Infectious diseases have long been a major concern for global health. While much attention is given to bacterial and viral infections, fungal diseases remain an underappreciated and growing threat. With limited treatment options and rising resistance to existing antifungal drugs, the world is facing a silent crisis that could have devastating consequences. David Angulo, MD, an infectious disease specialist and the president and CEO of SCYNEXIS, sheds light on the urgent need for new antifungal treatments and the challenges in combating fungal resistance in this interview with Infection Control Today® (ICT®).

In this interview, Angulo explains that when most people think of fungal infections, they often imagine superficial conditions like toenail or yeast infections. While these are common and generally treatable, a far more dangerous category of fungal diseases exists—one that attacks the lungs, bloodstream, brain, and other vital organs. These invasive fungal infections are often life-threatening, with mortality rates ranging from 20% to 80%, particularly among immunocompromised individuals.

Angulo explains that patients undergoing chemotherapy, organ transplant recipients, and those in intensive care units are at the highest risk. In these situations, “You have multiple catheters placed in your body because of that reason, and then the fungi had the opportunity to get into your body and to cause these very severe infections,” Angulo said.

Angulo discusses the most common invasive fungal infections, which include:

Invasive Candidiasis: A bloodstream infection caused by Candida species, which can spread to organs and cause severe complications.

Aspergillosis: An infection caused by Aspergillus, a mold commonly found in the environment. It can destroy lung tissue and lead to fatal respiratory failure.

Mucormycosis: A rare but aggressive fungal infection with a mortality rate as high as 80%, affecting the sinuses, lungs, and brain.

Coccidioidomycosis (Valley Fever): A fungal pneumonia endemic to certain regions, such as the southwestern United States, that is expanding due to climate change.

Polyenes (eg, Amphotericin B) – One of the first antifungal treatments, effective but highly toxic and limited to intravenous use.

Azoles (eg, Fluconazole, Voriconazole, Posaconazole) – The most commonly used antifungals, but resistance to azoles is growing at an alarming rate.

Echinocandins (eg, Caspofungin, Micafungin, Anidulafungin) – Newer antifungals with a better safety profile but limited to intravenous administration.

Angulo emphasizes the critical need for innovation: “Over the years, fungi have developed resistance against many of them, and at this point, that's really the biggest concern,” he said

His company, SCYNEXIS, is at the forefront of this fight, developing a new class of antifungal drugs called triterpenoids. "Our focus has been in trying to address the problem of antimicrobial resistance in the antifungal space, and really how to tackle those very difficult to treat diseases. That has been really the focus and the passion of this organization for the past 10 years," he explains.

As Angulo told ICT, "The antibacterial space was developed much earlier and faster, but right now, with a better understanding of the impact of fungal diseases and the development of resistance of fungal pathogens that has been evolving in the US, the CDC runs the primary surveillance program regarding the development of antimicrobial and antifungal resistance.”

By raising awareness and pushing for policy changes, the fight against deadly fungal infections remains a global priority.

Listen to ICT’s interview with Angulo to learn more about the history and treatment of fungal diseases. 

The Textile Rental Services Association (TRSA) plays a vital role in supporting the health care industry and critical infrastructure by providing hygienically clean health care contact textiles (HCTs) and personal protective equipment (PPE). Representing a $50 billion industry with over 200,000 employees across 2,500 facilities, TRSA ensures that essential supplies, including isolation gowns, scrubs, bed linens, flame-resistant clothing, and safety items, are available to hospitals, first responders, laboratories, and food processing facilities. However, the US health care system relies heavily on disposable HCTs, leading to dangerous supply shortages during public health crises like the COVID-19 pandemic.

