)] standards book” because it was “behind the door in the supervisor’s office.” Her commitment now is access for all shifts: “Doesn’t matter if it’s 3 o’clock in the morning or 9 AM.”

Rounding as Competency, Culture, and Prevention

Bush described rounding as one of the most effective tools leaders have to reinforce standard work, identify drift, and prepare staff for surveys. She gave concrete examples, from submersion decisions to rinse times to stopping when uncertain. “If you don’t know if it swims, don’t make it swim,” she said.

She also coached staff on what to say when asked a question they cannot answer. “Please don’t say ‘I don’t know,’” she said. Instead, staff should point to where the information lives: IFUs, policy, bottle label, or a supervisor.

However, Bush also reframed rounding as relationship-building rather than interrogation. Sometimes it is as simple as, “How was your weekend?” because approachability creates psychological safety. “That’s rounding,” she said. “You broke ice.”

Leadership, Mental Health, and The Human Stakes

Some of the most powerful moments came when Bush discussed leadership responsibility in high-stress departments. “You don’t know what people are facing at home,” she said. She shared an experience in which noticing a change in behavior, raising it with another leader, and acting quickly helped prevent a tragedy. “Mental health is a real, real thing,” she said, urging leaders to be attentive and compassionate.

Her summary advice for 2026 was simple and unusually direct for a technical field: “Just be nicer in 2026.”

Bush repeatedly connected sterile processing decisions to patient harm, even though the department rarely sees patients directly. “We’re the only department in the hospital that doesn’t actually get to see a patient,” she said. “But what we do is so important.”

When discussing distractions like phones and earbuds, she framed it in personal terms: “Do you have somebody you love a whole, whole lot?” If so, treat every tray like it is for them. “You never think it’s going to be you…until it is,” she said.

For sterile processing personnel, infection preventionists, and perioperative leaders, the interview reads as both a technical roadmap and a cultural one. The thread running through it is trust: trust in training, trust in standards, trust in each other, and trust that sterile processing is visible not only when something fails, but also when it succeeds thousands of times in a row.

Podcasts

In this ICT podcast, HSPA President Arlene Bush reflects on a year of global collaboration, shifting standards, and the realities of compliance in sterile processing. She shares why 2026 should focus on celebrating throughput wins, strengthening training through rounding, and leading with empathy in high-stress departments.

HSPA President Arlene Bush on Throughput, Standards, and Why Sterile Processing Must Celebrate Wins in 2026

Tommy Davis, By Tommy Davis, PhD, MMin, CMIP, CEPHP, LSSGB, BLS, is CEO, president, and principal officer at High Distinction Consulting, LLC, and is currently engaged in health care management. He is also a member of

Health care worker disinfecting a stainless steel sink in a medical facility for hygiene

At the peak of the COVID-19 pandemic, the author assumed an expanded operational role within the health care environment due to significant staffing shortages caused by mandatory quarantine protocols. In addition to serving in an executive leadership capacity during daytime hours, the author performed direct environmental services (EVS) responsibilities in the surgical suite during evening shifts to maintain a safe and sterile operative environment. This dual-role experience provided a unique opportunity for immersive, practice-based observation and served as preliminary field exposure informing subsequent case study research.

Operating rooms (ORs) require environmental control standards that exceed those of most other clinical spaces. Open tissues, invasive devices, and high procedural complexity increase the risk of exogenous contamination and subsequent surgical site infection (SSI). Systematic environmental cleaning and disinfection, including standardized, monitored, and evidence-based interventions, interrupts transmission pathways and functions as an essential adjunct to aseptic technique.

This review traces the historical evolution of OR hygiene, integrates contemporary evidence from perioperative environmental studies, and situates current practice within the scientific framework described in 

Block’s Disinfection, Sterilization, and Preservation

. Classic hospital housekeeping scholarship by Charlotte A. Aikens, RN; Sarah J. MacLeod, and Grace H. Brigham is examined alongside modern infection prevention literature to clarify EVS workflows, airflow dynamics, cross-contamination risks, medical waste realities, and the operational boundary between EVS and sterile processing departments (SPD).

