Am J Infect Control
· 2026 May · PMID 42128203
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BACKGROUND: The study investigated face-touching behaviors as a potential self-inoculation event, while examining sex differences and the role of handheld objects as possible fomites. Understanding these factors helps id...BACKGROUND: The study investigated face-touching behaviors as a potential self-inoculation event, while examining sex differences and the role of handheld objects as possible fomites. Understanding these factors helps identify non-obvious behavioral routes of infection. METHODS: A naturalistic field study observed 114 coffeeshop patrons. Observers recorded each instance of face touching as either T-zone touches (eyes, nose, mouth) or P-zone touches (cheeks, chin, ears), and whether handheld objects (putative fomites) were involved. Welch's t-test, multivariate and logistic regression were used to test for significance. RESULTS: Nearly all patrons (94.7%) touched their faces at least once, averaging 1.09 touches per minute. Women face touched their P-zone significantly more than men. About 21% of patrons used an object to touch their face, and object-use was significantly associated with increased T-zone touching compared with non-use. After controlling for sex, object-users had 9.1 times the odds of touching their T-zone compared to non-object users. DISCUSSION: The findings show the pervasiveness of face-touching behaviors. The results highlight face-touching as a key behavior in self-inoculation and pathogen transmission. Dynamic transmission models indicate increased pathogen dose for object-mediated face touching. Strategies to reduce face touching and increase public awareness are discussed. CONCLUSIONS: Future research should explore strategies to reduce direct and object-mediated face touching.
Cadnum JL, Milner AL, Memic S
… +1 more, Donskey CJ
Am J Infect Control
· 2026 May · PMID 42107606
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BACKGROUND: Environmental services programs may choose dilutable or ready-to-use (RTU) disinfectants. Dilutable products are generally less expensive but may have greater potential for incorrect use. METHODS: We conducte...BACKGROUND: Environmental services programs may choose dilutable or ready-to-use (RTU) disinfectants. Dilutable products are generally less expensive but may have greater potential for incorrect use. METHODS: We conducted a time and motion evaluation of environmental services post-discharge and daily room cleaning and disinfection practices before and after a facility-wide switch from dilutable to RTU quaternary ammonium disinfectants. Observations were completed to determine the time required for tasks, appropriateness of product use, and percentage of high-touch sites wiped. Personnel were graded using a standardized compliance scale (17-20, highly compliant). RESULTS: We observed 40 total hours of post-discharge room cleaning and disinfection by 10 personnel before and 9 after the product substitution. After the substitution, mean compliance scores increased from 11.5 to 17.7 (P = .003) and there was a reduction in time gathering supplies (3.8 vs 13.2 minutes; P = .002) but not in total time per post-discharge room (50.8 vs 65.2 minutes; P = .08). Noncompliance with dilutable disinfectants was often due to incorrect product use, including inappropriate mixing of disinfectants. For daily rooms, less than 3 minutes was spent wiping high-touch surfaces. CONCLUSIONS: In our facility, switching from dilutable to RTU disinfectants was associated with reduced time gathering supplies and improved compliance with recommended practices.
Foo E, Cheung W, Kol M
… +8 more, Shah A, Cross R, Wagh A, Gilfillan M, Brannelly A, Li Y, Mckinnon R, Whereat S
Am J Infect Control
· 2026 May · PMID 42105881
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BACKGROUND: N95 masks are used to protect healthcare workers from airborne infections, but mask leakage can occur with extended use. The objective of this study was to determine the proportion of mask leakage with extend...BACKGROUND: N95 masks are used to protect healthcare workers from airborne infections, but mask leakage can occur with extended use. The objective of this study was to determine the proportion of mask leakage with extended use for up to 4 hours. The primary outcome was N95 mask fit-test failure within 4 hours. METHODS: Testing for mask leakage was conducted on 40 healthcare staff, in a single ICU, while performing normal duties. Quantitative mask fit testing (QNFT) was performed using the Portacount method at 1-hour intervals for 4 hours. RESULTS: Of the 40 participants, 80% were female,75% were nurses, and 20% were doctors. N95 mask failure increased with the duration of mask use (P = .0167). Independent mask failure rates after 1, 2, 3, and 4 hours of usual work activity, were 12.5% (N = 5), 15.0% (N = 6), 18.5% (N = 7) and 20.0% (N = 8) of participants, respectively. Cumulatively, 65% of masks failed by 4 hours but only 27.5% failed by 2 hours. CONCLUSION: Failure of N95 mask fit using QNFT increased with time, with 12.5% of participants in this study failing after 1 hour and 65% of participants failing by 4 hours. Our research offers quantitative evidence on the performance of N95 mask fit over time. Understanding mask fit has important implications for infection control and may help inform policy development in preparation for future pandemics.