Currently, over 90% of HCTs used in US health care settings are disposable, although reusable HCTs provide equivalent or even superior protection. The excessive use of disposable textiles threatens supply chain stability, making hospitals susceptible to disruptions due to global supply shortages, shipping delays, and manufacturing constraints. During the pandemic, the supply of disposable PPE, including isolation gowns, was significantly compromised, forcing hospitals to search for alternatives. TRSA members stepped in to fill the gap by supplying reusable, hygienically clean HCTs, ensuring that health care facilities could continue to operate safely.

“TRSA members process 90% of the HCTs (ie, isolation and barrier gowns, bed linens, scrubs, etc) used by health care facilities across the US,” TRSA’s press release read, “As evident during the COVID-19 pandemic, laundry processing interruptions threaten the safe operation of health care facilities as well as other critical infrastructure businesses.”

Reusable HCTs processed by TRSA’s Hygienically Clean-certified laundries offer multiple benefits, including:

Recognizing the need for supply chain resilience, a bipartisan congressional letter was sent in 2023 to then-Health and Human Services (HHS) Secretary Xavier Becerra, urging an investigation into the benefits of reusable HCTs. This led the National Institute of Occupational Safety and Health (NIOSH) to contract with the National Academies of Sciences, Engineering, and Medicine (NASEM) to study the potential benefits of increasing reusable PPE adoption in health care.

In a 2-day NASEM workshop, technical experts, policymakers, health care providers, and industrial laundry operators evaluated reusable textiles’ safety, cost-effectiveness, and sustainability. The conclusion was clear: increasing reusable PPE use would significantly improve supply chain security, reduce waste, and lower costs. However, legislative action is required to drive widespread adoption.

TRSA’s Call to Action

Maryann D’Alessandro, director of the National Personal Protective Technology Laboratory (NPPTL), acknowledged the importance of reusable PPE but emphasized that the transition "is unlikely without legislation." She called for strategic partnerships to push for regulatory and legislative changes that support the increased use of reusable HCTs.

While long-term policy shifts take time, TRSA urges NIOSH to issue a “Workplace Solutions” document, which would serve as an interim step to promote reusable HCT adoption. Although it would not mandate enforcement, the document would raise awareness among health care facilities and provide guidance on integrating reusable PPE into daily operations.

The health care industry cannot afford another PPE crisis like the one experienced during COVID-19. Increasing the use of reusable HCTs is a proven solution for ensuring supply chain stability, cost savings, and environmental sustainability. TRSA remains committed to advocating for policies prioritizing reusable health care textiles, protecting frontline workers, and patient safety.

The conversation around reusable personal protective equipment (PPE) is gaining traction, especially in the wake of the pandemic-induced shortages. Infection Control Today’s interview with Joe Ricci, CEO of Textile Rental Services Association (TRSA), and Diane Troxel, MSN, RN, the director of clinical education at Handcraft Linen Services, shed light on the benefits and challenges of shifting toward reusable health care textiles. The experts cover key findings from the National Academies of Sciences, Engineering, and Medicine workshop on reusable personal protective equipment (PPE), addressing misconceptions about reusable linens, and current state policy issues.

The National Academies of Sciences, Engineering, and Medicine hosted a workshop to examine the viability of reusable PPE. Findings revealed that reusable textiles offer significant advantages: lower costs, reduced environmental waste, and strengthened supply chain resilience. Unlike disposable PPE, which creates 15,000 tons of waste daily, reusable PPE can withstand up to 75 washes while maintaining its protective integrity.

“The reusable product, specifically reusable PPE in [a] health care environment, it reduced cost, it reduced waste, it improved supply chain resilience, and is a more environmentally sustainable product for the industry. Their ultimate outcome is to explore partnerships with organizations that can help increase the adoption of reusable healthcare PPE,” Ricci said.

Hospitals often hesitate to adopt reusable PPE due to concerns over cleanliness and storage logistics. However, commercial laundries follow rigorous hygienic standards, ensuring that reused PPE meets or exceeds safety requirements. TRSA’s Hygienically Clean Certification ensures that laundering processes eliminate bacteria and contaminants effectively, reinforcing confidence in reusable options.

