2020 APIC HIGHLIGHTS

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By Kelly M. Pyrek

In the session, “Strengthening Infection Control: Risks, Gaps, and Opportunities,” panelists comprised of infection prevention and control experts and surveyorsshared their insights byexploring the most significant IPC-related risks and compliance challenges observed across healthcare organizations and care settings. Panelists discuss common gaps in Infection Control programs, discuss frequently overlooked foundational practices, and identify opportunities to strengthen regulatory compliance and patient safety outcomes.

The panelists first identified high-risk IPC-related vulnerabilities commonly encountered in healthcare settings.

Jeremy M. Gibson-Roark, BSN MBA RN CIC CNOR, a standards application and interpretation specialist with DNV Healthcare USA Inc., acknowledged the overriding priority for accrediting organizations to ensure that facilities meet the conditions of participation or conditions for coverage. One area of concern, according to Gibson-Roark, is sterile processing and the reprocessing of reusable medical devices. “In today’s market, we have a massive increase in technology and complexity,” he said. “It’s important to understand what’s coming into your facility, either by physicians or by vendors bringing in instrumentation and devices that are loaner equipment. Having control over those and knowing what is being used on patients and then reused either from another facility or in your facility on other patients and knowing what the requirements are for that safe reprocessing of those medical devices, is critical. It’s not just limited to sterile processing. You have it happening in clinics and in procedure rooms. Make sure that you are aware of what is being used on your patient, and what you need to do to reprocess those instruments and devices safely.”

Tiffany Wiksten, DNP, RN, CIC, director of standards development and interpretation, operations and quality assurance at the Joint Commission, emphasized that, “In healthcare, risk exists along a continuum, so you have certain parts of a process that inherently carry a higher risk if they’re not done correctly. You can increase the risk of a process if it’s a multi-step process where certain steps in the process are done incorrectly or missed altogether. You can have one observation that has a widespread high-risk impact, or you could have multiple observations across an organization that point to processes and procedures that are not being implemented as intended by your organization, which is then creating risks for patients and for healthcare workers.”

Wiksten then shared common observations by surveyors. “We know we have the highest risks related to high-level disinfection or sterilization that were not implemented as per the requirements of the manufacturer,” she said as an example. “Manufacturers must develop their validated instructions for reprocessing, for high-level disinfection and sterilization, to ensure those items are safe for use. If we are not adhering to those critical parameters and we’ve used that instrument or device on a previous patient, we must make sure we’re making sure that item is safe for the next patient.  We all wants the endoscope that was reprocessed following all 120 steps the way that the manufacturer says, and nobody wants the endoscope on which we only did 110 steps. When we’re looking at these complex instruments or devices, there are a ton of redundant steps; the more steps in the process that are being done incorrectly or not at all increases the risk that particular item isn’t going to be suitable for use for the next patient.”

Another significant area for deficiencies during survey is system-wide gaps in the implementation of IPC-related activities, Wiksten said. “As an infection preventionist, these really hurt my heart because they are the basic things that we do or that we want staff to do to protect themselves as well as prevent the transmission of microorganisms between patients,” she said. “If you’re a big organization, you will see a team of surveyors and at the end of the survey process, they’re looking at their observations in total. They are looking at how IPC is being implemented across the organization, and that’s where some of those ‘Aha’ moments live. Sometimes unit A might have some issues — maybe they’re not putting the isolation sign outside the door, but when surveyors go to unit B, and see people going in and out of contact precaution rooms without the appropriate PPE. Or they go to unit C — and those surveyors are nosy like infection preventionists—where they’re going into that electronic medical record to look at titrations of medications and maybe ventilator protocols, and they’re also seeing the flag at the top that says the patient is in contact precautions. Were they implemented on Friday at midnight when that CRE culture came back positive or were they implemented on Monday when infection control got into the office and said, ‘Oh, this patient shouldn’t have been in isolation.’ At the end of the survey, they’re bringing together all the observations that they have made independently across all areas in your organization. And sometimes it points to higher-risk issues that are associated with the implementation of IPC activities across the organization. This isn’t specific just to hospitals, but also behavioral healthcare, home health, ambulatory healthcare, etc.”

Tess Poland, RN, BSN, MSN, chief clinical officer for the AAAHC, addressed risk In the infection control arena. “When I’m talking about risk, I like to think about manner and degree, looking at what is an immediate jeopardy when it comes to infection control. We recently published a quality roadmap that lists all the different immediate jeopardies, and three of them were related to infection control. The first one is unsafe injection practices. From the OR to the treatment area, how is medication being drawn up? Is the provider drawing up anesthesia for other patients while a patient is in the room? It’s high risk. In an ambulatory surgery center, it can be tough when you’ve got limited space, but if we walk in and you’ve got your cleaning processes, your endoscopes and your plastic surgery trays in a small space, there’s no proper flow and that’s going to increase the risk of infection. Also look at the training of sterilization techs. Do they have competencies? Do they know where the manufacturers’ IFUs are? Also know your infection rates; are there infections in one type of procedure or across multiple procedures?”

Noting that the panelists were consistently seeing the same themes, Abby Nguyen, DBA, MBA, BSN, RN, NEA-BC, a standards interpretation specialist /RN surveyor for the Accreditation Commission for Health Care (ACHC) added that high-level disinfection is at the top of the list for high risk. “We see exactly what Tiffany was talking about, those missing steps, so we will often see gaps in processes. Hopefully you have a beautiful policy and process, however, the reality is staff members aren’t following all the steps, or the staff doesn’t understand the policy or the process. At many facilities it’s more of a train-the-trainer approach versus a more formal program, so they only learn what the previous person taught them. So, naturally, you’re going to see gaps in your processes, and that puts your organization at risk for infection outbreaks. It’s not just in the endoscopy department. Really look at your probes, especially in the outpatient areas. There is a lot of focus on acute care on the inpatient side, and outpatient isn’t always remembered. But outpatient areas are doing high-level disinfection of ultrasound probes. We are also seeing some gaps related to a lack of pre-treating instruments, in that staff are not spraying those instruments down while sterile processing personnel are waiting on them to be transported. How are we then storing those instruments prior to transport? I feel like central sterile has done a pretty good job, but there is an opportunity in some of those other areas around making sure all the processing steps are taken related to instruments before they go to sterile processing.”

Gibson-Roark concurred, adding that, “We all talked about multi-step processes and there’s a reason for those multiple steps because a lot of what we do in infection control is an unverifiable process. You can’t verify that you’ve removed all the microbes from an endoscope. The only way to do it would be to swab it, right? It’s like packing a parachute. There’s only one way to test if a parachute has been packed correctly, and there are multiple steps to packing a parachute. The only way to test if it has been done correctly without contaminating the output is to jump out of the plane and pull the cord. Because if you unpack it to validate it, you must repack it. So, if you think about it that way, and all the steps you must take, every step is important because somebody’s got to pull that parachute.”

OVERLOOK IPC-RELATED AREAS

Panelists then examined foundational components of effective IPC programs that are often inconsistently implemented or overlooked.

