By Sharon Ward-Fore, MS, MT(ASCP), CIC

Surface disinfection is key to containing viral outbreaks and has never been more important than it is right now. Fundamentally, the concept and importance of surface disinfection hasn't changed. However, the impact of the COVID-19 pandemic on today’s world makes it imperative to change how the health care community conducts proper surface cleaning and disinfection. It starts with mindset – because health care and lives depend on it.

Recent studies have shown that only 32% of the 110,000 objects in inpatient and outpatient health care facilities are thoroughly cleaned.

At iClean 2020, an evidence-based cleaning health care leadership conference, Didier Pittet, MD, MS, CBE, called for "urgent reform in our approach to cleaning and disinfection in hospitals and aged-care homes."

How cleaning is actually done today is based on time, the volume of room equipment, Environmental Services (EVS) staffing levels, experience and training, and the types of cleaning supplies available.

To mitigate the spread of potential pathogens that cause health care-associated infections (HAIs), infection prevention practices must evolve. Everyone practicing should know the following:

Proper cleaning and disinfecting are a top priority, and there is a definite distinction between the two

EVS plays a vital role in infection prevention

Everyone is responsible for infection prevention

Training about supplies must happen regularly and change based on the readily available supplies

Ruth Carrico, Ph.D., DNP, APRN stated at iClean 2020, "Reforming hospital and aged-care disinfection systems can not only help to continue to manage COVID-19 but also reduce the incidence of other hospital and aged-care facility-acquired infections."

So, what does success look like today, and how is it achieved? Here are 5 tips for getting cleaning and disinfecting right.

Between the trifecta of departments responsible for infection prevention—EVS, nursing and infection prevention—it’s every individual’s responsibility to ensure surface cleaning and disinfecting are done quickly and effectively to prevent potential pathogen transmission successfully. It all comes down to good teamwork and relationships with other IP experts, communication, accountability and unwavering protocol. Everyone must be on the same page.

Cleaning is a science. That means every element of the process matters, every single time—from quality cleaning with mechanical scrubbing to contact time to following CDC recommendations.

Protocols for individual patient care areas, including frequency, method and process, should be based on the risk of pathogen transmission. The probability of contamination is based on the patient’s care area, the vulnerability of the patient to infection (immunocompromised versus general patient), and the potential for pathogen exposure, ranging from high-touch to low-touch surfaces. For example, patient toilet areas should be cleaned last in the process because of their patient exposure, frequent contamination and higher risk of pathogen transmission.

The CDC recommends the following core practices for environmental cleaning and disinfection

Require routine and targeted cleaning of environmental surfaces as indicated by the level of patient contact and degree of soiling.

 Clean and disinfect surfaces close to the patient and frequently touched surfaces in the patient care environment on a more frequent schedule than other surfaces. Promptly clean and decontaminate spills of blood or other potentially infectious materials.

Select Environmental Protection Agency (EPA)-registered disinfectants with microbiocidal activity against the pathogens most likely to contaminate the patient care environment.

Follow manufacturers’ instructions for proper use of cleaning and disinfecting products.

 Consider the manufacturer’s dilution guidelines, contact time

, material compatibility, storage, shelf-life, safe use and disposal. The shorter the contact time and the more convenient disinfectants are to use, the more often they get used!

Tip 3: Pay attention to detail, provide coaching along the way and articulate success

Share these tips with your team so they can measure and evaluate cleaning quality

: EVS personnel and their supervisors should inspect their completed work to ensure that visible evidence verifies that basic cleaning is complete.

 Expert infection preventionists suggest that the evidence of the efficacy of the team’s cleaning is literally “on the wipe’ and easy to spot.

Adenosine triphosphate (ATP) bioluminescence test

: Place environmental surface swabs in the ATP reagent and a luminometer reads the amount of light. The results indicate whether the level is acceptable or unacceptable based on the number of relative light units (RLUs).

