Healthcare Infection Control Practices Advisory Committee Research Articles

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

SHEA Neonatal Intensive Care Unit (NICU) White Paper Series: Practical approaches for the prevention of central-line-associated bloodstream infections.

This document is part of the "SHEA Neonatal Intensive Care Unit (NICU) White Paper Series." It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: "Practical approaches to Clostridioides difficile prevention" published in August 2018 and "Practical approaches to Staphylococcus aureus prevention," published in September 2020.

Establishing an evidence-based infection surveillance program for home care and hospice: A large Midwest health system's experience

Home care and hospice are unique and rapidly growing healthcare settings. However, there is a lack of published findings related to evidence-based infection surveillance programs among these settings. Our health system hired a Home Care and Hospice Infection Preventionist to implement an infection surveillance program using evidence-based infection surveillance criteria appropriate for these settings, the Association for Professionals in Infection Control and Epidemiology (APIC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) definitions for home health care and home hospice infections, National Healthcare Safety Network long-term care facility (LTCF) criteria, and McGeer criteria for LTCFs. These surveillance criteria were built into new surveillance databases for Home Care, Home Hospice, and inpatient Hospice House. Infection Prevention reported infections and trends to respective departments monthly and as needed in the event of any significant infections. For most infection types, there were less infections identified during January-April 2021 than for the same period in 2019-2020. Having Infection Prevention coordinate the Home Care and Hospice infection surveillance program will help establish reliable healthcare-associated infection baseline data and help identify the population at risk. Future enhancements to automatically identify infections among this patient population are planned once Home Care and Hospice begin using the health system's electronic medical record.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Comparison of External and Internal Fixation for Management of Bicondylar Tibial Plateau Fractures in Terms of Surgical Site Infection

Objective: To compare external and internal fixation for the management of bicondylar tibial plateau fractures in terms of surgical site infection (SSI). Study Design: Randomized Controlled Trial. Settings: Faisalabad Medical University and affiliated Hospitals, Faisalabad, Pakistan. Duration: May 15, 2017 to November 15, 2017. Methodology: Approval from the institutional ethical committee was taken. All the patients with diagnosis of Bicondylar (Schatzker types V and VI) tibial plateau fractures in acute trauma setting who fulfilled the selection criteria were entered in the study by taking informed written consent. All selected cases were guided/informed regarding risk and benefits of the procedure. Randomization was based on computer generated numbers and allotted A & B groups. Group A patients underwent open reduction and internal fixation and in Group B patients’ external fixation with illizarove ring fixator was applied. All the relevant information was filled on predesigned Performa. Post-operative superficial surgical site infection was noted at 4 weeks after surgery in the ward of each patient. According to the Centre of Disease Control and prevention (CDC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) criteria for defining a superficial surgical site infection, the record from each patient was collected after carefully examining the surgical wound at 4 weeks after surgery. Results: Post-operative superficial surgical site infection was 10 %(n=4) in cases of Group-A and 47.5%(n=19) in cases of Group-B, whereas 90%(n=36) in Group-A and 52.5%(n=21) in Group-B had no SSI. Conclusion: We found lower rate of infection in cases treated with internal fixation than those undergoing external fixation for bicondylar tibial plateau fractures.

A Process for Assessing Products for Infection Prevention in Health Care Settings: A Framework From the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention.

Infection control is a complex task that spans people, products, and practices in diverse settings. For years, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has provided advice and guidance to the Centers for Disease Control and Prevention (CDC) on how best to prevent infections. These recommendations have focused largely on health care delivery practices and occasionally on general categories of products. With an influx of novel infection control products and growing use of these products by frontline clinicians, an efficient process for developing transparent, rigorous product recommendations that includes myriad data sources was necessary. To address this gap, the CDC asked HICPAC to develop a process that would help inform committees considering product-related recommendations. This article describes the process to develop this approach and provides an outline of how the tool may be used when products with infection control claims are recommended in guidelines or recommendations for infection prevention.

