“They shouldn’t wait,” he said. “Barb, the woman I’m about to go see, you know she developed her necrotizing fasciitis at an IV site, right?”

Her frown deepened.

“That means one of our ER nurses either used the same pair of gloves more than once or did not wash hands between patients before starting that IV,” Kilburn said flatly. “There is no other explanation for the spread.”

“I’ve put signs up everywhere about hand washing. I am trying to speak to every single staff member.” She looked on the verge of tears. “I can’t be pulled in any more directions.”

Kilburn smiled reassuringly. “I know, Barb. You’re wearing about twenty bull’s-eyes right now.”

She laughed halfheartedly.

“Just make sure people wash their damn thumbs, too.” He sighed. “Never fails to amaze me how many staff don’t include their thumbs when they wash.”

“You’re preaching to the converted, Graham.”

He laughed. “Actually, I’m preaching to the preacher. I think you once caught me with my thumbs dangling in the breeze when I was a junior resident.”

Moyes glanced at her watch. Her brow furrowed. “My meeting’s starting.”

Kilburn returned her wave and then headed straight for the ICU. Donning the head-to-toe body precautions, the sense of déjà vu was uncanny. Parminder Singh lay in the same room where Tom Mallek had died days earlier. Kilburn knew they were trying to limit the spread of the new superbug by physically clustering the cases. But he wondered if such measures had come too late.

He stepped through both sets of sealed doors and into the room. At Parminder’s bedside, a male nurse in a face shield was busy removing the dressing on the patient’s infected left arm. He stopped and looked up at Kilburn.

“I’m Dr. Graham Kilburn, with infectious diseases.”

“Mel,” the nurse grunted. “Mind if I finish this dressing change?”

Kilburn nodded. “Don’t mind me.”

The patient lay perfectly still on the bed during the painful-looking procedure, but Kilburn understood why. Singh was unconscious. And the endotracheal tube sticking out of her mouth meant she was connected to a ventilator.

Kilburn’s eyes fell to Singh’s swollen, deformed arm, as Mel peeled off the dressings. From the elbow to the fingers, the skin had been surgically splayed along the back of her arm. Large chunks of skin were missing, exposing gobs of yellowish-gray fat and patches of brownish-red muscle. Singh’s arm looked like the bloated body of a fish that had washed ashore, but it lacked the putrid smell. Instead, his nostrils filled with the strong antiseptic scent of iodine and alcohol.

“Look at this.” Mel pointed to a thick fiery band of red that led from her elbow up to her shoulder. “It’s spreading upward.”

“Are they taking her back to the OR?”

“What’s the point?” Mel shrugged.

“Where’s her medication record?”