John Parkinson

Why Evidence-Based PPE Practices Matter for High-Consequence Pathogen Care

This article first appeared on our sister brand, 

Jill Morgan, BSN, RN, the site manager of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital, is passionate about personal protective equipment (PPE) and improving standards to protect everyone involved in caring for patients with high-consequence infectious diseases (HCIDs).

One example is the doffing (removal) of PPE by ensuring health care workers’ processes are safe and follow an evidence-based approach.

“I think we need to be able to have that evidence,” Morgan said. “We have to give people that confidence that they can take care of these patients and do it safely. And I think that if we can show them the evidence, then more people will be willing to take on those roles. And right now that's really important, because if we had another outbreak of any kind, the concern is that people would hesitate to deliver care, and we know that every minute we hesitate to deliver care in an emergency room or urgent care anywhere in our hospitals, we're losing valuable minutes that can help save people's lives.”

She is working to bring this approach not only to Emory but also nationally. She is the co-lead of the PPE Working Group for the National Emerging Special Pathogens Training and Education Center (NETEC).

“In the hospitals, people ask you the same question all the time, or they ask you the same question multiple ways. What's your name and date of birth? Or, we check your armband and ask your name, or we're checking your chart that way. If you've had surgery on one limb, they'll write on that limb [to indicate] the correct site. We've put a lot of things in place to make sure that we can deliver care safely for our patients, and that's incredibly important. But I think it's time, 25 years later, to have a parallel initiative for staff safety.”

She cites the pandemic and its impact on health care workers.

“We know we lost health care workers during COVID-19, some of them who succumbed to COVID-19 itself, but many others who just got burned out and felt unprotected, and that's not okay. So, I think the most important thing I can do on this national academy’s committee is really [to] try to bring that frontline perspective that we need to do a better job making sure people feel like we value their safety,” Morgan said.

Videos

Jill Morgan, BSN, RN, of Emory University Hospital is calling for a national, evidence-based approach to personal protective equipment for high-consequence infectious diseases. Drawing on lessons from the COVID-19 pandemic, she emphasizes the need for safer doffing processes, stronger training, and a parallel commitment to staff safety that matches the rigor long applied to patient safety.

Personal protective equipment is more than a checklist item when caring for patients with high-consequence infectious diseases. Jill Morgan, BSN, RN, of Emory University Hospital explains why PPE education must start earlier, go deeper, and focus on supply, process, and competency to truly protect health care workers.

Beyond Gloves and Gowns: Rethinking PPE Training for High-Consequence Infectious Diseases

This interview first appeared on our sister brand, 

When Jill Morgan, BSN, RN, stepped into her role caring for patients with high-consequence infectious diseases (HCID), she quickly realized how much of her own clinical training had overlooked one critical area: personal protective equipment (PPE). Despite years of experience as a nurse, she found that she and many of her colleagues had never been taught to distinguish between different levels of masks, gowns, or protective ensembles, or how those choices affect safety. Now the site manager for the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital, Morgan is working to close those gaps by reframing PPE as a system built on supply, process, and competency, rather than a collection of disposable items.

“I realized that I hadn't paid any attention to that. I didn't know that there were different levels of masks or that there were different levels of gowns. I just in all my years of being a nurse, and there had been quite a few of them by then, it was just something that had escaped my notice. And I realized I'm not alone in that,” Morgan said. “An awful lot of people, both nurses, techs and physicians, really don't get much education about PPE, and so I think we need to do a better job, starting at the beginning, starting in nursing school and medical school, and really talking about what qualities are important, and what you should look for, and what that garment or article device can and can't do.”

In recent years, programs have come online to address caring for patients with HCID, including the proper donning (putting on) and doffing (removal) of PPE. Morgan has been involved in related initiatives. She is the colead of the PPE Working Group for the National Emerging Special Pathogens Training and Education Center (NETEC).

She says there are 3 pillars of PPE for treating patients with HCID: source of supply, processes, and training and competency.

For the supply source, the focus is on the PPE itself.

“You need to know what PPE is required for these different pathogens, and figure out with your supply chain, with your buying habits, with your staff, what you need, and then a lot of PPE does have an expiration date. So you need to figure out, how are we going to maintain that supply, how are we going to get the right sizes, where are we going to keep all this?” Morgan said.

For the process, it is all about donning and doffing PPE properly according to Morgan, and that leads into the third pillar of training and competency to teach all components of PPE.

“We have people [who] have been trying to teach this personal protective equipment ensemble and realize that they have many staff members who can't safely, for instance, reach their feet or shrug out of a coverall. Well, then that might not be either the right person or the right PPE to put in that space,” she said.