Thompson S, DiBiase L, Teal L
… +4 more, Weber D, Shamblin L, Baer K, Sickbert-Bennett E
Am J Infect Control
· 2026 May · PMID 42105879
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Tapes and adhesives are ubiquitous in health care for labeling equipment and posting signs, yet their removal often leaves residual material. This study aimed to (1) quantify the effect of tape residue on microbial adher...Tapes and adhesives are ubiquitous in health care for labeling equipment and posting signs, yet their removal often leaves residual material. This study aimed to (1) quantify the effect of tape residue on microbial adherence to environmental surfaces and (2) evaluate whether tape affects disinfection effectiveness. Experimental results demonstrate that tape-covered environmental surfaces do not harbor increased microbial contamination and do not impede complete disinfection.
Cadnum JL, Torres-Teran MM, Memic S
… +3 more, Milner AL, Kaple CE, Donskey CJ
Am J Infect Control
· 2026 May · PMID 42102974
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BACKGROUND: Aerosolized or vaporized glycols have been proposed as a safe and low-cost measure for air sanitization, but limited information is available on their efficacy in real-world conditions. METHODS: We evaluated...BACKGROUND: Aerosolized or vaporized glycols have been proposed as a safe and low-cost measure for air sanitization, but limited information is available on their efficacy in real-world conditions. METHODS: We evaluated 2 commercial glycol products, including a dipropylene glycol aerosol spray air sanitizer containing 30% to 60% ethanol and a triethylene glycol product released as a vapor over up to 48 hours. In a simulated patient room with 8 air changes per hour, we tested the efficacy of both products in reducing aerosolized bacteriophages Phi6 and MS2 in air and settling on disks, and the triethylene glycol vapor in reducing the viruses and bacterial pathogens and Candidozyma auris on steel disks. RESULTS: Both products significantly reduced recovery of the bacteriophages in air and significantly reduced recovery of bacteriophage Phi6, but not bacteriophage MS2, on settle disks. After 16 or 48 hours, the triethylene glycol vapor reduced recovery of Phi6, Acinetobacter baumanii, and C auris by > 1 log, and reduced methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Klebsiella pneumoniae by ∼0.5 log. CONCLUSIONS: The glycol products could be an effective adjunctive method to reduce airborne viruses, and with prolonged exposure might have a modest impact on surface contamination with bacteria and fungi.
Streetman DR, Hutchinson A, Hahn JM
… +2 more, Huang FS, Supp DM
Am J Infect Control
· 2026 May · PMID 42092482
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BACKGROUND: Chlorhexidine gluconate (CHG) is a commonly used antimicrobial cleanser, but its safety in children and neonates is not fully understood. This study analyzed the cytotoxicity of CHG and 2 alternatives in pedi...BACKGROUND: Chlorhexidine gluconate (CHG) is a commonly used antimicrobial cleanser, but its safety in children and neonates is not fully understood. This study analyzed the cytotoxicity of CHG and 2 alternatives in pediatric epidermal keratinocytes and dermal fibroblasts in vitro. METHODS: Keratinocytes and fibroblasts were cultured from skin of 3 pediatric donors. CHG, a baby wash, and a colloidal silver foam were diluted and analyzed in cells versus untreated controls. Proliferation, migration, and expression of genes involved in proliferation, apoptosis, and inflammation were analyzed in vitro. RESULTS: CHG inhibited keratinocyte and fibroblast proliferation the most; colloidal silver foam had the least effect. CHG and baby shampoo significantly inhibited keratinocyte migration, whereas no cleanser significantly affected fibroblast migration. Gene expression suggested CHG decreased keratinocyte proliferation, increased fibroblast inflammatory signaling, and increased apoptosis in both cell types. CONCLUSIONS: The results suggest CHG damages pediatric skin cells and less cytotoxic alternatives exist. Although keratinized epidermal layers in skin provide a barrier to protect deeper proliferative cells, this barrier is thinner in pediatric versus adult skin, potentially exposing these cells to cytotoxic CHG levels. Further studies including antimicrobial assays are required to fully define the optimal cleanser to combat infection without damaging pediatric skin.
