IPs have served as the clearing house for new products during the COVID-19 crisis.
By Daniel Beaird
As the COVID-19 pandemic raged, infection prevention information constantly changed. The Centers for Disease and Control and Prevention’s (CDC) interim guidance was continuously updated based on available information about COVID-19 and the situation in the U.S. All recommendations were organized into recommended infection prevention and control (IPC) practices for routine healthcare delivery during the pandemic and recommended IPC practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection.
Despite the previous best efforts of infection preventionists (IPs), if you asked some other healthcare professionals their opinions of infection prevention before the COVID-19 crisis, you might have heard the word hinderance. Yet when a worldwide pandemic arrived few judgments were made without the input of IPs. Decisions around personal protective equipment (PPE) use and reuse, visitors, cleaning and disinfection all demanded the expertise of IPs.
Patients with suspected SARS-CoV-2 infection were seen under nurse-directed triage protocols to determine if an appointment was necessary or if the patient could be managed from home. In some settings, patients opted to wait in a personal vehicle or outside the healthcare facility where they were contacted by mobile phone when it was their turn to be evaluated. Other facilities identified a separate, well-ventilated space that allowed waiting patients to be separated by six feet or more.
Because of this, the public also became much more aware of standard precautions in infection prevention. Patients became more involved in their own care and were more apt to remind healthcare staff about prevention practices like hand hygiene.
“The most striking change was infection prevention moving out of the healthcare setting,” said Ivan Gowe, an infection preventionist at Pardee UNC Health Care in Hendersonville, N.C.
Patients can also bring unrealistic and non-evidence based expectations into their care through their elevated recognition. But that’s a side effect IPs are willing to live with if it means patients are more informed.
“The lack of knowledge surrounding SARS-CoV-2 was disconcerting to the public and many people were looking for ways to protect themselves,” said Nancy Kerr, a registered nurse (RN) and manager of infection prevention at Hackensack Meridian Health in New Jersey. “As healthcare workers, we knew what to do but the general population wasn’t so sure.”
And just like that, the pandemic put the spotlight on infection prevention programs and the role of IPs.
“I’ve seen more emphasis on infection prevention in communities and hospitals in one year than I’ve seen in my 30 years in this profession,” said Eileen Sherman, system director of infection prevention at Main Line Health in Philadelphia.
Many tenets of infection prevention, such as hand hygiene, were not taken seriously by the public before the pandemic. But as the as the crisis intensified, communities sought knowledge on hygiene, masking, social distancing and vaccinations.
IPs were viewed as subject matter experts within and outside of the hospital walls.
“It’s nice when I tell people what I do and they have an idea what that means and they express gratitude,” Gowe said.
Shifting roles of IPs
Daily leadership decisions persist more than a year after the pandemic’s beginning.
“I continue to support an active system COVID-19 command center,” Sherman said. “The IP team makes rounds daily to provide support to the clinical team in applying isolation precautions and assessing exposure risks.”
New guidelines from the CDC and state health departments are constantly reviewed and toolkits are updated to support clinical teams on compliance with the latest guidelines.
“We got a glimpse into guideline developments and learned how to develop safe practice measures for ourselves,” Gowe said.
IPs wanted to ensure that their clinical staffs were protected. “PPE was probably the most significant concern,” Kerr said. “We vetted substitute products to ensure they were in line with NIOSH, OSHA, FDA and CDC guidelines. In addition, we looked to reprocessing or sterilizing other PPE such as N95 masks if we couldn’t get supplies.”
IPs played many different roles as subject matter experts. “I felt partially responsible for quelling fears in the staff,” Gowe said. “We have been professional coaches and repositories of evidence. Many conversations with healthcare workers surrounded concern for their families rather than how to don and doff PPE. That created a camaraderie with the staff.”
Rapid changes became the norm. “Our partnership with our process improvement team became critical to responding and operationalizing workflows that changed frequently with each new challenge the pandemic presented. Senior leadership support empowered the team,” Sherman said.
Supply chain partnerships
Supply chains increased production of PPE within the existing domestic manufacturing environment and using the Defense Production Act. Reliance on nontraditional manufacturers and suppliers as an alternate sourcing channel has been successful. Plus, traditional suppliers and sourcing channels are now meeting PPE needs and the larger health systems have sufficient PPE inventory levels.
“Our supply chain team have been tremendous partners in supporting the COVID-19 response,” Sherman added. “Sourcing for alternate products such as N95 respirators has been a labor of love.” Sherman said the IP team partners closely with the supply chain team at Main Line Health to evaluate all PPE and disinfection products before they are purchased. The two teams collaborate to communicate with staff regarding new products and to ensure education is provided to the end user.
Similarly, Kerr said the IP team at Hackensack Meridian Health continually cooperated with supply chain and clinical teams. “My role has always been in a leadership capacity, but the pandemic catapulted it into the prime resource and clearing house,” Kerr added.
“IPs were sought after by many vendors of new IP products during this pandemic,” Sherman said. “It was a difficult time to evaluate some innovative ideas while being solely focused on keeping patients and staff safe. We reviewed various disinfection options for the reuse of N95 respirators and considered various disinfecting products on different surfaces.”
As long as the FDA emergency use authorizations (EUAs) remain in effect and as more alternate sourcing channels emerge, the healthcare field must remain vigilant in vendor vetting programs. Hospitals utilizing nontraditional suppliers must follow their own formal vendor approval policies.
Preparedness
That vigilance and preparedness is vital for the future of healthcare planning. IPs must be embedded in emergency preparedness activities in a robust manner. Evaluation of PPE and other IP-related products to identify alternatives will continue to be an important activity for IP and supply chain teams.
“The development of an IP professional’s competency in leadership during a pandemic or crisis response should be included in all good IP programs,” Sherman said.
Kerr added that educational awareness on emerging infectious diseases and more prevention initiatives should be promoted. “People need to understand how outbreaks and clusters are mitigated and that we all have a responsibility to do our part, even if it means personal restrictions and inconveniences,” Kerr said.