Frank Diamond has been with Infection Control Today since November 2019. He has more than 30 years of experience working for magazines, newspapers, and television news. 

Frank Diamond

When it comes to staffing hospitals, public and private health care officials strive to reach a balance between the safety of HCPs and the ability of institutions to function properly, especially during COVID-19 surges. The issue came to the fore last December when the Centers for Disease Control and Prevention (CDC), with an eye on critical staffing shortages in the health care industry, which has lost about 20% of its workforce since the beginning of the COVID-19 pandemic, shortened the recommended isolation time for health care workers exposed to COVID-19 in high-risk situations from 10 to 7 days (Sharon Ward-Fore, MS, MT[ASCP], CIC, FAPIC, a member of the 

] Editorial Advisory Board [EAB], clearly spelled out the dos and don’ts of the recommendations in a 

spoke with Graham M. Snyder, MD, MS, medical director for Infection Prevention and Hospital Epidemiology at University of Pittsburgh Medical Center, and associate professor, Division of Infectious Diseases at University of Pittsburgh School of Medicine about a study on this topic. Snyder was the lead author on the 

 titled “Health care personnel early return-to-work program after higher-risk SARS-CoV2 exposure: A learning health system quality improvement project,” published in the 

). Snyder says, "In this quality improvement study, the lesson was in the learning." 

National Nurses United, a union representing more than 175,000 members, immediately 

 agaomst the study, arguing that the recommendation puts nurses on the front lines of the COVID-19 wars in jeopardy. And despite a recent 

 in hiring in the health care sector, hospitals and other health care facilities must still deal with staffing shortages.

Investigators with the University of Pittsburgh Medical Center wanted to see just what the effects of shortened quarantines might be. They concluded that HCPs can safely return to work (RTW) after 7 days of quarantine if they test negative for COVID-19 on days 5 to 7.

“To optimize employee health, patient safety, and health care capacity, extraordinary efforts are needed to address contingency and crisis planning to mitigate staffing shortages before the next wave of COVID-19 cases,” investigators reported in the study. “Implementing an HCP early RTW program is one strategy to increase staffing availability and therefore reduce burden of staffing shortages on the health care workforce, while maintaining a low risk of SARS-CoV-2 transmission.”

The observational study included HCP working at a 40-hospital integrated health care system in central Pennsylvania in which employees faced a higher risk of either workplace or non-household community exposure to COVID-19 in 4 or fewer days. HCPs could return to work 8 days after exposure “if they remained asymptomatic through day 7 with day 5-7 SARS-CoV-2 nucleic acid amplification test result negative,” the study states.

Investigators tracked 384 HCPs between January 4 and June 25, 2021, who followed the recommendations. Of the 384 participants, 333 (86.7%) remained asymptomatic. Of these, 323 (97%) tested negative and were thus eligible to return to work.

“Median day of early RTW was 8 (range 6-9, IQR 8-8),” the study states. “Mean days saved from missed work was 1.84 (SD 0.52). A total of 297 (92%) HCP did RTW ≤ 10 days from exposure and days saved from missed work was 546.48.”

Investigators note that COVID-19 may last for years, and Omicron might not be the last variant to emerge and challenge health care systems. The way those systems can meet future challenges will be to be as fully staffed as possible. The 10-day quarantine was established as a “conservative” way to manage risk of exposure to COVID-19, the study notes. While the CDC offers quarantine recommendations, many hospitals and other health care facilities will use different standards.

That’s a point made recently by Linda Spaulding, RN-BC, CIC, CHEC, CHOP, an infection prevention consultant and another 

 that “if nurses are still sick at day 5, they shouldn’t be coming back to work yet. But they’re feeling pressure by their hospital to return to work because of the nursing shortage.”

Spaulding added that infection preventionists can’t provide much help to stressed nurses. “IPs can listen to the nursing staff but they’re pretty much powerless if the administration [of a hospital] is requiring them to return to work,” says Spaulding. “From what I hear from nurses, they’re going to try hard to take care of patients with COVID-19. But as soon as this surge is over, they’re going to leave nursing and if there’s another surge, we’re going to have even less staff than we have now.”

 study state that the system they use builds in flexibility.