Ceballos-Garzon A, Desitter S, Sentausa E
… +3 more, Holzapfel M, Welsch J, Mercer D
Am J Infect Control
· 2026 Aug · PMID 42066996
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We report the draft whole-genome sequences of 2 Lodderomyces elongisporus strains accidentally isolated from human skin and a mobile device in France. Initial Vitek-MS identification was inconclusive, but ITS sequencing...We report the draft whole-genome sequences of 2 Lodderomyces elongisporus strains accidentally isolated from human skin and a mobile device in France. Initial Vitek-MS identification was inconclusive, but ITS sequencing confirmed the species. Whole-genome sequencing using Illumina NovaSeq X revealed high genomic similarity between the 2 isolates (ANIm: 99.34%). Antifungal susceptibility testing following CLSI-M27-4th edition showed low minimum inhibitory concentrations (< 0.5 µg/mL) for all tested antifungals.
Am J Infect Control
· 2026 Apr · PMID 42055194
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A nosocomial Candidozyma auris (formerly Candida auris) outbreak affecting cardiac surgery patients prompted implementation of a multifaceted infection prevention strategy in a large academic hospital. Interventions incl...A nosocomial Candidozyma auris (formerly Candida auris) outbreak affecting cardiac surgery patients prompted implementation of a multifaceted infection prevention strategy in a large academic hospital. Interventions included an expanded epidemiological line listing, enhanced surveillance, environmental culturing, whole-genome sequencing, and implementation of an in-house polymerase chain reaction assay. This integrated approach achieved sustained interruption of transmission in a high-risk cardiac population and provides an adaptable model for outbreak investigation in high-acuity settings.
Guerrero J, Paramalingam S, Bhoite S
… +2 more, Lovinsky R, Belhaj A
Am J Infect Control
· 2026 Apr · PMID 42034222
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BACKGROUND: Transmission of viral respiratory tract infections (vRTIs) from sick visitors with symptoms of upper respiratory tract infections (URTIs) to patients is a concern. This study aimed to quantify the impact of s...BACKGROUND: Transmission of viral respiratory tract infections (vRTIs) from sick visitors with symptoms of upper respiratory tract infections (URTIs) to patients is a concern. This study aimed to quantify the impact of sick visitors with URTI in an acute care hospital. METHODS: Retrospective chart review was conducted to identify patients exposed to symptomatic visitors with URTI. Patients who tested positive for a vRTI and their secondary contacts were identified. Attack rate and isolation days were calculated. RESULTS: Twenty-three patients were identified as primary contacts of sick visitors and were isolated for 192 days; 17 of the 23 patients tested positive for SARS-CoV-2, Respiratory syncytial virus, or Adenovirus. Twenty-five secondary contacts were identified, with 8 positive for SARS-CoV-2 and a total of 129 isolation days with secondary attack rate of 35%. DISCUSSION: Sick visitors with URTI may contribute to the transmission of health care-associated vRTIs. Limitations include reliance on visitor self-reporting and the assumption that symptomatic visitors were the source of the infection. CONCLUSIONS: Visitors are essential to patient care but those with URTIs pose a risk to patients. Visitors should avoid visiting when sick and adhere to hospital protocols including hand hygiene, personal protective equipment usage and compliance with masking policies.