“Because healthcare occurs in a variety of settings across the continuum, at least when it comes to hospitals and critical-access hospitals, the foundational elements of an infection control program are usually well done,” Wiksten noted. “You are probably the most resourced of all the healthcare sites across the U.S. Whether you’re big or small, you generally have some dedicated infection control resources. The biggest gap that I typically see in hospitals and critical-access hospitals also typically has to do with communication and collaboration around IPC. There are many treatment services and populations that you serve that have unique IPC implications so we may not have policies and procedures and guardrails in place to mitigate the risks associated with those vulnerable populations. Oftentimes when we’re thinking about foundational activities in hospitals and critical access hospitals, there’s that requirement to communicate and collaborate with all parts of the organization that have potential IPC implications. I want you to think about those things that you might feel are a little bit outside of your control, such as purchasing. What about if your facilities department is bringing in new environmental components such as  whirlpool tubs? Are they a medical device? Not always. Sometimes they’re just a plumbing fixture which doesn’t always have instructions for use that tell you explicitly how to clean and disinfect. Some whirlpool tubs that are used for birthing babies have these fancy little jets that recirculate water from the tub that the baby was birthed in. You see where I’m going with this, right?  A number of times surveyors have identified that whirlpool tubs that have jets that circulate the water from the tub do not have a policy or procedure for how to clean or disinfect, including the jets. Or there’s a policy and procedure that is largely built on communication from the nurse to the EVS staff to the EVS leader. There has been more than one occasion where infection control had no idea that the tubs were ever installed in the organization and had no opportunity to participate in the development of a policy and procedure. I saw one where somebody tried to develop a policy and procedure and the calculation for bleach disinfection, and I thought, ‘I don’t know what that is, but that is not a calculation for disinfection.’  So being very communicative and collaborative with your purchasing and facilities departments is so important because not everything that comes in that’s going to impact infection control is a product. You also want to have the ability to vet the products or instruments that are coming into your organization to determine if you have the technology to sterilize this device.”

Poland emphasized that the infection control program constituted the highest deficiency in the ambulatory surgery and office-based procedure space. “The first issue is implementation; you’ve got a great plan, but it’s difficult to implement, whether it’s resources or key personnel turnover. Another important component of implementation is risk assessment. Examine the risks within infection control, breaking it down so that you’re looking at it from a patient-flow perspective as well as from a device perspective. Are there risks with certain devices, certain procedures, certain processes? The third component that we find often lacking is governing body approval. If you update your risk assessment, send it to your governing body for approval.  When you’re developing your policies or introducing something new, always secure governing body approval.”

Nguyen pointed to ensuring that staff have competencies around processes as a foundational priority. “It’s important for everyone to truly understand the ‘why.’ We may be educating around good handwashing, but why? Why is it important for housekeeping to perform a thorough ceiling-to-floor terminal clean on a room? What is it that they are doing to contribute to the safety of patients as well as team members?  Make sure that you’re teaching the correct processes during orientation, but also ask yourself, how often are you then revalidating those competencies; do staff truly understand the processes and are they cutting corners? I think it’s extremely important to make sure that we are revalidating competencies from time to time, even though we feel like it’s some basic things. It’s those basic elements that can help protect patients.”

Poland agreed, noting how critical it is for the environment of care to be clean and safe. “When I worked in a health system, my environmental manager was excellent and her department had zero deficiencies. When I asked her how she did it, she said, ‘When I walk into a room, I let that room speak to me. From the floor to the ceiling, I let it speak.’ That’s a powerful message.”

Another foundational aspect of IPC is risk assessment, according to Gibson-Roark. “I think one of the biggest IPC opportunities starts at the beginning. Some IPs may see it as a document that they know surveyors will ask for once a year, and it’s oftentimes just a check-the-box exercise. We go through it, we review it, nothing’s changed except maybe changing the spreadsheet from 2025 to 2026. That said, I’ve also been in organizations that have really evolved the way that they utilize risk assessments. Their IPs are sending it to their department leaders for input, and then updating it based on the risks that are going on within the organization. A risk assessment should be a living document. It’s something that must constantly be reviewed and adjusted, and assesses what is going on within your organization, within your community, and among your staff. There are so many factors that if we’re only doing it once a year as a check-the-box exercise, we are missing a huge opportunity to mitigate risks before they impact patient care. And if organizations will use that document the way it’s intended, I think it will make a significant difference in the effectiveness of your IPC program. It also draws those department leaders into the process, so that you’re not the bad guy that comes into their department once a month or once a quarter to audit; you get to establish a collaborative relationship that is so important.”

IMPROVING OUTCOMES

Finally, panelists evaluated priority opportunities for strengthening IPC compliance and improving overall patient safety outcomes.

Poland listed her imperatives for IPC as surveillance, hand hygiene, and safe injection practices. “It’s tough, especially in ambulatory surgery centers, office-based practices, or medical clinics where there are a lot of moving parts and many people assuming multiple roles.”

Nguyen circled back to competency training and evaluation as priorities. “It must be done frequently enough and in a way that everyone on the team can become owners in that process,” she said. “Again, ensuing that personnel understand the importance of why they must do the 120 steps related to scope cleaning, and fostering high levels of engagement.”

Breaking down silos is key, according to Gibson-Roark, who asked the audience, “How many of you like that surveyors show up at your facilities unannounced?” He shares an experience from his professional life: “I spent most of my career in the operating room. And before I started in infection control, I was the manager and director, and my infection preventionist would show up unannounced, my department, would not invite me on the tour of the department, would go through, spend half a day, and then about three days later, I would be in copy on an email to my boss, which was the chief nursing officer, about all the things they found, which creates an adversarial relationship. IPs sometimes put themselves in an adversarial position. I don’t think any of us intend to do that, but it automatically causes people to start working in silos, with things getting hidden when you show up to the department. That decrease in transparency puts patients in possible jeopardy. So, invite people to participate in rounding, Tand tell them when you’re coming, don’t surprise them.  There’s no point in doing a surprise audit. No, you don’t want the Hawthorne effect, but you’re going to get it anyway. If you engage with others as you round in various departments,  it just creates that sense of a relationship that hopefully increases transparency. If I have a collaborative relationship with my infection preventionist, if something’s going on that just doesn’t feel right, I am much more apt to pick up the phone, say, ‘Hey, can you come look at this process because I’m not sure we’re doing that right?’  Sometimes it’s just changing the way we do things, and it’s simple changes that can alter the perception of what we as IPs do — thus increasing collaboration and breaking down those silos.”

Wiksten emphasized the importance of collecting the right data and then knowing what to do with it.  “Some of you have actual quality assurance performance improvement training, while some of you have been gradually learning quality and performance improvement along the way, and still others are thinking, ‘I have my data and I’m hoping that the performance improvement team is going to help me, because I’m not really comfortable with what I’m collecting, why I’m collecting it, or what I’m going to do with it.’ Sometimes we get stuck in a cycle of collecting data just to check boxes — because we’re reporting it to our governing body, to our QAPI program, or to the organizations that award stars and seals for reputational reasons. What I want to talk about is collecting data for a purpose.”

