Anthony Onunga, MBChB, is a practicing medical doctor and health enthusiast with a deep passion for sharing information on medical topics.

Anthony Onunga, MBChB

For over 8 decades, chicken eggs have been at the heart of vaccine production. While newer technologies for vaccine development exist, egg-based vaccines still account for over 80% of influenza (flu) vaccines produced globally.

 Egg-based vaccine technology goes beyond seasonal flu shots and nasal sprays to include vaccines for yellow fever and Q fever. Among these, the flu vaccines are the most commonly used because of the recurring threat of seasonal influenza.

But why do chicken eggs remain so vital in vaccine production in the modern era of genetic engineering and next-level science? Is it because of the cost, availability, or simply a case of old habits dying hard?

Why Chicken Eggs are Used in Vaccine Production

In the 1930s, scientists discovered that embryonated eggs could be used to grow influenza viruses. This breakthrough set the stage for egg-based vaccines, a practice that continues to this day.

Viruses require a biological environment for replication, and the egg was an ideal choice, especially in early times. It provides the nutrients necessary for viral growth, and by adjusting conditions such as temperature and humidity, scientists can optimize viral replication.

Egg-based vaccine production has stood the test of time. It is a well-understood process, with years of successful use. Researchers and industry players are familiar with the method, and the vast amount of available data makes it an easy choice compared to newer technologies.

Another advantage is cost: Producing vaccines in eggs is cheaper than using cell cultures or recombinant technologies. This makes eggs a practical option for large-scale vaccine production.

A Glimpse at the Process of Vaccine Development Using Eggs

The process begins with incubating fertilized eggs and inoculating them with the target virus. The infected eggs are maintained at optimal temperatures to allow viral propagation, and antibiotics are usually added to prevent bacterial contamination.

After 2 to 3 days, the virus-rich allantoic fluid is harvested. The viruses are then inactivated using chemical agents such as formaldehyde, β-propiolactone, or binary ethylenimine, each requiring specific conditions to ensure complete inactivation.

The viral particles are then concentrated, purified, and sterile processed before packaging for administration.

How Effective are Egg-based Vaccines in Rapid Pandemic Response?

Scientists predict that pandemics with mortality potential similar to COVID-19 could occur every 33 to 50 years.

 Can egg-based vaccines meet the demands of such emergencies?

For context, egg-based influenza vaccines take 6 to 8 months to produce under World Health Organization (WHO) guidelines. This extended timeline is ill-suited for pandemic control, where rapid vaccine availability is critical. Viruses associated with pandemics often mutate rapidly, leaving vaccines playing catch-up. There is no doubt that mRNA vaccines, which take about 1 to 2 months to produce, came into the picture during the COVID-19 pandemic.

Experience also highlights challenges with egg-based vaccines. For example, during the 2010 to 2011 flu season, the vaccine strain differed from the circulating virus, significantly reducing effectiveness. Such mismatches during a pandemic could have catastrophic consequences.

The egg-based vaccines have some shortfalls both terms of resources needed and the quality of the end product.

Egg-based production requires a steady supply of fertilized eggs. For influenza alone, vaccine production capacity is about 1.53 billion doses annually, which consumes millions of eggs. Therefore, disruptions in supply chains could threaten vaccine availability.

Viruses grown in eggs can mutate to better adapt to avian cells. Unfortunately, this may reduce their affinity for human receptors, lowering vaccine effectiveness. In some cases, egg adaptation can lead to loss of antigenicity. For instance, studies linked egg adaptation to reduced influenza vaccine effectiveness in the 2012 to 2013 flu season.

Viruses undergo frequent mutations, a process known as antigenic drift, which can quickly render vaccines less effective. Because egg-based production takes months, it often struggles to keep pace with these changes. The WHO selects strains annually for flu vaccines, but by the time vaccines are distributed, circulating strains may have already taken up different mutations.

Egg-based vaccines raise questions among individuals with egg allergies. Fortunately, influenza vaccines usually contain only trace amounts of egg proteins, insufficient to cause reactions in most cases. Purification steps during manufacturing further reduce residual proteins.

Since the 2023 to 2024 season, the CDC has recommended that no additional precautions are necessary for people with egg allergies who receive flu vaccines, regardless of the severity of their previous egg allergy. Overall, seasonal flu vaccines have an excellent safety record. In a vaccine safety study, the rate of anaphylaxis was 1.35 per million doses.

However, individuals with allergies to other vaccine components should avoid vaccination and seek specialist consultation.

