The CDC estimates that up to 70% of nursing home residents receive at least 1 course of systemic antibiotics a year. 

One of the best ways to decrease the unnecessary use of antibiotics is to practice antibiotic stewardship activities in long-term care (LTC) settings. Decreasing antibiotic usage can reduce adverse events, decrease antibiotic resistance, and improve outcomes for patients in the LTC setting. It is helpful to know the minimum criteria that should be used to initiate antibiotics in residents of LTC settings. Let’s discuss a few critical concepts that all LTC infection preventionists (IPs) should know.

In 1989, experts in infection control were invited to a consensus conference to establish standardized definitions of infections. These definitions were intended exclusively for long-term care facilities that housed patients for 24-hour care under professional nursing supervision. As the number of patients in LTC facilities grew, surveillance criteria were needed to identify infections in this specialized setting consistently. Residents were advanced in age, cognitively impaired, had indwelling lines such as bladder catheters or gastric tubes, and often required assistance with activities of daily living.

The McGeer criteria, led by Allison McGeer, MD, were published in the 

 They have been revised several times to update various components to modern-day standards of care but remain the measure by which most IPs determine infections in LTC. The clinical value of the McGeer criteria is to determine the number of actual infections and estimate the incidence/prevalence of a specific type of infection.

Nearly a decade later, another consensus conference of experts was held to establish minimum clinical criteria for the initiation of antibiotics in residents of LTC facilities. Headed by Dr Mark Loeb and colleagues, the findings were published in 

Infection Control and Hospital Epidemiology

 These became known as the Loeb criteria. These criteria were intended to inform clinical decision-making often before diagnostic testing results were available. Clinical criteria are on the side of caution, and empirical treatment for residents with a high likelihood of infection is recommended, not just for confirmed infections.

IPs need several critical tools to perform effective surveillance

 are tables of key information about each potential case of an infection. Line lists provide demographic information such as name, age, location, symptoms, and any pertinent lab findings. The CDC provides some templates for line lists to aid in organizing data for review.

 is also an essential factor in LTC infection surveillance. Awareness of central lines, indwelling Foley catheters, and other devices is essential when a patient shows signs of an infection. 

 is a necessity as well. Some infections, such as catheter-associated urinary catheter infections, are contingent upon a minimum colony count to be considered a health care-associated infection (HAI). Lastly, IPs need standardized

 constitutional infection criteria that are 

used consistently to assess each case. This can be the CDC criteria for HAIs or the criteria from the National Healthcare and Safety Network, which collects data and benchmarks for HAIs at the national and facility levels. Clear, descriptive documentation of symptoms is also helpful. For example, instead of just indicating “fever,” documentation should include the exact temperature reading, such as 100.9

It is important to remember that infection surveillance definitions are intended to standardize what health care facilities deem “infections.” They are different from clinical decision-making criteria at the bedside. The criteria defining infections for surveillance purposes were selected to increase the likelihood that the events captured by applying the definitions are actual infections. Presentations of infection in older residents of LTC facilities may be atypical, so failure to meet surveillance definitions may not entirely exclude the presence of infection. Every patient is different and reacts to infections differently.

It’s also important to remember that the McGeer criteria are a retrospective review of clinical data. They look at completed labs and tests that are often unavailable when the patient is seen in a real-time clinical assessment. Failure to meet surveillance definitions does not always mean there was no infection present; conversely, a resident meeting the definition does not always mean an antibiotic was indicated. While the McGeer criteria help determine if an HAI exists, the Loeb criteria help hold clinicians accountable for appropriate antibiotic initiation. IPs should be able to look at any antibiotics that have been started and see a clear indication using the standardized criteria established for antibiotic stewardship purposes. Again, clear documentation is key. Often, clinicians may use clinical information such as foul-smelling urine, positive urinalysis, history of urinary tract infection, behavioral or mental status changes, or falls as reasons to start antibiotics. Still, these criteria do not meet standardized infection surveillance definitions for urinary tract infections. This is where strong antimicrobial stewardship practices come into play and hopefully decrease the amount of unnecessary antibiotics prescribed. LTC surveillance is tricky but has come a long way since it began. These established criteria help level the playing field for all facilities regarding HAIs.

Antibiotic prescribing and use: core elements of antibiotic stewardship for nursing homes. CDC. March 18, 2024. Accessed December 7, 2024. 

https://www.cdc.gov/antibiotic-use/core-elements/nursing-homes.html

McGeer A, Campbell B, Emori TG, et al. Definitions of infection surveillance in long-term care facilities. 