“We were able to flex the 7-day quarantine period in the program back to a 10-day quarantine period when staffing constraints eased and resume the 7-day early RTW program when the pandemic surged again,” the study states. “As a learning health system, we used these findings to inform new methods for Employee Health specimen collection, including a program for symptomatic self-testing with results typically available within 1 day.

Investigators concluded that "adaptability is critical in pandemic response, as is real-time evaluation of interventions like the early RTW program. Outcomes from this program were reviewed no less than weekly to ensure a safe work environment for HCP and safe patient care.”

Snyder also mentions in the interview that a new study is coming soon on how quickly HCWs can come back if they are sick and contagious. The investigators are looking at the HCWs returning as soon as 5 days. 

Videos

Investigators concluded that HCPs can safely return to work after 7 days of quarantine if they test negative for COVID-19 on days 5 to 7.

Calculating Return-to-Work COVID-19 Policies Is a Balancing Act for Hospitals

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Bug of the Month helps educate readers about existing and emerging pathogens of clinical importance in healthcare facilities today. 

Bug of the Month: Trust Me, I Pose No Threat to You at All

The infection preventionist (IP) job in the Veterans Affairs (VA) health care system differs from the IP job in the private sector. Perhaps not by much, but it’s different, says Robbie Hilliard, MSN, RN, CIC, the infection prevention coordinator, at Carl Vinson V.A. Medical Center in Dublin, Georgia. One of the biggest differences is how infections are tracked, says Hilliard, who’s a member of 

’s Editorial Advisory Board. “We all calculate rates based on their days of care and the number of infections that each unit has,” says Hilliard. “But we classify our patients a little bit differently.” The VA acts as a proving ground for infection prevention innovations, such as printers that can 

 personal protective equipment. “A lot of these innovations are diffused from VA facility to VA facility before they ever hit the private sector,” says Hilliard. IPs in the VA system also work closely with other specialties. “And a good example of that,” says Hilliard, “is the 

non-ventilator associated pneumonia initiative

 that VA recently took on, and that was led by dental for the most part. Infection prevention benefited greatly.” In other words, an IP in the VA system has to be a Jack-of-all-trades. “We do everything,” says Hilliard. “We do ambulatory care. I do all of the outpatient clinics, just like I do the nursing home care facilities.”

I know that you’ve worked as an IP outside of the VA system, too. How do the two roles differ, if they differ at all?

Infection preventionists in the private sector and in the VA—they’re very similar. Both do surveillance for health care-associated infections [HAIs]. Both monitor hand hygiene. They’re involved in antimicrobial stewardship. They’re very similar in a way. The biggest differences that I have noticed are how they track infections in the baselines. We use different baselines in the private sector than we do in the VA for each respective area. VA uses 

—the Inpatient Evaluation Center. And it helps us to manage and organize our data. It’s where we report our HAIs. And then IPIC turns it over to the NHSN [

], which is where everyone else reports there’s. I think it’s very useful. It helps us to get our ratios and all of our percentages and that kind of stuff. We can just put in the data, and it automatically gives us the information that we need. That 

helps us to calculate all our rates and do our bed days of care and that kind of thing. That’s very helpful. I also liked that the VA has a national MDRO [

] program office. IPs in the private sector tend to have to do MDROs by themselves, and they have to do both jobs. Usually, they wear two different hats. But having a program office designates one person at this VA for multidrug-resistant organisms and that allows a single staff member to focus on those bugs that are hard to kill, that have the potential to do a lot of damage to patients, to do a lot of harm. And I also like that VA research often leads to innovative infection prevention methods. A lot of these innovations are diffused from VA facility to VA facility before they ever hit the private sector. It’s easy to sit back and let other disciplines help, I think in the VA, because those disciplines will ease the load on the infection preventionist. And a good example of that is the 

 that VA recently took on, and that was led by dental for the most part. Infection prevention benefited greatly. But when we saw the beginning of the program, the dental [experts were] assisting to help lead the way. I think that is very helpful to us to have other disciplines, where you don’t quite see that as much in the private sector as you do in VA.

Do hospitals and hospital systems outside of the VA reach out to you sometimes to find out what you’re up to?