Female External Catheter Use: A New Bundle Element to Reduce CAUTI

BACKGROUND Despite multiple efforts to decrease catheter-associated urinary tract infections (CAUTI's), the Center for Disease Control and Prevention (CDC) reports that more than 90,000 healthcare-associated infections (HAI's) occur each year. According to the Joint Commission's National Patient Safety Goals (NPSG's), CAUTI reduction remains a top priority. The leading risk factor for CAUTI development is prolonged use of an indwelling Foley catheter. Female external catheters present providers with a non-invasive method of managing incontinent patients effectively. The ability to offer alternatives can reduce Foley catheter utilization and decrease CAUTI events. METHODS This initiative concentrated on reducing CAUTI's through the reinforcement of the CAUTI bundle, developed from the 2009 Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines, with the addition of a new external female catheter option. This one-year project, at a 300-bed community hospital in the northeast, began in October, 2017. Baseline data for all in-patient CAUTI's, Foley utilization rate and standardized infection ratio (SIR), was analyzed and compared pre and post implementation from the CDC's National Healthcare Safety Network (NHSN). RESULTS Utilizing NHSN data to compare baseline versus post intervention from (10/1/2017- 9/30/2018) revealed a drastic improvement of 51.7% in CAUTI reduction. The Foley utilization rate was reduced from 15.7 to 10.7. SIR decreased from 1.319 to 0.965, which is significant, because it is below the NHSN SIR goal of less than 1. CONCLUSIONS This study provides evidence that using female indwelling catheter alternatives as a bundle element is a potential factor in decreasing CAUTI. These results offer providers a foundation for managing future patients safer. Continued support and education is essential in combating CAUTI.

Evaluation of vancomycin use in university-affiliated hospitals in Southern Khorasan Province (East Iran) based on HICPAC guidelines.

BackgroundVancomycin resistance has raised concerns about its effectiveness prospect in the treatment of patients with Gram-positive infections. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has recently established guidelines to delineate improper use of vancomycin. In this light, we sought out to determine the appropriateness of vancomycin prescription using the HICPAC guidelines.SettingThe study was carried out in two university-affiliated hospitals, Valiasr and Imam Reza, with 297 and 234 beds, respectively, from May 2012 to May 2013.MethodsThis retrospective study evaluated the vancomycin prescription and usage in the hospitals. Total vancomycin use was determined and expressed as vancomycin courses per 298 admitted patients. The patient information was collected on a data collection sheet as follows: demographic variables, etiology and localization of infection, microbiological data, duration of vancomycin treatment, reasons for vancomycin prescription, prescribed antibiotic dosing, and patient regimen.ResultsThe average age of the patients and vancomycin treatment duration were 55.965 years and 10.5 days, respectively. Septicemia (15.7%) was the most common cause of vancomycin administration. Vancomycin use was documented to be appropriate and inappropriate in 236 (89.4%) and 28 (10.6%) patients, respectively. No statistically significant differences were found among the wards and hospitals (P values =0.66 and 0.54, respectively) in terms of appropriateness of vancomycin use based on the HICPAC criteria. In addition, 29.21% and 62% of all patients exhibited complete and partial recovery, respectively. We found that 90% of the cases showed compliance with the HICPAC recommendations.ConclusionComprehensive programs are required to improve the vancomycin use in the hospitals. Vancomycin use should be monitored due to its large-scale empiric use. The rate of improper use of vancomycin in the infection and intensive care unit services may be high, and pharmacists must take appropriate action to optimize the use of the drug.

Wet contact time directly impacts antimicrobial efficacy of Environmental Protection Agency–registered disinfectants

Routine use of disinfectants is recommended by the Centers for Disease Control and Prevention to prevent transmission of pathogens that may cause healthcare–associated infections. 1 Rutala WA, Weber DJ; Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities, 2008. Available from: https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf. Accessed October 20, 2018. Google Scholar , 2 Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Available from: https://www.cdc.gov/infectioncontrol/pdf/guidelines/environmental-guidelines.pdf. Accessed October 20, 2018. Google Scholar Although the Environmental Protection Agency (EPA) regulates the registration process of disinfectants, there are a number of key issues with disinfectant use that are not currently addressed by the Centers for Disease Control and Prevention or EPA guidance, which can lead to suboptimal performance of disinfectants. This article discusses the issue of inconsistent interpretation and practice of contact time specified on disinfectant labels.