Genç S, Türkoğlu E, İça T
… +2 more, Demirkaya F, Renders DP
Am J Infect Control
· 2026 Apr · PMID 42034221
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BACKGROUND: In mid-2025, a sudden increase in urinary isolates of Myroides spp, was observed in high-dependency units (HDUs) of a tertiary-care hospital. This study aimed to determine whether the clustering represented s...BACKGROUND: In mid-2025, a sudden increase in urinary isolates of Myroides spp, was observed in high-dependency units (HDUs) of a tertiary-care hospital. This study aimed to determine whether the clustering represented sustained transmission or a pseudo-outbreak linked to a common source. METHODS: A combined retrospective-prospective investigation was conducted in HDUs comprising 8 intensive care units and 1 palliative care unit (total capacity: 89 beds). Seventy-five unique patients with Myroides spp isolated from urine cultures between July 2024 and August 2025 were included. Prospective isolates underwent identification, susceptibility testing, biofilm assessment, rep-PCR, and selected 16S rRNA sequencing. Targeted environmental sampling was performed in units with case clustering. RESULTS: A temporal peak occurred in June 2025 (n: 16). All prospectively analyzed isolates were identified as Myroides odoratimimus. Environmental sampling recovered the organism from urine collection containers. rep-PCR analysis of 33 isolates demonstrated a dominant molecular profile shared by 32 isolates, including 29 of 30 clinical isolates and all 3 environmental isolates. Most isolates showed strong biofilm production. After the introduction of single-use urine collection bags, no further isolates were detected. CONCLUSIONS: These findings indicate a health care-associated pseudo-outbreak linked to an environmental source rather than sustained patient-to-patient transmission.
Widesköld S, Nordenadler J, Tano E
… +5 more, Reinmüller B, Ljungqvist B, Gustafsson D, Hailer NP, Lazarinis S
Am J Infect Control
· 2026 Apr · PMID 42034220
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BACKGROUND: Microbiological air sampling in operating rooms, based on colony-forming unit (CFU) counts, is time-consuming and costly. Novel technologies, such as particle counters that detect fluorescent bioparticles (FB...BACKGROUND: Microbiological air sampling in operating rooms, based on colony-forming unit (CFU) counts, is time-consuming and costly. Novel technologies, such as particle counters that detect fluorescent bioparticles (FBPs), may offer a simpler method for estimating airborne bacterial loads. This study aimed to assess the correlation between CFU and FBP counts under realistic operating room conditions. METHODS: During 22 primary hip arthroplasty procedures at Uppsala university hospital, CFUs were measured using a Sartorius MD8 air sampler placed adjacent to the surgical field. Simultaneously, the Bio Aerosol Measuring System (BAMS), recorded FBPs sized 0.5-25 µm. FBP counts were analyzed during CFU sampling periods and using each CFU sampling interval as an individual data point, yielding 115 paired comparisons. Correlations were assessed using Spearman's rank correlation coefficient. RESULTS: No significant correlation was observed between FBP and CFU counts. Comparing FBP with CFU counts during Sartorius sampling intervals, rho was -0.31 (P = .23). Using individual CFU sampling intervals, the correlation for particles ≥ 3 µm rho was = -0.10 (P = .35). CONCLUSIONS: Analyses revealed no correlation between FBP and CFU counts in operation room air quality assessments, suggesting that BAMS-based FBP measurement is not a suitable alternative to established microbiological methods.