 1991;19(1):1-7. doi:10.1016/0196-6553(91)90154-5

Stone ND, Ashraf MS, Calder J, et al; Society for Healthcare Epidemiology Long-Term Care Special Interest Group. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. 

Loeb M, Bentley DW, Bradley S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. 

Long-term care (LTC) respiratory surveillance line list. Long-term care (LTC) surveillance outbreak summary. CDC. Updated March 12, 2019. Accessed December 7, 2024. https://www.cdc.gov/long-term-care-facilities/media/pdfs/LTC-Resp-OutbreakResources-P.pdf

Articles

Antibiotic stewardship in long-term care facilities relies on McGeer and Loeb criteria to guide infection surveillance and appropriate prescribing, ensuring better outcomes for residents and reducing resistance.

Antibiotic Stewardship in Long-Term Care: Leveraging McGeer and Loeb Criteria for Better Outcomes

Creutzfeldt-Jakob disease (CJD) is a widely recognized disease among medical device industry professionals that poses unique challenges for instrument reprocessing. Although care must be taken with all medical instruments, exceptional care must be taken with instruments potentially infected with CJD to ensure they are correctly disposed of or are safe for reuse. Generally, the safest and most accepted method for dealing with instruments contaminated with CJD is incineration.

However, incineration is only sometimes practical. Therefore, decontamination guidelines have been provided by the CDC and the World Health Organization (WHO) and are also addressed by the Association for the Advancement of Medical Instrumentation (AAMI). Many factors must be considered when choosing instruments in preparation for a surgical procedure on a patient with CJD. In the same way, departments that handle surgical instruments must consider unknown cases of CJD and how to handle instruments that could be potentially infected with CJD.

Before examining the disposal and decontamination guidelines for instruments confirmed to be infected or potentially infected with CJD, it is essential to understand the biological structure and impact of the disease. CJD is a type of prion disease, or a transmissible spongiform encephalopathy (TSE), that can cause abnormal folding of proteins in the body.

 This abnormal folding can lead to symptoms that progress rapidly and can often include dementia,3 unsteadiness and clumsiness,

 and other neurological symptoms. CJD is a progressive and fatal brain disorder that has no treatment to stop the progression of symptoms or to eliminate the disease.3

According to the WHO, human TSEs (including CJD) have been caused by “exposure to infectious material through the use of human cadaveric-derived pituitary hormones, dural and cornea homografts, and contaminated neurosurgical instruments.”

 Certain infections have been tied to distinctive types of CJD.

There are 3 primary forms of CJD: sporadic, genetic (familial), and acquired (can include iatrogenic).

 Sporadic CJD is the most common form, accounting for 85% of reported cases.5 Sporadic cases of CJD occur when proteins already present in the body fold abnormally for an unknown reason.

 Genetic (or familial) CJD occurs when genetic mutations are inherited from a family member with CJD.6 Iatrogenic cases are acquired in health care settings through contact with prions that can come from contaminated medical instrumentation.

 Due to this, guidelines for disposing and reprocessing medical instruments that have been potentially contaminated have been shared by the CDC and WHO and are included in ANSI/AAMI ST79:2017: Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities.

Notably, a variant form of CJD (considered acquired

), also known as vCJD, is classified as a bovine spongiform encephalopathy (BSE),

 a type of TSE that affects cows. Although similar in name to CJD, human infections of vCJD have primarily been attributed to the consumption of animal products from BSE-infected cows.

 Because of this, most available research on instrument decontamination has been reviewed for classic CJD. However, WHO guidelines specify that instruments used for patients with confirmed or suspected cases of vCJD shall be decontaminated following the guidance listed in the WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies,

 which also includes guidance for classic CJD.

Prion Resistance to Decontamination and Sterilization

Instruments confirmed to be infected with CJD and instruments potentially infected with CJD must be treated differently from standard instrumentation as this type of disease resists common decontamination and sterilization practices.

Incineration or Reprocessing of Instrumentation

Due to CJD’s resistance to standard reprocessing protocols, the CDC and WHO recommend incinerating instruments exposed to high-infectivity tissues.

 High-infectivity tissues are those of the central nervous system, including the brain, spinal cord, and eyes.

 The CDC and WHO have also discussed methods for instruments that are not incinerated.

It should be noted that all methods detailed below should be followed by cleaning the instruments, rinsing them in water, and subjecting them to routine sterilization.

 According to the WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies, heat-resistant instruments may be immersed in sodium hydroxide (NaOH) and run through a gravity displacement autoclave at 121 °C for 30 minutes.