: Apply an invisible fluorescent mark onto the soiled surface. If the fluorescent mark is visible under a UV light after the surface is cleaned, the surface requires recleaning.

: Quantitative environmental cultures such as swabs and Replicate Organism Detection and Counting (RODAC) plates can be used as markers of thorough cleaning; less than 2.5 CFU/cm2 is considered acceptable.

Armed with the right tools, products and knowledge, everyone involved in health care facility cleaning and disinfection is empowered to play a vital role in the lives of all who set foot inside—which is just as crucial of a role as patient care. Involving every team member in the surface disinfectant conversation helps solidify their buy-in.

Standards can also help empower professionals. The CDC recommends these core components for a successful environmental cleaning and disinfection program

 environmental services into the hospital's safety culture.

 all HCP responsible for cleaning and disinfecting patient care areas.

 appropriate cleaning and disinfection technologies and products.

 setting-specific cleaning and disinfection protocols.

 effectiveness and adherence to cleaning and disinfection protocols.

 on success and quality of cleaning and disinfection to staff and stakeholders.

Tip 5: Instill awareness and adherence of turnaround time

In the approximately 40-to-45-minute turnaround time window

 for room cleaning, every moment counts. Team members have to work together quickly and effectively within their allotted timeframe without cutting corners to achieve successful pathogen eradication.

For example, in a typical terminal discharge, nurses need time to clean equipment properly before rolling it out of the room and into the hallway, paving the way for EVS to clean and disinfect the room. The equipment moved to the hallway has to be wiped down again and returned to its place in the room. Having to do all of this in a limited timeframe makes it crucial to follow standardized guidelines that everyone can follow and for IPs to monitor.

Tip 6: Know what to value in cleaning and disinfecting products

When it comes to surface disinfection, success is priceless. However, it's no secret that cost is a consideration for a facility’s financial decision-makers. When weighed against product efficacy and contact time, however, the best tools for the job will be those that can be relied on to get infection prevention right the first time.

For example, choosing a disinfectant product with a U.S. Environmental Protection Agency (EPA) Emerging Viral Pathogen claim for all virus types (enveloped, large and small non-enveloped viruses) is a wise investment to help protect patients and health care workers. According to the National Institute of Allergy and Infectious Diseases, emerging viral pathogens like SARS-CoV-2 are those “that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range.”

To qualify for the EVP claim, a disinfectant must be an EPA-registered surface disinfectant and kill at least two 

 types of small non-enveloped viruses—those that are difficult to kill. The EPA created this claim to establish parameters for disinfectant products to carry specific off-label efficacy claims for new and harder-to-kill viruses during a pandemic. When you use disinfectants with an EVP claim, you are using products formulated to meet current and future infection prevention needs, thus anticipating unpredictable public health crises.

Decision-makers should also look for a surface disinfectant on the EPA's List N–a list of products that the EPA recognizes to be able to effectively kill SARS-CoV-2 when used according to label directions.

Recognizing the importance of proper surface disinfection to help eradicate emerging viral pathogens is the first step in making this life-saving change. Taking responsibility, paying attention to detail, empowering staff, adhering to best practices and knowing what to value—which ultimately saves lives—are crucial factors for success.

Sharon Ward-Fore, MS, MT(ASCP), CIC, serves as Metrex’s Infection Prevention Advisor. Sharon is also an independent infection prevention consultant and is a member of the editorial advisory board of Infection Control Today®.