On the other hand, yellow fever and Q fever vaccines contain relatively higher amounts of egg protein. Therefore, it is recommended that people with severe egg allergies consult a specialist before getting these vaccines.

All vaccines should be administered in settings equipped to recognize and manage allergies, in case an event requiring medical attention occurs.

Alternatives to Egg-Based Vaccines: Cell Culture-Based and Recombinant Vaccines

Cell culture–based and recombinant vaccines offer promising alternatives to the egg-based technology. With giant leaps being taken in vaccine production every day, it is evident that scientists are working towards reliable alternatives.

For cell culture-based vaccines, viruses are grown in specific mammalian cells. After replication, viral antigens are harvested, purified, and packaged for use. Initially, some viruses used for cell culture-based production were propagated in eggs, but they are now exclusively grown in cell cultures.

Recombinant vaccines use viral genetic material encoding the antigenic protein. The gene is inserted into a plasmid, expressed in host cells, and the antigen is then extracted, purified, and packaged.

With these methods, vaccine manufacturers can bypass the need for eggs, enabling faster turnaround times. Recombinant vaccines are particularly efficient since they do not require candidate vaccine viruses. Additionally, they avoid egg adaptation issues, often resulting in higher vaccine effectiveness.

However, these alternatives are more expensive than egg-based vaccines. While they guarantee faster production, the resources required can be out of reach, especially for developing nations that do not have access to even the cheaper egg-based vaccine production infrastructure.

While newer technologies produce viral strains very similar to human strains, there is still room for variation, especially with cell culture-based vaccines, which can be affected by mutations in host cells. Moreover, some cell culture-based technologies yield low viral titers.

The chicken egg remains a cornerstone of vaccine production. Its role as a medium for viral propagation is simple yet critical. Even as newer technologies advance, the egg continues to hold value due to its proven safety, cost-effectiveness, and historical success. While the future may lean more heavily toward cell-based and recombinant platforms, more work is still needed in research and improved efficiency to achieve high production rates with the alternative methods.

Despite global influenza vaccine production remaining steady, production and distribution challenges remain.

 World Health Organization. March 25, 2025. Accessed September 4, 2025. 

https://www.who.int/news/item/25-03-2025-despite-global-influenza-vaccine-production-remaining-steady--production-and-distribution-challenges-remain

Estimated future mortality from pathogens of epidemic and pandemic potential.

https://www.cgdev.org/sites/default/files/estimated-future-mortality-pathogens-epidemic-and-pandemic-potential.pdf

Choi YJ, Song JY, Wie SH, et al. Real-world effectiveness of influenza vaccine over a decade during the 2011-2021 seasons: implications of vaccine mismatch. 

 2024;42(26):126381. doi:10.1016/j.vaccine.2024.126381

Skowronski DM, Janjua NZ, De Serres G, et al. Low 2012-13 influenza vaccine effectiveness associated with mutation in the egg-adapted H3N2 vaccine strain, not antigenic drift in circulating viruses. 

 2014;9(3):e92153. doi:10.1371/journal.pone.0092153

Flu vaccines and people with egg allergies.

https://www.cdc.gov/flu/vaccines/egg-allergies.html

Boyce TG, Levine MZ, McClure DL, et al. Antibody response to sequential vaccination with cell culture, recombinant, or egg-based influenza vaccines among US adults. 

 2024;20(1):2370087. doi:10.1080/21645515.2024.2370087

https://www.cdc.gov/flu/vaccine-types/flublok-vaccine.html

Articles

For more than 80 years, the humble chicken egg has quietly powered one of modern medicine’s most vital defenses: vaccines. Even in an age of recombinant DNA, mRNA platforms, and cell-based innovations, more than 80% of the world’s influenza vaccines still begin in an egg. The process is time-tested, affordable, and reliable—but also imperfect. read this to learn more. 

What’s in an Egg: The Age-Old Vaccine Production Method Lives On 

A health care professional's gloved hands meticulously clean and sterilize a surgical instrument with a green sterile cloth.

Surgical site infections (SSIs) remain a major contributor to health care-associated infections (HAIs), accounting for roughly 20% of all HAIs in the US.

 This statistic is concerning, but it comes with a silver lining. Most SSIs are preventable. While the usual emphasis tends to fall on sterilization protocols and perioperative practices, one critical intervention can be done much earlier at the point of use of surgical instruments. These are the simple, immediate steps taken in the operating room (OR) to disrupt bioburden.

