Key Points Question What percentage of the Virginia population had been exposed to severe acute respiratory syndrome coronavirus 2 after the first wave of coronavirus disease 2019 (COVID-19) infections in the US? Findings In this cross-sectional study of 4675 adult outpatients presenting for non–COVID-19–associated health care in Virginia, a seroprevalence of approximately 2% was found, with an estimated 66% of seropositive results associated with asymptomatic infections. Hispanic ethnicity, residence in a multifamily unit, and contact with an individual with confirmed COVID-19 infection were risk factors significantly associated with exposure. Meaning This study found that, as of August 2020, the population of Virginia remained largely immunologically naive to the virus.

Hospital-acquired infections continue to pose a serious threat to patient safety and to the fiscal viability of healthcare facilities under pay-for-performance systems. There is mixed evidence that use of pay-for-performance systems leads to prevention of hospital-acquired conditions. Use of evidence-based guidelines has been shown to reduce hospital-acquired infections. Increasing use of pay-for-performance (PFP) systems results in potential loss of reimbursement for healthcare organizations that fail to prevent hospital-acquired infections (HAI). Healthcare administrators must work with front-line providers and infection control staff to establish and maintain evidence-based infection prevention policy. Additionally, infection control policy should be regularly updated to reflect best practices, and proper change management techniques should be employed in order to mobilize and empower staff to increase their ability to prevent hospital-acquired infections.

Television crime plots are formulaic-a body is discovered in an unexpected place, foul play is suspected, evidence is collected, and detectives work to piece together clues. Just as the episode is about to end, the final clue is discovered, revealing the perpetrator. With the criminal caught and jailed, justice ensues and public trust is restored. When a patient is harmed in healthcare, assigning blame is rarely that simple. Each year healthcare-associated infections (HAIs) harm 1 in 31 inpatients; HAIs lead to~99,000 preventable patient deaths in the United States annually. 1 Who do we hold accountable for these incidents of harm? Unlike on television, harm in healthcare rarely results from a single bad actor. Healthcare organizations historically held providers accountable for cases of medical harm, but following the landmark report, "To Err Is Human: Building a Safer Health System," focus shifted to system failures as key contributors to adverse events. 2 Researchers noted that after years of a punitive approach to clinician errors, this "no blame" movement was widely embraced, and new systems solutions were developed to improve safe healthcare delivery. 3 Continuing research supports a just culture framework, one in which a complex landscape of systemic and individual factors contributes to patient harm with shared accountability. 4 Researcher Derick W. Brinkerhoff describes accountability as "the obligation of individuals or agencies to provide information about, and/or justification for, their actions to other actors, along with the imposition of sanctions for failure to comply and/or to engage in appropriate action." 5 Tisné et al state, "Broadly speaking, accountability refers to the process of holding actors responsible for their actions. More specifically, it is the concept that individuals, agencies and organizations (public, private and civil society) are held responsible for executing their powers according to a certain standard (whether set mutually or not)." 6 Defining and practicing accountability is emphasized in patient safety cultures, and continuing research suggests accountability may influence the success of infection prevention strategy. At a large tertiary-care facility, establishing an individual hand hygiene accountability program resulted in improved hand hygiene compliance and decreased device-associated standardized infections. 7 These findings suggest that individual accountability may

Reflections on the COVID-19 pandemic in the USA: Will we be better prepared next time?"By failing to prepare, you are preparing to fail." Benjamin Franklin Faced with the threat of the 2019 novel human coronavirus (COVID-19), communities worldwide turn to healthcare systems with expectations of emergency preparedness. The ultimate scope and reach of the current COVID-19 pandemic are unknown. At the time of this writing (May 8, 2020), the COVID-19 toll in the United States of America (US) exceeds 1.2 million infections and 78,000 deaths, the greatest count per country worldwide (John Hopkins University, 2020). We reflect on the US and its response to the COVID-19 pandemic and focus on cultural, economic, and structural barriers that threaten both current and future responses to infectious disease emergencies.

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