Rutala WA. New technology in environmental cleaning and evaluation. Presented at 40th Annual APIC Conference, Fort Lauderdale, FL, June 10, 2013. Available at: 

http://disinfectionandsterilization.org/slide-presentations/

Global healthcare needs infection control reform, say experts 

http://hospitalhealth.com.au/content/clinical-services/news/global-healthcare-needs-infection-control-reform-say-experts-957448066#ixzz6WWvpZBtJ

Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings – Recommendations of the Healthcare Infection Control Practices Advisory Committee. 

https://www.cdc.gov/hicpac/pdf/core-practices.pdf

Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Update: May 2019. 

https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf

https://text.apic.org/toc/infection-prevention-for-support-services-and-the-care-environment/environmental-services/#book_section_references

Healthcare-associated Infections. Reduce Risk from Surfaces. 

https://www.cdc.gov/hai/prevent/environment/surfaces.html

Patient Room Turnover – A Balance of Speed and Quality 

https://www.eonsolutions.io/blog/patient-room-turnover-a-balance-of-speed-and-quality

What is an emerging viral pathogen claim? 

https://www.epa.gov/coronavirus/what-emerging-viral-pathogen-claim

List N: Disinfectants for Use Against SARS-CoV-2. 

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

Articles

Between the trifecta of departments responsible for infection prevention—EVS, nursing and infection prevention—it’s every individual’s responsibility to ensure surface cleaning and disinfecting are done quickly and effectively.

More to Surface Disinfection Than Meets the Eye

 as “the action or process of providing someone or something with an official document attesting to a status or level of achievement.” When certification pertains to healthcare, the dictionary definition is “a voluntary process by which a nongovernmental agency grants a time-limited recognition to an individual after verifying they have met predetermined and standardized criteria.” To become 

, an individual must meet eligibility requirements and pass an assessment.

Infection preventionists (IPs) have the opportunity to attain this level of achievement or 

 through the Certification Board in Infection Control (CBIC) certification examination once they meet the eligibility requirements and feel ready to take the exam. This initial exam, although not perfect, does assess many of the areas an IP with 2 years of health care experience should know. It is a broad assessment of the subject matter all IPs working in a health care setting should be able to speak to. They include:

Identification of infectious disease processes

Surveillance and epidemiologic investigation

Preventing/controlling the transmission of infectious agents

Cleaning, sterilization, disinfection, asepsis

This list may look daunting but remember that 2 years of on-the-job experience goes a long way in helping you prepare for the initial exam. That day-to-day stuff we do where we track and trace 

transmissions, work on construction and renovation ICRAs, participate in environment of care (EOC) rounds, audit insertion practices, perform outbreak reporting and investigation—this is the stuff that that initial certification examination is all about. Preparing for the exam helps us learn, grow, and become better IPs. Better IPs means better outcomes for patients. And this is what infection prevention is about.

This day-to-day learning can only come from actual experience in a health care setting. I firmly believe that this is the best way to help IPs become the best they can be. I am a visual learner and learned most of what I know from being out on the floors—watching, listening, questioning—everyone that would let me bother them. What an eye-opener it can be to watch actual practices versus a training module on central line insertion!

That’s why the eligibility requirements for first time/lapsed candidates are scheduled to be changed June 1, 2021. First-time candidates, candidates who have not successfully passed the examination, and those whose certifications have lapsed and who wish to become certified again must have all of these:

 including but not limited to medicine, nursing, laboratory technology, or public health.

Direct responsibility for the infection prevention program activities in a health care setting.

Work experience, defined as active engagement in infection prevention, determined by a current job description, for compensation, for a minimum of:

At least 1-year full-time employment, OR 2 years part-time employment, OR 3,000 hours of infection prevention work experience earned during the previous 3 years.

And that’s not all. The infection prevention activities must include:

Preventing and controlling the transmission of infectious agents

Cleaning, disinfection, sterilization, and asepsis

AND at least 2 of the remaining 3 components:

These requirements are the meat and potatoes of infection prevention. They are what, I believe, gives it value and prestige. This certification is not for everyone because it shouldn’t be. It should be for those actively working in health care supporting health care providers by providing education and training. For those who have earned the right to take the test not just because they have a degree but because they learned by “boots on the ground” everyday practice.

This certification shows your dedication to your craft. This is how we distinguish ourselves and stand with other professionals. So, take this opportunity to distinguish yourself and get the credit you deserve for your education, experience, and perseverance. Stand with the 7000 other IPs who decided it’s important to be certified. It isn’t easy, but the satisfaction of this achievement far outweighs the preparation needed to pass. You can and should do this so you can make yourself proud!