Wiksten continued, “Nobody wants that Friday 5 o’clock fire drill — it’s almost always when you have tickets to the theater, it’s your daughter’s birthday, or you’re leaving for vacation. It is going to happen; it’s inevitable. But if we are proactive with the data we collect and how we use it, we can move toward mitigating risks before they become safety events, patient harm, or staff harm. You must be very thoughtful and intentional about the data you’re collecting, because you’re going to want to keep your finger on the pulse of those high-risk opportunities.”

She relayed a recent experience to highlight the importance of risk assessment. “I had a conversation with an organization that, during their annual risk assessment, brought together all the leaders of hemodialysis and sterile processing. They discussed not only the care, treatment, and services and the populations they serve, but also the foundational systems that support those services. The sterile processing leaders noted that the year prior, they had full staff, funding to replace instruments and devices, and a dedicated leader. Coming into the new year, however, a lot of their staff had left, they were relying on agency staffing, their budget had been cut, and their leader had departed — leaving an interim leader in place. The processes in sterile processing were clearly riskier than they had been the year before. As a result of a risk assessment like that, you might determine that you need to audit more frequently — to make sure agency and travel staff are following your policies and procedures, and to ensure the interim leader knows where concerns need to go. Your data needs may change from month to month, day to day, and year to year. You do not have unlimited resources, so choose what you audit wisely. You do not have to audit everything, everywhere, all the time. But you should have your finger on the pulse of the organization. Some things may need to be audited every single week because they are high-risk or have known process defects, while others may only require a spot check.”

Wiksten also described how in one organization, they used to do quarterly CAUTI rounds — reviewing charts of patients with urinary catheters in place to confirm that all bundle elements were being completed. “One quarter, we were only 40 percent compliant. We paused, reflected on our data, and decided to conduct education and audit more frequently until we were confident our processes were back under control. Data, auditing, and surveillance — outside of required surveillance — are all very fluid. You don’t have to do everything all the time. But if you pick the right data and the right processes to audit, you are being proactive, hopefully identifying risks before they become safety events. If you are collecting data, be purposeful about it — and then use it. Don’t just keep it in binders. Ask yourself: what story does this data tell? Where do we need to put more resources? What needs to be escalated to leadership? Infection control does not own all of the processes in an organization. We have to know when the data is telling us that we need to engage our leaders and ask for help. It is the responsibility of infection control to identify risks and escalate them so that leaders can support the development and implementation of action plans to mitigate those risks. Hopefully, you will have far fewer Friday five o’clock fire drills and instead move toward the proactive identification and mitigation of risks — so that both staff and patients are protected.”

AREAS FOR IMPROVEMENT

The panelists next turned to what specific areas for improvement they would prioritize to ensure the greatest impact on infection control outcomes.

Nguyen pointed to handwashing. “I don’t want to sound overly basic when I say this, but it comes down to hand hygiene. I’ve been in healthcare for more than 30 years, and we’ve been auditing hand washing for just as long. If anyone has truly figured out a solid process that consistently yields good audit results, I would genuinely like to hear it. We’ve seen organizations try all kinds of approaches — students conducting audits, expensive electronic monitoring systems, secret shoppers. I’ve been in organizations where we’ve tried them all. But what it really comes down to is making hand hygiene auditing as valid as possible and then ensuring that there is true just-in-time coaching. This coaching must be real and meaningful. It’s not enough to note on a form that a colleague didn’t wash their hands if you didn’t actually say something to them in the moment. We have to be willing to address it directly — and that includes physicians, who can be another challenging group when it comes to receiving that kind of real-time feedback. Anyone entering patient rooms or high-touch areas of a facility should be a focus of hand hygiene efforts. It may sound basic, but from my perspective, hand hygiene is one of the most important practices we have to prevent the spread of infection.”

Gibson-Roark circled back to IPs’ lack of formal training in internal auditing.  “I think it’s an art form to audit processes effectively,” he said. “If I was going to improve myself as an infection preventionist, I would seek a course on internal auditing, speaking with experienced internal auditors about that process and how to effectively do it. You should not be conducting your internal audits on your own but instead creating an audit team and providing them with the training necessary to effectively audit, communicate those audit findings to the organization’s leaders, and then follow up on those audits. You just can’t just say, ‘Oh, you’re doing this process incorrectly’ or ‘You’re missing this step.’ You must have corrective actions, then follow through to ensure that your audit just doesn’t go into somebody’s pile of papers on their desk. And finally, those corrective actions need to be performed and they must be effective. You must re-audit the process to ensure that six months later we’re not repeating the same mistakes over and over again, expecting a different result.”

Wiksten emphasized the importance of policies and procedures. “When I aggregate infection control data across healthcare settings year over year, the number one opportunity — with the exception of behavioral healthcare — is consistently the implementation of policies and procedures. It is staff implementing the policies and procedures that organizations have carefully developed. One thing to consider is that policies and procedures are sometimes written with too many steps. The thinking is that if one layer of safety is good, fifteen must be better. But if staff have fifteen additional things to do, the likelihood that they will identify and prioritize the most impactful one is low. Be thoughtful about how your policies and procedures are written.”

Wiksten continued, “When preparing for surveys, we often focus on infection control standards and conditions of participation — checking off policies and procedures. But we also have to consider all of the other components that actually support implementation. Staff must have access to the resources they need to perform their job functions: the policies and procedures themselves, manufacturer’s instructions for use, and the appropriate PPE. If a surveyor walks into a decontamination area and finds no PPE available for staff performing decontamination, that is a serious problem — we are not protecting our people. Think carefully about education, training, and competency. Not everything requires a formal competency assessment — some tasks are better suited to education or training. But too often, surveyors find what I would call a ‘hope and a prayer’ approach. A defect is identified, the HR file is requested, and there is no documented education, training, or competency for that staff member. For some organizations, that approach works out. For others, it does not.”

She added, “Auditing supports implementation. It keeps your finger on the pulse of the organization and helps identify risks so that action plans can be developed and implemented. Having the right processes in place is what supports staff in consistently following policies and procedures. No two organizations’ policies and procedures are exactly alike. One of the first things I learned when I came to The Joint Commission was that there can be seven different correct ways to do something and still achieve a compliant outcome. We cannot assume that a seasoned staff member with 15 years of experience can move from one organization to another without any review of the new organization’s specific policies and procedures. We sometimes receive complaints from travelers in sterile processing who believe their way is the only correct way to do things. When surveyors investigate, they often find that nothing is actually wrong with the facility’s process. The traveler simply learned a different approach elsewhere. No matter who is coming into your organization — a new graduate, a traveler, or someone with 20 years of experience — you cannot assume they are familiar with your specific policies, products, or clinical guidelines. When you became an infection preventionist, you did not put on a magic hat and suddenly know everything. The same is true for any clinician moving from one organization to another. They do not intrinsically know what is in your policies, so keep that in mind.”