Future Research Opportunities in Peri-Prosthetic Joint Infection Prevention.

Peri-prosthetic joint infection (PJI) is a serious complication of prosthetic joint arthroplasty. A better understanding and reversal of modifiable risk factors may lead to a reduction in the incidence of incisional (superficial and deep) and organ/space (e.g., PJI) surgical site infections (SSI). Recently, the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) published the Guideline for Prevention of Surgical Site Infection. This targeted update applies evidence-based methodology in drafting recommendations for potential strategies to reduce the risk of SSI both across surgical procedures and specifically in prosthetic joint arthroplasty. A panel of PJI content experts identified nine PJI prevention research opportunities based on both evidence gaps identified through the guideline development process (transfusion, immunosuppressive therapy, anticoagulation, orthopedic space suit, and biofilm) and expert opinion (anesthesia, operative room environment, glycemic control, and Staphylococcus aureus nasal screening and decolonization. This article offers a road map for PJI prevention research.

Introduction to the Centers for Disease Control and Prevention and Healthcare Infection Control Practices Advisory Committee Guideline for Prevention of Surgical Site Infection: Prosthetic Joint Arthroplasty Section.

Peri-prosthetic joint infection (PJI) is a severe complication of total joint arthroplasty that appears to be increasing as more of these procedures are performed. Numerous risk factors for incisional (superficial and deep) and organ/space (e.g., PJI) surgical site infections (SSIs) have been identified. A better understanding and reversal of modifiable risk factors may lead to a reduction in the incidence of incisional SSI and PJI. The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recently updated the national Guideline for Prevention of Surgical Site Infection. The updated guideline applies evidence-based methodology, presents recommendations for potential strategies to reduce the risk of SSI, and includes an arthroplasty-specific section. This article serves to introduce the guideline development process and to complement the Prosthetic Joint Arthroplasty section with background information on PJI-specific economic burden, epidemiology, pathogenesis and microbiology, and risk factor information.

9-186 - Catheter-Associated Urinary Tract Infection Reduction in the Emergency Department as a Result of Dual Personnel Urinary Catheter Insertion

BACKGROUND: The Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Catheter-Associated Urinary Tract Infections (CAUTI) focuses on the following prevention strategies: appropriate indication for insertion and timely removal, proper insertion, and proper maintenance. A review of the facility CAUTI data demonstrated that an opportunity to reduce insertion-related CAUTIs existed and the majority of urinary catheters were inserted in the Emergency Department (ED). Therefore, a multidisciplinary team that included representatives from the ED, Infection Prevention Department, and the Nursing Clinical Quality and Research Specialists collaborated on strategies to reduce insertion-related CAUTIs.

Evidence-Based Update to the U.S. Centers for Disease Control and Prevention and Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection: Developmental Process.

Recommendations in the "Guideline for Prevention of Surgical Site Infection, 1999" were based on experts' selective interpretation of the scientific evidence. Effective 2009, the U.S. Centers for Disease Control and Prevention (CDC) and its Healthcare Infection Control Practices Advisory Committee (HICPAC) updated their guideline development process. This is a narrative summary of the updated process focusing on key changes and challenges specific to the Guideline for Prevention of Surgical Site Infection. The guideline development process now incorporates evidence-based methodology and provides explicit links between the evidence and the recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. There is also participation by professional surgical societies, an updated guideline structure (core and procedure-specific sections), additional planned related manuscripts (introductions to the guideline and research opportunities), and new proposed venues for publication. The new CDC and HICPAC "Guideline for the Prevention of Surgical Site Infection" represents a substantial advancement from recommendations for infection control practices based on expert opinion to evidence-based practices. The new structure is meant to facilitate future updates, in particular, those addressing specialty or procedure-specific surgical site infection prevention questions. Increased presence by the surgical community through the professional surgical societies' engagement in the guideline development process, lead authorship of related manuscripts, and proposed publication in the surgical literature not only increase adherence by the surgical community, but also promote an ongoing collaboration with public health and other partners in a multidisciplinary approach to SSI prevention.