This year I am due to recertify my Certification in Infection Control (CIC). I have recertified by self-achievement recertification examination (SARE) once and will now recertify using continuing education credits—such as infection prevention units (IPUs) training—a new option instead of taking the SARE. Re-certification feels even more important to me than ever.

During this pandemic everyone thinks they know infection prevention—from my hairdresser, who I have not seen in a year, to the gym attendant, who I have also not seen in a year. They will tell you they are experts in infection prevention. So, when I strike up a conversation with someone and mention that I am 

in infection prevention, they are somewhat impressed, but mostly curious.

So, what exactly is recertification? The dictionary definition is “to renew the certification of 

OK, that really doesn’t do it for me because the intent of recertification of the CIC is so much more. Recertification of the CIC is to revalidate all the education and experience that 

 to accrue while working as an infection preventionist. Health care is not a static environment. The amount of information, practices, and procedures that change is overwhelming. Recertification challenges IPs to keep up with changes and continue to learn.

Do you remember the definition of certification from the beginning of this article?Certification—“a voluntary process by which a nongovernmental agency grants a 

 to an individual after verifying they have met predetermined and standardized criteria.” 

The key words to striving to keep up to date with what is happening in your profession. Recertification every 5 years is s not exactly popular, but I believe it is necessary so we don’t get “stale” in our thinking and practices. It pushes us to keep up to date.

The CBIC is responsible for administering these exams. And to its credit, CBIC heard the issues about the SARE and came up with the continuing education (CE) IPU option for recertification. You can still sit for the SARE, or input 40 hours of CE/IPU, the choice is yours. And the 40 hours of continuing education must include 6 out of 8 of the following learning domains:

Cleaning, sterilization, disinfection, asepsis.

They are the same categories that are tested in the initial certification exam and the recertification SARE. So, you can’t just input a bunch of nonsense. You must participate in specific domains of learning. Even if you only work in one setting type, you are expected to stretch yourself professionally and attend other educational learning. This is a good thing. It forces us out of our silos.

I have begun the process of inputting all of the necessary CE/IPUs into the CBIC system. Word of advice—input the CE/IPUs as you get them. Don’t wait and enter them all at one time like I have done. It is time consuming. But being regarded as the infection prevention professional that I have worked so hard to become, a CIC, I will keep on plugging. I see the value in the certification and the continuing education for recertification. You should, too. Just. Do. It.

Stand with the 7000 other infection preventionists who decided it’s important to be certified. It isn’t easy, but the satisfaction of this achievement far outweighs the preparation needed to pass.

Infection Control Certification: What Are You Waiting For?

It’s almost hard to believe the United States has been dealing with coronavirus disease 2019 (COVID-19) since January 20, 2020. The virus is still raging around the world. Health care is still struggling to keep up. Many businesses, large and small, have closed for good. Everyday activities such as getting your hair cut, going to the grocery store, gathering with friends, going to school or work, and eating at your favorite restaurant have changed drastically. These struggles and changes, in the health care and non–health care sectors, may affect things forever, at least in some ways. Fortunately, COVID-19 vaccine distribution has already started for frontline workers and long-term care/congregate facilities. Essential workers will be next in line for vaccination to help to revive the struggling non–health care sector. However, it will be too late for many working in restaurants and other businesses that lacked the same resources and level of preparedness as the health care industry.

Those working in health care have learned a lot during the pandemic about keeping patients and staff safe; managing supply chain items such as personal protective equipment (PPE), disinfectants, and other critical supplies; and preparing for shortages of staff and their emotional needs. Preparedness planning was something most facilities reviewed annually. Now, they are reviewing plans to determine when it might be safe to resume elective surgeries and other procedures placed on hold, as the pandemic becomes more manageable due to vaccination. Health care relies on specific guidance from the Centers for Disease Control and Prevention (CDC), and state and local agencies. They have plenty of resources available, including staff such as infection preventionists (IPs) to safely guide them along the journey to reopening and fully resuming care.