Historical Foundations of Surgical Environmental Hygiene

Modern surgical cleanliness originated in the antiseptic reforms of Joseph Lister, OM, PC, FRS, FRCSE, FRCPGlas, FRCS, who applied germ theory to operative practice and demonstrated that environmental and instrument decontamination reduced postoperative sepsis. His methods reframed the operating space as a controllable microbial environment rather than an unavoidable source of contamination.

In parallel, Florence Nightingale institutionalized sanitation, ventilation, and order as pillars of patient survival, embedding environmental hygiene into hospital administration. Early twentieth-century hospital housekeeping manuals further professionalized these practices, translating cleanliness into routinized protocols, staffing structures, and supervisory accountability.

 offered pragmatic guidance for cleaning, supply preparation, and the governance of domestic affairs in institutions, signaling a move from improvisation to protocol.

 In the domestic sphere, but influential for methods of soil removal, agent selection, and workflow, Sarah J. MacLeod’s 

The Housekeeper’s Handbook of Cleaning 

compiled laboratory-tested strategies for cleaning materials and surfaces, many of which presage modern notions of soil chemistry and method standardization.

Housekeeping for Hotels, Motels, Hospitals, Clubs, Schools 

reflected a cross-sector professionalization of housekeeping with explicit hospital applications, including standardized routes, staffing, inspection practices, and the importance of training, which are elements that still underpin EVS programs.

By the early 2000s, objective verification tools such as fluorescent surface markers and adenosine triphosphate (ATP) bioluminescence assays transformed environmental hygiene from subjective assessment to measurable performance.

 These tools revealed persistent deficiencies in OR cleaning thoroughness and catalyzed data-driven quality improvement.

A surgically contaminated environment characterized by suboptimal environmental hygiene, inadequate ventilation control, and lapses in personnel adherence to aseptic protocols is comparable to conducting operative procedures in an uncontrolled, open-air setting exposed to environmental bioburden. Although immediate physiologic stability may be achieved, the postoperative surveillance period frequently reveals the downstream consequences of microbial contamination, often manifesting as SSIs and other health care-associated infections (HAIs) attributable to preventable breaches in environmental and procedural controls.

Environmental Cleaning and Patient Safety

Environmental surfaces in ORs serve as reservoirs for microbial transfer. A multicenter evaluation using fluorescent markers found that only one-third of high-touch OR surfaces were effectively cleaned during terminal disinfection, with peripheral objects demonstrating the lowest performance.

 Such findings confirm that environmental cleaning variability is a systemic risk factor.

A recent scoping review emphasized that OR cleaning effectiveness is inconsistent across institutions and often fails when improvement efforts target isolated elements (eg, product choice) rather than the entire work system, including workflow design and human factors.

 Environmental hygiene must therefore be approached as a complex sociotechnical process.

Air quality research further supports the conclusion that environmental control contributes to SSI prevention. Studies demonstrate that optimized airflow patterns and reduced turbulence over sterile fields are associated with lower airborne microbial counts and, in select procedures, reduced SSI rates.

 Surface decontamination and airflow management operate synergistically: Clean surfaces reduce particulate re-entrainment, while stable airflow minimizes redeposition.

1. OR Environmental Hygiene Is Clinical Care

Operating room cleaning is not housekeeping. It is a patient safety intervention. Surface disinfection, airflow management, and waste control directly influence SSI risk.

Fluorescent markers and ATP testing transformed OR hygiene from subjective assessment to measurable performance. Without objective monitoring, cleaning reliability declines.

3. Airflow and Human Behavior Are Interconnected

Door openings, equipment movement, and staff traffic alter airflow patterns and particle dispersion. Environmental cleaning and ventilation must be managed together as a system.

4. EVS and SPD Are Distinct but Interdependent

EVS manages environmental surfaces. SPD manages instrument reprocessing. Breakdown in either space increases the risk of contaminated devices entering the sterile field.

5. High-Reliability OR Hygiene Requires Systems Thinking

Standardized workflows, clear standard operating procedures, engineered room flow, real-time audit feedback, and coordinated EVS–SPD operations are necessary to sustain cleaning performance above 90 percent and reduce exogenous contamination risk.

