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The age of virulence & the future of infection control & prevention

In early 2020 when the pandemic became a reality for everyone in healthcare, the need for consensus regarding infection control practices became more urgent.

The age of virulence refers to several emerging and zoonic infectious diseases and underscores how quickly viruses and other deadly pathogens evolve. The role of the infection preventionist and the need for the entire healthcare organization to support them should not be underestimated.

In this webinar, we take a closer look at how to generate more awareness of evidence-based practices to become much more "infection prepared".


  • Brian Williams, vice president of compliance and learning, MedTrainer
  • Emily Wulf, lead nurse planner, MedTrainer

Learning objectives:

  • Become familiar with emerging and zoonic diseases and the potential impact in the U.S.
  • Understand the issues surrounding the post-antibiotic era and strategies to improve antibiotic stewardship and sepsis awareness
  • Discover how the basics of infection control and prevention are the best defense in the age of virulence

Key topics:

  • 1:10 - Introduction
  • 2:35 - "The Age of Virulence" in healthcare
  • 4:25 - Antibiotic resistance and sepsis
  • 7:30 - Organization response and preparedness
  • 13:55 - Health equity and antibiotic resistance
  • 21:55 - Infection control & prevention
  • 30:20 - Disease resurgence
  • 32:00 - CDC alerts
  • 34:20 - Infection preparedness models
  • 37:12 - References and resources

The age of virulence calls for enhanced infection control and prevention

In an age of virulence, which refers to several emerging and zoonotic infectious diseases and the quickness in which deadly pathogens evolve, the role of the infection preventionist and the need for the entire healthcare organization to support them is critical.

In our June 29, 2022 webinar, two speakers, Brian Williams, vice president of compliance and learning at MedTrainer and Emily Wulf, lead nurse planner at MedTrainer, addressed how to generate more awareness of evidence-based infection prevention practices so that healthcare facilities can become infection prepared.

Below are several key points from the webinar regarding infection control and infection prevention.

How emerging and zoonotic diseases impact the U.S.

Zoonotic disease or infection can be transmitted naturally from animals to humans or vice versa. Scientists estimate that more than 60% of known infectious diseases in people can be spread from animals, and 3 out of every 4 new or emerging infectious diseases in people come from animals.1

As the world experiences novel zoonotic viruses like COVID-19, the resurgence of other diseases is also taking place.

"Whether or not you believe in or support global warming, there are trends that show weather patterns have changed. All of these things can help to preserve or re-energize a disease," said Williams.

He pointed to monkeypox, which the Centers for Disease Control and Prevention (CDC) has recently tracked in countries – like the United States – that don't normally report this disease. In 1980, monkeypox was declared eradicated by the World Health Assembly until its first outbreak outside of Africa in 2003.

"It's important for us to understand that disease resurgence can be tied to our environment, to animals and to our practices within our healthcare organizations and our homes, and other diseases worldwide like Ebola are showing some resurgence," said Williams.

Additionally, as diseases resurge, some, such as Typhoid fever, are becoming more resistant to antibiotics, making it a challenge to treat and manage.

"We really need to train and make sure that our staff has the tools that they need to address these issues," he said.

The threat of antibiotic resistance is real

The CDC notes the following as the most urgent antibiotic-resistant threats and how they contribute to health disparities:

  • Candida aura rates are two times higher in Black people
  • C. diff (Clostridioides difficile) affects low income, foreign-born and non-English speaking people at home 
  • S. Aureus when compared with Whites, rates are higher in Black people
  • Carbapenem-resistant Enterobacterales (CRE) impacts infants, pregnant women, older adults, the Black population (regardless of age) and people with diabetes
  • Drug-resistant gonorrhea affects men who have sex with men 42 times the rate of other men

"It's important that when we look at the health disparities and we're trying to address these threats that we understand the value of taking care of the community and providing access, education and resources," said Williams.