Dentistry has a very strong COVID-19 program guided by the CDC in collaboration with the American Dental Association (ADA). And they should have, as most of what they do involves performing aerosol-generating procedures, placing dentistry into a high-risk group category. The 

ADA offers a robust Return to Work Interim Guidance Toolkit and a COVID-19 Hazard Assessment & Checklist with recommendations for before, during, and after appointments to protect dentists, patients, and staff.1 Dentists and their staff were already well versed in using PPE and cleaning and disinfecting patient care equipment. Typically, they designate someone as their infection control person who can answer questions and provide guidance and training. They were able to ramp up procedures and see patients safely, gradually resuming the provision of dental services.

The American Veterinary Medical Association (AVMA) also had a tremendous number of resources for safely managing their practices and patients during the pandemic.

They produced a comprehensive risk management guide, Resuming Veterinary Practice Operations During the COVID 19 Pandemic (described as a “playbook to help our veterinary practices recover by addressing specific issues that relate to your team, patients and clients, property, and the practice’s profitability”).2

The CDC also provided additional guidance for veterinarians, including specific recommendations about companion animal practice, recommending screening companion animals for exposure to people with COVID-19. Additionally, veterinarians are familiar with PPE use, cleaning, and disinfection,3 and had many resources to guide practice and answer questions. Their practices were up and running fairly quickly with mitigation procedures in place to keep staff, clients, and pets safe.

Health care, be it for animals, humans, or teeth, had plenty of experience with the nuts and bolts of providing care. They had PPE use, disinfectants, and a wealth of resources at their fingertips, including financial ones.

However, the non–health care sector—corporations, schools, fitness centers, libraries, hair salons, restaurants, and other businesses—was not so fortunate. They did not have access to an abundance of resources, exposing a huge, glaring knowledge and resource gap that threatened their existence. Very few, if any, had a preparedness plan. Their guidance has been general, mostly “one size fits all,” at best, from the CDC, the World Health Organization, and state and local agencies.

This is not to fault any agency, because saving lives was and still is the priority; health care was overwhelmed with patients, so resources were naturally directed to patient care. But the non–health care sector was left to struggle more or less on its own, interpreting guidelines that were ambiguous at best, with terminology and processes that few were familiar with, such as contact time and PPE. Their experience was not in PPE or pandemics but in cutting hair, preparing food, providing fitness classes, teaching children, and helping you find a good book. And we thought health care had been turned on its head!

As an IP, I was shocked and worried about my safety and others’ when I ventured out to a grocery store or small business. I saw single-layer bandanas open at the bottom, gaiters soaked in water in hopes of preventing virus spread, a homemade face shield made from a plastic page protector attached to a cloth headband, face shields without masks, welding helmets, and even a swim mask with a snorkel attached—I kid you not. The vast, creative interpretation of PPE took my breath away. And everyone seemed to touch or adjust their mask every few seconds. It was maddening. And don’t get me started on social distancing.

Human resource departments, store managers, librarians, hair stylists, and restaurant owners were thrown into the role of figuring out for themselves how to continue to operate safely for their employees and clients. No 2 businesses are alike. There are lots of similarities, but just enough differences to make many physical setups unique. Most businesses, unlike health care, had no one to walk through their space with them and talk through risk mitigation strategies such as using physical barriers, adequately spacing out tables and chairs, establishing occupancy limits, and setting up or improving ventilation so they could safely continue to operate.

They had no one trained in hand hygiene, respiratory etiquette, cleaning and disinfection, or PPE selection and how to wear it, and who could work with their staff. There was no one to call or page in the middle of the night with questions. They were essentially figuring it out for themselves to the best of their abilities. As the pandemic wears on, the toll it has taken on businesses of every kind, both large and small, is enormous. Livelihoods are at stake. The non–health care sector needs more than a bunch of guidelines to help them.

