It's time again! For the 4th consecutive year, the Infection Control Consulting Services (ICCS) team has come up with its list of the scariest healthcare infections and threats coinciding with Halloween. Our initial list was frighteningly long. We've narrowed it down to seven infections and threats we wanted to highlight most.

1. COVID-19

It's approaching three (!) years now since the start of the pandemic, and we're bracing for yet another surge. Vaccines and treatments have helped improve the odds of surviving a COVID-19 infection, but the disease remains a serious health risk that's claiming the lives of hundreds of people every day.

Which brings us to our next threat…

2. Lax masking practices

In early October, APIC issued a statement after CDC released guidance that relaxed recommendations for universal healthcare personnel masking. APIC urged infection preventionists to continue masking in patient care areas — a sentiment that was echoed on LinkedIn by ICCS Founder Phenelle Segal, RN, CIC, FAPIC.

Here's an excerpt of Phenelle's comments: "Despite CDC's confused messaging, the ICCS team continues to recommend universal masking in patient care areas. … It is a proven fact that masking with medical grade masks greatly reduce the number of droplets being emitted from the respiratory tract of the wearer. … While the worst part of the pandemic is over and vaccines have been a literal lifesaver, COVID-19 is not over, and it is hard to claim that we've reached endemicity. … Infection preventionists understand our obligation is to guide the medical field on how to best protect patients. Masking in patient care areas is not a huge demand, yet it can be a huge safety difference maker."

In years past, we've identified "complacency" as a threat, noting, "If we become complacent, we can very easily undo the progress we've made." That applies to masking as well.  

3. Increases in HAIs

A CDC analysis published in May revealed continued increases in HAIs in U.S. hospitals during 2021, with data showing significantly higher incidence in CLABSIs, CAUTIs, VAEs, and MRSA bacteremia. As Phenelle noted when the analysis was published, "Concerns about COVID-19 negatively impacting HAI prevention strategies and decades of progress is now a reality. We must be reminded that it is incumbent on us as infection preventionists to stress the critical need for infection prevention practices to return to pre-pandemic times, despite the ongoing serious challenges COVID-19 has created. Ongoing education, monitoring and feedback is critical to patient safety."

4. Improper reprocessing of instruments and medical devices

Year after year, improper reprocessing puts patients and staff at risk. It's already been several years since we drew attention to the challenges associated with the cleaning, disinfection and sterilization of duodenoscopes in a 2015 Special Report.

ICCS emphasizes the need for healthcare professionals to always follow manufacturer instructions/instructions for use (IFUs). Deficiency findings during ICCS onsite visits are often the result of failure to follow these instructions. If IFUs are unavailable, items should not be used unless nationally recognized guidelines, such as AAMI ST79 and AAMI ST91, are explicit enough to reprocess effectively and safely.

5. Fungal pathogens

WHO recently released its first-ever list of fungal "priority pathogens" that cause severe invasive infections and have growing resistance to antifungal drugs. Reports have noted that not only is fungi a neglected public health problem with few treatment options but more deaths are caused by fungal diseases than malaria and tuberculosis combined.

We can expect fungal infections to rise. Organizations must be prepared to effectively identify when they occur and be ready with appropriate antifungals.

6. Worsening mental health

A survey revealed that high percentages of infection preventionists reported that COVID-19–related stressors worsened their mental and physical health, and ECRI included "COVID-19 effects on healthcare workers' mental health" as one of its "Top 10 Patient Safety Concerns 2022" report. As the mental health of infection preventionists and other healthcare professionals suffer, so does the quality of care provided. Organizations must monitor their staff's mental wellbeing, provide resources to help employees do their jobs more efficiently, and work to ensure adequate staffing levels and external support to reduce the likelihood of burnout and compromised policies and procedures.

7. Staffing shortages

Speaking of adequate staffing levels, we would be remiss if we didn't note the threat caused by current shortages. Just last week, CNN reported that staffing shortages are contributing to children's hospitals being overwhelmed with respiratory infections, largely RSV (which could certainly hold a place on this list, considering its rapid rise this year that's leading some infectious disease experts to warn of a potential "tripledemic"). The nationwide healthcare staffing shortage is likely to remain a significant, long-term challenge for healthcare organizations. CDC identifies some strategies to mitigate shortages that are worth reviewing.

What are your scariest healthcare infections and threats?

Thanks for reading! As is the case with each year's list, we've worked to identify a variety of infections and threats we feel are deserving of a little more attention and we hope will help you think about the top threats facing the healthcare industry, your organization and your role as a healthcare professional. If we omitted a scary infection or threat that would be on your list, please let us know on LinkedIn.