Infection Prevention Risk We Think We’ve Solved (But Haven’t)

By Melissa Travis, MSN, RN, CIC, FAPIC

This article originally appeared in the March-April 2026 issue of Healthcare Hygiene magazine.

Over the last two decades, we have experienced the emergence and re-emergence of multiple infectious diseases.  Each one bringing it ‘s own defense mechanisms and transmission risks which lead to stress and uncertainty for those of us working in infection prevention.  Amid uncertainty, I take comfort in knowing that while the diseases may change, there are proven, core infection prevention strategies that don’t.   In my experience, the issue isn’t that we don’t know what to do.  The problem is we haven’t embedded the fundamentals deeply enough to withstand time, staffing pressures, and human behavior.  Despite decades of hard work, persistence, and innovation, certain infection prevention risks remain, and in some cases are worsening.

Progress with HAI Prevention

The Centers for Disease Control and Prevention (CDC) recently published its 2024 annual National and State Healthcare-Associated Infections (HAI) Progress Report. This report reflects the data from a variety of healthcare settings that are submitting specific infections to the National Healthcare and Safety Network (NHSN).  The report shows improvements in several HAIs including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and Clostridioides difficile (C.diff). These improvements provide evidence that prevention efforts work.

Despite the progress, CDC reports 1 in 31 hospitalized patients and 1 in 43 nursing home residents still acquire a healthcare-associated infection.  We know that many of these infections are preventable.  Additionally, there are more resources and products to address infection prevention now than when I became an Infection Preventionist over 2 decades ago. Progress is real, but elimination eludes us.

Basic Principles

I have heard this phrase many times throughout my career in both Nursing and Infection Prevention.  “We just need to go back to the basics”.  While I don’t disagree with the statement, I think “the basics” are defined differently by each individual.  For infection prevention, I consider the basics to be summed up in the unsung hero, Standard Precautions.  Standard Precautions require all blood, body fluids, and contaminated surfaces to be treated as infectious in the healthcare environment by using “common sense practices”.  It includes hand hygiene, personal protective equipment (PPE) use, respiratory hygiene, cleaning and disinfection, appropriate patient/resident placement, proper linen handling, and safe injection practices.   While Standard Precautions have been around since the 1900’s, they are not consistently applied.

Most of us have written and implemented hand hygiene protocols based on current guidelines.  We have also conducted education and activities to promote awareness and adherence.  Additionally, we have monitored compliance and reported the findings.  While these interventions seem to work for a little while, they are often not sustainable.

Likewise, cleaning and disinfection protocols exist in nearly every healthcare facility. Yet audit data often reveal missed high-touch surfaces, inconsistent dwell times, and confusion about product use. In addition, cleaning the environment is not seen as part of patient care even though it directly impacts their health.  The policies and procedures may be in place, but proper execution is not.

From my point of view, these are just a couple of examples where we seem to be doing everything to promote the right practices and behaviors, but the outcome is not desirable.  There appears to be a disconnect between knowledge, effort, and consistency.

Reality Check

Even though most healthcare workers could probably articulate the basic meaning of Standard Precautions, I don’t think they truly understand the full scope.  In my experience, they recognize certain pieces — but not the entirety of the practice.  In other words, it is not hardwired into their everyday tasks and interactions.  I believe this is where we still need to focus our time and energy.  Knowing the definition of Standard Precautions is not the same as operationalizing them under pressure habitually.

The Risk

The risk of infection in healthcare settings is well established, and the CDC reinforced this reality in its recent progress report: 1 in 31 hospitalized patients and 1 in 43 residents in long-term care facilities continue to acquire healthcare-associated infections. There is no question that our patients and residents are at risk for an HAI.  We also know that Standard Precautions were introduced over 30 years ago.  If it is not a question of risk and we have a primary mitigation strategy, why is there still a problem?

White Noise

I do not believe anyone intends to ignore Standard Precautions.  Very few people go into healthcare intending to do harm.  I think it’s something that happens over time as we become more confident and comfortable in our healthcare roles.  We have heard the same things over and over again such as “clean your hands” and “cover your cough”.  Perhaps we have heard these in the same way for so long that they have become white noise in the background.

Breaking Through

Like many others, I sleep with a white noise machine every night.  It is part of my routine, and I don’t even notice the noise anymore.  It doesn’t disrupt my sleep.  On the contrary, it actually helps me sleep more soundly.  A crash, loud music, or a child crying would wake me up temporarily then I would go back to sleep with the white noise in the background.  I think this is how we respond to HAIs.  It wakes us up for a short period, but then we get comfortable again by thinking we solved the problem.  A spike in CLABSI rates, a CMS citation, or an outbreak investigation wakes us up. We respond quickly. We re-educate everyone.   We audit their behaviors. We will initiate a campaign. Then, slowly, the white noise returns.