“I think a lot of folks got used to hearing the term PPE during COVID-19, the idea of gloves and gown and mask and maybe eye protection, but I think we still missed the importance of making sure that people were safely removing those things and not recontaminating themselves or their environment when they took things off,” Morgan said. “So how do we remove something? It's really important. And making sure people are competent in how they do that is really vital for their safety. It's not something that you can just leave off.”

Jill Morgan, BSN, RN, of Emory University Hospital, explains why PPE education must start earlier, go deeper, and focus on supply, process, and competency to truly protect health care workers.


National Foundation for Infectious Diseases

On World Hand Hygiene Day, The National Foundation for Infectious Diseases (NFID) released its 2025 State of Handwashing Report, based on a new national survey of US adult handwashing knowledge and behaviors. The survey showed that 48% of US adults admit to forgetting or choosing not to wash their hands at key times, like after visiting grocery stores, restaurants, or coffee shops, or a health care setting (doctor’s office, pharmacy, clinic, or hospital). In addition, 1 out of 5 (20%) admit to not washing their hands, even though handwashing can help prevent approximately 80% of infectious diseases.

"Given the importance of handwashing in infectious disease prevention, the stakes are high—improving hand hygiene can help improve health for all," said NFID Medical Director Robert H. Hopkins Jr, MD, in a statement. “While handwashing is an important strategy for disease prevention, and should be complementary to vaccination, it is a critical and often overlooked tool.” Estimates show that if everyone routinely washed their hands, about 1 million lives could be saved worldwide each year.

The survey was funded by NFID and conducted by NORC at the University of Chicago as part of the AmeriSpeak Omnibus, a monthly survey using the NORC probability-based panel designed to be representative of the US household population. The US survey received responses from 3,587 respondents from all 50 states and the District of Columbia via online and telephone interviews using landlines and cell phones. Data was collected in November and December 2024 and March 2025. The margin of sampling error is ±2 percentage points for all respondents.

Other findings from the survey show that only 30% of respondents reported that they are most likely to wash their hands after coughing or sneezing, which is a concern, given how easily respiratory diseases such as influenza can spread. Of those who did not wash their hands with soap and water, men are more likely to forget, while women are more likely to use alternatives like hand sanitizer.

According to the survey, 55% of US adults wash their hands primarily to stay healthy and avoid getting sick. In addition, 68% of respondents said that avoiding spreading germs to others was among their top 3 reasons for handwashing, showing concern for protecting others in the community.

Along with the report, NFID has launched its Hands In For Handwashing campaign to raise awareness about the importance of handwashing in helping stop the spread of infectious diseases.

As part of the campaign, NFID is also hitting the road with a Clean Hands Caravan, a mobile handwashing station to make it easier for people to wash their hands in places where germs can spread.

“The caravan was created to make handwashing accessible and visible during key moments in everyday life when it is important to wash hands,” NFID Chief Executive Officer Marla Dalton, PE, CAE, said in a statement. “We wanted to grab people’s attention with vibrant colors, eye-catching graphics, and memorable slogans to bring some excitement to an important but sometimes overlooked habit taught in kindergarten—washing your hands.”

The Clean Hands Caravan tour launched at the Washington Spirit soccer game in Washington, DC on May 2. Additional tour stops include the World Barbeque Cooking Contest in Memphis, TN, from May 14-17, and the Atlanta Jazz Festival in Atlanta, GA, from May 24-26.

Annual Conference on Vaccinology Research Will Focus on Vaccines for a Resilient Future

In addition to its handwashing campaign, NFID will host the 2025 NFID 

Annual Conference on Vaccinology Research

 as an online event, May 5 to 7, 2025. This year's theme, 

Vaccines for a Resilient Future: Innovation and Impact

, underscores the conference's focus on addressing global challenges in vaccine development, implementation, and evaluation.

 Discussions will feature leading scientists and public health professionals exploring advancements in vaccine research and strategies to combat emerging infectious diseases.

 A dedicated panel will spotlight influential women in vaccinology, sharing insights and experiences to inspire the next generation of scientists.

 The Maurice R. Hilleman Early-Stage Career Investigator Award will honor promising researchers contributing to the field of vaccinology.

The conference aims to foster interdisciplinary collaboration and highlight innovative research that shapes the future of global health.

