Infection prevention (IP) staff act every day in critical roles protecting patients, families and each other from pathogens and infections across hospital, patient room and other healthcare settings. As the second year of the COVID-19 pandemic plays on, prevention of the SARS-COV-2 virus and other community-spread or hospital-acquired infections (HAIs) remains center stage in care.
“HAIs are a major burden on healthcare costs in the U.S.,” noted Shawn Malek, Sales and Marketing Manager, Far UV Technologies, Inc. “Per the Centers for Disease Control and Prevention (CDC), at least one in 25 patients in U.S. hospitals is dealing with an HAI on any given day. HAIs are more than just added costs; they can cause irreparable bodily harm, drive up the costs of healthcare and even result in death.”
Preparedness and prevention of infectious diseases made ECRI’s “Top 10 Patient Safety Concerns for 2021.” “Of the 10 topics in the report, eight are related to or exacerbated by COVID-19. In addition to health disparities, others include emergency preparedness in aging care facilities, disease outbreak preparedness, supply chain shortages, telehealth, the improvised use of medical devices, and aerosol infection prevention. Each concern is coupled with strategic recommendations to avoid or counter it.”1
Accountability, resources
Ultimately, who is responsible for safety and infection prevention in facilities during a public health crisis, such as COVID-19? Everyone plays a part, expresses Sharon Ward-Fore, Infection Prevention Advisor, Metrex.
“During the height of the pandemic it was ‘all hands on deck,’” Ward-Fore observed. “Everyone was nervous about this virus because so much was unknown, so information was shared across departments regarding supplies, patient bed numbers, staffing shortages due to illness/quarantine and the latest news and developments. Most departments were working longer hours. All departments were attuned to the need to conserve and use supplies appropriately to be able to work safely. All departments were concerned about the impact of shortages on patient care.”
Certainly, IP staff perform a major role in the support of hand hygiene and personal protective equipment (PPE) for environmental services (EVS), clinical and other staff. They also support clean and safe healthcare facilities for patients.
“With their expertise, IP teams and infection preventionists use data to guide strategies, policies, and procedures for EVS teams,” stated Martin McGonagle, General Manager, SC Johnson Professional Healthcare. “IPs assess data through electronic hand hygiene monitoring systems, cleaning protocols in patient rooms and on equipment used on patients and confirm PPE is worn at the right times for all staff.
Infection preventionists, in particular, have spotlighted ongoing education on COVID-19 and protection, notes Karen Hoffmann, RN, MS, CIC, FAPIC, FSHEA, an infection preventionist consultant for the Vidashield UV24 from NUVO Surgical.
“Adding to oversight responsibilities of HAI prevention activities, IPs have always had to be ready to pivot to respond to outbreaks with added surveillance, rounding, education, data analysis and mandatory reporting,” Hoffmann explained. “IPs have also played a leadership role in their facility in real time by investigating, evaluating and implementing mitigation and prevention strategies. For many facilities, the IP is the face and communicator of the pandemic response for their facility.”
“EVS and IP teams have worked and continue to work grueling hours over the past year, with much of that time (and energy) focused on a single pathogen – SARS-CoV-2,” Kley shared. “They have also had to ensure that appropriate PPE and disinfectants were available at all times. This sometimes meant using products unfamiliar to them or in formats they were not accustomed to using. If this past year has shown us anything, it’s the importance of resilience – which is something that these teams embody everyday while keeping healthcare facilities safe.”
As the crisis persists, PPE sourcing should remain a top priority, stresses Don Lowe, Spokesperson, ProTEC-USA.
“Procuring sufficient quantities of high-quality PPE is a matter that's paramount in protecting front-line workers in the healthcare field,” Lowe indicated. “There have been numerous ‘pop-up’ PPE manufacturers, many of which are offshore, that fall well short of delivering a dependable PPE product on time. There is legislation under review at present that works to secure domestically produced PPE for maximum confidence and protection.”