Solving the Problem

I once heard someone say that your chores are never truly done.  While you might have completed the task temporarily, you will have to do it again later.  It’s part of an unending cycle.  Infection prevention is much the same.  We may reduce our HAI rates and improve cleaning and disinfection, but they will inevitably resurface if we are not diligent to maintain our progress.  Historically, we have done overhauls or started a campaign to boost our compliance numbers.  While this is effective in the short term, it typically doesn’t last.  It requires hardwiring and systems with small steps each day to sustain the results.  Sustained improvement doesn’t come from campaigns. I am convinced that it comes from redesigning workflows so that the safest choice is the easiest choice.  We must make it easy for healthcare workers to comply with infection prevention measures.

Looking Ahead

I love to think about a world where infection prevention is top of mind for everyone.  A place where we don’t have precautions because those behaviors are built into our everyday practices.  A culture where infection prevention isn’t a project we complete; it’s a practice we maintain.

The risks we think we’ve solved are the very ones most vulnerable to complacency. If we want sustained progress, we must treat the fundamentals not as background noise — but as non-negotiable behaviors woven into the fabric of care.  True infection prevention means treating “solved” risks as ongoing commitments not completed checklists and passing scores.

Melissa Travis, MSN, RN, CIC, FAPIC, is principal of IP&C Consulting, LLC.

 

The Future of Infection Prevention Is Leadership in Action

By Carole W. Kamangu, MPH, RN, CIC

This article originally appeared in the March-April 2026 issue of Healthcare Hygiene magazine.

When infection preventionists (IPs) embrace systems thinking, they evolve from managing risk to strengthening organizations and the communities they serve. That’s exactly what has happened in my professional journey.

I was born in the Democratic Republic of Congo (DRC), a country where outbreaks were part of everyday life. Infectious diseases were everywhere and even the most dedicated and educated healthcare professionals struggled to save lives because the system itself was broken. Resources were scarce and even effective care could not overcome the fragility of the health infrastructure. Watching that shaped everything about how I see healthcare today. From an early age, I knew I wanted to help improve health systems, even before I fully understood what that meant.

When I came to the U.S., I initially dreamed of becoming a surgeon. But my love and eagerness for healing and caring for people led me to switch to nursing to accomplish that dream much faster. In my early days as a nurse, I learned the true meaning of impact and how limited that impact could be as I was focusing on one setting and one person at a time.

Even though I was helping people with joy and care, I could not shake the feeling that the system around me determined so much of what I could or could not do for them. That realization quickly brought me back to my first love: public health.

Earning a master’s degree in public health opened the door to a broader kind of influence. Working as a nurse epidemiologist and disease investigator, I could help health systems fight infections at the population level. Around the same time, I co-founded a nonprofit and started serving on its board, where I gained firsthand experience in strategic thinking, problem-solving and systems-level leadership. I started to see how my work as a healthcare professional fits into a much larger ecosystem and how every role, every policy, every decision and process influenced outcomes.

That system-level awareness followed me as I initially started practicing infection prevention. Whether I was leading outbreak investigations, facilitating workshops or guiding quality improvement projects, I noticed my mindset had shifted. I was no longer just focused on compliance or surveillance; I was looking at the organization and the communities around it as an interconnected system. One colleague once told me, “You think like a leader and your focus as an infection preventionist is not so much in the day-to-day anymore, it’s high level at this point. You can easily make the connection between different parts of the system and how they work well together. You can tell where public health should get involved, or when to call vendor partners, talk to the CEO, or bring them all together to help us address the problem at the source to improve how things work.”

That feedback surprised me. I had not yet realized that my skills and perspective had shifted. It made me reflect and I realized that I was experiencing a real change in how I approached infection prevention work. I was no longer focusing on individual compliance-based tasks but on understanding how systems influence outcomes beyond infection prevention.

The COVID-19 pandemic fast tracked this evolution and made it more apparent globally. Infection control professionals became central to decision-making, working alongside organizational leaders, advising on crisis and risk management and helping organizations adapt. It made it clear that infection prevention is not just an operational role; it is a leadership function that requires strategic insight. Infection preventionists sit at a unique intersection between clinical teams, administration, public health, and, in my case, also business.