Yes, that happens a lot of times. We collaborate with outside facilities a lot, especially now that COVID-19 has hit. We work very closely with the epidemiologist in the local community. It’s in our area, or demographic area. We do work with them a lot. And they do reach out a lot. We receive a lot of research from facilities. In San Francisco, the universities there … there are a lot of places that would like to get our input because we serve such a large rural community. And so that’s fascinating to some people, because we don’t have transit. We don’t have a lot of the resources that other places have. But we still serve the same veterans and offer the same services. A lot of times they reach out to us to see what our best practices are for getting those services to veterans in a rural area, especially here in Georgia.

I’m thinking—and correct me if I’m wrong—that you serve an older demographic than do IPs in the private sector. Fair assumption?

Yes, we do have a lot of older veterans, but we also serve a lot of young. You’d be surprised: The age group here ranges greatly from low 20s, and our oldest patient in-house right now is 106.

I’m not only talking about ranges. Isn’t it fair to say that we’re talking about retired veterans who are older?

Yes, we do serve a lot of retired, older veterans. I just think that we’re doing more outreach as far as mental health and things. That is bringing in a younger population.

During the first wave of COVID-19 nursing homes were hit hard. Did you see that as well?

[Not really.] Because of our reporting requirements as [a federal agency]. We report a lot more than the general public. They may go in and report it to the Joint Commission. But we do a lot of different reporting and, I think, a whole lot more accountability. And when you do that, and you’re making an attempt to be transparent. I do think it brings more scrutiny and more spotlight to you. But I don’t think that our numbers were any different than anyone else’s. I think we were probably about the status quo about the same as everyone else as far as deaths in our older population for COVID-19.

Do you think COVID-19 changed the infection preventionist job in any way? And if so, how?

The job of infection preventionist didn’t change from COVID-19, but it evolved a little bit. There’s a lot more reporting these then there’s ever been. We’ve never reported the way that we report now. That has increased significantly. There’s huge need now for IP guidance in multiple disciplines. Our phones have never rung so much before. We’ve never had the email traffic that we have now. Like mental health patients. Mental health prevents COVID-19 differently than urgent care, for example. I don’t think we’ve ever had the request for our expertise quite as much as what we’ve had during COVID-19. And we continue to do the same thing we’ve always done. Stress hand hygiene, respiratory etiquette, social distancing, but we would always do that during flu season.

Does the infection prevention department occupy a different position in the health care hierarchy in Veterans Affairs than it does elsewhere?

I would probably say yes, because when a patient comes to the VA, the placement can be very unusual. For example, I’m under quality management. I’m considered quality management staff. Whereas in a hospital, you don’t really see that. You’re really more up under medical, and you work closer with medical. I think that because we have such a vast majority…. We have seven C-BOCs [Community-Based Outpatient Clinics]. Infection control for a C-BOC is very different than infection control for one of our CoCs [Continuum of Care units] like our nursing home units. And very different from our surgery unit. I think that we have such a wide variety that it takes somebody being better quality, versus just medical, because it’s not all usually about medical here. It’s about everywhere a patient is seen—that area being safe and conducive to patient care. We only have three VA [hospitals] in the state of Georgia that are medical centers. That’s Atlanta, Augusta, and us [Dublin]. That’s it. That’s health care for the veterans. If you’re a veteran who lives 50 to 75 to 100 miles away from us, the easiest thing for you to do is to go to one of our outpatient clinics, our C-BOCs. They’re freestanding clinics. They give vaccines, draw blood, do the things that meet the patient’s needs without them having to come all the way down here. And if they need to see a specialist, they’ll do telehealth. They could sit down at the C-BOC 100 miles away and confer with a pulmonologist here or a cardiologist there. Because rurally there’s just so much we can do. There’s such a wide amount of space covered here, geographically, that we just can’t cover it all with big VA [centers]. We have smaller clinics that are open to a serve our veteran population.

One of the concerns of the infection preventionist profession is that 40% of IPs are due to retire in the next 10 years. Is that demographic challenged faced at the VA as well?