In play for PPE disinfection changes are new guidelines from the U.S. Food and Drug Administration (FDA) “recommending healthcare personnel and facilities transition away from crisis capacity conservation strategies, such as decontaminating or bioburden reducing disposable respirators for reuse. Based on the increased domestic supply of new respirators approved by the Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) currently available to facilitate this transition, the FDA and CDC believe there is adequate supply of respirators to transition away from use of decontamination and bioburden reduction systems.”2
Holding much knowledge in their field, infection preventionists can provide guidance on IP protocols and product evaluation in facilities, suggests Eric Jungslager, Vice President of Healthcare, GP PRO.
“While the IP has always been responsible for isolating the sources of healthcare-associated infections and limiting their spread, this guidance has heightened their attention to hand hygiene, be it establishing hand hygiene compliance metrics, educating healthcare workers on the importance of adhering to hand hygiene protocols or overseeing compliance,” Jungslager emphasized. “In addition, the coronavirus pandemic has made the role of the IP much more visible and prominent, thereby driving their subject matter expertise to the forefront of facility operations and providing them with an opportunity to take a more active role in researching and selecting infection prevention solutions. By having a voice in this selection process, the IP is better poised to achieve a facility’s stated infection prevention goals.”
Following protocols, standards
“During the constantly changing course of the COVID-19 global pandemic, IP teams have been called to partner with healthcare professionals to the full extent of their role: observe practices; educate healthcare teams; advise hospital leaders and other professionals; compile infection data; develop policies and procedures; and coordinate with local and national public health agencies (APIC, 2021),”3 Johnson noted. “They continue to monitor reports from state and federal public health agencies to inform practice and update policies. The IP serves as a critical resource to review infection data and trends, and to consult and answer questions regarding COVID-19 testing, vaccination and new variants of the COVID-19 virus.”
On the patient care side, respiratory professionals provide medical equipment that is sanitary
“Generally speaking, respiratory care practitioners are responsible for the safe and effective reprocessing of ventilators in the ICU between patients,” Coombs said. “For the past year during COVID, special attention has been paid to ways in which this reprocessing can be streamlined while remaining safe and effective.”
“A recent BMC study demonstrated that, of more than 140,000 patients tested, those with COVID had a higher rate of potential HAIs, showing that essentially SARS-CoV-2 was associated with higher rates of certain types of hospital-onset infections, greater antimicrobial usage and extended hospital and ICU length of stay,”4 Yu indicated. “Additionally, resources normally diverted to education on how to properly manage PPE, including how to put on, use, store and remove (which has historically been an issue even before COVID), was highlighted this past year yet again, particularly given the high mortality rate.”
Examining HAIs prior to COVID-19, the National Human Genome Research Institute (NHGRI) reported that “researchers studied administrative data from 133,304 patients who stayed in National Health Service (NHS) hospitals in Oxfordshire, U.K. for at least 48 hours between 2011 and 2015…Using the data, the team could predict subsequent infection for bacterial and viral pathogens that commonly cause hospital-acquired infections: methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, Clostridium difficile and norovirus. These pathogens are usually transmitted either through direct contact, contaminated surfaces or contaminated food and drinks.
“For all five pathogens, the researchers found that patients were most likely to be infected if they spent more than 24 hours in the presence of a potentially infected person…According to the study results, if healthcare workers had tested patients based on the duration of exposure to known or suspected cases, new cases could be caught up to a day before they actually were detected. The researchers believe that implementing such an approach will help prevent the spread of hospital-acquired infections and vastly reduce the cost burden.”5
Instrument reprocessing has become another responsibility on the IP side, observes Theresa “Terri” Kunsman, Senior Product Manager for CDS (Cleaning, Disinfection, and Sterilization), Olympus America, Inc.
“Infection prevention managers have been taking a much more active role in understanding and following end-to-end endoscope reprocessing processes and re-evaluating protocols,” Kunsman indicated. “This additional oversight and day-to-day management of processes have led to additional investments being made in reprocessing tools and technologies, as well as education and training programs.”
Preparing for future roles
How can IP practices succeed and enhance patient safety in the future?