Appropriate vancomycin use in a Malaysian tertiary hospital based on current HICPAC recommendations.

Antibiotic resistance is a rapidly emerging problem. A major concern is methicillin-resistant Staphylococcus aureus (MRSA), especially in developing countries where cost-effectiveness is imperative. Restriction of vancomycin usage is necessary to reduce the emergence of vancomycin-resistant organisms. The aim of this study was to look into the appropriate use of vancomycin based on the Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines and to investigate serum levels of vancomycin. The study was performed retrospectively. Medical records of patients treated with vancomycin for the past year were identified and selected. Overall, 118 patients were treated with vancomycin. Appropriate use of vancomycin was significantly higher than inappropriate use (p = 0.001). Approximately 85% (n = 100) of patients were given vancomycin for treatment, whereas the rest were given it for prophylaxis. Appropriate use of vancomycin was observed in 67% (n = 79) of patients. However, there was still a high rate of inappropriate vancomycin use for prophylaxis and treatment (n = 39, 33.1%). The most common reason for inappropriate use was non-neutropenic and non-line related sepsis (n = 36, 30.8%). Therapeutic drug monitoring of vancomycin was performed in 79 patients (67%). Most patients (n = 53, 67%) demonstrated sub-therapeutic levels during the first measurement. There was no significant difference between trough levels achieved with a higher (> 15 mg/kg) versus a lower dose (< 15 mg/kg). This study demonstrates that there was still a high level of inappropriate vancomycin use, which could potentially contribute to vancomycin resistance.

Bronchiolitis and bacteraemia caused by Burkholderia gladioli in a non-lung transplantation patient.

Dear Editor, The Gram-negative bacillus Burkholderia gladioli is known to be a causative pathogen of pneumonia in cystic fibrosis 1,2. Chronic lower respiratory infections involving B. gladioli are associated with poor graft survival and unfavourable outcomes 1,2. Burkholderia gladioli was first identified as a plant pathogen in gladiolus, iris and rice, but this bacterium is found in diverse environments including soil, plants and the human respiratory tract. Its pathogenesis in humans was first described in the mid-1990s in case reports of cystic fibrosis 3 and chronic granulomatous disease 4, and the majority of the reported B. gladioli infections have been in immunocompromised adults, e.g. human immunodeficiency virus-infected patients, and newborns 5. Although it is still a fairly uncommon pathogen, B. gladioli in humans is an opportunistic pathogen and is associated with a poor prognosis. The genus Burkholderia was formerly classified as the genus Pseudomonas. The virulence of B. gladioli in humans is recognized to be low, and the clinical manifestations of this pathogen in non-lung transplantation patients have not been fully elucidated. We treated a 62-year-old female patient with myasthenia gravis, a thymoma and immune-mediated granulocytopenia. She had been treated with tacrolimus for the previous 12 months. From her sputum, non-fermenting Gram-negative rods were cultured microbiologically. The isolate was oxidase-negative, indole-negative and nitrate-negative. The 16S rRNA detection in our collaborator's laboratory confirmed B. gladioli as a 99% comparable DNA sequence. The patient's case was complicated with bronchiolitis followed by bacteraemia due to B. gladioli. The infection of B. gladioli presented as diffuse panbronchiolitis (Fig.​(Fig.1)1) and progressed into repeated bacteraemia. The pathogen was not isolated because a laboratory technician made an arbitrary decision not to proceed further to determine the species of the causative organism, although the patient had been suffering from repeated bacteraemia due to the same bacillus. Our institute's laboratory reported the pathogen only as ‘an environmental non-fermenting Gram-negative rod.’ Figure 1 Pulmonary infection by Burkholderia gladioli presenting as diffuse panbronchiolitis. (a) Transverse view showing the transbronchial distribution of small opaque nodules in the right upper lobe (S2), indicated by arrowheads. (b) Nodular infiltration shadows formed ... Non-fermenting Gram-negative bacilli are bradytrophic and can survive for long periods in a wet environment without sufficient nutrients. Such bacilli include Pseudomonas spp., Acinetobacter spp., Stenotrophomonas spp., Chryseobacterium spp. and Burkholderia spp., all of which are opportunistic pathogens. Non-fermenting Gram-negative bacilli have the following microbiological characteristics: (1) they produce various β-lactamases in nature, (2) they show multidrug resistance in nature, (3) they easily acquire plasmids harbouring antibiotic-resistant genes, and (4) they form a biofilm on surfaces to colonize. All of these features are linked to clinical issues in the treatment of infection, and they are linked to unfavourable outcomes. As stated in the position paper distributed by the US Health Care Infection Control Practices Advisory Committee (HICPAC), the surveillance of newly emerging pathogens is a critically important component of prudent infection control. Microbiological identification is also crucial, especially using samples obtained in clinical settings. In our patient, the isolated bacterium was not multidrug-resistant, fortunately; she was treated successfully with a carbapenem antibiotic, meropenem (0.5 g, three times per day, administered for 11 days). We recommend the microbiological identification of non-fermenting Gram-negative bacilli according to the clinical situation, even when the bacillus is likely to be found in the environment and is an unremarkable microbe. To do so, interdisciplinary interactions between clinical and laboratory personnel are helpful. The value of medical microbiology is based on interactive laboratories.