In response to this need, some programs became available for businesses or individual employees, such as an online course covering what COVID is and how it spreads; masking, hand hygiene, and cleaning; and basic safe workplace practices. Upon completion of one 50-minute course you can be “COVID certified.” These basic courses are a good start but may also lead to a level of competency that isn’t really there. Passing a computerized course, putting what was learned into place, and making sure it “sticks” are not easy to do.

As an IP, I know that practices drift, not everyone learns in the same way, and auditing practices are vital, especially those you are unfamiliar with.

What is required is a more robust program specifically fine-tuned to a particular business. A relationship such as the one IPs have with their units—someone designated to guide them, answer questions, and be there for them—would be ideal. And there are IP consultants who work with non–health care sectors in exactly this way.

They provide hands-on training, auditing, and protocols, and act as a resource to help those in the non–health care sector operate safely during the COVID-19 pandemic.

I spoke with Phenelle Segal, RN, CIC, FAPIC, the president of Infection Control Consulting Services, LLC, to get her take on the struggles of the non–health care sector. She said, “The challenge for the non–health care industry has been the extensive volume of guidance coming from nationally recognized agencies. Guidelines are often confusing, and the non–health care sector has done a good job of interpreting general guidelines and adapting them to the best of their ability. The gray areas subject to interpretation and finer details are definitely challenging, and that is where external assistance is needed.

“Our experience has been very positive as these industries rely on our expertise to guide them to…keep their employees and customers or clients as safe as possible. We are amazed at the conscientious approach of our non–health care clients and their level of involvement to do the best for their employees and customers or clients. Several clients had already implemented policies and procedures…and needed us to validate and provide further guidance.” This is what is needed to help the non–health care sector survive and thrive during COVID-19—an ongoing relationship with an expert who is there for them every step of the way.

Unfortunately, there will be other pandemics and outbreaks in the future. So, I see this as an opportunity for IPs, specifically, to use what they have learned in their health care roles to help guide the non–health care sector to success. IPs have the skill set to provide guidance beyond the health care setting. We know how to select PPE and how to use it. Cleaning and disinfection are like breathing to us. Issues concerning construction and renovation, including heating, ventilation, and air conditioning systems and the importance of air exchanges, are something we deal with all the time. We routinely train others, answer questions, and provide guidance and resources. We can and should begin to look at helping the non–health care sector so they can safely thrive now and in the future. Perhaps, working with our local public health departments, we can model the approach health department inspectors use for restaurants, salons, schools, and businesses, focusing on COVID-19 mitigation and staff training. We can visit businesses and help them make a plan. The need is there: we can help guide the non–health care sector and validate their best practices so they can safely open their business, school, or church during the pandemic. Their employees need us. Our economy needs us. We should think about how we can step up and help because this is what we are good at. We can do this.

SHARON WARD-FORE, MS, MT(ASCP), CIC, is an infection prevention consultant located in Chicago, Illinois. She is also a member of the Infection Control Today® Editorial Advisory Board.

Get the Return to Work Interim Guidance Toolkit. ADA. Accessed December 18, 2020. https://pages.ada.org/return-to-work-toolkit-american-dental-association?utm_campaign=covid-19-Return-to-Work-Toolkit&utm_source=cpsorg-alert-bar&utm_medium=cpsalertbar-virus&utm_content=covid-19-interim-return-to-work&_ga=2.148380273.75969005.1610378717-1039469849.1610378717

Practicing veterinary medicine during COVID-19. AMVA. Updated July 2, 2020. Accessed December 18, 2020. https://www.avma.org/resources-tools/animal-health-and-welfare/covid-19/practicing-veterinary-medicine-during-covid-19

Interim infection prevention and control guidance for veterinary clinics treating companion animals during the COVID-19 response. CDC. Updated August 12, 2020. Accessed December 18, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/community/veterinarians.html

Infection preventionists have the skill set to provide guidance beyond the health care setting. We know how to select PPE and how to use it. Cleaning and disinfection are like breathing to us.

