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How the T-zone can be reinforced to fight cold, flu & COVID-19

In the age of COVID-19, everyone's thinking about infection prevention — across the spectrum of school-age children to older adults. This heightened awareness provides a unique opportunity for healthcare professionals to teach patients about the importance of the T-zone (the eyes, nose and mouth).

Taking current infection prevention measures a step further

Social distancing and the use of masks have been effective tools for reducing the spread of not only COVID-19 but also colds and flu. In fact, an April 2021 Scientific American article reported 700 U.S. deaths from flu during the 2020-2021 season, compared with 22,000 and 34,000 in the prior two seasons.1

However, health expert Martie L. Moore, MAOM, RN, CPHQ, believes targeting the T-zone represents a highly underutilized preventive strategy. 

In this webinar, Moore shares the important work she's done in establishing special isolation/COVID containment units and how these experiences have reinforced just how critical the T-zone is for both prevention and containment.

Why targeting the T-zone is critical for infection prevention

Bringing our hands to our face is something we all often do, almost unconsciously. "We're touching our masks; we're pushing our glasses up — we do it all the time," says Moore.

Still, infection prevention has primarily focused on limiting exposure through masking and social distancing.

"But we're not wearing PPE [personal protective equipment] for 24 hours straight," she says. "We haven't given enough thought to inoculation [germs or pathogens getting through the T-zone] and how germs have entered the body through the eyes, nose or mouth."

With this in mind, Moore took a closer look at what systems of protection were currently in place to prevent inoculation — and how to close any existing gaps. The following three theories informed her research.

1 | High viral load theory

As viruses replicate, mutate and re-emerge in the form of new strains, there's a greater threat of submission due to higher levels of infectiousness. In this case, the 6-foot distancing recommendation may only go so far in limiting exposure and preventing inoculation.

2 | Swiss cheese model

Professor James Reason, a well-respected expert in patient safety,2 developed the Swiss cheese model to distinguish between hazards caused by human error versus hazards caused by ineffective layers of protection. Using this theory, Moore looked at ways to prevent the pathogen from getting through and causing harm -- all the holes of the Swiss cheese aligning -- by way of defensive systems, rather than placing the full burden of error on the provider.

3 | Human error factor

This is a difficult challenge to overcome in the current environment because nearly all healthcare workers are experiencing increased levels of fatigue and emotional stress. They're multitasking. Interruptions and distractions abound. Staffing levels are low. The culture of a practice or facility may also contribute to a higher likelihood of human error, especially if it's not geared toward safety.

Creating systems of protection in healthcare environments

After looking at infection prevention through the lens of these theories and models, Moore worked on developing systems and barriers to keep pathogens from getting past the T-zone entry points.

"We can't change outcomes if we don't change systems," she says. "So we have to look at what we can do differently."

Because eliminating errors entirely is impossible, Moore focuses her efforts on error management: limiting dangerous errors and developing systems better able to tolerate their occurrence and contain their damaging effects.

One such system is skin and surfactant protection, particularly in inhibiting pathogens from colonizing.

"We have to prevent things from adhering to the skin," she says. "Think of your hands as the airline ticket for pathogens to travel. We have to interrupt those travel plans!"

Though the Centers for Disease Control and Prevention (CDC) recommends using soap and water to remove germs, the practice strips your hands and skin. And when skin is dry and cracked, you're less likely to use hand sanitizer, Moore explains. "You're also changing the pH of your skin through soap and water hand-washing."

Also, even though hand sanitizer is incredibly effective, most people don't use the right amount or the right type — plus you can't use it in the T-zone, says Moore.

Innovative ways to protect the T-zone

What other products, strategies and environmental changes offer effective infection prevention tools, especially around the T-zone?

Moore shared many of these in detail during the webinar, and we'll highlight a few of them here:


Find ways to embed this valuable bacterial barrier in high-touch areas loaded with pathogens, like door plates or curtains and other linens.

Mucosa and points of entry

Mucus is one of the greatest tools you have for preventing the spread of pathogens, says Moore, because it traps and expels germs. Your skin also provides important immune responses and barriers.

When you wash your hands frequently, you have to work to keep your skin intact and prevent breakdown. Applying colloidal silver — often used in wound care — can be an excellent tool for preserving skin integrity. Allantoin and percutaneous endoscopic gastronomy (PEG) may also keep your skin resilient.

pH acidic system

Changing the pH levels in your skin is another successful way to prevent inoculation. An added bonus? Products like citrus paradisi (grapefruit) seed extract and CAPB (a coconut oil blend) are safe to use in the Tzone area as opposed to harsh, alcohol-based hand sanitizing products. Some pH products are used in surfactants to maintain the cleanliness of high-touch surfaces.


Moore shared how the placement of supplies for effective hand-washing impacted workflow and infection prevention. Because your hands may not dry fast enough when you wash them before putting on gloves, you need to think about where the hand sanitizer is in relation to the gloves or what happens when hand sanitizer isn't available nearby.

In addition, hand-washing isn't completely effective in preventing inoculation via the T-zone area because washing your face throughout the day is often impractical for busy healthcare professionals.

Environmental changes

Consider how your staff enters the building. Where do they congregate? Do the nurses stop to pick up med cards? What surfaces are they touching in that time frame, how long are they staying in a particular area and in close contact with co-workers? A closer look at these patterns can inform new ways of disrupting pathogen production and spread.

Think differently, act differently: Changing systems to stay ahead of COVID-19

Although vaccines are effective in reducing the numbers and severity of COVID cases, vaccines alone will not fully eradicate the disease. New variants of COVID are always emerging and the healthcare industry continues to face changes and challenges because of it.

Still, Moore believes this is a unique opportunity to make positive changes around infection prevention, particularly through these T-zone-targeted strategies and tools.

To that end, she encouraged webinar participants to "go on a quest" as she did, reading labels and researching commonly used products with new application insights. She also motivated participants to evaluate emerging evidence and learn more about best practices, then test and implement these new error management systems in their respective healthcare workplaces.

A big part of implementation — and a barrier to accomplishing it — is overcoming confirmation bias, a phenomenon Moore described during her presentation. It often happens among colleagues who have worked together for so long, they don't even question whether they've performed a task correctly. For example, a nurse managing a heavy patient load may forget to thoroughly wash her hands before a new patient assessment. Her colleague doesn't question whether she's performed this basic yet critical task because they've worked together for such a long time, she trusts her to do what's required.3

While both nurses did not intend any harm, the demands of the job, coupled with confirmation bias, could lead to infection. In this case, systems of protection — with an emphasis on infection prevention measures — would be valuable for the whole team and ensure patient safety.

"We need new strategies, tools, actions and changes to address things that may not be going away (like COVID)," says Moore. "But to do that, to really get the outcomes we want, we have to think differently and act differently."


  • Martie Moore, MAOM, RN, CPHQ, CEO, M2WL Consulting
  • Minute 00:29 - Introduction
  • Minute 03:27 - Presentation objectives, prevention and containment of COVID-19
  • Minute 05:01 - Human Error Theory and its impact on healthcare
  • Minute 14:27 - Swiss Cheese Theory and how systems create dangerous errors in healthcare
  • Minute 19:58 - Utilizing copper as a pathogen antagonist
  • Minute 22:27 - Changing the physical environment in order to change our practices
  • Minute 26:58 - Creating the right safety nets against COVID-19
  • Minute 30:59 - The T-Zone and points of inoculation - what to do when you aren't wearing PPE
  • Minute 41:59 - Question and Answer session

Webinar originally aired on January 13, 2021


Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.

© 2021 McKesson Medical-Surgical Inc.