Return to best practices

Hospitals are facing more pressures than ever before. Staffing shortages and razor-thin operating margins are two major areas of struggle, yet infection prevention still remains a critical area of focus. The key to overcoming these struggles and keeping infection prevention a top priority, according to industry experts, is a return to best practices and continued education.

Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST, principal infection preventionist for The Clorox Company, said, “With a rise in both emerging pathogens and hospital-acquired infections (HAIs), the importance of infection prevention and control measures is more relevant than ever. For the past three years, attention and resources have been singularly focused on COVID-19, but as we enter the fourth year of the pandemic, it’s apparent that we need to get back to a horizontal approach to infection prevention, such as ensuring the implementation of practices and products that will do the greatest good for the greatest number—in other words, is effective against most threats.”

Alice Brewer, MPH, CIC, CPHQ, FAPIC, Senior Director of Clinical Affairs, PDI agrees, she said, “COVID kind of clouded our view of all the things that could go wrong or all the problems in healthcare. The public health emergency has ended, but there are still so many things that we need to think about and worry about. Candida auris has been a huge issue. And it was a big issue before the pandemic. I remember listening to some talks about that in 2018 and 2019, and thinking ‘Oh no, this is going be a big problem.’ So that's certainly still a big issue—causing a lot of infections and causing a lot of problems in terms of identifying it and treating it. And unfortunately, during the pandemic, we actually saw a spike in some infections. CLABSI [Central Line-associated Bloodstream Infection] actually went up about 50% during the pandemic. We were doing everything that we could to keep patients safe and treat COVID patients at this time—I’ve been referring to it as kind of guerilla warfare. And so, we slipped on some of the best practices that we know should be done in order to prevent some of these infections. We’re seeing a need to return to what we know is best practice and address these things that were an issue pre-pandemic.”

Strong programs

On April 17, the New Jersey Department of Health (NJDOH) published a press release¹ calling on all healthcare facilities and professional healthcare organizations in the state to sign up their staff for infection prevention and control (IPC) training from NJDOH’s Project Firstline team. Project Firstline, a national initiative established and funded by the federal Centers for Disease Control and Prevention (CDC), provides training and educational tools on IPC practices for frontline healthcare workers.

The team is planning to expand the training throughout New Jersey following its successful first partnership with Hackensack Meridian Health (MHM) network.

Sharon Ward-Fore, Clinical Consultant for Metrex, stresses the importance of infection prevention and control programs. “Infection prevention and control programs are built upon an evidence-based approach to prevent patients and health workers from being harmed by avoidable infections,” she noted. “Without effective IPC it is impossible to achieve quality healthcare delivery, as IPC programs are an indicator of patient quality and safety. “

She added, “In fact, as recently as November 2022, the CDC revised its ‘Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings’ document to include a core set of infection prevention and control practices that are required in all healthcare settings, regardless of the type of healthcare.”

“Any healthcare facility that receives reimbursement from CMS is required to have an IPC program. CMS issued a revised guidance statement on July 14, 2022, on infection prevention and control and antibiotic stewardship programs,” Ward-Fore said. “This guidance created a rule for hospital Conditions of Participation (CoP) for infection prevention and control and antibiotic stewardship program requirements. The requirements are that ‘any healthcare facility must have an infection prevention and control program organization and policies, antibiotic stewardship program organization and policies, leadership responsibilities and unified and integrated infection prevention and control and antibiotic stewardship programs for multi-hospital systems.’”

Kley largely agrees, and gives tips for organization’s infection prevention departments, she said, “We recommend that infection preventionists take stock of the current status of their facility’s environmental cleaning and disinfection program. Any gaps identified should be included in this year’s annual Work Plan—the IP’s road map.”

Compatibility is key

When it comes to compatibility, Kley said, “As part of IPs’ evaluation of their cleaning and disinfecting programs, product inventory should also be assessed. With some of the supply chain issues accruing during the pandemic, unfamiliar and unapproved products often found their way into facilities. It’s important for healthcare facilities to incorporate the right disinfectants for the right jobs. This means ensuring disinfectant products have the appropriate kill claims needed to address pathogens of concern within their facility, fast contact times and broad surface compatibility.”

Brewer added, “We're having a lot more conversations lately about compatibility and instructions for use. There are so many products and options out there for hospitals to choose from. But we really have to pay attention to the compatibility of cleaning agents with our equipment and our surfaces. Because if you're using the wrong thing, and you're using it the wrong way, you can really cause a lot of damage, and that gets expensive. And no hospital wants to be constantly replacing equipment or refinishing surfaces. This is something that the Joint Commission has started paying a lot more attention to, as they're going in and certifying hospitals are really paying attention to appropriate use of products and that the right products are being used on the right surfaces and for the right indication.”

At PDI, Brewer said, they’re getting a lot of questions about compatibility and instructions. So much so, that the organization has a website dedicated to navigating compatibility questions. The website allows users to look up equipment and the product to determine compatibility.

Kley told Healthcare Purchasing News that Clorox Healthcare also has educational materials for infection prevention departments. She said, “Not only does Clorox Healthcare provide product solutions, but we have also invested in the development of educational resources with CloroxPro HealthyClean, an online learning platform offering best-in-class education and training on environmental cleaning and disinfection with the only industry-wide certificate course accredited by ANAB. Recently, the platform expanded with the launch of CloroxPro HealthyClean Introduction to Healthcare, a microlearning module for EVS managers, supervisors and new IPs entering the workforce to increase understanding of healthcare-specific considerations when cleaning for health.”

Staffing challenges remain

Brewer commented on one of the largest challenges in the healthcare industry today. She said, “Industry staffing is a big issue in infection prevention. The pandemic resulted in a lot of people just burning out, we overworked our healthcare staff beyond anything we've seen before so we've had a lot of infection preventionists step away from the profession, retire early, or go do something else. So, there are a lot of new infection preventionists and education and training are really critical.”

She added that PDI has always been focused on education, but the organization is stepping it up in terms of offering a lot of educational materials and continuing education courses that can help get new infection preventionists to be effective in the healthcare space.

“The other issue when you’re short staffed is figuring out how to do more with less,” Brewer added. “For example, finding efficiencies, and I think that will probably be a slower thing. We’re really going to have to try and figure out how we improve efficiencies and where we can find those efficiencies—this is what I’ve been hearing from people in the field. They all have so much to do and are trying to figure out how to get it all done in a day.”

David Nelson, Marketing Director, Metrex, shared his thoughts on staffing as well. He said, “Staffing remains a challenge in two ways: end-user staff turnover presents a challenge to IPs in trying to achieve compliance with cleaning and disinfection protocols; and turnover in the IP population itself post-pandemic resulting in many newer IPs.”

The possible solution? According to Nelson, effective products with simple-to-use instructions to help ensure end-user compliance.