Observed each year on December 27, the International Day of Epidemic Preparedness is a reminder that pathogens do not keep calendars or borders, and that the only durable defense is a living system of prevention, early detection, and rapid response. Pandemic fatigue is real, but so are the continuing signals: resurgent measles, expanding dengue, evolving influenza, and stubborn antimicrobial resistance. Preparedness cannot be a project we dust off during crises; it must be a core capability we fund, practice, measure, and improve every year.


Infection prevention personnel know that the most cost-effective outbreak is the one that never happens. Prevention begins with strong primary health care and a One Health approach that tracks risks at the human-animal-environment interface. It includes routine immunization, ventilation and environmental hygiene in schools and health facilities, safer supply chains for water and sanitation, and reliable access to personal protective equipment. Hospitals and long-term care centers should integrate infection prevention and control into their everyday operations, including hand hygiene, device care bundles, cleaning and disinfection, and antimicrobial stewardship. Investments in community trust are equally preventive: When people believe their health system, they seek care earlier and accept vaccines faster.


Minutes matter when an unusual cluster appears. Detection requires integrated surveillance that can “see” across care settings and geographies, including electronic case reporting, laboratory networks with surge capacity, and genomic sequencing that can identify variants before they spread. Complementary tools, such as wastewater surveillance, syndromic monitoring in emergency departments, and rapid point-of-care diagnostics, help shorten the time from the first case to the first signal of an outbreak. Just as important are interoperable data standards and analytics that deliver timely, actionable insights to frontline teams while safeguarding privacy. Technology should assist—not overwhelm—already stretched public health and clinical staff.


A swift response rests on practiced playbooks and prepared people. Every jurisdiction and health system should maintain a standing incident command structure; preposition contracts for staffing, oxygen, and critical supplies; and conduct regular drills that include community partners, from schools and shelters to faith and civic organizations. Clear risk communication—being honest about uncertainty, consistent across channels, and available in multiple languages—builds confidence and counters misinformation. Equity must be explicit: Surge testing sites, mobile vaccination, and treatment access should reach high-risk settings first, not last.


Preparedness rises and falls with funding that is predictable, flexible, and accountable. Dedicated domestic budgets and contingency funds prevent the familiar cycle of panic and neglect. Similarly, investment in people includes field epidemiologists, laboratorians, infection preventionists, environmental services teams, community health workers, and data scientists. Cross-training and protected time for exercises convert policy into muscle memory.

Set measurable targets (eg, time to detection, time to isolation, vaccination coverage, stockpile readiness) and publish progress.

Modernize data pipelines to enable laboratories and clinics to report once and reuse the data multiple times.

Upgrade facility infrastructure, including airflow, isolation capacity, and environmental hygiene, as well as digital tools.

Fund routine after-action reviews and close the loop on lessons learned.

Engage communities early and codesign plans with the people most affected.

Epidemics exploit our delays and divisions. On December 27—and every day before and after—preparedness asks us to do the opposite: Act early, act together, and act on evidence. The return on investment is measured not only in lives saved during the next emergency but also in healthier, more resilient systems all year long.

Articles

Observed on December 27, the International Day of Epidemic Preparedness highlights the need for continuous investment in prevention, detection, and response to protect lives and strengthen health systems against ongoing and emerging threats.

International Day of Epidemic Preparedness: Turning Lessons Into Lasting Systems

Do you think you know your way around disinfection protocols, cleaning validation, and environmental services (EVS) terminology? This challenging crossword is designed for EVS professionals and infection preventionists who want to test their technical knowledge. From precleaning procedures to regulatory acronyms, each clue digs a little deeper into the science and practice of keeping health care environments safe. Grab a pen—or gather your team—and see how many you can solve without peeking at the answer key!

Think you know your EVS science inside and out? This crossword puts your expertise to the test with clues drawn from disinfection practices, cleaning validation, and the terminology every EVS professional and infection preventionist should know. Grab a pen or a colleague and see how far your knowledge takes you.