 The WHO lists recommendations for heat-resistant instruments, starting with the most severe treatments. Aside from incineration, the NaOH/gravity displacement autoclave method is considered the most severe treatment.

Another method cited by the WHO and CDC suggests immersing instruments in 1N NaOH or sodium hypochlorite for an hour, transferring them to water, and heating them in a gravity displacement autoclave at 121 °C for an hour.

 The last method cited by the CDC that aligns with WHO recommendations is to immerse the instruments in NaOH or sodium hypochlorite for an hour, remove and rinse in water, transfer to an open pan, and either heat in a gravity displacement autoclave at 121 °C or a porous load autoclave at 134°C for an hour.

The least severe treatment in the WHO recommendations for heat-resistant instruments is autoclaving at 134 °C for 18 minutes.

Of course, not all instruments used in a surgical procedure are heat resistant. For instruments that are heat sensitive, the CDC suggests, “heat-sensitive reusable instruments…should be decontaminated. This can be done by flooding with or soaking in 2N NaOH or undiluted sodium hypochlorite for 1 hour. They should [then] be rinsed with water,” which aligns with WHO recommendations.

 Care must be taken during these processes to ensure the safety of staff handling the contaminated instruments and chemical agents.

While there are circumstances in which the previous methods may be appropriate, certain challenges related to instrument composition, practicality, and the safety of reprocessing professionals must be considered. In its guidance, the WHO states that hypochlorite can be corrosive to stainless steel instruments and should not be used to soak instruments while in an autoclave, as this could cause corrosion in the autoclave itself.

 Hypochlorite also poses a potential respiratory hazard if the process is not conducted in a properly ventilated location.

 The CDC recommends that when instrument composition and chemical intolerances are unclear, the manufacturer should be consulted.

 In this scenario, the instrument’s instructions for use (IFU) could also be a useful reference. In addition, staff should always wear proper protective equipment when they are in contact with CJD and the chemical agents used in these procedures.

As mentioned, understanding how to handle instruments potentially infected with CJD is essential to ensure the safety of all reprocessing staff. The WHO recognizes that it is impractical for every instrument used on an individual potentially infected with CJD to be unnecessarily incinerated, so instruments may be quarantined until suspected cases have been confirmed.

However, this raises a question for many industry professionals: What is considered a potentially infected instrument? Not all CJD cases may be suspected during a surgical procedure. Do all instruments used on high-infectivity tissues (eg, the brain, spinal cord, and eyes) have the potential to be infected with CJD if an individual was not tested before surgery?

The CDC touches on this topic in its guidance by stating, “[if] it’s not yet known if a patient undergoing neurosurgery has CJD (or another prion disease)…instruments involved in these procedures should be reprocessed as if the patient has suspected or confirmed CJD.”

Reprocessing all high-infectivity tissue instrumentation as if infected with CJD seems to be the safest method to avoid prion contamination, but how many reprocessing facilities comply with this guidance? Is this guidance practical for all health care facilities? Aligning recommendations and elaborating on this topic between WHO, CDC, ANSI/AAMI, and even the manufacturers’ IFUs would greatly benefit reprocessing staff to comply with best practices.

CJD’s resistance to standard decontamination protocols presents unique challenges for reprocessing staff. While incineration is generally the preferred method for managing instruments potentially infected with CJD, this is not always practical. To address this, decontamination guidance has been shared by the CDC, WHO, and ANSI/AAMI ST79:2017 for instruments that cannot be incinerated.

Unknown cases of CJD present yet another challenge when managing instrumentation. Continued advocacy from professionals in the medical device industry is essential to clarify best practices for unknown cases of CJD and promote the alignment of current recommendations.

Infection control for CJD. CDC. May 13, 2024. Accessed December 9, 2024. 

https://www.cdc.gov/creutzfeldt-jakob/hcp/infection-control/index.html

WHO infection control guidelines for transmissible spongiform encephalopathies: report of a WHO consultation, Geneva, Switzerland, 23-26 March 1999. World Health Organization. Accessed December 9, 2024. 