Infection Preventionists Can Help the Non–Health Care Sector Thrive

During the first surge of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, infection preventionists (IPs) had to figure out how to use/reuse single use personal protective equipment (PPE) and train staff to do the same. IPs had to change their message from “please don’t reuse that” to “please don’t discard that just yet.” This was not normal, and everyone knew it. The sheer volume of patients infected with COVID-19 drastically changed everything healthcare personnel (HCP), especially IPs, knew about PPE used to protect their health and safety while caring for patients.

In response to these nationwide PPE shortages, the US Centers for Disease Control and Prevention (CDC) developed an entire section on its website dedicated to strategies for optimizing PPE supplies titled “Optimizing Supply of PPE and Other Equipment During Shortages.”

 It describes how patient surge, defined as “the ability to manage a sudden increase in patient volume that would severely challenge or exceed the present capacity of a facility” can be used to help monitor PPE use for facilities experiencing shortages. There is a quick reference chart that summarizes the CDC’s strategies to optimize all PPE, providing detailed strategies for N95 respirators, facemasks, gowns, and gloves. It also includes links to the CDC’s full guidance documents on optimizing supplies. It is a very detailed chart meant to be implemented sequentially, based on conventional, contingency, and crisis capacity, which is clearly spelled out. Every IP should have this readily available.

In addition to the quick reference summary chart, the CDC, in collaboration with the National Institute for Occupational Safety and Health (NIOSH), developed the Personal Protective Equipment (PPE) Burn Rate Calculator.

The calculator was designed to help estimate how many days a PPE supply will last given current inventory levels and PPE “burn rate” or consumption. Originally a spreadsheet-based model that helped healthcare facilities plan and optimize their use of PPE for response to COVID-19 in the initial surge, it is now also available as an app for both iOS and Android, called the “NIOSH PPE Tracker App.”

To use the calculator, you enter the number of full boxes of each type of PPE in stock (gowns, gloves, facemasks, surgical masks, respirators, and eye protection/face shields) and the total number of patients at your facility. The tool calculates the average burn rate for each type of PPE entered in the spreadsheet. This information can be used to help estimate how long the remaining supply of PPE will last, based on the average burn rate. Using the calculator can help facilities make order projections for future needs. This is a really handy app for anyone to have who orders supplies, especially supply chain and unit managers, as we again begin to experience PPE shortages.

Although IPs generally have limited involvement with supply chain, it might be worthwhile to find out more about supply chain and how it works so you can understand the process of bringing in products. This knowledge might help answer questions when you are rounding on your areas and questions about supplies that come up from HCP. Knowing who the person is who keeps your areas stocked with supplies is also a very valuable relationship to nurture.

And don’t forget what happened in the first surge of COVID-19-positive patients. To conserve PPE for use by HCP on the frontlines, the CDC provided guidance on methods to reduce PPE use for patients on transmission-based precautions such as contact precautions for multidrug-resistant organisms (MDROs)—specifically vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA).

 Typically, contact precautions is the single use of gown and gloves when caring for patients who are either colonized or infected with one or more MDRO. But during the first COVID-19 surge, a “bundled” approach for patient care, to not using some PPE at all, with an emphasis on glove use and hand hygiene, was recommended by the CDC for HCP caring for patients in isolation precautions other than COVID-19. Much about the previous use of PPE in many facilities was deferred until supplies were replenished or COVID-19 patient volumes decreased to manageable levels.

Historically, PPE has been used to “break the chain” of transmissible disease. But PPE alone cannot reduce organism transmissions. A comprehensive program that includes antimicrobial stewardship, hand hygiene, chlorhexidine bathing, a cleaning and disinfection program of the patient environment and equipment, and decolonization, where appropriate, should be considered as a “bundled approach” to preventing transmissions.

The initiation of isolation precautions should be considered by the infection control program based on local, state, regional, or national recommendations, and be of clinical and epidemiologic significance for that particular hospital or region.