How can health care facilities and health providers implement point-of-use (POU) instrument care? Here’s a closer look at the entire process, the principles guiding its implementation, and the potential barriers to implementing point-of-use instrument care.


POU instrument care is the immediate precleaning, handling, and treatment of instruments at the site of their use, in this case, the OR. These are the initial steps to ensure there is no build-up of organic matter or dirt on the instruments before they are taken to the central sterile supply department (CSSD).

The steps involved in POU instrument care are

Removing gross debris from the instrument as soon as possible after use and at the end of the surgical case

Flushing cannulated instruments with sterile water to prevent build-up of debris and clogging of the lumen

Keeping the instruments moist to help keep the bioburden low

Disassembling all the instruments correctly, following the manufacturer’s instructions for use (IFU)

Segregating reusable sharps and properly discarding the disposable sharps

Transporting the instruments in the appropriate containers

Immediately after an instrument is used in the OR, the next thing to keep in mind should be how to prevent colonization by microorganisms. While reusable medical devices (RMDs) are sent to the sterilization unit, the initial step of decontamination should occur immediately next to the operating table. Once the surgeon hands over the instrument, the scrub technician should clean it as soon as possible. Simply wiping off blood or debris with a sterile gauze goes a long way in preventing SSIs and ensuring the instrument stays in great condition for a long time.

With proper POU instrument care, biofilms are not left to dry. Early removal of any debris or dirt enhances the effectiveness of decontamination and sterilization.


POU instrument care has a host of benefits, reducing the risk of SSIs in the long run and promoting good outcomes of surgical procedures:

POU instrument care reduces the number of microorganisms on the surface of the instruments and lowers the risk of contamination during the subsequent steps.

It breaks the cycle of biofilm formation by preventing the drying of the bioburden, thereby making it possible to sterilize the instruments effectively.

Precleaned instruments are easier to decontaminate.

It reduces the risk of surgical site infections by promoting proper disinfection and sterilization.

Point-of-use instrument care keeps instruments in proper working condition by minimizing corrosion and pitting from organic matter, therefore prolonging the lifespan of the instruments.


Health care facilities need to implement guidelines for the care of POU instruments and establish standards of reference. This is a multidisciplinary process that incorporates different cadres, including the people working in the OR, CSSD, transporters, as well as administrators.

How can facilities effectively implement POU instrument care? Here are the critical steps leading to effective POU instrument care.


 Once the staff understand and appreciate the importance of POU instrument care, they are more likely to embrace it. The aim is to elaborate on the benefits of POU instrument care and emphasize that it is a crucial step in fighting SSIs and improving the quality of care.


 To maintain effective POU instrument care, certain supplies will be required. For example, the ORs will need to be equipped with the appropriate enzymatic sprays, pre-soak containers, moist towels, and leak-proof bins, among many others that might be lacking.


 The availability of clear and precise standard protocols will ensure that steps are followed consistently and that everyone knows their responsibilities. These protocols are customized for the hospital or the OR, taking into consideration the staff available, their numbers, and their skill levels.


 The people working in the OR and those at CSSD need to be on the same page. Everyone should understand their roles as per the standard protocol. The 2 teams should also synchronize the time of collection and transportation of the instruments between the OR and CSSD.


 To ensure adherence, the facility should establish regular audits and feedback mechanisms from the staff involved in handling the surgical instruments. These will serve as the basis for making any necessary tweaks to the standard protocols and identifying gaps in the process.

The Barriers to Implementing Effective Point-of-Use Instrument Care


In establishing POU instrument care, challenges may be encountered along the way, especially in settings where this has not been standard practice. Here are some of the challenges identified in a study conducted by researchers from the Graduate School of Nursing in Bethesda, Maryland.


 The lack of simple and easy-to-follow procedures for the people handling surgical instruments presents a problem. Similarly, having multiple instruments from different manufacturers, each with its own specific instructions for use, is also the case. It is challenging for the staff to retain all the different instructions for use for the hundreds or even thousands of instruments in a surgical unit.
 The complexity of the procedures for preparing disinfectant solutions leads to inconsistencies. Different workers may interpret the procedures differently, resulting in varying concentrations and, consequently, differing effectiveness of microbial elimination.


 In settings with high-volume work or understaffing, there is constant pressure to prepare the instruments for the next case. This could make it difficult for the staff to carry out effective POU treatment. While it may not be possible to achieve spotless instruments during the procedure, additional cleaning can be done between cases.

Lack of Knowledge Among Healthcare Workers


 The workers handling the instruments may not possess the knowledge and skills required to manage some of the complex or newly procured equipment. This calls for fresh training and creating awareness to ensure everyone is well-informed.


