Infection Control: Back to the Future

Dr Keith Nelson

Remember when Purell was worth its weight in gold?  I think it’s safe to say that the COVID-19 pandemic has made the average person acutely aware of the importance of infection control. But this issue has always been a top priority in the healthcare provider world. Healthcare associated infections (HAI), particularly in hospitals, represent an enormous financial burden on the nation’s healthcare system on the order of $35-$45 billion per year.  Accordingly, healthcare providers continue to look for more effective ways to combat the spread of infectious agents (bacteria, viruses, fungus, parasites) in their facilities. 

And why are healthcare facilities ground zero for infections?  Because they are the environment where sick and immunocompromised people routinely congregate, which makes them a metaphorical petri dish for infection spread and germ mutation. It is not uncommon for a patient to check into a hospital with a specific medical condition and then end up accidentally contracting an infection which seriously complicates their stay.  Further, the increased potential for mutation of debilitating microorganisms in hospitals can easily lead to the development of treatment-resistant disease strains like MRSA, VRE and CRE.

Creating a Safer Environment

When designing an infection control program, it is important to take a detailed and comprehensive ground-up approach, starting with evaluating human behavior and then expanding the sphere of focus to the physical environment. Listed below are a few considerations.

Behavioral Issues

  • Diligent Hand Washing (hand sanitizer dispensers should be abundant and strategically located throughout the facility)
    Some hand washing guidelines to consider:
    • For Providers: Upon entry to the facility.  Before and after interacting with each patient.  Before and after performing any invasive procedure. Before and after touching medical equipment.
    • For Patients, Visitors and Support Staff: Upon entry to the facility and patient-occupied areas
  • Wearing of Masks where appropriate (must cover the nose and be changed regularly)
  • Discarding Shoe Covers when exiting higher risk areas
  • Changing Scrubs before leaving the hospital and after being exposed to highly infected environments
  • Conscientious Waste Handling and Disposal (OSHA)
  • Prohibiting Employees from Working When They’re Sick

Physical Environment Issues


  • Anything that is shared (computers, tablets, telephones, scanners, communication devices, pens, printers, copy machines, cafeteria tables, etc.)
  • Personal electronic devices (especially those carried on and off premises)

Surfaces and Floors

  • Entire Rooms
  • Room Contents
  • Air
  • Countertops, Chairs/Tables, Thermostats, Door Handles, Hanging Fixtures, Equipment

Where to Start

There is an endless array of products and operational approaches for controlling the spread of pathogens in a healthcare (or any other) environment.  Designing an effective program is dependent upon several factors including the organization’s culture and workflows, available budget, and the ability to train staff and monitor human activity. Beyond establishing proper behavioral procedures, protocols and oversight, it is essential to explore the supportive role of advanced technology solutions. Below are a few examples.

Selecting the Right Hardware

Wherever possible, it is prudent to select hardware that is designed for infection control.  Examples include products with an antimicrobial housing (keyboards, mice, bar code scanners, monitors, etc.), or wipe-down capability that protects the device from abrasive disinfectant solutions. For touch screens, an electronic “time-out” function would protect data from being inadvertently altered during the cleaning process.

UV and Autonomous Robot Disinfecting

Ultraviolet light is an effective sterilizer and there are various products that leverage this technology for infection control.  Among these are boxes that simultaneously disinfect multiple smartphones and tablets, lamps that sterilize surfaces and keyboards, and powerful UV towers that can sterilize entire rooms.  For rooms that are constantly occupied, there are UV devices that mount near the ceiling and project horizontally above people’s heads in order to sterilize the circulating air (as opposed to surfaces), and alternative devices that project a lower frequency UV wave that is harmless to humans. In all cases, line-of-sight applies where the surface of the target must be exposed to the light source in order to be disinfected.

Another solution is the use of inexpensive, fully autonomous robots that strategically and consistently spray the room and its contents with disinfectant, an option that is particularly compelling in situations where staffing is constrained.

Handwashing Oversight

In order to ensure that staff are diligently following handwashing protocols, technology sensors are available that strategically alert/remind the provider, as well as record, analyze and report handwashing compliance on an individual level.

Overhang from COVID-19

Other infection control measures that can be employed, perhaps on a seasonal basis, are those that became ubiquitous during the COVID pandemic, including temperature checks and contact tracing.


Finally, bringing things full-circle, the most important component of infection control is changing human behavior. The best way to achieve this is to advance persistent and mandatory education in addition to giving continuous performance feedback. Thanks to the pandemic, we have now been awakened to the previously underappreciated war against the unrelenting evolutionary army of microbes and the serious consequences at stake. Hopefully, we’ll use the knowledge we’ve so painfully gained to proactively seize the high ground and reduce or prevent future threats to our well being.

Dr. Keith Nelson is the Director of Healthcare Strategy at Connection and is responsible for formulating and implementing Connection’s go-to-market strategy for the healthcare industry. His responsibilities include identifying and developing differentiated use case driven technology solutions for Connection’s healthcare clients, promoting Connection’s healthcare practice, and driving strategic client and partner engagement. Before joining Connection, Keith led the healthcare vertical at Ingram Micro. Prior to that, he was a consultant to the healthcare industry, providing guidance to hospitals, large physician groups and vendors in the areas of business development, marketing, finance and improving operational efficiency. Concomitantly, Keith worked with various private equity firms focusing on roll-ups in the healthcare sector. He has held senior management positions at MDNY Healthcare, HealthAllies (now a subsidiary of United Healthcare), and was the founder of the Renoir Cosmetic Physician Network. Prior to that, Keith spent ten years in private medical practice focusing on surgical reconstruction of the foot and ankle and chronic wound care. He has an MBA in Finance, as well as a Doctorate in Podiatric Medicine, and is Board Certified by the ABPM.