Effective Communication of Infection Control Data: How Do We Give Them What They Want?

capacity to meet regulatory standards. An autoclave needs assessment was completed. Redesign of existing work space and/or purchase of additional autoclaves ensued as needed. Phase II encompassed development of an annual mandatory education and theoretical competency by Infection Preventionist (IP). An electronic training series included sixteen modules with twenty-two possible combinations for customized training by Instructional Designer. Collaboration with Nursing Education offered the capacity to electronically assign by job code a training series as an annual mandatory competency. RESULTS: No valid measurement method existed previously. Theoretical annual competency compliance rate prior to electronic education was estimated to be 50%. Post implementation of the electronic educational training, the theoretical competency compliance rate is now measured at at 82%. On site observations demonstrate improved practices consistent with regulatory standards to include to include Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines, American Association of Medical Instrumentation (AAMI) Standards, Joint Commission (JC) Standards, Local Department of Health (DOH) Regulations, and Occupational and Safety and Health Administration (OSHA). LESSON LEARNED: The need for standardized instrument processing documentation forms was identified during this Project. Standardized forms were developed and uploaded to a shared intranet site for access by all staff. Electronic training series fulfill the need to measure theoretical competency but does not guarantee competency in actual practice. Consistant on-site supervision is required with return demonstration of correct practices by all staff with documentation of practice competency to be included in employee training record.

Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety.

ABBREVIATIONS CIED = cardiovascular implantable electronic device; CT=computed tomography; EP=electrophysiology; FDA= U.S. Food and Drug Administration; ICD=implantable cardioverterdefibrillator; MRI = magnetic resonance imaging; QA = quality assurance; QI = quality improvement; RF = radiofrequency; VT = ventricular tachycardia (Heart Rhythm 2014;11:e9–e51)

Preventing Total Hip and Total Knee Surgical Site Infections in a Multi-hospital System through Numerous Interventions Including Standardized Infection Ratios