As I continued to grow in my career, pursuing an MBA strengthened that systems thinking mindset even further. It was not about changing professions but more about deepening my perspective. Business principles like strategic planning, resource optimization, and systems alignment turned out to be just as valuable in healthcare as they are in other corporate settings. Diverse skill sets, whether in leadership, business or communication, equip infection preventionists (IPs) to achieve lasting change. When IPs broaden their understanding of how systems function, they are better positioned to protect both people and organizations.

Today, I see infection prevention as leadership in action and not just a checklist of regulatory compliance tasks to fulfill. Infection control professionals (ICP) are connectors, problem-solvers and strategists. And to truly protect their organizations in the long term, healthcare leaders must empower them to:

1. See the system, not just the checklist. Every infection metric is a signal of how the system performs.
2. Lead through collaboration. ICPs have the ability to influence multiple departments and entire health systems. That is a strategic advantage for any organization that leverages it.
3. Think like strategists and act like leaders. The ICP’s daily work influences culture, policy and, when implemented effectively, leads to system resilience.

The future of healthcare depends on leaders who invite infection preventionists to work alongside them to think systemically, collaborate across silos and approach their work as part of a larger mission to strengthen their organizations. By strengthening systems, they not only help prevent infections but also help build respected organizations that stand out and build stronger communities.

For Infection control professionals interested in strengthening their ability to engage leadership and align infection prevention with organizational priorities, I’ve developed an executive brief that explores practical strategies for building those conversations. Learn more at https://www.dumontelhealthcareconsult.com/executive-brief

Carole W. Kamangu is a nurse epidemiologist, health system & infection prevention strategist, and CEO of Dumontel Healthcare Consulting. With more than 15 years of experience across healthcare, public health, and the nonprofit sector, she helps healthcare executives and public health leaders design cost-effective, resilient systems that strengthen workforce sustainability, reduce harm, and align infection prevention with enterprise strategy. Her work has supported over 33% in infection reduction, more than $1.1 million in cost savings, and helped achieve Magnet recognition for healthcare organizations.

 

 

From Seat to Strategy: Embedding Infection Prevention into Organizational Leadership

By Deborah Ellis, PhD, MPH, AL-CIP, CPHQ, FACHE

This article originally appeared in the January-February 2026 issue of Healthcare Hygiene magazine.

Early in my career as an infection preventionist (IP), I remember feeling a deep frustration. Despite writing policies, conducting audits, leading training sessions, influencing workflows, and creating strategy, I often saw implementation fall apart or worse, never taking hold at all. The decisions that shaped our infection prevention efforts were often made elsewhere; in rooms I wasn’t invited into. I didn’t have language for the problem until one night, sitting in a theater watching the stage play Hamilton. When the cast broke into the song “The Room Where It Happens,” something clicked: That’s the problem. I need to be in the room where it happens. That moment shifted my career trajectory — and my perspective on what it really means to lead infection prevention.

IPs have fought hard to be heard by healthcare leadership. We’ve demonstrated our value during crises, many have learned to speak the language of the C-suite, and we have framed our initiatives in strategic, financial, and operational terms. But influence is only the beginning.

The next evolution for infection prevention is integration. Not just being consulted on policy but shaping it. Not just reacting to outbreaks but helping design systems that prevent them in the first place. It’s time for IPs to move from advocates to architects of organizational strategy.

Why Integration Matters

True integration of infection prevention into healthcare leadership ensures that safety is not just an initiative but it’s a core operating principle. When IPs are embedded into the planning, budgeting, and governance processes, infection prevention becomes proactive, not reactive. This shift drives stronger patient outcomes, operational resilience, and financial performance.

Healthcare systems that wait to involve IPs until after a problem arises, or as part of survey readiness, are inherently less prepared. The systems that lead in safety, efficiency, and compliance bring infection prevention to the table early—during design, decision-making, and strategy setting.

Three Pillars of Strategic Integration

To embed infection prevention into the DNA of a healthcare organization, IPs must operate across three critical pillars:

1. Governance and Leadership

Strategic integration starts with where IPs sit in the organization. Do IP leaders report into nursing, quality, or clinical operations, or do they have a direct line to enterprise-level leadership? The closer IPs are to decision-makers, the more likely infection prevention is to be represented in board-level strategy.

IPs should serve on safety and quality councils, enterprise risk committees, and even strategic planning task forces. Regular presence in these venues elevates IP from compliance oversight to risk mitigation and value creation.

In my own experience, serving on system safety and quality councils allowed me to directly influence annual strategic goals, such as reducing central line-associated bloodstream infection (CLABSI) rates and implementing an enterprise-wide prevention of surgical site infections initiative. Because of our early involvement, we aligned infection prevention priorities with broader organizational objectives, which resulted in measurable reductions in hospital-acquired infections within one fiscal year.