For more information and registration details, visit: 

1. New National Survey Finds Nearly Half of US Adults Admit to Not Washing Their Hands at Key Moments. NFID press release. May 5, 2025. Accessed May 5, 2025.
https://www.nfid.org/new-national-survey-finds-nearly-half-of-us-adults-admit-to-not-washing-their-hands-at-key-moments/

2. 2025 Annual Conference on Vaccinology Research. NFID. May 5, 2025. Accessed May 5, 2025.
https://events.rdmobile.com/Events/Details/18699

Articles

NFID 2025 Report Reveals Alarming Gaps in Hand Hygiene Practices Among US Adults

This article first appeared in our sister brand, 

The incidence of STIs has been increasing in the US over the past few years, with a disproportionate impact among MSM and transgender women. According to the CDC, an estimated 2.5 million cases of syphilis, gonorrhea, and chlamydia occurred in 2021, which is up from 2.4 million cases in 2020.

Within STIs, there is a newer virulent multidrug-resistant strain of gonorrhea. Specifically, the penA 60.001 allele in 

, a genetic variation helps contribute to antibiotic resistance. The penA 60.001 allele alters the bacterial response to cephalosporins.

, ranked among the highest-tier “urgent threats” among the 18 bacteria and fungi on the CDC's 2019 antibiotic resistance threats report.

Although the multidrug-resistant gonorrhea strain has been seen mostly outside the US, last year 2 cases of this pathogen were confirmed in the US and identified by the Massachusetts Department of Public Health. Massachusetts officials reported that clinicians were able to treat the patients successfully with ceftriaxone. However, this strain of the sexually transmitted infection had reduced susceptibility to 5 antibiotic classes—including cephalosporins, the group of last-resort drugs that includes ceftriaxone.

As there has been an increase in the STI and the emergence of a multidrug-resistant threat, a need for newer therapies has arisen.

Zoliflodacin a first-in-class oral, single-dose antibiotic for the treatment of uncomplicated gonorrhea is in late stage clinical trials, and has demonstrated efficacy and safety. This phase 3 trial was a global, randomized, controlled study that evaluated the efficacy and safety of zoliflodacin.

The topline data from this trial was previously disclosed at the European Society of Clinical Microbiology and Infectious Disease (ESCMID) 2023, which showed that zoliflodacin was noninferior to a combination of ceftriaxone and azithromycin (5.31%, 95% confidence interval: 1.38-8.65) with urogenital microbiological cure rates of 90.9% (88.1-93.3) and 96.2% (92.9-98.3), respectively, for the microbiological intent-to-treat population. Zoliflodacin had a favorable safety profile with comparable overall number of adverse events between the treatment arms.

At this week’s ID Week 2024, Innoviva Specialty Therapeutics CMO David Altarac, MD, will be presenting data on zoliflodacin. “The data that we are here to present is for the treatment of gonorrhea, including resistant strains of gonorrhea,” he said in an interview with 

Altarac says the company is looking at 1 main indication for the therapy. “We are focused on developing the drug for uncomplicated gonorrhea. We believe that, as we've done with other products, a focus on targeted development will advance the efforts towards developing products that have specific focus will be used responsibly, and will hopefully increase the longevity of that product," he said.

With the phase 3 results, the company is planning to file for FDA approval. “We are targeting a new drug application in the United States for the first quarter of next year. Zoliflodacin has been reviewed by the FDA and given both qualified infectious disease product and fast track designation; therefore, if our new drug application is accepted, we would aim for a priority review,” Altarac said.

1. Sexually Transmitted Infections (STIs). CDC. Last reviewed January 30, 2024. Accessed October 16, 2024. https://www.cdc.gov/std/statistics/2022/default.htm
2. Abene S. A Growing Concern About Gonorrhea's Resistance to Antibiotics. 

. January 26, 2024. Accessed October 16, 2024.


https://www.contagionlive.com/view/a-growing-concern-about-gonorrhea-s-resistance-to-antibiotics


3. Landhuis EW. Multidrug-Resistant “Super Gonorrhea” Rallies Multipronged Effort. 

 2024;331(20):1695–1697. doi:10.1001/jama.2023.15355
4. Innoviva Specialty Therapeutics Presents Findings from Subgroup Analyses of zoliflodacin in uncomplicated gonorrhea at the 2024 Sexually Transmitted Infections Conference. Innoviva press release. September 19, 2024. Accessed October 16, 2024.
https://innovivaspecialtytherapeutics.com/innoviva-specialty-therapeutics-presents-findings-from-subgroup-analyses-of-zoliflodacin-in-uncomplicated-gonorrhea-at-the-2024-sexually-transmitted-infections-conference/



The rise of multidrug-resistant gonorrhea highlights the urgent need for new therapies. Zoliflodacin, a promising oral antibiotic, shows effectiveness in late-stage trials.

