Initiative Overview
Elizabeth A. Monsees, Ph.D., RN, CIC, FAPIC, FSHEA, FAAN is a Nurse Researcher in Missouri who focuses on Implementation Science. She was previously the Senior Director of Infection Prevention and Stewardship Integration at her facility and currently serves on the national committees of The Society for Healthcare Epidemiology of America Epidemiology (SHEA) and The Association for Professionals in Infection Control and Epidemiology (APIC). Dr. Monsees worked in neonatal nursing, adult infection prevention and for the past 18 years has worked in pediatric infection prevention, patient safety, and antibiotic stewardship. Dr. Monsees is a member of The Society for Healthcare Epidemiology of America Epidemiology (SHEA) which is a professional society that improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers.
Dr. Monsees has the perspective of an infection preventionist, which is incredibly valuable as infectious disease control and reduction of single use plastics are often seen in conflict. Dr. Monsees was invited to speak at SHEA in April 2025 as this year’s conference focus was on sustainability in healthcare.
“In over 20 years of clinical practice, infection preventionists continue to struggle with addressing glove appropriateness” states Dr. Monsees, noting that even when priorities change, infection prevention tends to have leverage.
Collaborators and Stakeholders
Dr. Monsees’ talk at SHEA focused on the evidence for proper use of gloves and how to avoid misuse. “Gloves are appropriate for many scenarios and there is good evidence to show that when providers wear gloves we can prevent transmission of C-Diff and other diseases. The other piece of it is to talk about misuse of gloves. We wear gloves for a variety of things where we do not need to have some sort of barrier on. There are times where clinicians engage in wearing gloves that are not necessary from an infection prevention and safety standpoint.” Dr. Monsees’ sustainability work has been largely in her time outside of work. She is happy to be able to provide content expertise as an infection preventionist. “I’m very interested in studies and practices that consider how we best use resources. Take antibiotics as an example. Upwards to 30-50% of antibiotic use is unnecessary. When you pick up a prescription, there is the drug, plastic bottle, paper insert, paper bag, preparation time, etc.. Now imagine if the antibiotic wasn’t needed in the first place. There is a great study from Dr. Emily Spivak that describes the connection between unnecessary antibiotic prescriptions and greenhouse emissions.”
This past spring, Dr. Monsees also co-authored a paper which surveyed healthcare workers’ attitudes and practices around environmental sustainability in infection prevention. Dr. Monsees states “To my knowledge there haven’t been too many papers that have looked at healthcare worker perceptions, but we are certainly starting to see more papers in the epidemiology space exploring resource use and sustainability.” Examining attitudes of healthcare workers at this intersection of environment and infection prevention is particularly relevant since the COVID-19 pandemic, which led to an increase in single-use personal protective equipment (PPE).
In the published study, out of 465 voluntary survey responses from healthcare providers, more than half of the respondents said that the benefits of using personal protective equipment (PPE) outweighed the environmental effects. Just under a quarter of the respondents said they were adequately aware of environmental sustainability in healthcare with only 14% saying the healthcare workplace encourages environmental sustainability. The paper concluded that healthcare workers are interested in sustainable policies and identified areas for policy changes to reduce PPE waste.
Collaborators included Dr. Gonzalo Bearman and Dr. Ashley Lin. “I have had the opportunity to participate in a number of professional groups where connections and conversations about shared interests emerge.” Dr. Gonzalo Bearman is the Infectious Disease Division Director at Virginia Commonwealth University and Editor in Chief of Antimicrobial Stewardship and Hospital Epidemiology. Dr. Monsees serves on the Editorial Board and was recently appointed as the Associate Editor for the pediatric section. Dr. Bearman was looking for an infection prevention nurse interested in sustainability and reducing, where appropriate, PPE use.
Implementation Challenges
There are a number of competing priorities in healthcare however Dr. Monsees notes that in her experience “clinicians voice being concerned about certain practices (e.g., isolation) and the waste that it contributes, but we don’t always have a pathway to engage them in.” She suggests giving people actionable steps so they can discern what might be feasible for a first step towards sustainability.
With under a quarter of healthcare providers in the published study stating they were adequately aware of environmental sustainability in healthcare and only 14% saying the healthcare workplace encourages environmental sustainability, education by those in infection prevention can allay fears and explain the science of glove use and when it is indicated. Education can play a big role in reducing unnecessary glove use while keeping staff and patients safe and preventing infection and disease.
Results and Impact
Dr. Monsees’ has been invited to deliver a Grand Rounds talk at her facility in October 2025. “Because I was so interested in all the talks from SHEA [The Society for Healthcare Epidemiology of America Epidemiology ], I wanted to bring this back to my organization.” As a nurse practicing in the infectious disease space, she remains surprised by some of the different resistant organisms being reported as a result of climate change.
“I like the idea of being able to introduce that there are small things that we can do that can make a big impact. Right now, I’m really thinking about the volume of supplies that we are using, how are we using them responsibly and appropriately – that can go a long way to contributing towards planetary health. Because of that conference and exposure to different speakers, I wanted to bring that to Children’s Mercy and have the opportunity to do that on October 1st.”
Dr. Monsees noted that at SHEA, one of the speakers noted that children are concerned about planetary health. “I wanted to talk about this at Grand Rounds mainly because I presume that our pediatric nurses are hearing questions or concerns about this in schools or other channels. My goal is that nurses are equipped to be able to have conversations around what we can do to support good practices.”
Key Recommendations for Nurses
Dr. Monsees states that there is good evidence to show that when providers wear gloves, they can reduce transmission of certain infections, like C diff. She states it is important to identify that one thing that you can do to just get started right now. Small changes can create a big impact and we can support planetary health through stewardship.
Conclusions
Dr. Monsees recently joined Glove Wisely which is a newly formed interdisciplinary working group of the Medical Society Consortium on Climate and Health (MSCCH) with the goal of reducing unnecessary glove use in healthcare and getting back to hand hygiene. The group is pursuing avenues to reduce medical trash, carbon emissions and healthcare costs – all while maintaining standards of excellence in patient care and infection prevention.
The group is currently reviewing current literature on glove reduction strategies in order to produce and publish a reference guide for clinicians to use and expand Glove Wisely as a broader campaign to impact practice. This summary of the data will also include a call to action.Dr. Monsees elevates the nursing voice throughout this process.
Dr. Monsees notes that “I want people to wear gloves, I just want them to wear gloves when they are necessary for the protection of self and to prevent transmission of infections to our patients.” Dr. Monsees’ critical thinking and expertise about how infection prevention can be accomplished while also addressing sustainability in healthcare settings has demonstrated that environmental and individual health isn’t “either/or.” We don’t need to sacrifice safety and infection control to make small changes in our nursing practice that can create a big impact.
Lin, A.L., Doll, M.E., Pryor, R.J., Monsees, E.A., Nori, P., Bearman, G.M. (2025).
Healthcare workers’ attitudes and practices around environmental sustainability in infection prevention. Antimicrobial Stewardship & Healthcare Epidemiology.
https://pubmed.ncbi.nlm.nih.gov/40290184/
Spivak, E.S., Tobin, J., Hersh, A.L., & Lee, A.P. (2024). Greenhouse gas emissions due to unnecessary antibiotic prescriptions. Antimicrobial Stewardship & Healthcare Epidemiology, 4, e114, 1–2. https://doi.org/10.1017/ash.2024.354.