Airflow, Behavior, and Cross-Contamination

Airborne particles in the OR originate from staff movement, equipment manipulation, and door openings. Experimental studies using fluorescent particle tracers show that activities such as repositioning overhead lights or activating forced-air warming devices can disperse particles toward the sterile field.

 These findings underscore that human behavior influences microbial dispersion as much as ventilation engineering.

Mitigation strategies include strict door discipline, minimized unnecessary equipment movement, and airflow designs that promote laminar or directed flow over sterile zones.

 Environmental cleaning supports these controls by removing reservoirs that could otherwise be aerosolized.

EVS personnel perform high-to-low damp dusting of overhead lights, booms, monitors, and horizontal ledges before sterile supplies enter. This removes settled particulates that airflow or staff movement could mobilize.

Turnover cleaning follows a clean-to-dirty, high-to-low sequence. High-touch surfaces near the patient and anesthesia workspace are disinfected with Environmental Protection Agency- (EPA)-registered agents using manufacturer-specified contact times. Visual coverage aids and standardized wipe systems improve dwell-time compliance.

 Single-use microfiber textiles are frequently employed in high-risk zones to reduce cross-contamination.

End-of-day terminal cleaning includes all horizontal surfaces, mobile equipment, wheels, cords, and floors, with particular attention to peripheral items identified as common audit failures.

 Fluorescent marking and ATP assays provide objective verification and feedback loops that sustain performance above 90% in long-term programs.

Foundational disinfection science emphasizes that soil removal precedes effective microbial inactivation and that disinfectant performance depends on compatibility with surface materials and organic load.

 These principles guide product selection in OR environments, where varied substrates (vinyl, stainless steel, cables, polymer surfaces) demand chemical compatibility and residue control.

ORs generate substantial volumes of regulated medical waste (RMW) and nonregulated packaging waste. Increased use of single-use cleaning textiles and protective barriers reduces cross-contamination but increases waste streams.

 Effective segregation at the point of generation, sharps discipline, and adherence to infectious waste handling principles are essential.

 Recycling initiatives must not compromise infection prevention or regulatory compliance.

SPD is responsible for medical device reprocessing, including decontamination, inspection, assembly, packaging, sterilization, and sterile storage under validated conditions.

 The sterile processing environment is of equal critical importance, as it serves as the controlled setting in which reusable surgical instruments are prepared for transfer to the operating room. Compromise of environmental controls in this setting increases the risk that extraneous particulate matter or microbial contaminants may become entrapped within instrument sets or packaging systems. Subsequent introduction of these contaminated devices into the sterile field can facilitate microbial inoculation of surgical tissues, thereby elevating the risk of SSIs and other procedure-related HAIs.

In most hospitals, EVS is responsible for environmental surfaces in both ORs and SPD workspaces but does not reprocess instruments. Clear handoffs and defined boundaries prevent workflow overlap while supporting aseptic integrity.

A High-Reliability Model for OR Environmental Hygiene

 Develop detailed SOPs covering precase, turnover, and terminal cleaning, including peripheral surfaces.

 Align supply placement and room flow with a unidirectional cleaning path; coordinate with surgical teams to reduce airflow disruptions.

 Employ fluorescent markers and ATP testing with real-time feedback.

 Integrate audit data into staff training and performance dashboards.

 Maintain role clarity while aligning environmental and device hygiene strategies.

EVS professionals are expected to demonstrate advanced expertise in disinfection science and practice, often exceeding that of other health care personnel, owing to their central role in establishing and maintaining a care environment that supports healing and minimizes pathogen transmission. Regardless of whether a surgical intervention involves superficial incisional, deep incisional, or organ/space procedures, EVS functions as a critical partner in the continuum of care, contributing directly to infection prevention, SSI risk reduction, and overall patient safety through evidence-based environmental hygiene practices.

From Lister’s antiseptic practices to modern human-factors-informed cleaning systems, the evolution of OR hygiene demonstrates that environmental cleaning is integral to clinical care. Airflow control, surface disinfection, waste segregation, and coordinated EVS–SPD operations collectively reduce exogenous contamination risk. When grounded in scientific principles and verified through objective monitoring, OR environmental hygiene becomes a reproducible, high-reliability safety practice.