completed the collaborative which ran September 2010-December 2011. The 16 facilities encompassed 44 reporting units including 19 critical care, 5 step-down, 19 wards, and 1 specialty care area. Requirements included establishing/maintaining multidisciplinary project teams, completing a pre/post-assessment, implementing the Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of CAUTIs, reviewingprogressmonthlywith project team and staff, and participate in site visits, live training, and monthly collaboration calls. Additionally, facilities reported all CAUTI events in participating units via the National Healthcare Safety Network (NHSN). All CAUTI event data was collected via the NHSN user group function, analyzed using the NHSN statistical calculator, and presented only in aggregate format for confidentiality purposes. RESULTS: The pre/post-assessment identified 3 major improvements participants made over the course of the collaborative. The proportion of facilities that had a procedure for daily assessment increased from 64% to 85%, those that provided regular training to staff increased from 57% to 85%, and those that used alternatives to indwelling catheters increased from 57% to 85%. Overall, both the CAUTI rate and the DUR remained fairly stable during the collaborative. While there was no significant decrease in the CAUTI rate when comparing the baseline period (October 2010 e March 2011) to outcome period (July 2011 e December 2011), the DUR decreased from 0.39 during the baseline period to 0.38 during the outcome period, a 3.8 % reduction (p<0.005). CONCLUSIONS: The results of the collaborative reflect that a comprehensive approach to CAUTI prevention as highlighted in the HICPAC guideline may reduce the DUR. Limitations of data include aggregate reporting which may mask significant changes, and the 15 month collaborative period which does not provide sufficient data points to reliably and validly identify special cause variation. The collaborative has been continued with a second cohort which includes 50% of original participants, giving these facilities 27 data points to analyze.

Best practices in disinfection of noncritical surfaces in the health care setting: Creating a bundle for success

Because increasing evidence suggests that the environment plays a role in transmission of health care-associated infections, more attention is focusing on environmental cleaning and improving its efficacy. Creating and sustaining a successful cleaning and disinfection program should include several key components using a bundle approach and requires ongoing commitment within the institution.

EDITORIAL (Thematic Issue: Infection Control: A Paradigm Shift)

Centers for Disease Control and Prevention (CDC) defines hospital-acquired infections (HAIs) as infections caused by bacteria, viruses or fungi that occur during the course of receiving medical care [1]. This is a rapidly evolving field with tremendous interest from the public, regulatory bodies and the policymakers alike. The overall annual direct medical costs of HAIs to US hospitals is estimated between 30 and 45 Billion US$ [2]. The majority of HAIs are preventable with adequate planning and follow up. The availability of the details of HAIs in the public domain has resulted in robust infection control measures by medical facilities across the US. The Medicare non-payment for HAIs has also bolstered the overall infection control efforts. In this issue, the reviews are a mix of traditional reviews, dynamic clinical experience and promising new technology. Porkywka and Byers focus on traffic in the operating room [3]. A topic that is well established as a risk for surgical site infection (SSI) with little literature available. Yassin and Gupta review Hepatitis B virus (HBV) infection in hemodialysis (HD) units. [4] They summarize in detail the infection prevention measures from practical application perspective. Ferrelli and DiCuccio enumerate a successful strategy in promoting hand hygiene at an academic institution in a step-by-step fashion [5]. The experience with hand hygiene adherence exploring the implementation of novel strategy provides a different aspect of a commonly discussed topic. Clair and Colatrella present an excellent review of Infection control measures from the perspective of construction (new and maintenance of existing ones) in a healthcare setup [6]. Kandiah and colleagues review monochloramine use in prevention of Legionella in hospital water system [7]. This combines information on new technology and actual experience as the first medical center in the USA using an innovative delivery system. Qureshi and Yassin discuss the use of Ultraviolet (UV) radiation for environmental surface disinfection [8]. They describe the role of environmental surfaces in the spread of infections and provide updates on the usage of UV radiation in disinfection. Bacteremia in HD patients remains a major problem that requires multidisciplinary approach for its containment. Gupta and Yassin provide an updated concise review regarding prevention of vascular access related infection in HD patients [9]. The article spans through the various guidelines provided by societies ranging from infection control- Infectious Disease Society of America (IDSA), Healthcare Infection Control Practices Advisory Committee (HICPAC), CDC, Association for Professionals in Infection Control and Epidemiology (APIC) to primarily renal organization like the National Kidney Foundation (NKF), providing trans-societal, multispecialty recommendations. These articles were chosen to interest general medical or nursing reader as well as the specialists in the field of infection control. These reviews not only provide excellent appraisal of literature but also enumerate practically useful tips for providers working in the field. REFERENCES