Clinical overview of Creutzfeldt-Jakob disease (CJD). CDC. May 13, 2024. Accessed December 9, 2024. 

https://www.cdc.gov/creutzfeldt-jakob/hcp/clinical-overview/index.html

Prion diseases are a group of rare, neurodegenerative brain disorders. CJD Foundation. Accessed December 9, 2024. 

https://cjdfoundation.org/types-of-prion-disease/#acquired

Classic Creutzfeldt-Jakob disease. CDC. May 13, 2024. Accessed December 9, 2024. 

https://www.cdc.gov/creutzfeldt-jakob/about/index.html

CJD diagnostic criteria. CDC. May 13, 2024. Accessed December 9, 2024. 

https://www.cdc.gov/creutzfeldt-jakob/hcp/clinical-overview/diagnosis.html

Asked & answered: device disposal. Association for the Advancement of Medical Instrumentation. March 1, 2020. Accessed December 9, 2024. 

https://array.aami.org/content/news/asked-answered-device-disposal

ANSI/AAMI ST79:2017 with amendments A1:2020, A2:2020, A3:2020, A4:2020: comprehensive guide to steam sterilization and sterility assurance in health care facilities. Association for the Advancement of Medical Instrumentation. Accessed December 9, 2024. 

https://aami.org/standards/featured-standards/ansi-aami-st79

Clinical overview of variant Creutzfeldt-Jakob disease. CDC. November 12, 2024. Accessed December 9, 2024. 

https://www.cdc.gov/variant-creutzfeldt-jakob/hcp/clinical-overview/index.html

About prion diseases. CDC. April 22, 2024. Accessed December 9, 2024. 

https://www.cdc.gov/prions/about/index.html

Creutzfeldt-Jakob Disease (CJD) presents significant challenges for infection control. Learn best practices for safe instrument disposal, reprocessing, and compliance with CDC and WHO guidelines.

Ensuring Safe Practices: Managing Surgical Instruments in the Context of Creutzfeldt-Jakob Disease

The morning light filters into the surgical intensive care unit, washing over the beeping monitors and scurrying footsteps of the nurses making their rounds. Cups of coffee litter the nursing station, the sunlight catching the steam like waves floating through the air. For most, it’s just another day filled with managing drips, dressing wounds, and comforting loved ones. But for me, it’s an opportunity.

You can’t see me, but I’m here. I thrive amid unclean hands, dirty stethoscopes, and portable ultrasound machines. I lie in the quiet corners that have long been forgotten. And although you may know me as methicillin-resistant 

 bacteria, you underestimate how proficient I am at silently spreading through your quarters. You underestimate us all. To you, I’m just a pathogen that occasionally causes skin infections, pneumonia, or sepsis, to name a few. But I’m an explorer, a conqueror, a survivor of health care worlds. And you remain blissfully unaware of the part you play in my story. My mission is simple: Spread, colonize, thrive, and repeat.

Today, I’m beginning my morning in the darkness, hiding within the folds of a health care worker’s scrubs who’s hastily stashed contaminated medical supplies in her pockets. It’s a cozy haven I’ve nestled in during her preparation for today’s shift. The air smells faintly of disinfectant, but I know better than to fear it. Human carelessness is my ally, and I sense that my next move is close at hand.

A nurse enters room 302, her gloved hands expertly adjusting an intravenous (IV) line. A patient, post-op, total knee, is lulled to sleep by the last remnants of anesthesia. The nurse finishes her task and quickly moves to her next patient without a second thought.

As she removes her gloves, she reaches into her pocket for supplies where I lie waiting. Ah, a familiar sight: As I now cling to the webbing between her fingers, she absentmindedly passes by the hand sanitizer and enters her next room. And in a moment of minor oversight or a mere split second of distraction, my prime opportunity appears.

In room 305, my new host is waiting—a patient recovering from abdominal surgery. His immune defenses are already weak, and a dressing change provides a golden opportunity for me to strike.

The nurse reaches for her stethoscope draped lightly around her neck, touching her contaminated hands to the diaphragm. Stethoscopes are my favorite highway to infection. They’re carried everywhere by these medical teams, pressed against patient after patient, picking up bacterial hosts along the way. Their owners rarely stop to disinfect them during the rush of a busy day, giving my friends and me an easy mode of transmission. As she moves the stethoscope along the patient’s body, I quietly await the perfect moment of attack. She listens to his beating heart and the breath in his lungs before pausing at his abdomen to listen closely for a rumbling within. At that moment, I make my move, sliding effortlessly away from the stethoscope and onto my new host’s skin.

The incision lies only inches away from where I’ve landed. My multiplication under the dressing alone would suffice. As the nurse transitions to the dressing change, she begins meticulously opening the supplies for the procedure. Although she’s careful not to contaminate the dressing materials inside, she will soon make another grave error, which will cause the patient a deadly infection. “Ring, ring, ring, ring,” the familiar tone of the nurse’s phone chimes within her pocket. As she reaches inside to grab it, I cling to the phone as it’s removed. She listens for a minute to the charge nurse on the other end, receiving instructions for her next patient. The conversation is long enough for me to also advance from the phone to her hands, another opportunity to invade my new host.