The Housekeeper’s Handbook of Cleaning.

Housekeeping for Hotels, Motels, Hospitals, Clubs, Schools.

Carling PC, Church N, Jefferson J. Operating room environmental cleaning—evaluation using a new targeting method. 

Fieldhouse S, Bastaki BB, Ledgerton A, et al. Assessing the effectiveness of hospital cleaning using fluorescence: a proof of concept study and comparison with ATP testing. 

Feusner B, Alderman S, Heishman C. Equipment and surface location in operating rooms and potential impact on terminal clean effectiveness. 

Xie A, Sax H, Daodu O, et al. Environmental cleaning and disinfection in the operating room: a systematic scoping review through a human factors and systems engineering lens. 

 2024;45(7):880–889. doi:10.1017/ice.2023.280. Accessed online at 

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/environmental-cleaning-and-disinfection-in-the-operating-room-a-systematic-scoping-review-through-a-human-factors-and-systems-engineering-lens/542AB8D088D864124D7965F37398153F

Wagner J, Gormley T, Markel TA, Greeley D. Operating room improvements based on Environmental Quality Index risk prediction can help reduce surgical site infections. 

Cooper RA. Surgical site infections: epidemiology and microbiological aspects in trauma and orthopaedic surgery. 

Cutler HS, Romero JA, Minor D, Huo MH. Sources of contamination in the operating room: a fluorescent particle powder study. 

https://www.infectioncontroltoday.com/topic/operating-room

Revolutionizing hospital cleanliness: how color additives transform infection prevention. 

The rise of disposable products in health care cleaning and linens. 

https://www.infectioncontroltoday.com/view/rise-disposable-products-health-care-cleaning-linens

Block’s Disinfection, Sterilization, and Preservation.

 6th ed. Wolters Kluwer; 2020. Available online via Lippincott Williams & Wilkins Ovid Platform: 

https://internalmedicine.lwwhealthlibrary.com/book.aspx?bookid=2960

Articles

From Joseph Lister to modern airflow engineering, operating room safety depends on more than sterile technique. This in-depth review explains why EVS, airflow control, objective cleaning verification, and SPD coordination are critical to reducing surgical site infections and building high-reliability perioperative environments.

Surgical Site Infections Don’t Start in the Wound. They Start in the Room

Illustration of human kidney on blue background

(Adobe Stock 719193500 by Oleksandr with AI)

Infection prevention is evolving rapidly, and nowhere is that more evident than at the intersection of chronic disease, 

 outcomes. As the health care community continues to refine its approach to protecting vulnerable populations, timely, evidence-based discussion is essential.

 meeting on February 18, 2026, hosted by Kevin Kavanagh, MD, MS, a member of 

’s) editorial advisory board, and featuring Christos Argyropoulos, MD, PhD, MS, FASN. This session will focus on one of the most clinically and operationally relevant questions facing infection prevention and public health professionals today: the effects of repeated COVID-19 vaccinations versus COVID-19 disease in patients with kidney disease.

Topic: Health Watch USA Meeting
Time: Feb 18, 2026 07:00 PM Eastern Time (US and Canada)
 Every month on the Third Wed, until Dec 16, 2026, 11 occurrence(s)
Join Zoom Meeting


https://us02web.zoom.us/j/89170206444?pwd=WFi32Sdl5bPpZygQ5tGoqH3FHFvQpQ.1



Meeting ID: 891 7020 6444
Passcode: 240008

 or transplant care represent a uniquely high-risk population. They face increased susceptibility to infection, higher rates of severe COVID-19 outcomes, and complex immune responses shaped by uremia, inflammation, and immunosuppressive therapies. For infection preventionists, understanding how repeated vaccination compares with infection-related immune and nonimmune effects is critical to guiding policy, education, and patient-facing conversations.