Challenge Yourself and Your Team With ICT's Environmental Services Crossword

Infection preventionists (IPs) are living through peak complexity: new guidance, staffing churn, device alerts, and dashboards that multiply overnight. When everything feels urgent, it’s tempting to reach for the latest tool or the flashiest initiative. However, the fastest way to protect patients and your team right now is to recenter the basics in infection prevention and control (IPC)—not because they’re easy, but because they’re the only things delivered thousands of times a day, in every unit, and by everyone.

“It would be beneficial for IPs to concentrate on the areas within their control: practicing proper hand hygiene, wearing [personal protective equipment] correctly, maintaining cleaning and disinfection routines, and environmental hygiene. These 3 areas work together,” said Sharon Ward-Fore, BS, MS, MT(ASCP), CIC, FAPIC, an independent IP consultant from North Carolina. “If we can ensure that all these practices are carried out properly, it would be a win for everyone. Therefore, I’d like IPs to spend some time on the unit. Observe, observe, observe.”

Small Gains on a Massive Scale Beat Rare Heroics

A 5% improvement in a basic behavior performed 1000 times a day prevents more harm than a 100% improvement in something done twice a month. When you shave misses from those moments, the math favors you—quietly and relentlessly.

Variants come and go, supply chains wobble, and new bugs surprise us. Core practices are our all-hazards tool kit. They don’t require us to know the name of the organism on day 1. When you make fundamentals reliable, you’re buying resilience for the subsequent unknown.

Reliability Builds Trust—Inside and Outside the Room

Staff, patients, and families don’t judge us by policies; they judge us by what they see. Consistent basics are visible signals of safety. They calm anxious families, reduce staff conflict (“We all do it this way”), and give leaders credible ground to stand on when the rumor mill spins.

The Basics Expose System Problems You Can Fix

When something simple isn’t happening, it’s rarely because people don’t care. It may be because the dispenser is empty, the product conflicts with the device’s instructions for use, or the workflow conflicts with the device's behavior. Focusing on fundamentals pushes you to remove friction. Every barrier you eliminate pays dividends all year.

Going Back To Basics Is the Shortest Path to Measurable Wins

Executives fund what moves metrics. Fundamentals change denominators fast. Quick wins buy runway for bigger projects and restore team morale.

Checklists and microdrills aren’t busywork; they are kindness to the brain. When the core moves are automatic, people have bandwidth for the exceptions that truly need judgment. Basics create space for critical thinking where it matters.

Basics are a shared craft. When we celebrate catches, remove barriers, and show peers the difference they make, fundamentals become identity. Culture outlasts campaigns.

Pick 1 fundamental that touches every patient on your busiest unit. Make the right way the easy way—physically, visually, and socially. Measure a simple leading indicator, share it weekly, and thank the people who move it. Tell 1 story about harm prevented because someone did the basic thing reliably.

Back to basics isn’t nostalgia; it’s a strategy. It’s how we convert ordinary moments into extraordinary safety— shift after shift, season after season. We all, including IPs, don’t need louder programs; we need quieter reliability. Recommit to the moves you can deliver everywhere, by everyone, every time, and let the results speak for themselves.

BACK TO BASICS: Why It’s the Smartest Move in IPC Right Now

Stethoscopes are the third arm of the clinician—reached for instinctively, used dozens of times per shift, and rarely the star of infection prevention policies. Yet a lively roundtable of clinicians and infection preventionists (IPs) makes a compelling case that this everyday tool can be a stealth vector for transmission, and that fixing the problem will require more than wipes on a cart. It will require muscle memory, clearer guidance, practical products, and a culture that treats stethoscope hygiene with the same importance as hand hygiene.

This was a frank discussion that moved from outbreak investigation to human behavior, from device manufacturer instructions for use (IFUs) to dwell times, from single-use disposables to UV gadgets—and, ultimately, to culture, trust, and training that begins far upstream.

Elsy Mady, MSN, BSN, RN, CIC, independent infection preventionist consultant

Aaron Woodall, MPH, CIC, LTC-IP, chief of infection and control for the US Department of Veterans Affairs

Peter Graves, MSN, RN, CNOR, independent perioperative consultant, speaker, and peer-reviewed writer

The conversation opened with a vivid case study. Mady described investigating an alarming cluster of cases at a small, 100-bed hospital in Lebanon during the early months of the COVID-19 pandemic. “I started receiving positive cultures…an 

 resistant to all antibiotics,” she recalled. Because the hospital had previously battled outbreaks from the same organism, “[only] 1 positive result was enough to create an outbreak alert.”