Lara C, Kappes M, Chandia P
… +3 more, Osorio K, Ferreira-Umpiérrez A, Brotons de Los Reyes P
Am J Infect Control
· 2026 Aug · PMID 42025849
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BACKGROUND: Health care-associated infections (HAIs) remain a major patient safety challenge in hospital settings. Surveillance systems provide monitoring, but few studies integrate long-term trends in infection risk and...BACKGROUND: Health care-associated infections (HAIs) remain a major patient safety challenge in hospital settings. Surveillance systems provide monitoring, but few studies integrate long-term trends in infection risk and outcomes with measures of system capacity and emergency investment. METHODS: We conducted a descriptive analysis of national HAI surveillance data from Chilean public hospitals spanning 2017 to 2022, reported in accordance with STROBE guidelines. Indicators included HAI prevalence, device utilization ratios, incidence densities for ventilator-associated pneumonia (VAP), central-line-associated bloodstream infection, catheter-associated urinary tract infection, VAP case fatality rates, and outbreak reports. Emergency health investment data were integrated to explore temporal patterns before, during, and after the COVID-19 pandemic. RESULTS: HAI prevalence remained stable over 6 years. However, device utilization increased during 2020 to 2021, with corresponding rises in device-associated infection rates, particularly VAP. VAP case fatality rates increased in 2020 to 2021, reversing pre-pandemic declines. Periods of rapid expansion in critical care capacity coincided with higher outbreak reports. CONCLUSIONS: During the COVID-19 pandemic, device-associated infections and infection-related severity increased despite stable HAI prevalence. By linking surveillance data with indicators of system capacity and emergency investment, this study helps explain how large-scale system disruptions affect infection risk and patient outcomes. Strengthening infection prevention alongside surge planning remains essential.
Am J Infect Control
· 2026 Apr · PMID 42025848
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Accurate health care-acquired infection (HAI) classification is an important component of infection prevention programs. This quality improvement project aimed to improve HAI accuracy using the Plan-Do-Study-Act (PDSA) m...Accurate health care-acquired infection (HAI) classification is an important component of infection prevention programs. This quality improvement project aimed to improve HAI accuracy using the Plan-Do-Study-Act (PDSA) methodology. Checklists, audit forms, and case vignettes were utilized. A standardized HAI competency toolkit should be available from National Healthcare Safety Network or other national professional organizations to assist infection preventionist programs in ensuring accurate HAI data. This will enhance the infection prevention profession and further strengthen infection preventionist contributions to patient safety.
Huang L, Zhang Y, Xu N
… +5 more, Peng X, Ju X, Lai Y, Liu Y, Li H
Am J Infect Control
· 2026 Apr · PMID 42009078
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BACKGROUND: To identify high-touch surfaces (HTS) in the operating room and evaluate the effect of an enhanced cleaning and disinfection protocol on contamination and surgical site infections (SSIs). METHODS: A 3-phase s...BACKGROUND: To identify high-touch surfaces (HTS) in the operating room and evaluate the effect of an enhanced cleaning and disinfection protocol on contamination and surgical site infections (SSIs). METHODS: A 3-phase study was conducted at Sun Yat-sen University Cancer Center. Phase 1 descriptively identified the HTS. Phase 2 assessed contamination levels of identified HTS postprocedure before and after cleaning and disinfection. Phase 3 used a self-controlled design to evaluate the impact of enhanced HTS cleaning and disinfection on SSI incidence. RESULTS: The HTS identified were the computer mouse-keyboard, door switch, and chairs, with contamination rates of 65.0%, 15.0% and 60.0%. Notably, 20% of chairs and 15% of computer mouse-keyboards exceeded acceptable contamination thresholds. Post-intervention contamination levels significantly decreased for computer mouse-keyboard (median: 1.25 vs 0 CFU; Z = -3.561, P < .001) and chairs (median: 2.25 vs 0 CFU; Z = -3.494, P < .001). A nearly statistically significant decrease in SSI incidence was observed following the intervention (P = .056). CONCLUSIONS: Enhanced cleaning targeting identified HTS significantly reduces surface contamination. Integrating HTS identification into routine SSI control monitoring and dynamically adjusting turnover clean and disinfection protocol is recommended.
Li Y, Becker ER, Joski P
… +2 more, Bouvier M, Cimiotti JP
Am J Infect Control
· 2026 Jul · PMID 42001959
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Exposure to bloodborne pathogens is a concern for healthcare systems. Using data from several sources, we estimated the rate of occupational exposure to bloodborne pathogens in six acute care hospitals. Units with adequa...Exposure to bloodborne pathogens is a concern for healthcare systems. Using data from several sources, we estimated the rate of occupational exposure to bloodborne pathogens in six acute care hospitals. Units with adequate staff, time, and resources had significantly lower rates of unintentional exposure to bloodborne pathogens. These findings underscore the importance of a supportive work environment that promotes safety among hospital workers.