Argyropoulos will examine both immunological and nonimmunological impacts of COVID-19 vaccination and disease in kidney patients. This includes how repeated vaccine exposure may influence immune function, inflammation, cardiovascular risk, and overall disease progression, as well as how COVID-19 infection itself can exacerbate kidney injury and long-term health outcomes. The discussion will emphasize evidence over ideology and data over speculation.

 readers, this session offers practical value beyond theory. The information shared will help inform risk communication with patients and families, guide vaccination and booster strategies within dialysis centers and 

 and support collaboration between infection prevention, nephrology, and public health teams. It also provides context for navigating ongoing vaccine misinformation that disproportionately affects medically vulnerable populations.

Health Watch USA meetings are designed to foster informed discussion grounded in clinical evidence and public health realities. This upcoming session is particularly timely as health systems prepare for future respiratory virus seasons while continuing to care for patients with complex chronic conditions.

, and join the conversation on how best to protect kidney disease patients through science-driven infection prevention strategies.


Topic: Health Watch USA Meeting
Time: Feb 18, 2026 07:00 PM Eastern Time (US and Canada)
 Every month on the Third Wed, until Dec 16, 2026, 11 occurrence(s)
Join Zoom Meeting


Join Health Watch USA on February 18, 2026, as Christos Argyropoulos, MD, PhD, MS, FASN, discusses how repeated COVID-19 vaccinations compare with COVID-19 disease in patients with kidney disease, with implications for infection prevention, risk communication, and care of vulnerable populations.

Health Watch USA to Examine COVID-19 Vaccination and Kidney Disease Outcomes

Closeup view of mold fungi Aspergillus invading lung tissue in pulmonary aspergillosis

(Adobe Stock 915520237 by InspireStock Gallery)

Invasive aspergillosis (IA) remains a serious and often fatal infection despite advances in diagnostics and antifungal therapy. Although mold-active triazoles have long been recommended as first-line therapy, liposomal amphotericin B continues to be used in selected patients because of drug interactions, toxicity concerns, and rising azole resistance. A new multicenter retrospective study published in 

 provides updated real-world data comparing these 2 approaches as primary therapy.

“Over the past decade, described risk factors for IA have broadened beyond classical disease states such as hematologic malignancies and solid organ transplantation to include patients with chronic pulmonary diseases, chronic steroid treatment, and prolonged [intensive care unit] hospitalization,” the authors wrote.

The study evaluated adult patients with proven or probable IA treated at 2 tertiary academic hospitals in northern Italy over a 10-year period from January 2013 through December 2022. Investigators compared outcomes among patients who received either liposomal amphotericin B or mold-active triazoles as initial antifungal therapy, focusing on all-cause 90-day mortality from diagnosis.

A total of 401 patients met the inclusion criteria. The median age was 65 years (interquartile range, 56-74 years), and 60.8% of patients were male. Most cases were classified as probable IA (96.0%), with proven disease accounting for 4.0%. The most common predisposing condition was hematologic malignancy in 151 patients or 37.7%, followed by viral-associated pulmonary aspergillosis in 120 patients or 29.9%. Chronic steroid treatment and chronic pulmonary disease were each present in 64 patients, or 16%.

Initial antifungal therapy consisted of mold-active triazoles in 296 patients (73.8%), whereas 105 patients (26.2%) received liposomal amphotericin B. Among those treated with triazoles, voriconazole was used in 272 patients (91.9%), and isavuconazole in 24 patients (8.1%). No patients received posaconazole as primary therapy. Combination antifungal therapy was uncommon overall, occurring in 18 patients (4.5%), but was more frequent in the liposomal amphotericin B group than in the triazole group (9.5% vs. 2.7%).

Treatment modification was significantly more common among patients who initially received liposomal amphotericin B. In this group, 66 patients (62.9%) switched therapy at a median of 10 days after diagnosis. The most common reason for switching was transition to oral triazoles, which occurred in 71.6% of those who changed therapy. In contrast, only 46 patients (15.5%) in the triazole group required treatment modification at a median of 13 days, most often due to adverse events (45.1%).

Despite differences in treatment durability and switching patterns, survival outcomes were similar between groups. The overall 90-day survival rate was 58.8% for patients treated with triazoles and 53.3% for those treated with liposomal amphotericin B. Using a landmark analysis beginning at day 7 postdiagnosis and inverse probability of treatment weighting to address confounding by indication, investigators found no statistically significant difference in mortality. The adjusted hazard ratio for death was 1.43 (95% confidence interval, 0.87-2.33).