Her team launched a comprehensive search, including environmental culturing, [heating, ventilation, and air conditioning] checks, staff scrubs and fingernails, and respirators—“Everything possible that could harbor this bacteria.” When nothing explained the resurgence, a pulmonologist caring for the affected patients handed Mady her stethoscope. “I dismantled it piece by piece and sent it to culture,” she said. “The surprise was that the bacteria were inside the stethoscope…not on the outside, but inside.”

The response was decisive: Collect every stethoscope, disassemble it, clean, disinfect, sterilize, and then reassemble it. “We stopped this outbreak,” Mady reported. The lesson stuck. When she later asked US physicians how they managed stethoscope hygiene, she often heard, “I put it on the patient’s clothes, so I don’t need to disinfect.” Her reply was blunt: “How do you know your patient’s clothes are clean?”

Operating room leader Graves immediately connected Mady’s discovery to surgical practice. “As an operating room [OR] nurse, that’s something we’re always concerned about: lumens and nooks and crannies,” he said. Surface cleaning alone won’t cut it. “To thoroughly clean something, you have to disassemble it—not just wipe the outside off. It’s the ‘wax on, wax off’ idea: thorough cleaning, not topical cleaning.”

But thoroughness collides with reality. Woodall, an infection-prevention leader, cautioned that expecting providers to disassemble stethoscopes after each use is impractical. “The more you tack on to the daily work, the more it gets pushed off,” he said. “Most providers are already behind. Are you going to get them to stop and take apart a Littmann?” Even when policies exist, “it’s not going to be met with a friendly face.”

The group agreed that evidence exists—in abundance—of contamination, even if causal chains to specific infections are rare. Graves had scanned 16 studies before the call: “Depending on location and how often they’re cleaned, stethoscopes are contaminated 40% to 100% of the time.” Yet he confessed he couldn’t think of a guideline that frames stethoscope cleaning with the same clarity and urgency as hand hygiene. “Maybe we need to codify it,” he suggested.

Guidance Gaps, IFUs, and the Dwell-Time Blind Spot

If guidelines are thin, IFUs can be maddeningly vague. “Most providers default to the Littmann,” Woodall noted. “Their IFU talks about 70% [isopropyl alcohol]. And then they do the irritating thing: ‘mild soap and water.’” Hospitals often don’t stock wipes clearly labeled as 70% isopropyl alcohol, he added, “so any hospital that doesn’t carry something specific to that…most aren’t going to use it correctly.”

The group raised a second, ubiquitous problem: failure to respect dwell time—the time a disinfectant must remain wet on a surface to achieve its claim. The moderator shared a personal moment at an eye clinic: “She opened a wipe and swabbed the chin rest. She said, ‘Go ahead.’ I said, ‘I’m not touching that until it dries.’ …People don’t understand: if you don’t let it dry, it’s not killing anything.”

Woodall agreed: “Cleaning is not disinfecting—and that’s the piece generally missed. You have to hit your dwell time. Otherwise, you’re not doing anything, and you’re putting people at risk.” Graves added a cautionary tale: a center using wipes with a 10-minute dwell time, but staff only allowed 2 minutes before toweling dry. “It defeats the purpose.”

Mady’s bottom line for product selection was practical and familiar to IPs: “Follow the IFU for the disinfectant you have.” Hydrogen peroxide, quaternary ammonium compounds, and alcohol, “every hospital uses something different. If the disinfectant is tested for the stethoscope, use it.”

Ultraviolet Devices and the Limits of Line-of-Sight

Could engineering controls help? Phone-sanitizing boxes and small UV chambers promise quick and consistent disinfection without the need for handling chemicals. Graves asked for reactions. Woodall was cautious: “It depends on the device and the UV type. Some could be valuable, while others probably are not. And behavior fades—initial use is high, then it tapers. It’s like Christmas presents.”

The moderator highlighted a fundamental constraint: “UV-C only works on surfaces it can reach. It won’t do a darn thing for the issue [Mady] had—contamination inside the stethoscope.” Graves concurred: “It only gets where the light shines.”