Poland pointed to a critical gap: “The No. 1 reason I have identified for lack of compliance with infection control programs, through reviewing multiple reports, is the absence of infection control leadership. It is simply missing. In some cases, oversight exists at the health system level but only reaches individual sites once a month. In others, someone new has been handed a file and is also managing risk, overseeing the OR, serving as risk manager, and taking on a host of other responsibilities. In smaller facilities, staff are wearing multiple hats and stretched thin — sometimes across multiple facilities. That is a significant challenge. As infection preventionists, coach others, teach others, and if you are part of a large health system, identify someone at each site and empower them with the knowledge you have. Advocate for training and certification, because when there is a lack of knowledge, it impacts implementation, it impacts risk assessment, and it impacts the authority, accountability, and ability to escalate concerns up to the governing body.”

Wiksten encouraged attendees to “Be your biggest champion. Advocate for what you need. Advocate for the resources that you need. Advocate for the education that you need. And don’t let anybody tell you you’re an immediate expert. You’re an infection preventionist, so now you’re an expert in sterilization. Ask for the training. Ask for the resources. You’ll be far more effective in your job, and you’ll create a far safer environment.”

By Kelly M. Pyrek

In the session, “Advancing Infection Prevention Guidance: Updates from APIC Practice Guidance Committee,” presenters explained how APIC’s PGC  compiles, assesses, develops, and influences guidelines and standards related to infection prevention and control (IPC). The PGC provides a means within APIC to guide and inform the membership on practice issues and recommends official positions on standard guidelines and other pertinent documents affecting IPC practice.

Jennifer A. Ormsby, DNP, RN, CPN, CIC, CPNP-PC, FAPIC, senior director of infection prevention and control at Boston Children’s Hospital, reported that in 2025, the PGC reviewed 23 documents submitted by external organizations such as AAMI, AORN, and SHEA, with a subject matter expert group providing feedback on each. The committee also released a whitepaper on safe injection practices, launched a manufacturers’ instructions for use (MIFU) toolkit, released three tools for long-term care along with three supporting webinars, and maintained ongoing, bi-directional communication with 11 external organizations.

“In January, I was invited to participate in an MIFU summit in Washington, D.C., with CMS and FDA present in person and by phone,” she said. “They were relatively quiet, but they were listening and engaged. We also had five accreditation organizations, along with representation from APIC, HSPA, and AAMI. We spent a full day reviewing two examples of problematic MIFUs, with the goals of the summit being to define what a problematic MIFU is and to determine what should be included in a high-quality risk assessment. APIC provided extensive member feedback, and there was a great deal of wordsmithing and compromise throughout the day. People were very vocal and engaged.”

Ormsby described how a problematic MIFU should be handled: “First, a multidisciplinary team of subject matter experts determines that an IFU is too complicated, contains too many steps, or does not align with available evidence. The key point here is that a single infection preventionist should not be making that determination alone,” she said. “Other indicators of a problematic MIFU include outdated information, inaccessibility of the MIFU, or the absence of instructions for the intended use. At the summit, we focused specifically on low-level and intermediate-level disinfection of non-critical devices — though we frequently had to redirect the conversation back to that topic from HLD and sterilization. Additional examples include a disinfectant that is unavailable at the organization or not commercially available in the U.S., instructions that create healthcare worker safety concerns, missing cleaning or disinfection instructions for all approved uses of the device, or guidance that is not aligned with current evidence from the CDC or other authoritative bodies.”

Regarding what should be included in a high-quality risk assessment, Ormsby said the essentials include defining the problem, incorporating multidisciplinary input, knowing the available evidence, proposing an alternative if the MIFU will not be followed, and reviewing all relevant regulatory agency guidance. “A quick search of what the EPA, CDC, or CMS says can help ensure you are not inadvertently violating local, tribal, state, or federal guidelines,” Ormsby reminded attendees.

A key issue with accreditation surveyors is compliance with an MIFU. “If your organization is going to deviate from an MIFU and conduct a risk assessment instead, you must have done a recent literature search and understand what the relevant regulatory agencies are saying,” she emphasized. “From there, you complete a risk summary — weighing the pros and cons of using an alternative — and put risk mitigation strategies in place. Risk mitigation was a lengthy discussion at the summit. If you are not going to follow the MIFU as written, you need strategies such as audits, real-time education, and ongoing process monitoring in place. Critically, that data needs to be reported to a governing body within the organization — it should not remain only in an IP’s inbox. A governing body also needs to formally sign off on the risk assessment, and a review cycle should be established for when the assessment will be revisited. For most of my organizations, that has been every three years, aligned with MIFU updates.”

Ormsby reported that accreditation organizations reviewed APIC’s MIFU toolkit and agreed to train their surveyors on it and incorporate the high-quality risk assessment framework. “Whether that will fully materialize as surveys continue is something we are still watching,” she commented. “APIC also submitted a formal request to CMS to update their conditions of participation and potentially issue a letter recognizing the toolkit; that conversation is still pending.”

Ormsby pointed to a June 9 webinar on APIC’s MIFU toolkit in which the most common problematic non-critical devices were identified through attendee polling. “They included  were IV pumps, glucometers, infant incubators and isolettes, and blood pressure cuffs,” Ormsby noted. “Blood pressure cuffs were the most frequently cited, and they are currently the focus of the examples in the toolkit. Additional examples will be added through ongoing sessions.”

Ormsby also reported that current APIC initiatives, shaped results from the APIC member survey, include the application of artificial intelligence (AI) in infection prevention, water quality, environmental cleaning, and emerging infectious diseases. “We also have a group specifically examining clinical water use for patient care, including the question of what type of water should be used for enteral flushes, as well as a group working to define what infection preventionists need to know about AI.”

PGC vice chair Anoshe Aslam, MPH, CIC, associate director of inpatient services and infection prevention at Memorial Sloan Kettering Cancer Center, provided attendees with an overview of the organizations with which the PGC liaises on behalf of APIC. “Currently, actively liaise with 11 organizations, with others for which we are either awaiting more information or we’re working to establish a relationship. All of these groups have an impact on IPC practices, so these relationships are incredibly important,” she said, adding, “This year we’ve continued to work on reinvigorating these relationships, sharing what APIC is working on or releasing, and they do the same so that we have an opportunity to opine on items that have a direct impact on our work before they get released or when they’re available for public comment.”

Aslam reviewed some of the work from other organizations with ramifications for IPC.

The Association for Advancing Medical Instrumentation (AAMI) is due to release ST-113, a comprehensive guide to steam sterilization and sterility assurance in dental facilities. “This guidance is for outpatient dental practices with tabletop sterilizers, hand hygiene, PPE, and transport,” she explained. Related to MIFUs, AAMI has its technical information report, TIR-12, which addresses designing, testing, and labeling medical devices intended for processing by healthcare facilities, and it is a guide for device manufacturers. “APIC was largely involved in advocacy to limit the steps, ensure feasibility, notify IPC of IFU changes, limiting the brand and trade names, and limit reassembly at the point of use,” Aslam said. “There will be a new table in this TIR to help manufacturers in their device design to reduce complications with disinfection. So, this guidance in TIR 118 is on how to use UV machines for HLD and low-level disinfection, intermediate-level disinfection. Tattoo machine devices, TIR 117, provides guidance for processing tattoo machines and accessories in the healthcare setting.”

