The COVID-19 pandemic, the first of this scale in over 100 years, has been a traumatic event for many, if not all, working on the hospital frontlines. Doctors, nurses, and other members of the healthcare team were forced into working conditions they never expected (without sufficient personal protective equipment [PPE] in many cases) and saw things they never wanted to see. Tragically, more lives were lost to this outbreak than any other in recent history. Infection Preventionists (IPs) were alongside the clinical staff, being placed in the position of having to make decisions that went against their training, such as the extended use of or re-use and decontamination of PPE.
While the healthcare industry has endured many infection control challenges in the past, such as bioterrorism scares (smallpox, anthrax, etc.), influenza pandemics, Ebola outbreaks, emerging pathogens and growing antibiotic resistance, the sheer magnitude of COVID-19 was like no other before it.
As we are still reeling from the COVID-19 pandemic and will do so for some time to come, we need to take a step back and assess five key learnings so we are better prepared for a possible second wave, as well as future pandemics. A few things to reflect on include:
- Surveillance: We need more robust syndromic surveillance for the early detection and investigation of outbreaks, including emerging infections and illnesses. And we need this surveillance at the hospital-level, not just the government level. We live in the era of big data, yet still are coping with how best to use the data to drive decisions and actions. How can we best capture the wealth of data provided in our patient’s medical records? For example, use of machine learning to rapidly identify trends in the patient population within our facilities and to alert the IP. As states and communities start to reopen, how are we preparing for a possible next wave of COVID-19?
- Surge Capacity: Over the years, hospitals have conducted surge capacity drills to ensure ability to meet a sudden increase in demand of services. Often these were table-top drills or scaled-down drills. But now that we have lived an actual event, what have we learned that caught us completely by surprise and how will we better address it next time? Will we be able to quickly ramp up setting up portable segregated care areas and units dedicated to care for the outbreak patients? What about rapid training of the staff who will be assigned to these areas? How about the screening process for staff and patients entering the facility? And finally, how about outpatient areas? How will a surge of patients impact them and how might we handle it? Agility is key. We must be able to respond quickly.
- Supplies: Despite using their emergency stockpiles, facilities quickly ran low on key supplies such as test swabs, PPE, hand hygiene and surface disinfecting products which were at an extreme demand. Manufacturers were working around the clock to meet this demand yet it was still not enough. Some even resorted to 3D printing their own supplies such as face shields. Facilities typically have resources to stockpile several weeks of supplies, not several months. We need solutions beyond stockpiling. How can we address or think about supply issues differently? Can we read early signals to help forecast needs sooner? Do facilities and suppliers have plans A, B and C for supply chain? Is it wise that we obtain our supplies from once source or should we several, including both within and outside of the country? Do facilities have a plan for a worst-case scenario in the event they cannot obtain supplies or obtain them in a timely manner? For example, many facilities that could not get traditional healthcare disinfectants resorted to diluting “jug” bleach.
- Staff: Hospitals and health systems need to re-build staff trust. A consequence of reacting and adapting to the situation was the constantly-changing guidelines and PPE shortages. Clinical staff needed to believe that the IP teams, administration and CDC were doing their best to do the right thing, even if the outcomes were less than desirable in the field. While we need to acknowledge and address their fears, frontline staff members need to understand that this pathogen was not only new to us, it was new to the experts. In the setting of an emerging communicable disease, the CDC always implements the highest and most stringent infection control measures first and then loosens the precautions accordingly as more scientific evidence becomes available. Staff must accept and expect the guidelines to change in the early weeks of an emerging pathogen. Facilities must have a clear and coordinated communication system. Finally, we should be sure to include the frontline staff who are actually doing the work in the planning going forward.
- Sustain: Day-to-day operations such as surveillance for healthcare-associated infections should not have to go to the wayside during events such as this. While IPs in any given facility are a limited resource, can we cross-train others to assist with some of these tasks? Can we utilize furloughed workers as extra pairs of hands and eyes? Developing infection control champions in every department can also help to lighten the work. Importantly, we need to use this event to re-evaluate the standard of 1 IP for every 100–250 beds. It’s a matter of patient safety.
These five S’ above provide a glimpse into considerations moving forward beyond COVID-19. As we heal and mitigate, we must also grow from this pandemic. Evolutions of our previous practices will unfold in the coming weeks and, without a doubt, the role of IPs will be transformed forever. Below are some of the lasting impacts this pandemic could have on IPs, as well as longer-term lessons that industry leaders must come together to address:
- Provision of resources for long-term care facility IPs: This vulnerable population was hit the hardest, highlighting the need for trained IPs. Long-term care facility leadership must recognize the importance of sending their IPs for training from organizations like the Association for Professionals in Infection Control & Epidemiology (APIC) or state and local public health departments. Furthermore, they must allow the designated IP sufficient time to carry out infection control duties. Certification should be strongly encouraged if not required. Lastly, frontline staff need frequent infection control education and training so they can feel confident in this area.
- Educate facility leaders in infection prevention & control: This pandemic has brought awareness that administrators need a better understanding of the depth and breadth of IPs role. In general, IPs have what I call “faux authority.” At the end of the day, it’s the facility administration that makes decisions based on recommendations from their infection control team. The more knowledgeable our leaders are, the more confidence they will have in their IPs recommendations. These decisions greatly impact staff and patients.
- Consider IP specialization: There are many unanswered elements of an IP’s role that we must consider over the coming weeks. Is there opportunity for IPs to specialize? Should there be IPs who specialize in cleaning, disinfection & sterilization as an example? What can come off of the IP’s plate? A few initial thoughts are to train quality staff to perform surveillance. Could tasks such as latex-related issues or bloodborne pathogen exposures be handed off to our counterparts in Safety or Occupational Medicine?
- Employ more MPHs as IPs: This pandemic may have frightened off potential IPs from pursuing a career in infection prevention and control so we may need to think about alternatives to staffing our departments. Additionally, the 2015 APIC Mega Survey found that 82% of IPs are nurses and 38% are approaching retirement age. As the Baby Boomers retire, the American Association of Colleges of Nursing anticipates the nursing shortage to intensify. We should be considering other disciplines to fill the role of IP. Persons holding a master’s degree in public health and epidemiology (MPH) actually have more training in epidemiology and program planning than does the average IP. Yes, these MPHs would have to learn more about healthcare, specifically nursing, but IPs had to learn epidemiology.
Regardless, IPs need to rally and advocate getting the funding needed for pandemic plans and preparedness. If this pandemic has taught us anything it is that we need to be prepared at all times.
While COVID-19 has forever changed the healthcare landscape. What has not changed is the importance of IPs. This pandemic has brought us out of the shadows and has shined a bright light on the great work that we do every day, not just during times of crisis. We are in the business of preventing the spread of disease in healthcare settings to protect patients and staff. A solid IP program can help patients feel safe about coming back into healthcare system to seek medical attention when they need it. I have never been more proud to be an IP and of the work that we do to protect our staff and patients. Thank you all for your hard work and dedication to the profession. We see you! Please stay safe out there.
For the latest information on COVID-19 and variants, visit our CloroxPro COVID-19 Hub.