New Antibiotic Zoliflodacin Offers Hope Against Multidrug-Resistant Gonorrhea

 finds that 61% of respondents who were infectious disease professionals said mosquito-borne pathogens represent the greatest threat to climate change.1

Specifically, viruses from these insects include dengue fever, Zika virus, West Nile virus, and malaria—which are endemic to various parts of the world, including Latin America and Africa—could likely see a rise in case rates. The driving concern is the warming temperatures globally and more flooding that pushes these insects into new areas or persist in endemic regions, extending environmental exposure. Scientists predict that 1.3 billion people could be impacted by Zika by 2050, and 61% of the world’s population could be impacted by dengue by 2080.1

"Temperature increases and extreme weather events are impacting how humans, animals, and insects interact, and we are finding mosquito-borne viruses in new places," Jorge Osorio, DVM, PhD, MS, a professor and director of the Global Health Institute at the University of Wisconsin-Madison and codirector of the Colombia-Wisconsin One Health Consortium, said in a statement. "As these viruses appear in more parts of the world, we need a globally coordinated effort to share learnings from countries who have successfully managed these illnesses, as well as ensuring that effective surveillance and countermeasures are in place."

The Abbott Pandemic Defense Coalition is a novel industry-led global scientific and public health partnership dedicated to the early detection of and rapid response to future pandemic threats. The coalition seeks to identify, track, analyze, and test emerging outbreaks, including COVID-19 variants.

"Just as scientists have developed sophisticated monitoring systems to track emerging storms and hurricanes, our job as virus hunters is to identify pathogens that have the potential to spark outbreaks in order to stay one step ahead," Gavin Cloherty, PhD, head of infectious disease research at Abbott and head of the Abbott Pandemic Defense Coalition, said in a statement. "Disease surveillance acts as our radar, helping us prioritize which viruses are most likely to trigger an outbreak and where those outbreaks may occur."

More than 100 professionals in virology, epidemiology, and infectious diseases globally were asked a variety of questions including:

About their priorities for addressing the gaps in readiness for disease outbreaks,

Their views on how the changing environment is impacting infectious diseases,

Suggestions for building a resilient healthcare system that identifies and responds to emerging disease outbreaks worldwide.


Invitations to participate in the online survey were distributed to more than 400 experts at Coalition member institutions, the Centers for Research in Emerging Infectious Diseases (CREID) Network, the Global Virus Network (GVN), the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), as well as other academic research institutions. 103 experts fully completed the survey. The survey was conducted between April 2024 and June 2024, and participation was voluntary and anonymous.

The coalition recommended focusing on three priorities to maintain and strengthen the ability to manage local, regional, and global infectious disease outbreaks:

The need to address gaps: Public health systems need surveillance programs to quickly identify new pathogens and outbreaks using the diverse tools available. Funding for public health should be available to sustain these programs, help train the next generation of virus hunters, identify and respond to outbreaks, and educate the public on infectious diseases.​

Know what we are looking for: While every outbreak is important to understand, only some have the potential to spark national, regional, or global health concerns. Understanding the profile that presents the most risk enables the healthcare community to calibrate efforts to protect public health.​ As viruses are discovered in new locations, the medical community and the public need to know what viruses may be circulating, pointing to the need to continue strengthening surveillance and education efforts.

Understand the changing environment: Experts are nearly unanimous in their view that the evolving way humans, animals, and insects overlap and interact will change the dynamics of infectious disease outbreaks. Continued research and investments in new technology are needed to help understand how those dynamics are at play locally–old diseases in new regions, acceleration of transmission routes–to help guide more effective preparation.


"As these viruses appear in more parts of the world, we need a globally coordinated effort to share learnings from countries who have been successfully managing these illnesses, as well as ensuring that effective surveillance and countermeasures are in place," Osorio said.


1. New survey from Abbott finds epidemiologists believe viral and mosquito-borne pathogens are priority concerns for disease outbreaks. Eurekalert press release. September 17, 2024. Accessed September 22, 2024.


https://www.eurekalert.org/news-releases/1058163

2. Remaining Ready for Outbreaks. Abbott Pandemic Defense Coalition. Accessed September 22, 2024.
https://www.abbott.com/virushunters.html

A new survey finds that 61% of infectious disease professionals identify mosquito-borne viruses, like dengue and Zika, as the greatest threat posed by climate change, demanding global action.

Survey Highlights Mosquito-Borne Viruses as Major Climate Change Threat

The CDC is reporting an increase of 18% in emergency department (ED) visits in the agency’s most recent week of reporting, which was through June 29. Along with ED visits, there has been a subsequent increase of 13% in hospitalizations in the most recent week of reporting (June 9 - June 15).1

Geography has played a role as the western United States has increased.