Aslam also touched upon AAMI’s TIR-119 which provides guidance on the implementation of water quality standard ST-108, as well as TIR-121, low-level disinfection of patient-care equipment. She also reported that ST-79, a comprehensive guide to steam sterilization and sterility assurance in healthcare facilities, is currently being revisited by AAMI, as well as new guidance around protective barriers and personal protective equipment (PPE).

The American Association of Post-Acute Care Nursing (AAPACN) is working on guidance around PCR testing of wounds in long-term care, Aslam mentioned, and then turned to the  Association of periOperative Registered Nurses (AORN), which released environmental hygiene guidelines that were effective as of April 2026. “The guidance underscores the importance of a bundled approach to environmental hygiene, and they break it down,” she said. The hot topic of AI in the perioperative setting will be addressed through an evidence-informed practical guidance, which will be released very soon. AORN’s surgical specimen management guideline is currently open for public comment, and it’s designed to help perioperative teams safely manage specimens from collection through disposal; it is anticipated to be released later this summer. The moderate sedation guideline will be open for public comment late this summer and anticipated to be released by the end of the year.”

Aslam noted that the Society for Healthcare Epidemiology of America (SHEA) released its multi-society guidance for infection prevention and control in nursing homes in October and is currently planning guidance for the prevention of C. auris in pediatrics and IPC and burn units, both as consensus documents, and then a practice update for animals in healthcare. “In the near future, they are looking to expand their Compendium for strategies to prevent healthcare-associated infections with viral respiratory infections, hospital-onset bacteremia, and low-level disinfection,” she said.

She next addressed the long-awaited 2026 code books from The Facilities Guidelines Institute (FGI). “These are going to be for hospital outpatient and residential. These individual code books will be available for free; however, the handbooks that will accompany each document are not free. Those have the information that used to be found in the appendices, and FGI is describing these handbooks as indispensable in terms of interpretation. We expect this release later this year.”

Amy Courtney walked attendees through the PGC’s document review process, noting that, “As we reviewed our documents this past year, we recognized that we needed an evidence-based and standardized approach to how we were reviewing them. This internal review process has helped us take a consistent approach so that each of us reviews documents through the same lens and with the same methodology. It also means that anyone joining the subcommittee in the future will have a standard process to follow.”

Courtney reported that the PGC reviewed more than 30 documents this year. “For the most part, everything from AORN came through public comment, while everything else came through content review through APIC via PGC.”

The first document Courtney highlighted was the AAAHC Accreditation Handbook for Ambulatory Care. “If you’re an IP working in ambulatory care and your organization is pursuing initial AAAHC accreditation, this is a valuable handbook. It’s user-friendly, offers a self-assessment format, and walks through the standards and policies comprehensively so you can evaluate whether your organization is prepared. Next is the SHEA Expert Guidance for Infection Prevention in Nursing Homes, an update that provides new and revised recommendations for evaluating and processing surgical instruments. It includes new recommendations supporting borescope inspections, cooling devices for decontamination, perfusion technology for lumened instruments, and updated guidance on cleaning verification and inspection when instrument reprocessing is delayed. This is a helpful resource if that’s part of your work as an IP. The next document is also from SHEA — IPC guidance for nursing homes. If you work in a nursing home or long-term care setting, this updated guidance provides a framework to help nursing homes prevent and control infections.”

Courtney continued, “Next is the APIC surgical irrigation document, which synthesizes current evidence-based guidance from multiple organizations. It addresses regulatory considerations and practical implementation guidelines, supporting IPs in practice. It evaluates safe and effective irrigation approaches and ensures alignment across multi-organization guidelines. Then, AORN’s environmental hygiene guidelines, which address multimodal cleaning strategies. It recognizes that coordinated strategies are more effective than isolated measures in preventing infections, and focuses on training, standardization, monitoring, and strengthening feedback loops and accountability. The next one is the AAMI UVC disinfection document — TIR118 — which we touched on earlier. It evaluates UVC as a supplemental disinfection tool for reusable medical devices. This isn’t about environmental disinfection; it’s about safely and effectively disinfecting and reprocessing reusable medical devices. Note that this is a Technical Information Report (TIR), not a standard or a requirement.”

She then turned to the APIC Water Intrusion Playbook, a resource for IPs seeking guidance on managing water intrusion events within their facilities. “It helps with preparation and response, guides risk assessments and mitigation efforts, and supports real-time decision-making,” she said. “We’ve heard there’s significant demand for education and training on this topic, so we’re excited to have been part of this review process and look forward to its release.”

Lastly, Courtney mentioned AAMI TIR119, which supports ST108 water quality guidance. “It’s a practical guide for understanding and operationalizing the requirements of ANSI/AAMI ST108, allowing you to partner with your facility and SPD on implementation. It also helps you monitor risk and performance related to reprocessing in your environment Again, this is just a sample. As I mentioned, our review process centers on an evidence-based lens — looking at how we can apply our expertise to these external documents and ensure everything published is grounded in evidence from an infection control perspective.”

By Kelly M. Pyrek

In the session“When Leadership Says No: Infection Prevention in Hostile Environments,” presenter Aaron A. Woodall, DrPH, MPH, CIC, LTC-CIP, CM, chief of infection prevention and control for the Department of Veterans Affairs in Wesley Chapel, Fla., helped attendees identify common reasons why leadership may resist or refuse infection prevention recommendations, as well as how to apply communication and framing techniques that increase the likelihood of leadership buy-in. He also demonstrated strategies to document, escalate, and mitigate infection risks when leadership refuses support.

“The thing about infection control is it costs money,” Woodall said. “Infection control is always asking for additional funds for some big project to eliminate some things that we don’t really see. Leadership may think infections don’t really happen or that we waste a lot of money, or there isn’t a return on investment. I’m sure a lot of you have been on the receiving end of things like that. So, are we actually taking charge of what we are doing or do we just kind of let things unfold? Do we make sure that if we see a problem happening, we actually advocate for what we’re doing? One of the misconceptions we have as IPs is just because we’re technically right doesn’t mean that something is going to be automatically approved just based on that. It’s a hard pill to swallow, but it’s something that happens throughout life. You know that you are completely and technically right. You have the data but somebody says no. We’ve all been there, and it’s a part of life and it’s something that we have to deal with, but when you are working on the work that we do to protect people, it makes it so much more impactful when we hear that ‘no.’”