 Getting new supplies, such as enzymatic sprays or foams, can add more costs to the facility. Additional resources must be mobilized to address this. On the bright side, the cost will be reduced in the long run if the hospital succeeds in implementing POU instrument care, thereby reducing the occurrence of SSIs.


 Ambiguous policies make it difficult to execute the plan of POU instrument care because there is no clarity on who is responsible for specific roles, and it is difficult to maintain accountability.
 Hospitals can effectively maneuver these barriers by availing the resources needed and ensuring the guiding policies that are clear.


 Implementing POU instrument care is a simple yet powerful step towards reducing SSIs, protecting patients, and ensuring good surgical outcomes.
 By empowering OR teams to take responsibility for instrument hygiene at the initial stage of processing, health care facilities create a culture of safety, accountability, and excellence. For infection preventionists and surgical teams alike, embracing POU care is not just good practice, it is essential.

1. Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. 

2. Eberhardt GL, Atwood BI, Smith JD. Point of Use Treatment for Medical Devices: From Bedside to Battlefield. 

. 2024;189(9-10):e1910-e1916. doi:10.1093/milmed/usad499

3. Weber DJ, Rutala WA, Anderson DJ, Sickbert-Bennett EE. Biofilms on medical instruments and surfaces: Do they interfere with instrument reprocessing and surface disinfection. 

. 2023;51(11S):A114-A119. doi:10.1016/j.ajic.2023.04.158

4. Whitacre Martonicz T. Environment and time cause chemical changes in clinical soil on medical devices. 

. April 28, 2022. Accessed July 17, 2025. https://www.infectioncontroltoday.com/view/environment-time-cause-chemical-changes-clinical-soil-medical-devices

Implementing Point-of-Use Instrument Care to Mitigate Surgical Site Infections in Operating Rooms

 remains a problematic bug in hospital settings, contributing to a range of nosocomial infections. In the US, multidrug-resistant 

 causes 13% to 19% of health care–acquired infections (HAIs) annually.

 The pathogen can survive harsh conditions, and it has devised virulence mechanisms and resistance to a broad range of antibiotics. This is particularly the case for the strains that carry the Verona integron–encoded metallo-β-lactamase (VIM), an enzyme that confers resistance to carbapenems, often reserved as last-line antibiotic therapy. Multiple cases of VIM-positive 

VIM-PA), have been reported in intensive care units (ICUs), raising concerns for the patients and the staff. The mortality rate of these infections is quite alarming, usually exceeding 30%, depending on the site of infection and the underlying condition of the patient.

The nature of the clinical cases often managed in the ICU and the therapeutic procedures carried out in this setting can create a breeding ground for formidable disease-causing microorganisms, such as 

. Long hospital stays, severe illnesses, and deranged immune defenses are characteristic features of the typical ICU patient. These may encourage infection with VIM-producing 

 or even silent colonization, which can remain undetected until clinical deterioration or transmission to other patients occurs.

To develop effective guidelines for infection prevention and manage outbreaks, a deeper understanding of the risk factors that specifically lead to VIM-PA colonization and infection is needed. This piece highlights some of the environmental, patient-related, and provider-related issues in the ICU that can contribute to the growth of these superbugs.

The environment in the ICU is a key contributor to colonization and infection by VIM-PA. In a retrospective study conducted in the Netherlands, researchers found that persistent environmental contamination by 

 was the primary source of bacterial transmission. In the study, 86.3% of the transmissions were attributed to a contaminated environment, compared with 13.7% of the cases that were attributed to cross-transmission.

, routine disinfection protocols are sometimes insufficient, primarily due to the virulence and antimicrobial resistance patterns exhibited by these bacteria, particularly in biofilm formation. 

 can adhere to surfaces and employ other mechanisms such as quorum sensing and growth inhibition to perpetuate the biofilm and promote tolerance to antibacterial agents.

In the ICU environment, numerous high-touch surfaces can serve as reservoirs for VIM-producing 

. Most health care workers will be concerned about countertops and medical trolleys, while ventilator buttons, bed rails, and infusion stands may receive less attention during routine cleaning despite being potent niches for these bugs.Ventilator circuits, bronchoscopes, urinary catheters, and extracorporeal membrane oxygenation lines can also harbor biofilms that protect VIM-PA from both immune clearance and disinfectants. If not rigorously sterilized or replaced, these devices can act as persistent sources of infection.

 thrives in a wet environment, and sink drains provide a preferred niche for these bacteria, with splashes traveling a distance of up to 1 m from the basin.