Disposable Stethoscopes: A Green and Quality Dilemma

What about single-patient, disposable stethoscopes? They offer a clean slate and eliminate the need for shared devices. In practice, the panel found them wanting. “If you have a really good process, it can work,” Woodall said, “but the cost incurred can be high.” Graves added the OR perspective: “Anesthesia is not fond of those. The quality is significantly less. And the tubing is often too short.”

Mady raised waste as another concern. “If a hospital pays for waste, imagine the volume from these items. And if we find them in the garbage—not hanging where they belong—you don’t know where that stethoscope was.” On balance, the panel identified narrow use cases but concluded that disposables are not a scalable solution for high-acuity, noisy environments.

Why is adherence so difficult? Partly, fear fades. During COVID-19’s early surge, “everybody paid attention to all the details,” Mady said. “When the pandemic was declared over, we’re back to business, and everyone is not paying attention.” Woodall put it starkly: “Easy times breed soft minds.” The public doesn’t grasp the day-to-day reality of antimicrobial resistance; absent a crisis, risk feels abstract.

Training gaps also matter. “Medical schooling doesn’t address infection prevention in a manner it should,” Woodall argued. Clinicians know how to assess a patient’s infection, “but not the small things like dwell time.” “You get people from [gastrointestinal] or [genitourinary], where they're using a lot of scopes and instruments. They understand the disinfection portion and sterilization a lot more than some of the other areas that have to kind of speed through what they're doing just to get things turned over.”

The group returned repeatedly to muscle memory—a concept Graves illustrated with his daughter’s volleyball team. “They practice and practice, so they know instinctively what to do in a game,” he said. “We try to do that with hand hygiene. We need the same for stethoscope hygiene.”

Beyond the Walls: Culture, Trust, and Early Education

For sustainable change, the panel returned to the topic of culture. “It comes down to building a culture of trust,” Woodall said. It must be trust that infection prevention guidance protects patients, staff, and families. “infection prevention doesn’t stop at the hospital walls. It continues into the community.”

Mady argued for starting far earlier than orientation: “To build a pianist, you start early. The same with infection prevention.” She envisions incorporating age-appropriate concepts into K-12 education and establishing dedicated courses in nursing and medical schools. “By hearing it over and over and practicing it, we will end up making a change in the culture.”

Graves framed the destination succinctly: “Do the right thing when no one’s looking.” That means aligning stethoscope hygiene with the “high reliability organization” pillars many hospitals espouse—preoccupation with failure, sensitivity to operations, and commitment to resilience.

Stethoscopes will always be in the pockets of health care workers, around their necks, and on their patients. The question is whether policies, products, and habits will catch up with their risk profile. The roundtable’s consensus is not to overcomplicate it: Match IFUs with available disinfectants, honor dwell times, build small routines at the right moments, make contamination visible, and foster a culture where cleaning the stethoscope is as reflexive as sanitizing hands.

Or, in Woodall’s bracing shorthand about human nature: “Easy times breed soft minds.” IPs have an antidote: steady, visible, practical habits that harden into muscle memory—one wipe, one dwell time, one patient at a time.

Videos

Much is discussed about stethoscopes, the "third arm" of clinicians, but what about the risk of spreading health care-associated infections? 

The Dirty Truth About Stethoscopes: Why This Everyday Tool Deserves Attention

Dental and oral surgery clinics have historically been underrepresented in the scope of practice of infection preventionists (IPs). Infection prevention and control (IPC) lapses in dental clinics can have a significant impact on patients. The CDC has published recommendations since 2003, with the most recent updated edition of summary recommendations in 2016.

Basic IPC practices have a universal application. For example, standard precautions apply in dental clinics as they do in acute care facilities. Hand hygiene is a cornerstone of IPC practices, as well as the use of personal protective equipment, environmental disinfection, and safe injection practices. Instrument cleaning and sterilization are key topics for ensuring safe dental care. Mechanical cleaning is preferred over manual cleaning.