Woodall continued, “So, the first thing that we need to do is check our perception. Is the environment actually hostile? Because if it is, then we’re going to run into some problems. But if we are just perceiving it to be hostile, then it’s probably us and how we’re approaching things. If we find that leadership is resistant, maybe they have some concerns or some priorities or gaps in understanding, or they’re seeing something that we don’t see, and that’s workable. All we have to do is maybe fix what we’re doing, or present it in a different way, but that’s workable. If they are avoiding decisions or if they’re deferring, maybe they’re just uncomfortable with it at the moment. Maybe they don’t have enough information to make that decision for you. But if leadership is actually hostile, you are going to probably experience things that are going to undermine safety. Maybe it’s retaliating, or chronically refusing, despite you having all the evidence. There can become a time where it’s not workable, but you can get through that.”

Woodall examined what constitutes a hostile work environment. It can be systemic and repeated, he explained, not consisting of a single ‘no’ but chronic pattern of refusal despite escalating evidence. “There are many reasons why you are told ‘no’ but it can feel very hostile when you’re told ‘no’ all the time. When that happens, we might just need to take a step back. Sometimes the money’s not there, sometimes the timing is wrong, sometimes your argument was not strong enough, sometimes it’s just leadership not having all the information, or it’s normal organizational friction. It’s frustrating, but it’s not necessarily hostile. Now, if we are seeing an organization that is completely disregarding evidence in a chronic pattern, that’s when we have a problem. It can pose a real risk to patients, and if you are unable to step in, it’s just going to get worse and worse. If you feel like you are constantly in one of those hostile work environments, it is a systemic failure, it’s not a personal one. An IP is professionally exposed when recommendations are given but leadership overrides without ownership. Ethical compromise is often required, where IPs are forced to remain silent thereby endorsing decisions you believe are unsafe. And finally, there can be retaliation for raising concerns, where speaking up results in being undermined or facing unprofessional consequences.”

Woodall reviewed the four doors after the “no” that are available to IPs. “Everybody knows how a door works, right? You can go in the door and then you can go back out of the door, right? But there are some doors that once you go through, you are through. Door number one is accepting the no. So, if we’re going to accept the no, that means that we were able to talk about it, we were able to present something, and we were told no. We can say, ‘You win this round, but I’m coming back.’ We can challenge the no. This means we can admit that maybe my argument wasn’t strong enough or I needed a bit more evidence. So, you’re going to put a little more effort into what you were doing on top of the effort you already did previously, digging a little deeper because you know you can find something. You’re going to challenge that no, escalate that no. But if you decide that you are going to accept the no because the energy required to fight this will cost more credibility than the issue is worth right now and it’s not a patient safety emergency, then you accept the decision for now. So, what are you going to do when you accept that no? First, document everything. And ensure leadership signs off or acknowledges in the record, because if anything comes back, you have an evidence database of your own work that you’ve done. Put it in writing and put a review date on it; put a little blip on your calendar to review this again. And most of all, don’t feel guilty because you accepted that no, because out of all the things that you do as IPs, you don’t want to carry a burden that will lead to burnout.”

Woodall next addressed door number two: “So, if you are going to challenge that no, you will prepare to walk through this second door, challenging the no professionally and respectfully. Remember, there are many fiscal and operational issues that the C-suite carries, so when we target where it hurts, it is much harder for leaders to say no, especially when you pair your evidence with what they care most about. Perhaps initially you did not lead with the financial or regulatory angle, or you originally presented while they were managing a crisis, or the data was compelling but the ask was unclear, or you were emotional, or they need to hear it from a champion who isn’t you. When we are going to challenge that no, we’re going to reframe it as a financial risk by quantifying the cost of inaction in dollars and outcomes, leading with what leadership cares about most. Sometimes you have to play hardball — return with that sharper recommendation, better information that is targeting that financial risk. We must think about how we communicate, especially when we get emotional and put our whole heart into it. You must remember to stay professional. Instead of accusing people of putting patients at risk, frame it as being what the data shows, and that this is the standard. When you use these types of phrases, it helps get your point across. If you’re going to write a memo for leadership, make sure that it is short, correct, concise, and straight to the point — risk first, solution second. Use numbers and data and that will continue to anchor your credibility in your organization and hopefully it will start to shift that hostility that you’ve been feeling in that organization to get you to a better place.”

He emphasized the importance of knowing your C-suite audience and their respective roles. “If we are going to talk to the chief financial officer, we want to address things like cost avoidance, length of stay, reimbursement impact, litigation exposure and the incurred cost of HAIs. If it’s the chief medical office, then we want to talk about morbidity and mortality, risk and physician liability. If it’s the chief executive officer, then it’s regulatory standing, reputation and community trust, as well as optics and board exposure. Know your audience.”

Door number three is all about escalation of the no, Woodall explained. “This is the pathway that once you start, you might not be able to turn around, so consider that a warning before you go through this door. Escalation must be backed by documented recommendations because without records, escalation is just complaining — that’s how leadership will see it. This is why documentation is so important. Maybe your first attempt at escalation is with the department or unit leadership, where you sit down and talk about what needs to be addressed. Maybe you need to escalate things to the CMO, CNO or vice president of quality, where you discuss the data and frame it as a patient safety and regulatory risk. Or maybe you need to go to the C-suite, bringing your evidence of a documented pattern or a serious imminent risk in a formal briefing. At this point, everybody is going to feel some pressure, so you must be ready to stand your ground with your data, your track record, your reputation, and your passion for what you do. And if that isn’t getting results, you may have to escalate to the board or the quality committee, when leadership is the problem. Or you can go to external authorities such as regulatory, state and accreditation bodies. Do not use this as a first move, because this is a last resort. When you go this route, just know that you will ruffle a lot of feathers and you must make sure that you are right and your evidence and data is rock solid.”

Woodall mentioned that state and federal laws exist to protect whistleblowers, and IPs should familiarize themselves with these statutes.

The last door Woodall addressed is the emergency exit. “Once we go through this one, we are not coming back. When doors one through three are no longer an option, we must start considering the emergency exit. You’ve worked so hard in what you do. You care so much about the patients that you have. And you constantly are being barraged with hostilities, being told no, being told your department is pointless, that you’re just the hand hygiene police, that you’re always asking for money, you always want this, you always want that. And then you realize that there’s no way to salvage anything by staying. Over time, you are at risk for burnout, so, if you are at this point, really consider the emergency exit. And what that means is, you leave the organization. Take a step back and consider your decision. If you have documented things and nothing has changed, if you are seeing patient harm has occurred and the recommendations that you are constantly talking about are not going anywhere, maybe the culture is just chronically normalizing preventable harm.  It’s the organization is not prioritizing patients, and that’s very, very hard. If you are at this point and you need to go, you’ve got to go. When you do leave, that action protects more than you, it can protect your license, your credibility, patients, staff, and the profession overall.”

Woodall emphasized that “IPs should leave with their integrity intact, refraining from burning bridges, no matter how much you want to. Your reputation travels. Document, don’t dramatize. Transition thoughtfully. Protect your own story. Your future patients need you.”

Finally, Woodall shared some tools and principles for high-stakes communication. He noted success depends on an IP’s ideas, writing and ability to speak. “The quality and rigor of your recommendations will determine whether you are taken seriously in the short and more importantly, the long term. A recommendation that is not written is a recommendation that does not exist. Document everything, clearly, precisely, and with supporting data, documents and professionalism. The room where decisions are made is won or lost in the first few minutes. How you communicate under pressure is the skill that moves mountains.”