For infection prevention personnel, these findings reinforce several important points. First, IA continues to affect a broad population beyond traditional hematologic malignancy patients, including those with severe viral respiratory infections and chronic steroid exposure. Second, primary therapy with liposomal amphotericin B was well tolerated and associated with outcomes comparable to triazoles in this real-world cohort. Finally, the high rates of treatment switching highlight the importance of antifungal stewardship, monitoring for adverse events, and early reassessment of therapy.

The authors conclude that, although triazoles remain the standard first-line therapy, liposomal amphotericin B is a viable alternative for selected patients. Further studies are needed to better define which patients may benefit most from primary liposomal amphotericin B therapy and how treatment choice impacts outcomes across evolving IA risk groups.

A multicenter study of 401 patients with invasive aspergillosis found similar 90-day survival with mold-active triazoles and liposomal amphotericin B as primary therapy. As IA risk expands beyond traditional populations, the findings underscore the role of antifungal stewardship and careful treatment selection in infection prevention.

Triazoles vs Liposomal Amphotericin B Show Similar Survival in Invasive Aspergillosis Study 

Ali Cadili, MD, MBA, MS, is a US surgeon and clinical researcher in surgical critical care and acute care surgery at West Virginia University Medicine. 

The wellness industry is moving faster than science, and infection preventionists are increasingly left to sort out what actually works from what merely sounds promising.

From supplements claiming to “boost immunity” to wearables marketed as early infection detectors, wellness content often blurs the line between personal optimization and public health protection. For clinicians and infection prevention professionals, that confusion carries real consequences: misplaced confidence, wasted resources, and missed opportunities to invest in interventions that truly reduce transmission.

) speaks with Ali Cadili, MD, MBA, MS, a U.S. surgeon and clinical researcher specializing in surgical critical care and acute care surgery, to cut through the noise. Drawing on clinical outcomes, transmission dynamics, and real-world feasibility, Cadili offers a clear-eyed assessment of which “2026 wellness trends” belong in the legitimate infection prevention toolkit and which belong firmly in the hype bucket.

: When you hear “2026 wellness trends,” what do you immediately put in the legit bucket for infectious disease prevention, and what goes straight into the hype bucket? What criteria are you using (clinical outcomes, transmission dynamics, real-world feasibility, equity, cost)?

 Legit trends include hygiene and handwashing, vaccination, improved air quality (especially indoor) and ventilation, gut health optimization with fiber-rich foods and probiotics. Hype bucket: unproven supplements which claim immune-boosting effects, vacations marketed as boosting immunity through physical activity in "clean environments," and personalized "biohacking" apps and wearable devices. The main criteria for deciding include evidence and data on clinical outcomes, as well as specific disease and transmission dynamics.

: Which trend do you think will have the biggest measurable impact on respiratory virus spread in everyday settings (home, schools, workplaces)? What does the evidence actually show, and what’s the most common misunderstanding you’re seeing online or in your practice?

 Improved indoor air quality and ventilation for home and public spaces, handwashing, and basic hygiene principles in hospitals and medical centers. Evidence shows that improved indoor ventilation and air quality lower COVID-19 incidence in schools and minimize aerosol buildup. A common misconception is that hand hygiene and surface cleanliness (wiping) alone are adequate in preventing respiratory (lung) viruses. This ignores the all-pervasive airborne route via aerosol particles.

: Much of wellness content blurs “immune support” with infection prevention. What claims are scientifically plausible, which are overstated, and what red flags should clinicians and consumers watch for (dose, endpoints, surrogate markers, conflicts of interest)?

 Scientifically plausible claims: vitamin D supplements, zinc, vitamin C, probiotics, as well as selenium and other micronutrients (when the person is deficient in them). Overstated claims: echinacea or elderberry (for blanket, broad immune enhancement), vitamin C or zinc as a panacea (cure-all) for infections, superfoods (such as garlic or turmeric) for comprehensive immunity, any food or supplement that is mistakenly touted as a replacement for hygiene, good air quality, and vaccinations. 