Oral surgery can also impact patient outcomes, as microorganisms from the oral cavity may potentially spread to normally sterile sites and cause secondary infections. Risk factors for surgical site infections (SSIs) after oral and dental procedures can be classified as patient-related or procedure-related. Patient-related risk factors include variables such as age, diabetes status, smoking status, and other comorbidities. Procedure-related risk factors include instrument sterilization, preparation of the surgical site, prophylactic antimicrobial use, and duration of the procedure.

In acute care facilities, patients may have oral and maxillofacial procedures for various admitting diagnoses, such as trauma (eg, motor vehicle crash, assault, falls), cleft lip and palate, impacted teeth, or other skeletal malformations. Dental surgery and procedures in outpatient settings are typically performed for less complicated issues, such as tooth extractions or dental implants.

In the US, limited data exist to understand the rate of SSIs following oral surgery. Literature has reported rates that can range from 2.15% to 30.8%, depending on the type of procedure.

 A study recently published from Saudi Arabia found a rate of 10.3% of SSIs after oral or maxillofacial surgery.

The study by AlKhamis et al reviewed patient- and procedure-related risk factors for SSIs. They found that increased age, male gender, and diabetes status were strongly associated with increased risk for SSIs.

 Interestingly, the use of a chlorhexidine mouthwash was not found to be a statistically significant variable in the prevention of SSIs. However, the group that used the mouthwash before surgery was small, so there might not have been a large enough sample size to establish significance. Oral care and hygiene are key patient-level factors that contribute to the risk of poor outcomes and have been shown to be significant in other studies.

As far as procedure-related risk factors, when comparing procedure types, cases classified as head and neck lesions had the highest prevalence of SSIs, followed by maxillofacial trauma and then dentoalveolar surgeries.

 However, the analysis showed no statistically significant difference in risk according to the type of surgery. The variables associated with an increased risk of oral surgery are consistent with those for other procedures, including multiple trips to the operating room, a higher American Society of Anesthesiologists score, and a higher wound classification.

The use of prophylactic antimicrobials in dental surgery to prevent SSIs showed variation in practice in this study. Typically, dentists in the outpatient setting are more likely to prescribe an antimicrobial for patients with a history of joint replacement or other risk factors. This is to prevent the seeding of a secondary site rather than to prevent a primary SSI. In an acute care setting, preoperative antimicrobials may be used more often as part of standard procedures and processes to prevent postoperative complications.

Dental SSIs are not required to be reported as infections for acute care facilities in federal or state health care–associated infection reporting. Therefore, surveillance is largely limited to focused published research. Outpatient clinics and surgery centers would have even less structured surveillance approaches. Because of these limitations, it is challenging to understand the scope of the problem and identify trends to address opportunities for improvement.

Several key factors should be included in a dental SSI prevention program. First, patient-related factors need to be managed as much as possible preoperatively. Diabetes management is a key factor to consider in preoperative counseling. Maintaining blood glucose levels within a normal range can decrease the risk of postoperative infection. Patient oral hygiene practices can be reviewed and improved. The use of a chlorhexidine mouthwash preoperatively should be considered, along with regular good oral care. If patients are hospitalized, tooth brushing and oral care should be continued as part of standard patient care.

The use of prophylactic antimicrobials is a key step in surgical procedures, but the growing concern about antimicrobial resistance poses a challenge. To decrease the risk of resistance, some guidelines recommend reserving the use of prophylactic antibiotics for patients and procedures at the highest risk.

 It would be essential to review data to validate this practice, understand how infection rates may be impacted, and weigh the risk of infection vs potential resistance when making such recommendations.

Environmental cleaning and disinfection must be performed with products registered with the Environmental Protection Agency. Between patient cleaning and end-of-day cleaning, there should be standard processes. High-touch surfaces would be a focus for between-case cleaning, with a terminal clean performed at the end of the operative day. Checklists and standard operating procedures can assist with staff training and consistency. It’s essential that any manufacturer’s instructions for use (IFUs) related to proper cleaning and disinfection are followed for both surfaces and any instruments or reusable medical equipment.

IPs should discuss the processes for instrument cleaning, disinfection, and sterilization with staff to ensure that all IFUs are being followed and that staff have documented competencies. Single-use instruments are another option, especially in outpatient settings where volume is high and there may not be large enough autoclaves to handle the turnover needed to meet schedule needs.

