Post-2020, elementary schoolers across the United States wash their hands more deliberately. Standing on a stool in front of the sink, waiting for the water to get warm, they prepare to sing the ABCs or maybe the song “Happy Birthday to You” twice — their choice, teachers say. What’s important is 20 seconds of scrubbing.

Healthcare professionals have long known what the COVID-19 pandemic revealed for everyday Americans. “I think people understand that hand hygiene is important for preventing infection; It’s something we’ve been taught since grade school,” says Chief Epidemiologist Ken Sands, MD, MPH. “But people may not appreciate what that means if you’re a nurse, for example. Nurses have to perform hand hygiene every time they enter and leave a patient’s room. That means they are washing their hands hundreds — if not thousands — of times a day.”

Parents and teachers can attest to the ripple effect of viral and bacterial infections during cold and flu season. But in healthcare facilities, the stakes are even higher.

“Our buildings are busy and complex, and people are sick, so the opportunity to spread infection goes with the territory,” says Dr. Sands. “It is important to protect our whole community — anybody who interfaces with our facilities — including patients, employees and visitors.”

When Dr. Sands thinks about preventing the spread of infection in healthcare facilities, three categories come to mind. The first is hospital patients who have infections that need to be contained. “An example is someone with tuberculosis, measles or chicken pox,” he says. “The goal here is making sure those infections don’t spread to other patients and employees.”

The second category is patients potentially prone to infections because of a related surgery. After surgery, a wound could become infected, for example. “Whenever there is a foreign body in the human body, that is a potential source for infection,” says Dr. Sands. “We have to be sure our care involves all the right things to minimize risk.”

Finally, healthcare facilities consider infections in their communities, like influenza, which can be a threat when patients are exposed to infected visitors. “We’re coming into respiratory season,” says Dr. Sands. “People coming into work may have been exposed to the flu and not know it. So what do we do to make sure the spread of those respiratory viruses is minimized?”

HCA Healthcare’s Infection Prevention program plays a leadership role in researching and establishing best practices. “We’ve conducted national studies in our hospitals, which have generated evidence now used throughout the country and the world,” says Dr. Sands.

Best practices include the methods healthcare workers use to screen for certain types of infections for patients in the hospital, as well as how doctors manage antibiotics in the hospital to make sure they’re not overutilized.

“Our community should be proud of the fact that we are not simply good at infection prevention; we are leading the science of infection prevention,” he says.

Sometimes research reveals surprising correlations between daily hygiene practices and the spread of infections. For example, emerging evidence shows that brushing your teeth is important in pneumonia prevention.

“Your mouth has a lot of bacteria in it. If you’re up and at ’em and healthy, you naturally clear those secretions from your windpipe,” explains Dr. Sands. “But if you’re in the hospital, you may be sedated or weak. Once those secretions in your mouth make it into your lungs, it’s a setup for pneumonia.”

The seemingly simple routine of brushing one’s teeth is not so simple in the hospital, he adds. “It’s not necessarily at the top of the list for a nurse to be thinking about brushing their patients’ teeth. Family members may not be thinking about it over the course of everything else going on with the patient’s care. We are striving to make it a standard reflex.”

Research also shows the importance of mobilizing patients to the extent they’re able. “If they are capable of walking, getting out of bed and walking is important. If they can’t walk but can sit up, then that is important,” Dr. Sands says. Even if patients aren’t able to sit up, healthcare providers can raise the head of the bed. “It’s about people expanding their lungs as much as possible to keep their strength and to keep them as healthy as possible.”

HCA Healthcare leaders remain abreast of emerging threats in infectious diseases. Dr. Sands points to recent challenges: “We’ve had COVID; we’ve had bird flu that has been increasing in the bird and bovine populations; overseas issues with Ebola and Marburg virus.”

He explains that, as the global population increases and the climate changes, viruses and bacteria have a broader survival range. “That means there are potential new threats on the horizon, and we always need to be alert to those.”

Only one disease, smallpox, is considered eradicated from the planet. “That was largely done because of the smallpox vaccine,” says Dr. Sands. Other potential targets for eradication include polio and measles, but that depends on both access to vaccines and broad endorsement for vaccines. “Vaccine-responsive diseases rely on the concept of herd immunity to make sure the diseases don’t spread,” he says. “That means, even if there’s only one person who didn’t get the vaccine and they’re surrounded by people who have all had the vaccine, they can’t get sick because they are protected by the herd.”

But immunity breaks down among a community of unvaccinated people.

“One of the challenges for something like measles is that people don’t see it anymore,” says Dr. Sands. “You didn’t used to have trouble convincing people to get the measles vaccine because they saw what happened to their neighbor’s child, or they remembered what happened when they or their sibling had it. Now we are asking people to get the vaccine on faith, and that can make it harder to keep the momentum going with the same veracity it had in the past.”

Dr. Sands counters reluctance by listening to people’s concerns and offering scientific evidence. “I think it’s important to understand that people are nervous about their loved ones’ health or their own health, and to provide them with information is an important strategy.”

Infection prevention awareness is the key to keeping HCA Healthcare patients, providers and visitors safe.

“If you’re a patient, you should know that HCA Healthcare is a leader in putting protocols in place to prevent the spread of infection. If you are an employee, it is a matter of knowing we have put the guidance in place to try to keep people as safe as possible,” says Dr. Sands. “And if you’re a visitor, thank you in advance for following the protocols we have in place to protect you as a visitor as well as your loved ones.”