2. Resource and Capital Planning

Embedding IP into capital and operational planning ensures infection risks are considered before projects launch, not after problems arise. Pre-Infection Prevention Risk Assessments (P-ICRA) are even more important than Infection Control Risk Assessments (ICRAs), that start right before the project launch. Whether designing a new facility, investing in sterilization equipment, or evaluating staffing models, infection prevention should be a co-author of the resource conversation.

Proactive IP input can reduce future costs, avoid redesigns, and accelerate compliance readiness. Systems that include IPs in budget cycles also send a strong message: infection prevention is not overhead—it’s essential infrastructure.

When an organization that I worked at planned the construction of a new space for their dental clinic’s relocation, I advocated for infection prevention involvement from the blueprint phase. This allowed us to make key decisions, such as airflow design, surface materials, sterilization reprocessing workflows, and location of hand hygiene sinks, that prevented costly post-construction fixes. Working closely with the construction company, and regulatory, ensured that the center passed infection control inspections once the project was complete, and an initial inspection survey to obtain operational license proceeded smoothly.

3. Data, Metrics, and Dashboards

C-suite leaders rely on performance dashboards to guide decisions. Infection prevention metrics must be integrated into these systems. That means aligning IP data with organizational KPIs such as safety scores, readmission rates, length of stay, and reputational benchmarks.

It also means shifting from raw infection counts to strategic indicators: cost avoidance, HAI prevention ROI, or risk-adjusted safety gains. When infection revention metrics appear alongside financial, patient experience, and operational data, infection prevention becomes part of the enterprise narrative.

At one hospital where I led the IP team, we collaborated with the quality department and the board to build infection metrics into the executive performance dashboard. For the first time, we linked our HAI reduction efforts to cost avoidance projections. As a result, IP outcomes began showing up on monthly operations and quarterly board reports, increasing leadership buy-in and unlocking dedicated resources for prevention initiatives.

Case in Point: Systemic Visibility

One health system recently elevated its senior IP leader to a VP-level role reporting directly to the Chief Quality Officer. This allowed the IP program to participate in strategic planning, lead annual safety initiatives, and influence capital investments in infection-control technologies. The result? A 22 percent decrease in CLABSI rates over two years, faster rollout of antimicrobial stewardship, and stronger Joint Commission readiness.

An example of this model can be seen at Intermountain Health, a not-for-profit health system based in Utah. Their infection prevention leadership reports at the system level and collaborates closely with executive teams across their hospitals and clinics. Intermountain has publicly emphasized the integration of infection prevention in enterprise-level quality improvement initiatives, contributing to high performance on safety scores and regulatory readiness. Their strategic approach, which includes real-time data dashboards and cross-departmental infection prevention councils, exemplifies the proactive model that elevates IP from a compliance task to a leadership role.

This kind of structural visibility turns infection prevention from a reactive service into a proactive leadership asset.

Steps IPs Can Take Now

Even if you’re not yet embedded in your organization’s executive structures, you can start laying the groundwork:

• Retitle your IP Plan – it is more than a department plan, it’s the opportunity to show organizational alignment, it’s your IP Strategic plan, based on real data, population served, and annual performance.
• Map where IP fits in the current org chart, budget, and planning cycles.
• Identify cross-functional opportunities to contribute to strategic conversations (e.g., safety councils, facility design teams, budgeting committees) and insert yourself into those committees.
• Aligning IP goals with strategic priorities such as value-based care, quality incentive programs, workforce or patient experience.
• Engage executive sponsors who can advocate for IP integration at higher levels. These are in addition to your unit sponsors, and physician dyads.
• Develop a multi-year vision for IP that shows how your program supports enterprise goals.

The Future of IP Is Strategic

The healthcare landscape is only growing more complex—financial pressures, workforce shortages, and patient expectations continue to climb. Infection prevention is not a support service in this environment; it’s a stabilizing force.

But only if we’re at the table.

By embedding infection prevention into governance, planning, and metrics, healthcare systems signal that safety isn’t optional—it’s foundational. And IPs, when integrated at this level, become catalysts for resilience, innovation, and strategic success.

We’ve claimed our seat in the room. Now it’s time to shape the agenda.

*Source: Intermountain Healthcare Annual Report (2022); Intermountain Quality and Patient Safety Programs Overview.

Deborah Ellis, PhD, FACHE, is an infection preventionist, healthcare executive strategist, with over two decades of experience driving system-level change in patient safety and organizational performance.