A New Era in Infection Control

Sometimes it takes an unprecedented global event to help facilities refocus their efforts on the basic, tried-and-true protocols that fell by the wayside as pressing issues demanded immediate attention. COVID-19 was certainly one of those events.

“There’s no question that the pandemic has brought infection control to the forefront,” says Nancy L. Havill, MT(ASCP), MHA, CIC, manager of infection prevention and ambulatory services for Yale New Haven (Conn.) Health System.

Formerly frustrated infection control specialists who used to go hoarse reminding staff to comply with basic protocols now find that virtually everyone is on board with doing things right. “When protocols can save your life, everyone is happy to follow them,” says Ms. Havill, who handles infection control at 300 ambulatory sites throughout Connecticut.

From reinforcing basic protocols to overhauling current practices, the pandemic-influenced trend of taking infection control more seriously is likely to stick around long after COVID-19 is an acute threat. Here are the infection control areas that are likely to garner the most attention moving forward.

• Proper hand hygiene. Infection control professionals have for years been emphasizing the importance of consistent hand-washing protocols and the use of hand sanitizer after each patient interaction. Of course, those reminders sometimes fell on deaf ears. However, thanks in a large part to the pandemic, hand hygiene has become top of mind for everyone who enters a healthcare facility — including non-staff. “The most striking thing to me is that people routinely use the hand sanitizer outside our cafeteria now, and in common public spaces where we used to not focus on hand hygiene compliance,” says Ms. Havill. “We used to have signs encouraging visitors to sanitize. Now the signs are no longer necessary because people just do it automatically.”

There’s nothing new or revolutionary about the hand hygiene practices facilities leaned upon heavily during the surge months of the pandemic; these are the same basic guidelines agencies such as the CDC and the WHO have been stressing for years, says Marisa Ynchausti, RN, BSN, an infection prevention specialist and clinical nurse manager at the National Ambulatory Surgery Center in Los Gatos, Calif. Will the adherence stick? That depends on how proactive surgical leaders are about enforcing the protocols (see “5 Ways to Keep Infection Control Top of Mind”). “Facilities need to encourage meticulous compliance,” says Ms. Ynchausti.

• Air purification. Making sure OR air is properly purified can present a challenge, especially in facilities that were built long before modern ventilation was available. For instance, hospitals constructed in the early 1900s have suboptimal air exchanges for the kinds of procedures being performed today. New hospitals and surgery centers are being built with airborne pathogen prevention in mind, but what about older facilities that are up to code but aren’t up to the air purification challenges of today? Yale New Haven is a case study in combatting this problem head on. The health system’s facilities were largely built during the suboptimal air exchange era, but air purification has been a primary focus of its infection control plan of attack. “We spent a lot of time focusing on the number of air exchanges per hour in our spaces, whether it’s an office, exam room or procedure room,” says Ms. Havill.

Yale New Haven Health relied on information from the CDC to help. The agency puts out a chart that tells facilities how to make sure patient rooms are purified and safe for the next patient — based on airflow in the space and how many air exchanges are needed for the air to be totally turned over.

“We need to know the area of the space, the ventilation properties of the room, and then we can calculate the number of minutes or hours we need to rest the room between cases,” says Ms. Havill. “We started calling that process ‘resting the room.’”

To aid and expedite the process, Yale New Haven Health bought room air purifying devices such as portable HEPA filtration units and distributed them to locations as needed based on their air exchanges per hour, the number of aerosol-generating procedures being performed and whether they were seeing COVID-19 cases.

• Airway management precautions. The pandemic has also encouraged infection control professionals to think more broadly about the definition of an aerosol-generating procedure. “It’s something that causes the patient to cough or expel particles,” says Ms. Havill. “When you take a nasopharyngeal specimen, the patient is likely to cough or sneeze. This is just one of many examples, and it’s important to consider every situation that might cause expulsion of particles.”

Limiting traffic in the OR to only necessary personnel, especially during intubation and other aerosol-generating procedures, is another change that should stick as the pandemic enters its endemic stage, adds Ms. Havill.

• Superior surface disinfection. One of the major silver linings of the pandemic for infection-minded surgical leaders was the healthcare industry’s reemphasis on proper surface disinfection. “In the beginning, everyone thought that one of the main dangers of infection would be from surfaces, such as doorknobs,” says Ms. Havill. In response, her organization hired staff to wipe down high-touch surfaces on a more frequent basis. The staff would even clean printer buttons and refrigerator doors on a rotating basis. That emphasis on surface disinfection continues to this day. “We still use a fluorescent dye marker to make sure high-touch points have been completely cleaned. If not, the room must be recleaned,” says Ms. Havill. “We’ve had this protocol in place since before the pandemic, and it remains as important as ever.”

• Visitor restrictions. Ms. Havill believes patients, family members and staff should not be exposed to a greater risk of infection if it can be avoided by maintaining social distance and limiting the number of people allowed in facilities. To that end, infection preventionists see limiting the number of visitors allowed as a positive trend. “Continue to limit the number of people in the waiting room,” says Ms. Havill. “Do not allow patients to bring someone with them unless there is a special need.”

Ambulatory sites should continue to ask friends and family members to wait in their cars while patients are having their procedures, according to Ms. Havill. “I think the days of 25 people packed in a waiting room are over,” she says.

• Design overhauls. From an infection control standpoint, the pandemic has directly impacted the way new facilities are being constructed. For instance, Ms. Havill’s organization was in the middle of building a new lung disease clinic when COVID-19 forced them to shut down. This offered them an opportunity to revise key design features of the new facility. “When the pandemic hit, the construction was halted immediately,” she says. “They reconfigured the facility to make many of the rooms negative pressure, so in the event of another pandemic that is airborne in nature, there would be no need for the use of portable HEPA filters.” Moving forward, expect new surgical facilities to be built with airborne diseases and future pandemics in mind.