“In June 2024, we saw increases in COVID-19 test positivity and a slight increase in emergency department visits, suggesting increases in COVID-19 activity across several western states and increases in rates of COVID-19–associated hospitalizations in May and June 2024 among adults 65+ at some sites,” according to a CDC spokesperson.

If there has been a silver lining, it is in mortality, as rates of death are down 25% in the most recent week’s reporting.

Summertime is a season to see family and friends and spend time in close proximity to each other. Although people may associate this time of year with being outdoors, there is often a “summer hibernation” element to the season where people want to stay indoors, near the air conditioning. However, this can lend itself to breathing in air with people in close quarters. Depending on the indoor air quality and the size of the location, it makes people vulnerable to respiratory viruses.

"There are many contributing causes, including the traditional large group activities and air travel in a situation where very few are implementing precautions to prevent infection," said Robert H. Hopkins, Jr, MD, medical director of the NFID. “In addition, unfortunately, far too few people are up to date on COVID-19 vaccination.”

“COVID-19 activity tends to fluctuate with the seasons, meaning it has some seasonal patterns. Data from four years of COVID-19 cases, hospitalizations, and deaths show that COVID-19 has winter peaks (most recently in late December 2023 and early January 2024) but also summer peaks (most recently in July and August of 2023). There is no distinct COVID-19 season like there is for influenza and respiratory syncytial virus (RSV),” says a CDC spokesperson.

According to the CDC’s COVID-19 tracker, which tracks data such as the types of variants and incidence rates in the US, the most dominant strain of SARS-CoV-2 is the KP3 variant, with 36.9% of cases in the US. And the second biggest strain is the KP2 variant, which accounts for 24.4% of cases. These numbers reflect the 2-week period ending on July 6, 2024.1 These 2 strains account for approximately 60% of all cases in the country and are a part of the Flirt strains, a newer family of variants named after their mutations.

These newer “FLiRT” variants have been so named based on the technical names for their mutations, one of which includes the letters “F” and “L,” and another of which consists of the letters “R” and “T.”

According to the CDC, it is essential to note that as of May 1, 2024, hospitals were no longer required to report COVID-19 hospital admissions, hospital capacity, or hospital occupancy data to Health and Human Services through the CDC’s National Healthcare Safety Network (NHSN). Thus, the data in the future could be limited, especially as medical institutions are not obligated to report data.

However, the CDC still encourages ongoing, voluntary reporting of hospitalization data.

With this in mind, statistics on incidence rates, hospitalizations, and deaths may not be complete.

Are the COVID-19 Vaccines Still Efficacious?

Within the last few weeks, the CDC’s Advisory Committee on Immunization Practices (ACIP) met to discuss updating this fall’s vaccine.

As pharmaceutical companies update their vaccines, are the current crop of immunizations still offering protection? Hopkins makes an important distinction between those considering a vaccine now and those considering waiting until the fall and the launch of the newer COVID-19 vaccines.

“Currently available COVID-19 vaccines do help protect against severe disease from the latest variants. Updated COVID-19 vaccines will be available by early fall,” Hopkins said. “It’s important that those who are at increased risk and have not yet received an updated vaccine (including adults aged 65 and older and people who are immune compromised) get vaccinated now. In the fall, when updated COVID-19 vaccines are available, everyone ages 6 months and older should plan to get vaccinated.”


Along with getting up to date with vaccination, NFID’s Hopkins recommends several other strategies to prevent transmission. To help prevent the spread of disease, here are some other measures he recommends:

Wash your hands with soap and water for at least 20 seconds

Avoid touching your eyes, nose, and mouth

Avoid close contact with people who are sick, and stay home if you are sick

Consider wearing a high-quality face mask, particularly if you are at high risk for severe disease

Take steps for cleaner air, such as opening windows or going outdoors


With these aforementioned prevention measures and up-to-date vaccination, most people can avoid the summer surge of COVID-19 and continue to enjoy their summer uninterrupted.

1.COVID Data Tracker. CDC. Accessed July 12, 2024.


https://covid.cdc.gov/covid-data-tracker/#variant-proportions

2. Parkinson J. A Member of Newer Family of ‘FLiRT’ COVID-19 Variants is Dominant Strain In United States. Contagion. May 6, 2024. Accessed July 12, 2024.


https://www.contagionlive.com/view/a-member-of-newer-family-of-flirt-covid-19-variants-is-dominant-strain-in-united-states

The CDC and the National Foundation for Infectious Diseases (NFID) discuss the evolving summer COVID-19 season and strategies for prevention.