 A study in a Swedish hospital established that sink drains harbored VIM-PA, and dispersing the biofilms in the drainage system led to control of an outbreak.

In another study in Switzerland, the researchers went a step further and removed all sinks near the patients in the ICU, adopting a completely waterless model.

 They decided to go completely waterless after the initial attempts to replace the sink siphons led to reinfections in just a few weeks. In the waterless model, a handwashing sink was placed outside the ICU rooms, and disposable wipes and single-use hygiene kits were used. Oral medication was dissolved in spring water. Only after these interventions was the outbreak of the multidrug-resistant 

These studies underscore the importance of reconsidering the drainage architecture of ICUs and hospitals at large.

High patient-to-nurse ratios, poor hand hygiene, and a lack of adherence to personal protective equipment regulations among health care workers contribute to horizontal transmission. Additionally, family members and other visitors, especially in neonatal or long-term ICUs, can serve as vectors if proper infection control measures are not enforced.

Prior Antibiotic Use and Prior Hospitalization

Patients with prior antibiotic exposure, especially to carbapenems or fluoroquinolones, are at a higher risk of VIM-PA colonization and infection. This is because overuse or prolonged use of these broad-spectrum antibacterial agents favors the colonization by resistant strains. The use of these drugs often leads to the elimination of susceptible strains, leaving behind undetectable and resistant strains that are then spread from patient to patient or colonize the environment. Antibiotic use within 3 months of admission to the ICU puts patients at risk of developing carbapenem-resistant 

Patients previously admitted to a hospital before their current ICU admission are more likely to develop VIM-PA infection and colonization due to the increased risk of exposure to these bacteria.

 Similarly, longer admission periods in the ICU can lead to a higher risk of colonization and infection. In the same breadth, long-term care facilities are also known to harbor many drug-resistant bacteria.

Patients coming to the ICU with an already established 

 colonization are more likely to have positive cultures later. In a study at the University of Maryland Medical Center, patients were tested for 

 colonization at admission and monitored. Patients colonized with 

 were over 6 times more likely to have a subsequent positive clinical culture than patients who were initially not colonized.

Advanced age is a known risk factor for developing HAIs mainly because of weakened immune function. Additionally, people of advanced age are more likely to have comorbidities and frequent exposure to health care settings, which directly translates to more exposure to disease-causing microorganisms. A 2010 study found that people above 86 years of age in a long-term care facility were more likely to develop drug-resistant strains of bacteria.

In the ICU, older patients often spend longer periods on the ventilator. They are also likely to undergo more invasive procedures, leading to a higher risk of exposure to pathogens such as VIM-PA.

A study conducted in 2 district hospitals in the United Kingdom identified anemia as a risk factor for 

 infection, with 53% of cases having hemoglobin levels below 11.5 g/dL.

This can be attributed to the fact that anemia is often associated with other factors, such as poor nutritional status, which can compromise the immune system. Anemia can also be caused by conditions such as bone marrow suppression, inflammatory conditions, and even cancer, which can all predispose patients to infections by drug-resistant bacteria.

The severity of a patient’s illness correlates with the risk of acquiring VIM-PA. Patients with severe disease are more likely to undergo more invasive procedures, stay longer on the ventilator in the ICU, and receive more broad-spectrum antibiotics, all of which can increase the risk of colonization by VIM-PA.

Studies have shown that specific clinical conditions are more likely to be associated with 

 colonization. A 2006 study established that neurological disease, urinary tract infections, and renal failure were significant risk factors for metallo-β-lactamase(MBL) 

Chronic wounds, surgical sites, and burns provide a direct entry point for 

. The organism’s ability to form biofilms on necrotic or moist tissue surfaces allows it to persist despite topical or systemic treatment. This is particularly problematic in ICUs, where pressure ulcers and surgical wounds are common.

Posttransplant patients are also at higher risk of developing carbapenem-resistant 

 infections when they are admitted to the ICU. This is due to their immunosuppressed states and the prolonged use of antibiotics. Studies have established that both solid organ and stem cell recipients are at a higher risk of colonization and infection by drug-resistant bacteria.

Breast Milk Feeding Practices in Neonatal ICUs

Breast milk is a rich source of nutrition that also helps boost a newborn’s immune system. However, in cases where breast milk is expressed, proper handling and hygiene should be observed to protect the baby from exposure to pathogens. In the neonatal ICU (NICU), for example, improper handling of expressed breast milk can lead to colonization by bacteria.