A drive to spread sepsis awareness

While sepsis isn't contagious and doesn't spread, almost any infection can lead to sepsis. Sepsis is the body's overwhelming response to a life-threatening infection. As the leading cause of death in hospitals, the leading cause of hospital readmissions and the single biggest cost of hospitalizations in the U.S., sepsis causes the following consequences annually, according to the Sepsis Alliance:2

  • Affects nearly 49 million people worldwide
  • Most common killer of children (3.4 million annually)
  • 1.7 million adults are diagnosed in the U.S.
  • The mortality rate for children is 9.1%
  • 1 in 3 patients of hospital deaths
  • 87% of cases start outside of hospitals

"Learning to recognize sepsis is very important because disease virulence is not dependent on how it spreads, but on the degree of pathology caused by the organism," said Wulf.

Sepsis recognition is an important tool for prevention, she added. However, according to the Sepsis Alliance, while 72 percent of Americans can identify stroke symptoms, less than one percent can identify the most common sepsis symptoms, including:3

  • Fever, shivering, very cold
  • Extreme pain or discomfort
  • Clammy or sweaty skin
  • Confusion or disorientation
  • Shortness of breath
  • High heart rate

Because the most effective way to treat sepsis is with antibiotics, Williams said sepsis and antibiotic stewardship are two sides of the same coin. "In promoting antibiotic stewardship, it's all about reducing the use of antibiotics and using them appropriately. Where sepsis is concerned, one of the major treatments for it is antibiotics. So...when those campaigns are run simultaneously it tends to confuse healthcare workers," he said.

To address antibiotic resistance and sepsis, the National Center for Emerging & Zoonotic Infectious Diseases (NCEZID), which is part of the CDC, created the following plan for 2018-2023:

  • Strengthen public health fundamentals
  • Implement high-impact prevention and intervention
  • Enhance preparedness, detection and response
  • Innovate to stop emerging and zoonotic infections

Because nursing homes have the highest prevalence of risk for sepsis, the CDC created a checklist detailing the core elements of antibiotic stewardship specifically for this vulnerable group. The list acts as a baseline assessment of policies and practices which are in place and can be used to review progress in expanding stewardship activities on a regular basis.4

"[Understanding] what that checklist is, using it and coming up with a plan to ensure that patients who need sepsis-induced antibiotics are identified but at the same time, keeping in mind the importance of reducing the use of antibiotics overall. I think that's a challenge for every facility out there," said Williams.

Back to the basics of infection prevention

Infection control and prevention for all healthcare facilities include:

  • Hand hygiene
  • Healthcare workers who are up-to-date with vaccinations
  • Appropriate use of antibiotics
  • Care of catheters or indwelling devices (feeding tubes, etc.)
  • Safe injection practices
  • Supply and appropriate use of personal protective equipment (PPE)
  • Equipment and environment cleanliness
  • Infection identification and review
  • Isolation

While it's prudent to utilize basic principles of prevention, Wulf said identification of infection risk is also important.

"Recognizing the risk, such as when hand sanitizer is empty or if there is broken skin, such as an IV or wound [or] things left, such as open needles – all these leave risk and opportunity for injury and infection in that environment even when practicing standard precautions," she said.

Infection preparedness models are changing

Williams said that infection preparedness models are being integrated conceptually with emergency and disaster preparedness. He pointed to the ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE), known as the ASPR TRACIE. As the emergency preparedness gateway, it includes plans, disaster drills and resources for how local counties handle health-related disasters.5

Healthcare providers and those in public health can look up their county's 2022 disaster preparedness plan to see how prepared it is. "You can see what their policies are, how they make decisions, whether their strategies for resource allocations work and whether or not they're really plugged into being prepared [because] those guidelines and educational resources flow down to facilities and systems," said Williams.

Although the country is still under an emergency declaration for COVID- 19, which was supposed to end in July 2022, Williams said the medical community should prepare for when it ends.

"[When] it does expire, we're going to see a stronger compliance focus from the Occupational Safety and Health Administration (OSHA) and others on infection control and prevention. They're really looking to marry the two," he said.

"Before the pandemic, we often [saw] OSHA referring to CDC standards, but not necessarily enforcing them. I think that's changing and if you didn't have a COVID-19 plan during [the pandemic], you may want to get one in place."

And to stay up-to-day on alerts for cleared information about urgent public health incidents subscribe to the CDC's Health Alert Network (HAN).6

Webinar originally aired on June 29, 2022


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