The nurse doesn’t bother using hand sanitizer after touching her phone. She doesn’t recognize the possibility that she’s contaminated her hands by the activity. So, she returns to the task in front of her as I find my way to the clean dressing supplies on the bedside table. This is where I’ll shine, infiltrating and multiplying in the most vulnerable and vital parts of my new host’s body.

My job is done by the time the nurse has donned her sterile gloves. Now, all I need to do is wait for the supposedly clean supplies to be placed atop the patient’s surgical wound. From there, I stealthily detach myself from the mesh dressing and find my way between the staples of my host’s fresh surgical wound.

As the sun rises higher, the patient stirs as I enter his bloodstream. The fever will come soon, followed by a rapid heartbeat and a drop in blood pressure. I thrive in this chaos, feeding on the body’s attempt to fight back as I quickly multiply, untouched by the antibiotics the medical team will first attempt. My multiplication is swift and efficient. Within hours, I’ve set up colonies in the patient’s body, disrupting his delicate internal stability. The immune system responds swiftly, but his defenses are a weak attempt to win my war.

Nurses rush to stabilize my host, unaware that I’m the culprit. Blood cultures, IV fluids, surgical washout, and yes, even their hands—all offer new pathways for me to spread. This is how I will win: one small oversight at a time, one unclean stethoscope or phone at a time, carried by the hands of a blissfully unaware health care worker.

Alas, every so often, vigilance will come along. When I’m sure I’ve won, a new nurse enters the room. Her first move? Sanitizing her hands with deliberate care. She reaches for the stethoscope and pauses, grabbing one of the disinfectant wipes from the canister on the wall.

“No. Not this. Please, not this,” I think.

The wipe’s sting is immediate, its alcohol content deadly. I cling desperately to the stethoscope’s surface, but it’s useless. With each pass of the wipe, my numbers quickly dwindle. The nurse cleans the diaphragm, the tubing, and even the earpieces—a comprehensive job.

She’s one of the vigilant ones, the kind I hate. The sort who knows the importance of disinfecting even the smallest of medical tools. As she moves to the patient, her hands freshly sanitized and her stethoscope disinfected, I find myself finally defeated. My plans for continued transmission are completely foiled.

This wasn’t my first defeat, nor will it be my last. Humans like to think they’re winning this war against our microbial army, but I know better. Complacency will always be our greatest ally. Ignorance will help us win this war.

Every skipped hand wash, every unclean stethoscope, and every rushed moment will always create another opportunity for me. I need only 1 oversight, 1 breach in your routine, to make my final move.

But here’s the thing: Although I may be resilient, I’m not invincible. Alcohol wipes, proper hand hygiene, and consistent cleaning practices are my kryptonite. These small acts disrupt my plans and stop me from spreading throughout your facilities.

Knowledge and vigilance are your greatest weapons. Treat every stethoscope like a critical tool and disinfect it regularly. Wash your hands like lives depend on it—because they do.

I’ll be waiting in the morning light for your next mistake. The question is: Will you let me win?

Health care is a battlefield, and the fight against this invisible microbial army is ongoing. The stakes are high, but the tools to win are simple: hand hygiene, cleaning, disinfection, sterilization, proper use of personal protective equipment, and aseptic technique. These and other prevention measures can and will save lives—if you choose to believe in the power of these interventions. Let this story be a reminder that every scrub, every wipe, every moment of vigilance in infection prevention and control matters. Together, we can ensure that a pathogen’s story ends at the next disinfectant wipe or hand sanitizer dispenser.

A silent invader lurks in health care settings, exploiting human oversights to spread. Discover how vigilance, hand hygiene, and disinfection can stop infections before they begin.

A Day in the Life of a Pathogen: From Your Hands to Stethoscopes and Beyond

Vector-borne diseases are medical conditions in humans caused by pathogens transmitted by host organisms, which facilitate the transmission of diseases between individuals, from animals to humans, or through vectors. Vectors are often insects or other parasites that feed on the blood of animals and spread pathogens through that blood contact. Vector-borne illnesses account for more than 17% of all infectious diseases.

Some of the most common vector-borne diseases include malaria, dengue virus, Zika virus, West Nile fever, and Lyme disease. However, numerous other illnesses are transmitted by vectors worldwide. Some common vectors include mosquitoes, fleas, ticks, and select species of flies.

Vector-borne pathogen hosts can be divided into 3 main types: reservoir, incompetent, and dead-end hosts. Reservoirs are animals or environments where the pathogen can survive and reproduce without causing illness or symptoms. Incompetent hosts are organisms that provide nutrition for the vector but do not develop disease. Dead-end hosts are the final link in the chain of infection, where the pathogen causes illness but is not directly transmitted to other susceptible hosts. Humans are often the dead-end hosts for many vector-borne diseases.