Oh, absolutely. Infection preventionist is a dying breed. Usually when you go into this position, you stay in it for a long while because it takes so long to learn everything and to get certified. In the old days, you had to practice actively for two years as an IP before you could even take your certification board. They’ve waived that now and that’s to help more people get certified. There’s such a large variety of things that infection control encompasses that it’s hard to be knowledgeable and it’s hard to know everything that you need to know without just putting in the years and that’s the truth. And the only way that you’re going to get the experience is that every time something crops up that you don’t know very well you learn it very well when you face it one-on-one in your facility. I do think that that is probably an issue we do see a lot of. Another thing is it takes so long to hire in the VA system that the old infection preventionist has gone by the time new one gets there. When I came on, there was nobody that knew anything about infection prevention here. I just had some background myself, and I was flying by the seat of my pants.

How do you try to encourage younger people to consider infection preventionist as a career choice?

Well, we do have students that come all the time. We have lots of nursing students. We have pharmacy students, radiology students. And we also have people that we do practicum for our nursing population, like when nurses or go back to school to get their bachelor’s or their master’s or they’re here for their clinicals. That’s always a good opportunity. We do a presentation to them for orientation. And I try to make my presentation as interesting as possible. Because I love infection control, it fascinates me. And I try to use some of the things that fascinate me to fascinate them. To say, “Hey, look at this slide of MRSA [Methicillin-resistant 

] and look at what happens after you use some hand gel. Take a look at the difference.” And it’s fascinating. And most people have never seen that. I’ll try to use what’s fascinating to me to show them that, “Hey, look at what a big difference a little bit of hand gel makes. And you wouldn’t think that but look at it. This is a visual of what it actually does.” I think that showing them the fascinating side of it doesn’t hurt. And I think that’s going to lead more people into it. And also making it easier to get certified. [At one time] nobody wanted to hire you unless you were certified. But you had to practice for two years before you could get certified. It was a Catch-22. I think all of those things are going to lead to more people into infection control in the future, hopefully.

And tracking is one of the things that sets VA infection prevention apart?

Out in the general private sector, they use NHSN. Now we’re all using CDC guidelines. But we view our populations a little bit differently. We all calculate rates based on their days of care and the number of infections that each unit has. But we classify our patients a little bit differently. And that’s just because VA is a little bit different than everyone else. We have specific programs like the 

National Multidrug-Resistant Organism Office

. That is nothing but a VA-based program that puts a person in that position to handle those bugs that are really hard to kill, or that have a high mortality rate, like MRSA in hospital settings. I think the private sector has not set aside a person just to do that. I think that that is two of the biggest differences that I see.

When you talk shop talk with IPs in the private sector do they seem interested in how you battle infection at the VA?

Oh yes. I think so. All the infection preventionists, whether you’re a private or public, are all facing a lot of the same issues. We don’t handle them the same way. But we’re all facing the same issues. With all these cases of COVID-19, all of our reporting requirements have gone up, because everybody at the hospital is reporting just as every COVID-19 case they have, just like I am. And so that is additional job duties that we’ve never had to do before. That’s extra work. And we thought that it would go away after 2020. And it’s two years later, and I’m still putting in 10 to 20 cases a day. So that’s so much more than what we’ve ever had to do for any other virus. For any other infectious process.

The Association for Professionals in Infection Control and Epidemiology [APIC] is lobbying for states to mandate that anybody with the title infection preventionist in a health care setting have 

. Have CIC after their name. Is that already in place at the VA?

It’s encouraged, but it’s not mandatory. It is something they look at heavily when they’re doing hiring. If there’s a certified person, a person who is certified in infection control, interviewing for that position, they’ll more than likely get the job over a person who’s not. I was not certified the first couple years I was here. I let my certification lapse in the private sector when I went to work in an ICU because I didn’t think I needed any more. And so actually, I was not certified when they hired me, but there was no one else certified that applied. And the fact that I had been certified in the past let them know that I had the ability to pass the exam. I think that’s what helped me get in the door here. But there were no certified IPs, not one that applied for this position here when it was posted.

APIC also wants to see a full-time IP in 

. Is that an issue within the VA health system?