Woodall continued, “When in high-stakes conversation with leadership, lead with what matters the most to them. State what you need in that first sentence, don’t ramble. Military uses what we call the bluff: Bottom line up front. Put your ask right at the front, don’t bury it at the bottom because nobody’s going to get through that. If you’re in a meeting, use silence strategically. Pause. Let it get awkward. Because if you try to fill the space, everyone else is going to sit back and retract. But the longer you can hold silence in a room, it becomes effective. Never apologize because it is your professional recommendation. You are a professional. It is your recommendation. And then know your bottom line. If you know that you are going to draw a line in the sand and you’re not going to cross it, don’t let it be crossed.”

He advised the following points as an IP’s survival guide to communication with leadership in a hostile environment:

· Check your perception first.

· Understand leadership’s reality.

· Build your case around their priorities.

· Technically correct is not enough.

· The no is a hallway. Just choose a door.

· Your integrity is absolutely non-negotiable.

“I understand that it’s going to be tough,” he acknowledged. “Nothing in this is easy. It will be painful, it will be awkward, and it will hurt. But you have to make sure that you are doing what’s best for your organization, for your patients, for yourself, for your families. It’s not easy. So, make sure that you’re practicing speaking. Speak precisely. Write defensively and think strategically. The more you do this, the better it will be. So, I know that when you leave here, those wheels are already turning on what you can put in an e-mail to your leadership on something that you worked out probably while you’ve been here away from your organization. I know all of you. You can’t let it go. That’s why we checked the hotel rooms when we got here. Just remember that you are a professional and you don’t have to deal with hostile work environments. Just make sure that you’re framing it in a way that helps you. And if it doesn’t, what’s that last door we have? Emergency exit. And remember, that decision is your professional decision should you get to that. So, you’re not hired to be agreeable, you’re hired to protect. Do both.”

By Kelly M. Pyrek

In an era of viral social media posts, AI-generated content, and 24-hour news cycles, infection preventionists (IPs) are increasingly finding themselves on the front lines of a different kind of outbreak — one made of false information. In the session “Facts, Fiction & Frontlines: Combating Misinformation in Infection Prevention with Science and AI” at the recent APIC annual meeting, experts from leading institutions to equip healthcare professionals with practical strategies for identifying, combating, and pre-empting health misinformation.

Led by Emily Sickbert-Bennett, PhD, MS, CIC, FSHEA, the system executive director at UNC Health, the session drew on contributions from a multidisciplinary team including Mohamed Yassin, MD, PhD, CIC (UPMC); Janet Haas, PhD, RN, CIC (Innovative Infection Prevention); Janet Glowicz, PhD, RN, MPH, CIC (CDC); and Stephanie Stroever, PhD, MPH (Texas Tech University Health Sciences Center).

Defining the Problem: Misinformation Is Not One-Size-Fits-All

Sickbert-Bennett opened by drawing a distinction that is often overlooked: not all false or misleading information is created equal. Framing it along a spectrum from fact to falsity and a spectrum of intent to harm, she outlined four key categories:

1. Genuine information — factual and intended to inform

2. Misinformation — unintentionally misleading, not meant to cause harm

3. Malinformation — factually based but used out of context to mislead or manipulate

4. Disinformation — deliberately created to deceive and cause harm

Sickbert-Bennett explained that these categories can manifest in many forms: satire, propaganda, imposter content, fabricated stories, manipulated media, or even simple errors from reputable organizations. Clickbait and sponsored content masquerading as editorial coverage round out the list. “Often, false information is mixed with genuine content in order to mislead,” she emphasized.

Health misinformation is not a fringe problem, and Sickbert-Bennett noted it is important for IPs to understand the context in which misinformation appears in the workplace. A systematic review by Suarez-Ledo, et al. found that vaccine-related content is the most common domain for health misinformation, followed closely by drug and smoking topics, non-communicable diseases, and — at roughly 10 percent — pandemics and infectious diseases. For IPs, this represents core professional territory.

She pointed to a study by Bash, et al. that examined 100 online news reports during the 2025 U.S. measles resurgence and found that only 11.6 percent of mainstream digital news articles used credentialed authors, while 28 percent of alternative outlets blended factual reporting with anti-vaccination narratives under the guise of “balanced coverage.”

“When it comes to vaccination-related information, it can reduce patients’ willingness to vaccinate,” Sickbert-Bennett said. “It can obstruct measures that we need to contain disease outbreaks and physically interrupts the way we access healthcare. It can amplify discord under political crisis. It can increase social fear, panic, and stress associated with these things. It can also enhance misallocation of resources. It can slow our countermeasures, and it can exacerbate overall poor-quality content. So, it’s really important to be aware of these harms that misinformation can cause.”

She encouraged IPs to understand what healthy information looks like. “Healthy information is evidence-based information. So we are actively citing peer-reviewed research, primary data, Healthy information is information that’s credentialed. It’s authored by a verified subject matter expert or a recognized health agency. Healthy information should be transparent and should acknowledge study limitations, evolving science, any conflicts of interest. And healthy information should also have a balanced tone associated with it. So, it should be informative, objective, avoid emotional manipulation, or dread-inducing language.” 

Using real-time examples around hantavirus coverage, Sickbert-Bennett walked attendees through what separates trustworthy health journalism from misleading content.

One news article titled “Where Does Hantavirus Lurk in the U.S.? Scientists Found Hot Spots in Surprising Areas” cited three verifiable primary sources — including publications from Ecosphere and Transboundary and Emerging Diseases, as well as CDC case data — demonstrating transparent, evidence-based reporting despite its attention-grabbing headline. By contrast, another article reporting that “Hantavirus can remain in semen for six years” cited another news article as its primary reference and leaned on a single-subject study to imply broad public health risk — a classic example of context collapse. The study itself documented RNA persistence in one individual over a limited follow-up period, a finding that hardly justifies the alarm implied by the headline, she noted.

“Understanding the science behind the stories is really important to put it in context,” Sickbert-Bennett said, “and that context is not always conveyed within mainstream news articles.”

She outlined four markers of healthy information that IPs should look for:

1. Evidence-based — citing peer-reviewed research and primary data

2. Credentialed — authored by verified subject matter experts or recognized health agencies

3. Transparent — acknowledging study limitations, evolving science, and conflicts of interest

4. Balanced in tone — informative and objective, without emotional manipulation or dread-inducing language

AI: A Double-Edged Tool

The session addressed the growing role of artificial intelligence.

On the risk side, Sickbert-Bennett highlighted AI’s role in accelerating misinformation through sensationalized content optimized for engagement, psychological echo chambers that reinforce existing beliefs, and digital influencers amplifying false narratives to audiences with low health literacy. She also flagged the very real problem of AI hallucinations — responses that confidently cite fabricated journal articles with plausible-sounding titles and author names.

“Even something that looks like a verifiable journal is something that you need to go to, to read, to understand yourself,” she cautioned.