According to World Health Organization (WHO) data, up to 80% of the world’s population is at risk for 1 or more vector-borne diseases.

 However, the most significant burden of vector-borne diseases is currently in tropical and subtropical areas.

Climate change is having a direct impact on the epidemiology of vector-borne illnesses. Travel-associated cases of vector-borne diseases do occur. However, there had been no local spread because the vector could not survive in the new environment. We now see favorable climate changes for the expansion of vector habitats. An example of how climate-impacted vector conditions is the Zika virus outbreak in South America in 2015. The weather patterns associated with El Niño in that same time frame were very conducive to the mosquito species

resulting in an expanded vector population and a regional outbreak of Zika virus in the human population.

Human interactions with the environment also impact vector-borne diseases. Building dams, crop irrigation, deforestation, farming and livestock practices, and urban expansion impact the vector habitats that transmit pathogens to newly susceptible hosts. For example, the expansion of irrigation for farming purposes has been shown to significantly impact the spread of emerging infectious and zoonotic diseases in the local population.

Dengue virus is the most widespread vector-borne illness. A study of cities in India found that increased green spaces with open water and densely populated areas with poor waste management practices had increased the

 Traditional approaches to removing the vectors in these urban areas are no longer effective, as the vectors’ breeding grounds evolve with changes in city design.

Travel from endemic areas often introduces vector-borne diseases to nonendemic regions. For example, mosquitoes transmitted on flights have been known to spread malaria, dengue virus, and chikungunya to France.

 Typically, the vector would not have been available in France to continue the transmission cycle, but with adaptation, the local mosquito population is now capable of transmitting these pathogens, and numerous local cases are identified annually.

Additionally, antimicrobial use in livestock and humans can cause mutations in the pathogen’s genetic code, leading to drug-resistant variants. Like other multidrug-resistant organisms, antimicrobial stewardship is essential for vector-borne diseases.

Prevention practices for vector-borne diseases have a hierarchical level of effectiveness. The most effective control types are elimination, engineering, and behavioral controls. Active surveillance and understanding a disease’s epidemiology are the foundations of prevention efforts. As with many prevention programs, a combination of all types is necessary to reduce the transmission risk effectively.

Elimination controls in these cases include the removal of the vector. Chemical insecticides are used widely in this instance. Insecticides have proven effectiveness; however, there are concerns with resistance and adverse effects of the chemicals, which limit their use.

Removal of the breeding ground for the vectors is another approach to elimination controls. Water and sanitation programs are crucial public health practices that can reduce risk. Zoonotic transmission and reservoirs must also be included in control efforts. Trends over the past decades have shown that most emerging infectious diseases have a zoonotic transmission origin. For example, the West Nile virus emergence in the US was seen as one of the most significant zoonotic diseases transmitted via vectors to humans.

Engineering controls help to isolate people from a hazard. Some examples of engineering controls include mosquito nets, screens in windows and doors, and, more recently, genetic modification of vectors to limit their ability to spread pathogens. Research on arboviruses can lead to possible genetic solutions to disease transmission. For example, a 2022 study examined why yellow fever is not endemic in Asia, even though the vector is prevalent. Researchers found that the mosquitoes infected with Japanese encephalitis could not transmit yellow fever.

 Understanding these natural occurrences could lead to further research on potential genetic modification to mimic the same controls.

Vaccination is available for some vector-borne diseases, such as yellow fever and dengue virus. However, further research and development are needed to increase vaccine availability and effectiveness. Additionally, trust in national public health and vaccine programs has decreased over time, so much education and culture-specific dialogue are needed to regain the acceptance of vaccines internationally.

Behavioral modification is often the least effective intervention, as human factors cannot be controlled in a standard way to ensure compliance. However, education and personal practices are still essential in prevention practices. Examples include using bug sprays or lotions, wearing long sleeves and pants, emptying standing water around one’s home, and engaging in behaviors to minimize vector exposure. The use of prophylactic medication is another example of behavioral control.

With all this information, what does a typical infection preventionist need to know about vector-borne diseases? As stated above, the prevention aspects are typically in public health, which aligns with infection prevention but has a slightly different lens to how disease prevention is approached. Infection preventionists must collaborate with local public health agencies. Knowing your local epidemiology of vector-borne diseases, concerns, and whether we have known vectors in our area should be shared with your frontline staff, including emergency room providers and infectious disease clinicians. I worked with local public health staff members when the first locally transmitted case of dengue virus was identified in an assisted living community under our health care organization’s umbrella. Infection prevention acted as the liaison between public health and the administrators of the subacute facility to help with case identification, implementation of mitigation efforts, and staff and resident education. As vector-borne diseases spread into novel areas, infection preventionists can be at the forefront of preparedness efforts to ensure their facilities and communities are proactively engaged.