Not really. We’re a master of none but a Jack-of-all-trades because we do long-term care and acute care. We do everything. We do ambulatory care. I do all of the outpatient clinics, just like I do the nursing home care facilities. And we have four of those that are operational now. Four separate buildings. One is a memory care unit. One is a hospice unit. One’s a palliative care unit. One’s a rehab unit. And they’re all very, very different. Now there’s not a separate infection control person for that. That is just all me. That’s not something that we see a lot of: more than one infection preventionist unless it is a really, really large facility.

This interview has been edited for clarity and length.

IPs in the VA system aim their infection prevention sights on most areas of care: acute care, nursing homes, palliative, mental health. They track infections differently. In addition, the VA acts as a testing ground for IP innovations.

How Veterans Affairs Handles Infection Prevention

Long COVID might be exacerbating the labor shortage in the United States as a whole and in health care in particular, according to recent data about both problems. This doesn’t surprise Linda Spaulding, RN-BC, CIC, CHEC, CHOP, an infection prevention consultant and a member of 

’s) Editorial Advisory Board (EAB). Spaulding contends that hospitals want heath care professionals complaining of long COVID symptoms to return to work nonetheless. “They’re not always listened to or told ‘it’s all in your head’,” says Spaulding. “We are going to see more and more of this because no one knows how to treat or care for people with long COVID because it’s a condition that we haven’t dealt with in the past. Some medical professionals and hospital management just don’t want to hear the compliant. They just want you to return to work to care for the patients. No one is caring for the health care workers.”

Katie Bach, MBA, a nonresident senior fellow at the Brookings Institution, 

 that “31 million long Covid patients stayed sick for an average of three months. That means that about 4.5 million may have been sick at any given time over the past 20 months.”

 suggests that many workers may also be dealing with long COVID by reducing the number of hours that they’re on the job. 

 looks at data from 3762 individuals who’ve complained of having long COVID symptoms. The study states that “for those who returned to their job, respondents reported experiencing relapses triggered by the mental exertion and stress of work, often needing to go back on leave. This emphasizes the importance of all patients having adequate time off to recover, being able to qualify for disability benefits if long-term assistance is needed, and receiving accommodations at work including telecommuting, flexible hours, and phased returns.”

 from the United Kingdom says that of all occupations, health care worker is the third most likely to report symptoms of long COVID. The UK’s Office for National Statistics states that “as a proportion of the UK population, prevalence of self-reported long COVID was greatest in people aged 35 to 69 years, females, people living in more deprived areas, those working in health care, social care, or teaching and education….”

The health care system lost 20% of its workforce over the course of the pandemic, according to the US 

. The combination of wave after wave of COVID-19 and understaffing at hospitals have resulted—as Spaulding and other experts have told 

 among frontline health care professionals still on the job.

Nurses in intensive care units and non-clinical workers are especially vulnerable to getting COVID-19, according to a recent 

Rebecca Leach, RN, BSN, MPH, CIC, another 

 EAB member, predicts that the health care system will feel the effects of long COVID for many years to come. Many nurses are baby boomers and this may be what pushes them into retirement, which will force hospitals to make systemic changes. Leach says hospitals will “look at alternative care methodologies; things like team nursing and allowing non-nursing clinical staff to practice at expanded roles. Cross-training like we do for free-standing EDs, for example, where you have limited staff, and everyone has to help out with other tasks.”

One good thing that Leach hopes comes out of this is more oversight of traveling nurse pay, saying that there should be “regulation on how much those companies price gouge during these types of emergencies.”

Monica Verduzco-Gutierrez, MD, director of the COVID Recovery Clinic at University Health in Texas, 

 before the House Ways and Means Committee on February 3 about the problem with long COVID. Verduzco-Gutierrez 

 Axios this morning that cancer patients have said that “their COVID-related fatigue was 100 times worse than when they had cancer and were going through chemotherapy.”

Spaulding warns that “we haven’t seen the worst of staffing shortage yet. I predict that as soon as this current spike tapers off more health care workers will leave their job for other careers and the next spike in cases will be unbearable because of the lack of health care workers. Health care workers deserve better care and respect. Not being pushed back to work too soon just so the unvaccinated have someone to care for them. This is a shortage that will last for a very long time.”