Last, healthcare institutions should have a process in place to remove isolation precautions since the necessary duration of contact precautions for patients treated for infection with an MDRO, but who may continue to be colonized with the organism at one or more body sites, remains an unresolved issue.

According to the latest updated CDC guidelines “Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006,”

 contact precautions can be discontinued when 3 or more surveillance cultures for the target MDRO are repeatedly negative over the course of a week or 2 in a patient who has not received antimicrobial therapy for several weeks, especially if there is:

no evidence implicating the specific patient in ongoing transmission of the MDRO within the facility.

But being able to do this is a lot harder than it might seem. Issues with frequent admissions and transfers within and outside of facilities, and monitoring antibiotic use makes this especially difficult, so patients sometimes remain on contact precautions for MDROs like VRE and MRSA indefinitely, despite the best efforts by IPs.

Those facilities that have been performing some kind of surveillance on VRE and MRSA transmissions during COVID-19 should look at their data. The ability to compare transmission data for patients on contact precautions using the recommended full complement of PPE versus transmissions for patients on contact precautions when PPE was being utilized differently or not at all, would be very valuable information for a healthcare facility to have.

Now would be the time to determine the value of how PPE is used for contact precautions, with facility level data regarding patient transmissions—one of the main reasons for PPE use.

Your facility could reap the benefits of lower costs, higher patient and staff satisfaction, a greener future for our planet, and a method to always have enough PPE on hand. But remember to audit this process and track transmissions. As most IPs know, practices drift. So, stay on top of it! 

SHARON WARD-FORE, MS, MT(ASCP), CIC, is an infection prevention consultant located in Chicago. She is also a member of Infection Control Today®’s Editorial Advisory Board.

Centers for Disease Control and Prevention. Optimizing Supply of PPE and Other Equipment during Shortages. Centers for Disease Control and Prevention website. Updated July 2020. AccessedNovember 6, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Centers for Disease Control and Prevention. Personal Protective Equipment (PPE) Burn Rate Calculator. Centers for Disease Control and Prevention website. Updated April 7, 2020. Accessed November 6, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html

National Institute for Occupational Safety and Health. Personal Protective Equipment. NIOSH PPE Tracker App. National Institute for Occupational Safety and Health (NIOSH) website. Updated June 2020. Accessed November 6, 2020. 

https://www.cdc.gov/niosh/ppe/ppeapp.html

Centers for Disease Control and Prevention. Clinical Questions about COVID-19: Questions and Answers. Centers for Disease Control and Prevention website. Updated November 18, 2020. Accessed November 20, 2020. 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#Infection-Control

Young K, Doernberg S, Snedecor RF, Mallin E. The things we do for no reason: Contact Precautions for MRSA and VRE. 

. 2019 March;14(3):178-180 | 10.12788/jhm.3126

Centers for Disease Control and Prevention. Management of Multi-Drug Resistant Organisms in Healthcare Settings – Duration of Contact Precautions. Updated February 15, 2017. https://www.cdc.gov/infectioncontrol/pdf/guidelines/mdro-guidelines.pdf

Centers for Disease Control and Prevention. Management of Multi-Drug Resistant Organisms in Healthcare Settings Updated February 15, 2017

https://www.cdc.gov/infectioncontrol/pdf/guidelines/mdro-guidelines.pdf

The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

. 2017 Mar; 32(3): 262–268. Published online 2016 Oct 17. doi: 10.1007/s11606-016-3862-4

Compare transmission data for patients on contact precautions using the recommended full complement of PPE versus transmissions for patients on contact precautions when PPE was being utilized differently or not at all.

By Sharon Ward-Fore, MS, MT(ASCP), CIC

Articles

More to Surface Disinfection Than Meets the Eye

Infection Control Certification: What Are You Waiting For?

Infection Preventionists Can Help the Non–Health Care Sector Thrive

Time to Update Personal Protective Equipment Protocols?