One last thing to consider, as many of these diseases are preventable with basic public health strategies, is why they still have such an impact. Understanding the impacts of climate change, focusing efforts on vaccine development, and ensuring access to prophylactic medications are needed from international perspectives to reverse the trend of increasing spread and suitable reservoirs for vectors. Support of legislation and regional and national public health efforts that address sanitation, urban development, and mitigation factors is essential to decrease the global impact of vector-borne diseases.

1. Vector-borne diseases. World Health Organization. September 26, 2024. Accessed November 17, 2024. 

https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases

2. Updated WHO guidance for controlling vector-borne diseases through indoor residual spraying. World Health Organization. February 15, 2024. Accessed November 5, 2024. 

https://www.who.int/news/item/15-02-2024-updated-who-guidance-for-controlling-vector-borne-diseases-through-indoor-residual-spraying

3. Rocklöv J, Dubrow R. Climate change: an enduring challenge for vector-borne disease prevention and control. 

. 2020;21:479-483. doi:10.1038/s41590-020-0648-y

4. Chala B, Hamde F. Emerging and re-emerging vector-borne infectious diseases and the challenges for control: a review. 

5. Vector-borne diseases: mosquitoes, ticks, biting flies… how far will they go? 

. June 17, 2024. Accessed November 18, 2024. 

https://www.pasteur.fr/en/research-journal/reports/vector-borne-diseases-mosquitoes-ticks-biting-flies-how-far-will-they-go

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"Climate change is having a direct impact on the epidemiology of vector-borne illnesses. Travel-associated cases of vector-borne diseases do occur."

Vector-Borne Diseases: Understanding Their Transmission and Prevention, and the Role of Infection Preventionists

Proper glove use is essential in health care settings to prevent the spread of infections and safeguard patients and health care workers (HCWs). Gloves act as a crucial barrier, shielding HCWs from exposure to harmful microorganisms such as bacteria, viruses, and other pathogens in bodily fluids or on contaminated surfaces. When used correctly, gloves are highly effective in reducing the risk of health care–associated infections (HAIs) and cross-contamination, thus ensuring a safer environment for health care professionals and patients.

However, the protective benefits of gloves depend heavily on their correct selection, use, and disposal. Misusing gloves—such as wearing them unnecessarily or failing to change them between tasks—can compromise hygiene protocols and inadvertently spread contaminants.1 For instance, wearing gloves for tasks for which they are not needed or failing to change them between patients can create a false sense of security, which may lead HCWs to neglect essential infection control practices, including hand hygiene. Gloves must also be used alongside other preventive measures to control infection risks effectively.

Leading organizations such as The Joint Commission (TJC), CDC, and World Health Organization (WHO) have developed comprehensive guidelines for glove use in health care environments. These guidelines provide HCWs with clear instructions on when gloves should be worn, which types are appropriate for specific tasks, and how to properly dispose of gloves to avoid contamination. By complying with these established standards, health care professionals can contribute to a safer health care system that aligns with global and national infection prevention protocols.

TJC emphasizes that gloves should be worn as part of standard precautions, particularly when there is potential exposure to blood, bodily fluids, or other infectious materials.

 The organization underscores that gloves should not be used in isolation but in conjunction with other infection control measures, such as regular hand hygiene. HCWs are encouraged to wash their hands before donning gloves and immediately after removing them. This ensures that pathogens are not transferred from hands to gloves or vice versa, minimizing the risk of contamination.

TJC also highlights the importance of changing gloves between patients and between tasks on the same patient to prevent cross-contamination.

TJC cautions against overusing gloves, noting that wearing gloves when unnecessary can lead to a false sense of security. This reliance on gloves, without proper hand hygiene or complying with correct disposal procedures, can compromise patient safety.

 To support health care facilities in maintaining best practices, TJC incorporates compliance with these guidelines into its accreditation surveys, ensuring that organizations comply with infection prevention protocols as part of their commitment to patient safety and quality care.

The CDC views gloves as integral to standard precautions in all health care settings.

 Gloves should be used whenever HCWs anticipate contact with blood, bodily fluids, mucous membranes, nonintact skin, or potentially contaminated surfaces and equipment. The CDC stresses that gloves must be changed between patient contacts and when moving from contaminated to clean tasks for the same patient. This practice helps ensure that microorganisms are not inadvertently spread between patients or within the same individual.

