Infection Prevention's Big Moment

Infection Prevention

By: Jared Bilski

Published: 5/27/2020

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Amid the COVID-19 crisis, a back-to-basics mantra emerges.


From the HIV crisis of the 1980s to the H1N1 pandemic of 2009 to the Ebola outbreak in 2014, Maureen Spencer, MEd, RN, CIC, FAPIC, has seen a lot during her more than 40 years as a board-certified infection preventionist. But she's never seen anything like what we're experiencing with COVID-19. "I semi-retired back in December, and I've been absolutely swamped with questions, concerns and requests for help," says Ms. Spencer, an independent consultant based in Boston.

She's not alone. Guidance from infection prevention experts is in high demand right now as healthcare professionals adapt to a new normal in surgical care. There's a tremendous opportunity to capitalize on the focus infection prevention practices are receiving and use that attention to drive home a critical back-to-basics message that could spark real change in how your staff protect themselves and their patients from infection.

"The SARS outbreak taught us how to [make change happen] correctly," says Ann Marie Pettis, RN, BSN, CIC, FAPIC, president-elect of the Association for the Professionals in Infection Control and Epidemiology (APIC). "Because of the fact that healthcare workers were primarily getting infected as a result of taking off PPE incorrectly, the proper donning and doffing of PPE became the new normal."

Ms. Pettis is already starting to see that sort of messaging growing out of the COVID-19 pandemic, but knows the real work lies ahead. "That's the charge for infection preventionists," says Ms. Pettis. "We need to constantly message, educate, create policies and procedures, audit, get out and interact with staff and conduct one-to-one training."

The good news is that everyone who's been employing proper hand hygiene, skin prepping and surface disinfecting won't second-guess your standardized infection prevention protocols moving forward. "It'll be easier to get the message to stick, even among the staff that are a bit reluctant," says Ms. Pettis.

"This is our chance to get back to basics in infection prevention," says Lee Anne Blackwell, BSN, RN, EMBA, CNOR, CAIP, vice president of clinical services at Practice Partners in Healthcare in Birmingham, Ala. "It's our chance to perform appropriate cleaning and disinfection protocols, and to treat every patient like you don't know what they have."

The result of this back-to-basics approach could very well highlight the invaluable role proper, consistently applied protocols play in keeping patients infection-free. "What I hope to get out of the renewed emphasis on hand hygiene and enhanced environmental cleaning and disinfection is infection prevention best practices that stick around and lead to decreased healthcare-acquired infections and fewer SSIs," says Ms. Spencer.

Of course, there's a danger of returning to the status quo once things finally settle down. "After the H1N1 outbreak, a lot of healthcare professionals went back to their old habits," says Ms. Spencer.

She also fears that infection prevention departments that hired extra staff — additions that finally brought the departments to adequate staffing levels — will be hit with layoffs as soon as the wave of COVID-19 patients subsides. And in high-volume, fast-paced facilities there will always be pressures to cut corners.

Changes ahead

FULLY COVERED Infection preventionists hope one result of the pandemic will be a renewed focus on equipping all healthcare workers with proper PPE.

"When there are time pressures, it's human nature for administrators to want to say, "?Hurry up, get that surface disinfecting done' even if the proper dwell time isn't being reached," says Ms. Blackwell. "But it's our job to do what's right, even if it's the hardest thing to do."

We're already seeing plenty of patient screening changes as a result of the coronavirus pandemic. Outpatient centers that are performing emergent procedures are not only aggressively monitoring patients, but also staff. "I urge facilities to monitor their own staff in the same way they monitor patients," says Ms. Blackwell. "Run through the questionnaire every time they come in for work, take temperatures using a consistent method or, if you can't, document exactly what you did."

Ms. Blackwell recommends all outpatient facilities add COVID-19 screening questions to pre-op phone calls and says you shouldn't expect the screening practices to disappear when the spread of the virus subsides. "Moving forward, we're going to continue to monitor and screen patients aggressively," says Ms. Blackwell. "In the future, you'll see organizations develop extended policies based on what we're experiencing right now."

Healthcare workers on the front lines have faced well-documented supply shortages, and infection preventionists like Ms. Pettis hope shortages will be enough to change the industry's current attitude toward supplies and PPE stockpiling. "I think there's a lot of soul-searching that needs to be done in health care regarding just-in-time supply management," she says. "There are a lot of reasons to keep inventory down to a bare-bones minimum — lack of adequate storage, cost concerns and wanting to avoid stocking expired supplies — but we're seeing how dangerous this approach can be, and why it needs to be carefully reconsidered."

Ms. Pettis believes this could involve rethinking the reliance on other countries for medical supplies and looking for areas where easily reprocessed supplies such as isolation gowns could be used in conjunction with disposable items.

In the future, you'll see organizations develop extended policies based on what we're experiencing right now.
— Lee Anne Blackwell, BSN, RN, EMBA, CNOR, CAIP

Another positive Ms. Pettis hopes to see come out of this crisis is a greater focus on employee safety. "I'm hoping it will become normal for healthcare workers involved in aerosol-generating procedures, or any procedures where staff could be infected with respiratory viruses, to wear face masks to protect their eyes, nose and mouth," she says.

Some infection prevention professionals foresee the coronavirus disrupting everything from patient interactions to how new facilities are designed. "I think we're going to see a lot of changes coming out of this pandemic that will alter how health care is delivered," says Lori Groven, MSPHN, RN, CIC, an infection preventionist at TRIA Orthopaedic Center in Bloomington, Minn. "Telehealth will be essential after the pandemic in treating patients with conditions that prohibit in-person visits such as a lack of transportation, mobility issues and infectious diseases," says Ms. Groven. "The reduction in face-to-face encounters with patients will work in our favor as we struggle to bring PPE levels back up to par."

Ms. Groven also sees the pandemic eventually altering the physical structures of outpatient facilities by reducing the amount of square footage dedicated to patient care in favor of private areas to conduct patient phone calls and video visits. COVID-19's effect will even play a role in how new facilities are laid out. "I think more attention will go toward ensuring new construction includes design elements needed to contain novel pathogens that so many are missing right now — such as the elusive airborne infection isolation ?room," says Ms. Groven.

The silver lining

Before worrying about the future, however, surgical facility leaders must get through the present. For those who work in infection control, the road ahead consists primarily of doing what they've always done. "Stick to the facts, don't panic and rely on your experts," says Ms. Groven.

Infection preventionists should cast a wide net when it comes to seeking help from experts. "They need to work with their local health departments as well as their state health departments," says Ms. Pettis. "They need to broaden their areas of expertise and keep track of what the different health departments and experts such as the CDC and the World Health Organization are doing."

When the dust finally settles and healthcare organizations slowly and cautiously return to some semblance of a pre-pandemic routine, perhaps some good will come out of the current crisis. Says Ms. Pettis, "If there's a silver lining in any of this, which you really have to search for right now, it's that surgical professionals are hopefully developing some really good habits that we've been trying to get them to embrace for many years." OSM

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