Long COVID might overlap with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In a recent 

, Jamie Seltzer, the director of scientific and medical outreach for #MEAction, a patient advocacy organization for people suffering from ME/CFS, stated that long COVID could quadruple the number of people in the US with ME/CFS. 

 study also points to that possibility. Investigators asked participants whether they experienced worsening symptoms after mental or physical exertion, which is 1 of 3 required symptoms for an ME/CFS diagnosis.

“We found PEM [Post-Exertional Malaise] to be highly represented in this cohort (89.1% at any time during the course of illness, 72.2% at month 7),” the study states. “Intriguingly, among those still experiencing symptoms at month 6 with no PEM (

 = 707, 28.8%), fatigue was still the most common symptom.”

Spaulding points to the practical implications of dealing with long COVID and/or ME/CFS. “Many health care workers are single moms who have to leave the workforce to care for their children who get COVID or are sent home from school because of an exposure. Where is their assistance? Who is standing up to help them? The unvaccinated sure aren’t.”

Long COVID appears to be worsening the labor shortage in the United States, and the health care industry—which has lost 20% of workers over the pandemic—could be particularly hard hit.

Long COVID Might be Taking Toll on Health Care Workforce

When the COVID-19 pandemic ends, where will infection preventionists (IPs) find themselves in the health care system? One of the goals for infection prevention and control should be to educate young people who want a career in health care about what being an infection preventionist entails, says Lisa Waldowski, DNP, RN, CIC, a regional director in infection prevention and control for Kaiser, Permanente. “It’s definitely something for someone who is seeking a lot of different experiences, and wants that type of excitement, and knowing that it’s not going to be the same-old same-old each and every day,” says Waldowski, who is a member of 

’s Editorial Advisory Board. “It’s just such a growing field and I hope that we can support one another along the way.” It’s important to grow a new crop of infection preventionists in a profession in which 40% of the members are due to retire in the next 10 years. However, demographic challenges aren’t the only ones facing IPs, Waldowski tells 

 in wide-ranging discussion, in which she also talks about the importance of certification and the educational obligations of IPs.

Did the pandemic move the needle at all in terms of mandating that infection preventionists have to be certified?

I don’t think I can completely support that I’ve seen that reflective across the country. I do have some insight on that having consulted for many years prior to taking the job that I currently am in. And I think that that’s a great move, a great incentive. I think that there may even be more scrutiny or looking at infection prevention certification prior to even getting in the field to broaden that reach and help support getting 

Lisa Waldowski, DNP, RN, CIC, Regional Director in Infection Prevention and Control, Kaiser, Permanente

certified. I think many infection preventionists that have been in the role—and they come from many different backgrounds, public health, nursing, lab—that to level that playing field, and to have that certification is an important step in infection prevention. But I also see that that also would need in tandem to have leadership and organizations support getting that test taken and pay for it, allow for education to ensue to take the exam. And that becomes a challenge. And that’s not something that’s standardized across the country.

You’re the regional director of infection prevention and control for one region of Kaiser Permanente. You do some hiring. Do you look for a CIC after somebody’s name when they’re going for an infection preventionist job?

Yes, I do. But again, based on organizations and what they put through human resources in their job description, you will commonly see certification as a preferred element and not a required element. Although I am seeing that change, or verbiage to say within two years upon hire, acquiring your CIC certification. It would certainly be a stronger requirement to put that verbiage in a job description that you have to have it before you’re even considered for hire. And that’s not a standardized element that I see across the country.

Some experts have told me that I can be hired by a hospital tomorrow, and they can tell me: “You’re our Infection preventionist.” Is that really the case? Was it the case before the pandemic? Has it changed at all because of the pandemic? Or is that an exaggeration?

That’s not far off. I’ve been in health care over 30 years. And when I first got into infection prevention and control, oftentimes this was the reality. I’m not exaggerating or making this up. If I was on workman’s compensation, they could put you into infection prevention and control as a nurse in this environment. That location at least required you to be a nurse at that point in time. And I see various backgrounds I think, because like many roles in health care—shortages, people retiring, burnout, many reasons—that there are not enough infection preventionists to do the good work that is required to keep an organization safe. Given the fact that from a regulatory standpoint, everything essentially has to be integrated into infection prevention and control. We’re in high demand, but the backgrounds that constitutes that role are varied from an LPN all the way up to doctorally prepared infection preventionist. Some certified, some not. In response to your question, yes, I can see many organizations: “Oh, you’re interested? Great. You’re hired.” There is that still to this day in health care going on.