 The CDC also emphasizes the importance of hand hygiene, advising HCWs to wash their hands before putting on gloves and after removing them to prevent contamination.

The CDC provides guidance on selecting the appropriate type of gloves for different tasks, such as sterile gloves for surgical procedures and nonsterile gloves for most routine care activities. These guidelines aim to balance effective infection prevention with resource sustainability, ensuring gloves are used to maximize their protective benefits without creating unnecessary waste.

The WHO underscores the importance of using gloves appropriately and judiciously as part of broader infection prevention and control strategies. WHO guidelines state that gloves should be worn during procedures with a high risk of exposure to infectious materials, such as invasive procedures, patient care activities involving broken skin or mucous membranes, and when handling contaminated medical equipment.

 Additionally, the WHO stresses the necessity of changing gloves between patients and tasks, especially when transitioning from contaminated to clean areas, to prevent the spread of pathogens within health care settings.

A critical point raised by the WHO is that gloves should never replace proper hand hygiene. HCWs are advised to perform hand hygiene before and after using gloves to avoid contamination. The WHO also warns against the unnecessary use of gloves, particularly when hand hygiene alone is sufficient, as overuse can lead to waste and reduced glove availability during high-risk procedures. WHO emphasizes the need for HCWs to receive proper training on glove use to ensure compliance with these guidelines, thus enhancing patient safety and infection control efforts globally.

By complying with the guidelines from TJC, CDC, and WHO, health care organizations can implement best practices for glove usage, ultimately minimizing the risk of HAIs.

Infection preventionists (IPs) ensure that HCWs follow proper glove usage protocols to minimize the risk of HAIs. They educate staff on when and how to use gloves, emphasizing the importance of appropriate hand hygiene before and after glove use. This helps prevent the spread of pathogens and ensures gloves are used appropriately as part of a broader infection control strategy. IPs also help develop and implement policies that align with guidelines from organizations such as TJC, CDC, and WHO. These policies outline the circumstances when gloves should be worn and how they should be disposed of.

Additionally, IPs regularly audit HCWs’ compliance with these guidelines, identifying issues such as overreliance on gloves or failure to change gloves between tasks. They provide feedback and corrective actions to address their concerns. By offering ongoing support and guidance, IPs ensure that staff comply with the latest infection control standards, helping maintain a safe health care environment for patients and HCWs.

Lindberg M, Skytt B, Lindberg M. Continued wearing of gloves: a risk behaviour in patient care. 

. 2020;2(4):100091. doi:10.1016/j.infpip.2020.100091

Hand hygiene: key components of a compliant hand hygiene program. The Joint Commission. Updated June 7, 2024. Accessed December 11, 2024. https://www.jointcommission.org/standards/standard-faqs/home-care/national-patient-safety-goals-npsg/000002354

Prevent infections and ask caregivers to wash their hands. The Joint Commission. Accessed December 11, 2024. 

https://www.jointcommission.org/resources/for-consumers/take-charge/prevent-infections-and-ask-caregivers-to-wash-their-hands/

Clinical safety: hand hygiene for healthcare workers. CDC. February 27, 2024. Accessed December 11, 2024. 

https://www.cdc.gov/clean-hands/hcp/clinical-safety/index.html

WHO guidelines on hand hygiene in health care. World Health Organization. January 15, 2009. Accessed December 11, 2024. 

https://www.who.int/publications/i/item/9789241597906

Vaccine administration. CDC. June 18, 2024. Accessed December 11, 2024. https://www.cdc.gov/vaccines/hcp/imz-best-practices/vaccine-administration.html

Proper glove use is crucial in health care settings to prevent infections. Guidelines from TJC, CDC, and WHO stress correct selection, usage, and disposal to minimize health care–associated infections (HAIs) and cross-contamination risks. Infection preventionists (IPs) play a key role in educating staff, enforcing compliance, and improving patient safety through standardized glove practices.

Infection Control Today, January/February 2025 (Vol. 29 No.1)

Antibiotic Stewardship in Long-Term Care: Leveraging McGeer and Loeb Criteria for Better Outcomes

Ensuring Safe Practices: Managing Surgical Instruments in the Context of Creutzfeldt-Jakob Disease

A Day in the Life of a Pathogen: From Your Hands to Stethoscopes and Beyond

Vector-Borne Diseases: Understanding Their Transmission and Prevention, and the Role of Infection Preventionists

Glove Usage Guideline: From The Joint Commission, CDC, and World Health Organization