Sterilization of instruments is a high-risk process in any setting, including dental clinics. Tabletop autoclaves are the typical device for sterilization. Autoclaves require monitoring with indicators to ensure sterilization is achieved. Additionally, routine maintenance is necessary to ensure the proper functioning of the autoclave.

In acute care settings, IPs are required to have water management programs. If a hospital licenses a dental clinic, then that clinic would also need to be included in the program. Water management is equally important in an outpatient dental setting. IPs must have a basic understanding of all the risk factors that contribute to water quality issues in dental care.

Dental waterlines are a potential source of contamination during procedures in clinics. There are published guidelines for managing dental waterlines, including cleaning, disinfecting, and testing the lines. At a minimum, the water must meet the exact requirements for drinking water, with fewer than 500 colony-forming units per milliliter.

 For surgical procedures, sterile saline, irrigating solutions, and/or water must be used. These sterile solutions cannot flow through the main dental unit waterlines; therefore, they must be delivered via alternative methods, such as single-sterile, prefilled syringes or utilizing a sterile bulb or syringe from a multidose container.

Practitioners should be aware of several areas of innovation in oral surgery. Research into advanced antiseptic products is ongoing, as dual-action antimicrobials are being explored for increased effectiveness in reducing infection and inflammation.4 Use of laser-assisted surgery is also becoming more common, which decreases the risk of SSIs. Finally, the use of nanomaterials, such as silver-impregnated implants or sutures, has shown promising results in reducing the risk of infection.

IPs may have limited experience working in dental clinics or reviewing safe practices for oral surgery. There are several resources available to assist IPs as they educate themselves on best practices, such as the “Infection Prevention Checklist for Dental Settings” published by the CDC in 2016.

 Bringing forward the basic knowledge of disinfection, sterilization, standard precautions, and patient safety practices, IPs can be a valuable resource for dental health professionals to collaborate and develop strong IPC programs for dental health providers. 

Standard precautions. CDC. May 15, 2024. Accessed May 16, 2025. https://www.cdc.gov/dental-infection-control/hcp/summary/standard-precautions.html

Bromberg N, Brizuela M. Preventing cross infection in the dental office. In: StatPearls. StatPearls Publishing; 2023. Accessed May 16, 2025. https://www.ncbi.nlm.nih.gov/books/NBK589669/

AlKhamis M, Abedalqader T, Ouban A, et al. Surgical site infections in oral and maxillofacial surgeries: prevalence and associated risk factors. World Journal of Surgery and Surgical Research. August 12, 2024. Accessed May 7, 2025. https://www.surgeryresearchjournal.com/open-access/surgical-site-infections-in-oral-and-maxillofacial-surgeries-prevalence-and-9748.pdf

Bouguezzi A, Abdellatif C, Hentati H, Selmi J. Infection control in oral surgery: innovations and protocols. Journal of Pharmaceutical Research and Reports. January 30, 2025. Accessed May 13, 2025. https://www.onlinescientificresearch.com/articles/infection-control-in-oral-surgery--innovations-and-protocols.pdf

Healthcare-associated infections: infection prevention in oral health settings. Wisconsin Department of Health Services. Revised February 14, 2025. Accessed May 14, 2025. https://www.dhs.wisconsin.gov/hai/oral-health.htm

Infection prevention checklist for dental settings: basic expectations for safe care. CDC. Accessed May 16, 2025. 

https://www.cdc.gov/dental-infection-control/media/pdfs/Infection-Prevention-Checklist-for-Dental-Settings-fillable-form.pdf

Dental and oral surgery clinics are often overlooked in infection prevention programs, yet lapses can have serious consequences. Strengthening surveillance, sterilization, and patient safety practices is critical to reducing surgical site infections.

Infection Control Today, November/December 2025 (Vol. 29 No.6)

International Day of Epidemic Preparedness: Turning Lessons Into Lasting Systems

Challenge Yourself and Your Team With ICT's Environmental Services Crossword

BACK TO BASICS: Why It’s the Smartest Move in IPC Right Now

The Dirty Truth About Stethoscopes: Why This Everyday Tool Deserves Attention

Elevating Infection Prevention in Dental Clinics: Addressing Surgical Site Infection Risks