Red flags include mega doses of supplements (such as vitamin D) linked to extraordinary or sweeping claims, using surrogate markers such as cytokine levels or antibody titers to support extraordinary claims (such as reducing infection or boosting immunity by 1000%), influencers or endorsers with conflicts of interest, and supplements with only studies produced by the manufacturer without independent scientific verification.

: What is the current state of play on “wearables and AI” for infection prevention? Which use cases are realistic (early symptom detection, exposure notification, indoor air monitoring), and where do you worry we’re overpromising or creating false reassurance?

 High risk of overpromising accuracy, leading to a false sense of security and/or delinquency or laxness in proven and time-honored methods of preventing infections. They show promise in early symptom detection, notification of exposure, and indoor air quality monitoring. However, there is definitely hype in overstating their accuracy, and there are also significant privacy risks and concerns.

: There is renewed interest in environmental controls (air cleaning, Far-UV, antimicrobial surfaces, “cleaning hacks”). What actually reduces transmission risk, what depends heavily on context, and what questions should a facility ask before investing (validation, safety, maintenance, workflow fit)?

 Practices which actually reduce transmission risk: air cleaning, HEPA filters, far-UV light, and antimicrobial coated surfaces such as silver and copper. Depends heavily on context: standard ventilation and air circulation systems, DIY and home-based disinfectants, chemical disinfectants, and routine surface cleaning. Questions: efficacy data and evidence, safety, maintenance requirements, longevity, and overall fit with existing milieu.

: If you had to give one “2026-proof” playbook for preventing infectious diseases that cuts through trend cycles, what are the top 3 actions you’d prioritize—and how would you measure success?

 Basic hygiene practices, ventilation, and indoor air quality, vaccinations. Success measured: infection rate and death rate (most important), compliance, and ventilation targets.

: Would you please provide guidance on mask use (which masks?) and the 6-foot rule? Do they really work, and what do you say to those who say they don’t work?

 I recommend well-fitting N95 masks over cloth masks to minimize aerosol transmission; the next best option is surgical masks. The 6-foot rule does work in indoor and crowded settings, but more is better, since evidence has shown that aerosols can linger and travel longer than this distance. To skeptics, I would empathize that masking and distancing may cause inconvenience and are by no means perfect, but there is evidence to back their utility; this situation may be similar to how seatbelts do not prevent all car crash injuries but have been shown to save lives.

As “wellness” trends flood social media and consumer health marketing, separating credible infection prevention strategies from hype has never been more urgent. In this Q&A, surgeon and clinical researcher Ali Cadili, MD, MBA, MS, breaks down which 2026 wellness trends are grounded in evidence, and which risk creating false reassurance, covering air quality, hand hygiene, supplements, wearables, masking, and environmental controls.

Wellness vs Science in 2026: What Actually Prevents Infections—and What’s Just Hype

Preventable healthcare-associated infections (HAIs) remain a costly and persistent threat to patient safety, and the reprocessing of semi-critical devices—particularly ultrasound probes—represents a critical point of vulnerability. Manual cleaning methods are time-consuming, inconsistent, and highly dependent on human performance, creating wide variability in outcomes and increasing the risk of residual contamination like biofilm formation and downstream infection transmission. Despite their routine use across clinical settings, few healthcare facilities have fully addressed the limitations and compliance risks inherent in manual probe cleaning workflows.

As regulatory scrutiny and staffing pressures intensify, ensuring consistent, validated cleaning prior to high-level disinfection has become essential. Automated cleaning technologies are emerging as a practical response to these challenges, offering standardized, repeatable processes that reduce human error and integrate more seamlessly into modern clinical workflows. Evidence increasingly shows that automation not only improves cleanliness outcomes but also reduces operational burden, audit risk, and long-term financial exposure associated with HAIs and device damage.

Insights from Jill Holdsworth, CIC, FAPIC, Medical Affairs Manager at CS Medical, highlight the risks of manual ultrasound probe cleaning, as well as how automation can strengthen reprocessing programs, improve patient and staff safety, and deliver measurable operational and cost benefits for healthcare facilities navigating today’s complex clinical environment.