In a study conducted in an Italian NICU, breast milk feeding was associated with colonization by a well-defined, imipenem-resistant, MBL-

Colonization and infection with VIM-PA in the ICU are driven by an interplay of patient factors and environmental persistence, as well as clinical practice gaps, including inadequate handwashing techniques and suboptimal disinfection protocols. The nature of care offered in the ICU is inherently risky, meaning patients are constantly at risk of developing infections with resistant strains of bacteria. The invasive procedures and prolonged hospital stays, in addition to the nature of diseases, call for vigilance and appropriate infection prevention and control measures to disrupt the growth of disease-causing organisms that might be lurking.

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 infections: a systematic review and meta-analysis. 

. 2018;7:79. doi:10.1186/s13756-018-0370-9

2. Peña C, Suarez C, Ocampo-Sosa A, et al; Spanish Network for Research in Infectious Diseases (REIPI). Effect of adequate single-drug vs combination antimicrobial therapy on mortality in 

 bloodstream infections: a post hoc analysis of a prospective cohort. 

. 2013;57(2):208-216. doi:10.1093/cid/cit223

3. Pham TM, Büchler AC, Voor In ‘t Holt AF, et al. Routes of transmission of VIM-positive 

 in the adult intensive care unit-analysis of 9 years of surveillance at a university hospital using a mathematical model. 

. 2022;11(1):55. doi:10.1186/s13756-022-01095-x

4. Hota S, Hirji Z, Stockton K, et al. Outbreak of multidrug-resistant 

 colonization and infection secondary to imperfect intensive care unit room design. 

5. Fraenkel C-J, Starlander G, Tano E, Sütterlin S, Melhus Å. The first Swedish outbreak with VIM-2-producing 

, occurring between 2006 and 2007, was probably due to contaminated hospital sinks. 

. 2023;11(4):974. doi:10.3390/microorganisms11040974

6. Schärer V, Meier MT, Schuepbach RA, et al. An intensive care unit outbreak with multi-drug-resistant 

. 2023;139:161-167. doi:10.1016/j.jhin.2023.06.013

7. Chiotos K, Tamma PD, Flett KB, et al. Multicenter study of the risk factors for colonization or infection with carbapenem-resistant 

. 2017;61(12):e01440-17. doi:10.1128/AAC.01440-17

8. Harris AD, Jackson SS, Robinson G, et al. 

 colonization in the intensive care unit: prevalence, risk factors, and clinical outcomes. 

. 2016;37(5):544-548. doi:10.1017/ice.2015.346

9. Ghibu L, Miftode E, Teodor A, Bejan C, Dorobăţ CM. Factori de risc pentru infecţiile cu 

10. Zavascki AP, Barth AL, Gaspareto PB, et al. Risk factors for nosocomial infections due to 

 producing metallo-beta-lactamase in two tertiary-care teaching hospitals. 

. 2006;58(4):882-885. doi:10.1093/jac/dkl327

11. Giannella M, Bartoletti M, Conti M, Righi E. Carbapenemase-producing Enterobacteriaceae in transplant patients. 

. 2021;76(suppl 1):i27-i39. doi:10.1093/jac/dkaa495

12. Freire MP, Camargo CH, Bubach L, et al. Recurrent outbreak of carbapenem-resistant IMP-1-producing 

 in kidney transplant recipients: the impact of prolonged patient colonization. 

. 2025;27(1):e14414. doi:10.1111/tid.14414

13. Mammina C, Di Carlo P, Cipolla D, et al. Nosocomial colonization due to imipenem-resistant 

 epidemiologically linked to breast milk feeding in a neonatal intensive care unit. 

. 2008;29(12):1486-1492. doi:10.1111/j.1745-7254.2008.00892.x

VIM-producing Pseudomonas aeruginosa isn’t just surviving in ICUs; it’s thriving. With mortality rates exceeding 30%, colonization risks hiding in drains, devices, and even donor milk, IPs must take proactive steps to outsmart this pathogen. Now is the time to double down on environmental controls, risk factor recognition, and surveillance strategies. Let’s break the biofilm cycle before the next outbreak takes root.

Anthony Onunga, MBChB

Articles

What’s in an Egg: The Age-Old Vaccine Production Method Lives On

Implementing Point-of-Use Instrument Care to Mitigate Surgical Site Infections in Operating Rooms

Unmasking VIM Pseudomonas aeruginosa: Threats in Critical Care