But AI also offers meaningful utility for IPs when used critically:

• Starting research faster — AI can generate an initial overview of a topic or identify relevant literature, which then requires human fact-checking

• Deepening understanding — thoughtfully crafted prompts can help clinicians work through complex mechanisms (e.g., generating a diagram of how HIV enters a cell as a study tool)

• Literature identification — queries can surface highly cited references on clinical topics like chlorhexidine efficacy for MRSA reduction

• Evidence frameworks — tools like Open Evidence provide cited, verifiable responses to clinical questions with direct links to primary literature

Reading the Literature Like a Scientist

Stephanie Stroever, PhD, MPH, shifted the conversation to a foundational skill: evaluating research validity. She cited Maul (2018) who defined validity as “The degree to which a study accurately measures what it intends to measure, ensuring that the conclusions drawn are sound and applicable.” She said that true validity equals sound conclusions, while compromised validity can lead to misleading conclusions.

She introduced three types of validity that IPs should hold in mind when appraising evidence:

1. Internal validity — Is the result true? Threats include bias, unmeasured confounding, and poor measurement. A QI example: a new disinfectant appearing to reduce HAIs while hand hygiene compliance was simultaneously improving makes it impossible to attribute the outcome to any single intervention.
2. External validity — Is the result generalizable? A well-designed study from a resource-rich academic medical center may not translate to a rural community hospital or a different patient population.
3. Construct validity — Are we measuring what we think we’re measuring? Surface contamination on cultures, for example, does not necessarily equal transmission.

Stroever also walked through the evidence hierarchy, from laboratory and animal studies at the base of the hierarchy to meta-analyses and systematic reviews at the top. Her message was direct: one study does not equal proof.

“We don’t prove anything with a single study,” she said. “The idea is we do it once — this is interesting, let’s do it again, and let’s see if we get the same result.” She pointed to  golden rule of research evaluation that evidence supports a conclusion but does not prove it.

When reading a journal article, she emphasized three steps. The first is checking the foundation: Identify the study design and locate where it sits on the hierarchy pyramid. Step two is inspecting for cracks: Assess the validity and look to see if the researchers actually measured what they claimed to be measuring. Step three is weighing the evidence: Does the strength of the researchers’ conclusion(s) match the quality of their study design? She explained that a single study is an observation but true scientific proof is an aggregate structural achievement wherein proof equals repetition multiplied by time multiplied by different populations and conditions.

When encountering new evidence, she recommended a structured approach:

• Focus on methods and results, not just the introduction and discussion

• Identify the study design early to know what validity threats to look for

• Use AI as a starting point for critique — prompting tools like ChatGPT or Claude to identify threats to validity in a specific paper — then evaluate whether those concerns make sense

• Weight findings according to their position in the evidence hierarchy before presenting to leadership or clinical staff

Treating Misinformation Like an Infection

Janet Haas, PhD, RN, CIC, brought a familiar framework to an unfamiliar problem: the chain of infection. Misinformation, she argued, behaves like a pathogen. It has reservoirs (social media ecosystems, closed online communities), modes of transmission (manipulated content, false photographs, algorithmically driven feeds), and susceptible hosts — all of us.

Key points from her analysis:

The continuing influence effect means that even retracted misinformation continues to shape beliefs. The Wakefield MMR-autism paper, withdrawn after 12 years and thoroughly discredited, still drives vaccine hesitancy decades later.

On X (formerly Twitter), false news is approximately 70 times more likely to spread than fact-checked news, and false stories reach 1,500 people roughly six times faster than verified information.

Susceptibility is increased by illusory truth (the more you hear something, the truer it sounds), time pressure (scrolling past partial headlines), and confirmation bias.

Breaking the Chain of Misinformation

Janet Glowicz, PhD, RN, MPH, CIC, emphasized that breaking the chain of misinformation requires several steps:

• Understanding that misinformation is resistant, and that it can defeat the facts designed to stop it. She said the misinformation can influence reasoning even after it has been retracted, and that it undermines accurate information while neutralizing facts.

• Realizing that misinformation can spread far and deep. She likened sources such as the mainstream news media  and social media as superspreaders.

• Understanding that misinformation spreads by identifiable modes of transmission, such as satire or parody, propaganda, imposter, fragmented and manipulated content, as well as clickbait and sponsored content online.

• Realizing that misinformation may infect rational people who are exposed and infected by information with perceived source credibility and selective exposure in information echo chambers.

Understanding that host susceptibility affects uptake, she described the following susceptibility factors:

• Illusory truth effect:

• Repeated claims are more likely to

be judged as true

• Inattention to account

• Social media distracts people from making news-sharing decisions based on accuracy.

• Limited time and resources to reflect on content

• Motivated reasoning

• Reasoning begins with a predetermined outcome

Debunking (reactive) — responding to misinformation already in circulation. Effective debunking requires more than fact-checking. It involves identifying the false message, presenting the truth, referencing scientific consensus, keeping the correction simpler than the original false claim, and providing an alternative causal explanation. Crucially: do not repeat the misinformation more than necessary.

Pre-bunking (proactive) — inoculating people against misinformation before it reaches them by warning of manipulation tactics in advance and refuting misleading arguments preemptively. Haas described this as “prophylaxis” — building cognitive immunity before the pathogen arrives.

Strategies to build trust, according to Lewandowsky, et al. include:

1. Identify the false message

2. Respond with the truth

3. Appeal to scientific consensus

4. Ensure the correction is not more complex that the initial misinformation

5. Explain why the misinformation is wrong

6. Provide a coherent alternative casual explanation

Panelists recommended the truth sandwich as a communication structure: begin with the facts, keep them simple and memorable, name the misinformation briefly (but don’t amplify it), and expose the manipulation technique as well as provide an alternative explanation through facts. A well-delivered truth sandwich should be brief, coherent, and emotionally resonant. According to Lewandowsky, et al. facts used to refute misinformation must be clear, concise and compelling.

The Bottom Line for Infection Preventionists

The session’s closing message was clear: IPs already possess the intellectual toolkit to combat misinformation. They evaluate evidence, interrogate study designs, and communicate complex risk to diverse audiences every day. What is needed is intentional application of those skills to the information environment itself. Be a critical consumer. Verify sources. Understand where evidence lands in the hierarchy. Use AI as a starting point, not an endpoint. And when confronted with a colleague, patient, or administrator who has absorbed a compelling but false health claim — serve them a truth sandwich.

The panelists advised IPs to take the following steps:

• Become a trusted source

• Create a method for personnel to verify information

• Create a method for the public to verify information

• Practice identifying the mode of transmission when you encounter misinformation

• Share your experience with others

• Provide unit-based leaders training in countering misinformation

• Evaluate your messages for complexity

• Have personnel generate “sticky” facts

The panelists summarized by noting that viral misinformation is a serious threat. Pre-bunking builds resilience against misinformation. Clear and simple refutations can build trust between the general public and infection preventionists. Infection preventionists are experts in content and communication and they must become the trusted source.