CS Medical manufactures and markets automated medical device reprocessing solutions that clean and high-level disinfect ultrasound probes, helping healthcare providers reduce patient risk and improve compliance. Founded in 2003, the company is recognized as a pioneer in automated ultrasound probe reprocessing, delivering science-based, FDA-cleared technologies that replace manual processes with consistent, validated workflows across transesophageal, endocavity, and surface ultrasound probes. For more information, visit 

The risks of manual ultrasound probe cleaning are costly. Jill Holdsworth, CIC, FAPIC, Medical Affairs Manager at CS Medical, shares insights on how automation can improve consistency, compliance, and patient safety while also driving financial savings.

Manual Cleaning vs Automation: Achieving Consistent Cleanliness for Ultrasound Device Reprocessing

 helps educate readers about existing and emerging pathogens of clinical importance in health care facilities today. Each column explores the 

's etiology, the infections it can cause, the modes of transmission, and ways to fight its spread. The pathogen profiles will span bacterial, viral, fungal, and parasitic species. 

 as a teaching tool to help educate health care personnel and start a dialogue about microbiology-related imperatives.

I am older than your hospitals and quieter than your alarms. I was first identified in the 1930s and first isolated in 1978. I do not need crowds, airports, or coughing strangers to move from place to place. I wait. I persist. I thrive in the overlooked spaces where dust settles, and no one thinks to look twice.

I do not belong to you; I never have. My true home has whiskers and sharp teeth and a heartbeat that quickens at night. I circulate silently among small mammals, passing without ceremony, without illness, without consequence. In them, I am harmless. In you, I am anything but.

You rarely notice me at first. It takes 1 to 8 weeks for your first symptoms from me to show up. I arrive without drama, carried on the air you disturb when you sweep, clean, renovate, or enter spaces left undisturbed too long. I am invisible, inhaled rather than touched, drawn deep into lungs built for oxygen, not for me. I do not announce myself immediately. I give you time to doubt what you’re feeling.

At the beginning, I am subtle with fever, fatigue, aching muscles. A headache that feels like so many others. You tell yourself it’s viral, seasonal, nothing unusual. There is no rash to warn you, no telltale sore throat. Even now, you underestimate me.

Your lungs tighten. Breath becomes work. Fluid seeps where air should be. Your immune system, trying desperately to help, turns the battlefield inward. Capillaries leak. Oxygen falls. What began as a mild illness accelerates into something that demands intensive care, ventilatory support, and vigilance. Some of you recover. Approximately 38% of you do not.

Others of you feel me elsewhere. I reach the kidneys, where balance and filtration are sacred. Your urine output drops, and your blood pressure wavers. Fluids shift dangerously. You swell, then dehydrate. Again, your body fights hard, but the cost is steep.

Only one of my strains, which is not found in the US, spread between humans. That is not my way. I do not need pandemics to survive. My power lies in rarity and severity, in the way I appear unexpectedly, tied to geography, climate, season, and human behavior. When drought pushes my hosts closer to your homes, when construction disturbs old spaces, when cleaning happens without protection, you invite me in.

You look for me only after I have made myself known. By then, treatment is supportive. You have no targeted cure waiting in your pharmacy; you will only receive supportive care, including rest, hydration, and treating the symptoms. Early recognition, awareness, and understanding that infection prevention does not end at the bedside; it begins with environment, wildlife control, ventilation, and respect for what lingers unseen.

I do not care about your schedules or staffing shortages. I exploit gaps between cleaning protocols and construction plans, between occupational safety and infection prevention, between what you know and what you assume won’t happen here.

Bug of the Month: The Quiet Guest in the Dust

A long-term care facility's nurse ministering to an elderly woman.

A recent case-control study found that continuous photohydrolysis disinfection significantly reduced environmental bioburden, MDRO acquisition, COVID-19 cases, and hospital transfers in a long-term care facility, without adding staffing demands. The findings highlight the role of continuous air and surface disinfection as a complementary strategy to manual cleaning in addressing antimicrobial resistance and infection risk in LTC settings.
