Last year, the team at Infection Control Consulting Services (ICCS) shared 10 of their scariest healthcare infections and threats. Below is our list for 2020. Some were clear-cut choices. Others were debated. All are scary, and all are important.

Agree? Disagree? Let us know what you would have on your list by commenting on LinkedIn.

1. COVID-19

Global. United States. Healthcare professionals. Be vigilant.

2. PPE shortages

Personal protective equipment (PPE) shortages garnered significant attention in the initial weeks and months of the pandemic. Unfortunately, more than six months into the health crisis, shortages of PPE remain a substantial challenge. As the Harvard Business Review noted in September, "Hospitals, nursing homes, and medical practices routinely have to waste time and heighten their disease exposure by decontaminating disposable masks and gloves for reuse. Many organizations must still forage for critically needed equipment through back channels and black markets." 

As the pandemic continues, deaths will continue to add up. PPE shortages are likely to further contribute to the loss of life. U.S. PIRG recently highlighted the growing and serious risk facing nursing homes. 

3. Drug shortages

Drug shortages have long been a problem in the United States. The pandemic has only worsened the situation and it's costing patients their lives and wellness. A recent report from the Center for Infectious Disease Research and Policy noted that more than 70% of the 40 critical drugs for COVID-19 patients are experiencing shortages, citing American Society of Health-System Pharmacists (ASHP) data. The current shortage list maintained by ASHP includes more than 200 drugs. On it are the likes of propofol, morphine, fentanyl, albuterol, midazolam, hydroxychloroquine, and azithromycin.

4. Antibiotic-resistant bacteria

The title of a recent Business Insider article helps to frame the significant threat that we still face from antibiotic-resistant bacteria: "There's another pandemic-level health threat slowly building — this one from bacteria." The CDC notes that antibiotic resistance "is one of the biggest public health challenges of our time," reporting that nearly 3 million Americans contract an antibiotic-resistant bacterial infection annually and, of those, about 35,000 die. 

The good news is that the United States has a national action plan for combating antibiotic-resistant bacteria that was recently updated and we've seen some progress made thanks to prevention efforts that have reduced deaths. The bad news is that the progress is fairly slow, and we continue to learn that this threat may prove even more difficult to combat and control than realized. A recent study showed that antibiotic-resistant bacteria can linger in hospitals even after deep cleaning.

5. Misinformation

This is a topic we wrote about in March, when we debunked potentially dangerous myths concerning the prevention of and treatment for COVID-19 (a list that could be much longer now). Misinformation, disinformation, and rumors, particularly those which "go viral," can complicate efforts to inform the public about health threats and appropriate preventive and responsive actions. This can ultimately lead to dangers, including harm to individuals and the potential prolonging of a threat. As a Scientific American column simply stated, "COVID Misinformation is Killing People."

6. Suboptimal hand hygiene

One of the few silver linings of the pandemic is increased awareness and appreciation of the importance of hand hygiene. Hopefully that translates over to sorely needed improvements in proper hand hygiene practices within healthcare organizations, and there is some evidence that this is occurring.

Such improvements are critical. The CDC references studies showing that, on average, healthcare providers clean their hands less than half of the times they should. A study published in Infection Control & Hospital Epidemiology from early in the year demonstrated that poor hand hygiene continues to contribute to hospital-acquired infections, with the researchers stating that "… current best practice recommendations do not provide a strong guidance regarding patient hand hygiene."

7. Unsafe injection practices

Back in February, Mayo Clinic Proceedings study further highlighted this avoidable threat. Researchers found that nearly 67,000 patients were notified about potential exposure to unsafe injection practices by healthcare personnel between 2012 and 2018, and the total number of U.S. patients notified of potential exposures to blood-contaminated medications or injection equipment since 2001 is close to 200,000.

The same month the study was published marked the 10-year anniversary of the "One & Only Campaign" — a public health effort to eliminate unsafe medical injections. Unfortunately, significant work remains if this campaign is to be declared successful.

8. Sterile processing failures

This is a safety threat that has lingered for years and one we brought attention to in last year's list in the section on "endoscopes testing positive for bacteria after cleaning and disinfection." In ECRI's "Top 10 Patient Safety Concerns for Healthcare Organizations 2020" report, the organization identified "device cleaning, disinfection, and sterilization" as fifth on its list, noting that sterile processing failures can lead to surgical site infections. In addition, ECRI stated that, "Incidents involving improperly reprocessed instruments can potentially result in devastating effects on patients, damage to organizational and provider reputations, citations and fines from regulatory bodies, prompt review by accrediting agencies and lawsuits."

9. Sepsis

Twenty percent. That's the percentage of annual worldwide deaths attributable to sepsis, either as cause or contributing factor, according to a study published in Lancet. The study analyzed death certificates for more than 100 million deaths records in 2017 and found that the number of deaths associated with sepsis was twice as high as previously believed. The researchers also found that nearly 49 million incident cases of sepsis and 11 million sepsis-related deaths were recorded worldwide in 2017. The good news is that the number of global sepsis cases has declined since 1990.

Considering patients who are critically ill with severe COVID-19 and other infectious diseases are at higher risk of developing and dying from sepsis, reports the World Health Organization, it will be interesting to see whether global cases rise in the coming years.

10. Home-laundered scrubs

We conclude with this threat because the question of whether organizations should permit their staff members to take scrubs home and wash them is one that our team is asked regularly. The Association of periOperative Registered Nurses (AORN) provides recommendations and guidance concerning what organizations should do if they go the route of

• laundering at a healthcare-accredited laundry facility,

• laundering scrubs themselves (following state regulatory requirements or following CDC guidelines if no state requirements exist), or

• allowing staff members to launder scrubs at home.

While organizations must ultimately choose whether to permit home-laundered scrubs and develop a policy that reflects their decision, ICCS strongly advises against home-laundered scrubs. Among our reasons: How will the organization control the laundering? Who will review and monitor the process in individual homes? Ultimately, we believe that the potential safety risks associated with home-laundered scrubs are not worth taking.

What are your scariest healthcare infections and threats of the year?

We hope you found our list informative. It wasn't easy to settle on just these 10, and we could easily have made a much longer list. But we tried to cover a range of threats and hopefully help you gain a better understanding and appreciation of some that may not be receiving the level of attention they deserve as we are largely focus on battling this pandemic.

Did we omit your scariest infection or threat? Let us know on LinkedIn!