As part of planning, Jon Imms, Global Technical & Product Director, CleanSpace Technology, recommends focus on respiratory PPE.
“As part of an ongoing Pandemic Preparedness Program, there is a clear mandate for practices around the world to prioritize the improvement of policies, procedures and equipment for PPE,” Imms stated. “While N95s have a place in the community and some clinical settings, in high-risk environments where airborne pathogens exist, such as in the COVID-19 and Ebola outbreaks, staff need to be using Powered Air Purifying Respirators (PAPRs).”
Peg Fox-Giacomuzzi, MSN, BSN, RN, National Director of Surgical Services, Standard Textile, proposes relationship building within the medical industry and development of sustainable products.
“IP professionals need to be in close contact with infectious disease physicians and epidemiologists in order to stay current on what seems to be daily changes to CDC guidelines, as we continue to learn more about the COVID-19 virus,” expressed Fox-Giacomuzzi. “Looking ahead at new strategies to advance infection control and patient care, IP professionals should also advocate for increased research on sustainable practices. All relevant stakeholders (frontline staff, linen services, vendors and IP) play a role in also understanding the value of creating a safe, sustainable culture in healthcare, and reusable textile solutions are an important part of that conversation.”
Sarah Simmons, DrPH CIC FAPIC, Senior Director of Science, Xenex Disinfection Services, advocates for team collaboration, adhering to the latest disinfection standards and openness to new technology.
“The COVID-19 pandemic has served to underscore the importance of teamwork between the EVS and IP teams,” Simmons noted. “The challenges of emerging infectious diseases will continue, and the slow but steady emergence of multi-drug resistant and pan-drug resistant bacteria will only increase in the coming years. Assuring a gold standard of environmental disinfection will be a key part of stopping the spread of these organisms. IPs and EVS Directors need to make sure they keep abreast of the newest and most effective technologies for enhanced disinfection.”
In terms of education, the American Hospital Association announced earlier this year that it “received two grant awards totaling $6 million from the Centers for Disease Control and Prevention (CDC) to advance public health and infectious disease prevention initiatives,”6 including a “grant for $4 million,” which “will support collaboration between the AHA, CDC and community colleges through Project Firstline, CDC’s national training collaborative for infection prevention and control…Through this initiative, current and future generations can start their careers with a more solid understanding of infection control. The initiative will also promote connections between hospitals, learning institutions and other parts of the health care system.”
Sharing observance and guidance with one another is another good practice, adds Metrex’ Ward-Fore.
“Teams can continue to collaborate with each other and share their knowledge and what they see happening on the floor – good or bad,” she said. “We can encourage others to speak up – if you see something that doesn’t feel right – say something. We can all help others see the importance of basic infection control by setting the good example.”
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References
1. Racial, Ethnic Health Disparities Top Patient Safety Concern for 2021, March 15, 2021, https://www.ecri.org/press/racial-ethnic-health-disparities-top-patient-safety-concern-for-2021
2. FDA Recommends Transition from Use of Decontaminated Disposable Respirators - Letter to Health Care Personnel and Facilities, https://www.fda.gov/medical-devices/letters-health-care-providers/fda-recommends-transition-use-decontaminated-disposable-respirators-letter-health-care-personnel-and
3. Association for Professions Infection Control (APIC). (2021). Who are infection preventionists? https://apic.org/monthly_alerts/who-are-infection-preventionists/
4. A multicenter analysis of the clinical microbiology and antimicrobial usage in hospitalized patients in the US with or without COVID-19, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05877-3
5. A new tool to prevent the spread of hospital-acquired infections in the era of COVID-19, https://www.genome.gov/news/news-release/a-new-tool-to-prevent-spread-of-hospital-acquired-infections-in-era-of-COVID-19
6. AHA Receives CDC Grants Totaling $6 Million to Support Vaccine Confidence, Infection Control Expertise, https://www.aha.org/press-releases/2021-02-24-aha-receives-cdc-grants-totaling-6-million-support-vaccine-confidence