Troxel said, “We have to convince the people [that the process is safe], and that's part of my job as the clinical educator. I go in and explain the process, invite them to our plant and tour, showcase that we are hygienically clean certified by TRSA, and explain that part of it to get them to understand.”

Despite the benefits, barriers to widespread implementation remain. Many healthcare facilities rely on disposable PPE due to habit, convenience, and purchasing structures tied to group purchasing organizations (GPOs). Decision-makers often view PPE as a disposable commodity rather than a service-based system, making the transition challenging.

Nurses and frontline workers must also feel comfortable using reusable PPE. Studies indicate that 60% of healthcare workers prefer cloth-based PPE over disposable alternatives due to comfort, durability, and perceived safety. Educating staff and administrators about the efficacy of reusable textiles is essential to shifting mindsets.

Ricci explained that several states, including New York and California, are considering mandates to require at least 50% reusable PPE usage in health care facilities. Europe’s health care sector has already embraced reusable textiles, experiencing fewer PPE shortages during the pandemic. The CDC and other federal agencies could play a pivotal role by recommending reusable PPE in health care guidelines.

“Europe had about 30% more reusable products than Canada, and they avoided shortages because they could rely on that rotating inventory. Since that inventory was available, production continued, allowing them to obtain that product and not [have the shortages we experienced.] They also consider the environment seriously. They are ahead of us on environmental issues, no doubt about it. Just look at their approach to the carbon tax and their efforts on extended producer responsibility and reducing single-use products. It makes a lot more sense to them than it does to us, but we're making progress. I think we're beginning to look at it more universally.”

The shift toward reusable PPE requires a cultural change, strategic investment, and industry-wide collaboration. As health care facilities prioritize sustainability and supply chain resilience, reusable PPE offers a proven, long-term solution.

Ricci said educating health care workers on the benefits of reusable linens is vital. “We're making an effort to sit down with the stakeholders in our industry, collaborate with them, communicate with them, educate them on the importance of the reusable product and what it does within our current healthcare environment and our changing health care environment.”

Troxel agreed and said, “It's about making sure that frontline staff have what they need for their best protection possible to keep patients safe.”

Resources for the video:

Infection prevention has long focused on hand hygiene, but what about the surfaces patients and healthcare workers touch throughout the day? Jim Gauthier, MLT, CIC, alongside coauthors Carol Calabrese, RN, BS, CIC, and Peter Teska, MBA, introduced the concept of Targeted Moments of Environmental Disinfection (TMED)—a structured approach identifying 5 critical moments for cleaning high-touch surfaces in patient care areas, published in The Joint Commission Journal on Quality and Patient Safety. 

In this interview, Gauthier discusses the importance of real-time disinfection, the hidden dangers of overlooked surfaces, and practical strategies to integrate TMED into daily health care practices, ultimately aiming to reduce health care-associated infections and enhance patient safety. 

“TMED is a heuristic, risk-based model proposing additional cleaning and disinfecting within the patient zone modeled on a similar concept developed by [World Health Organization] for hand hygiene,” The authors wrote. “TMED identifies and suggests when disinfection should be conducted by [health care workers], either after or before certain procedures or events that may leave organisms on high-touch surfaces, or to remove organisms that may have been deposited during other care procedures.”

In an exclusive interview with Infection Control Today, Dr. Deborah Birx, MD, shared crucial updates on the ongoing threat of avian influenza (H5N1) and its implications for public health. With the H5N1 strain spreading globally and showing concerning cross-species transmission, Dr. Birx stressed the importance of strong infection prevention strategies, including improved surveillance, strict biosecurity measures, and cross-sector collaboration. She also highlighted the risks of viral mutations, the potential for human-to-human transmission, and the urgency of preparing healthcare systems for emerging threats. Her insights provide infection preventionists with actionable recommendations to tackle the evolving challenges posed by avian flu.