Have you noticed—or do you know—whether nursing programs have started to include infection prevention more in their training for nurses?

I think that there’s still an opportunity. I don’t see it strictly standardized or stood out. And I would also offer that it shouldn’t just be nursing. It should be in medical professions. We would not struggle as much as we do with infection prevention and control implementation, if there was a more standardized representation and effort within our education system to become a nurse, to become a physician in any of the roles in public health and others that ended up going into this role. Many wonderful working opportunities I’ve had with professionals in infection prevention and control have also included from other countries internationally, those that have relocated to the United States. And they’re physicians that ended up becoming infection preventionists and such. I think that the role needs to be clearly supported. And that content, which should be everybody’s content, should be taught in their training and education prior to working as a physician, as a nurse. Because we struggle with basic concepts—like hand hygiene, and aseptic technique, and PPE use—that should be something that everybody is taught in their respective professional programs.

As you know, the Centers for Disease Control and Prevention last year launched 

, the $180 million program to teach basic principles of infection prevention to anybody on health care’s frontlines. Now, if everybody knew basic principles of infection prevention on the frontlines, where would that leave the infection preventionist? There are still some things that infection preventionists—and only infection preventionists—can do and monitor. Is that a fair assumption?

Yes, it’s a specialty. You certainly need to be aware that there’s some basic information that covers all areas. I think that we can be taught something, but to sustain that is another piece. Whether you call it process improvement, or whether you call it high reliability. Whatever you want to term it, that you can be taught these concepts but implementing them and sustaining them is entirely different. There will always be a role for infection preventionists. I don’t worry about job security, so to speak. There are so many elements within infection prevention and control. And I think that that word prevention is something we continually strive to work toward. I still think we’re in that mode of putting out fires. And obviously, with your original comments about COVID-19, I think that really currently has highlighted some of our opportunities within health care with infection prevention and control activities that were very glaringly apparent and that we could do better.

One of the jobs of an infection preventionist is to monitor staff. To make sure that they’re following infection prevention guidelines and also to make sure that they’re not infected. How has that role changed? Or has it changed through the course of the pandemic? Is staff more knowledgeable now and monitoring has to be done less?

I think that with the broad spectrum of infection prevention and control, often that word “employee” as opposed to “patient” … employee typically partners that role in that issue with employee health. And that has become hopefully a stronger link or an opportunity to build stronger relationships working with employee health with what we’ve been faced with COVID-19. The infection preventionist—even though there’s that working relationship with employee health—is typically more in efforts to prevent infection and transmission with patients and to include employees obviously, as well. But that transmission between patients. There’s certainly room for growth and working with the employee and understanding because there’s been, for example, the PPE education and [how is was] used during the COVID 19 pandemic. That has run the gamut of what we typically as infection preventionists would strive to constantly enforce following the manufacturer’s instructions for use for single patient use items. And as you well know, we broke all those rules during shortages during the pandemic, and who knows more to come as to being able to extend use and things that we would never have done during, quote, pre-COVID times. I think it’s been a constant learning opportunity and keeping people updated with the latest and greatest information as to how to safely protect themselves. If we’re talking about employees with PPE use as a perfect example. And then the confusion of when you’re not at work and now I’m just a, quote, regular person in the community. And that’s had different instructions than what I am told to do in health care. I think they’ve constantly needed to work together, infection prevention with employee health, and other key stakeholders in this, to get it right to make sure employees are safe doing the good work they do in their environments.

Are you hearing more interest among young people who are talking about possibly going into the health care field of maybe thinking about becoming an infection preventionist? If you do, how do you sell it to them? What do you say it involves?

That’s a loaded question. I think that there have been some ups and downs with infection prevention being at the table during COVID-19. I don’t think there are enough of us to have made such visible impression during COVID-19 that could really change the tide across the board. A lot of us ended up having to do a lot of things behind the scenes to help strengthen our COVID-19 response. And getting out and about in being patient facing or being out on floors and units and clinics may have not been awarded or afforded to us because there was so much that had to go on with answering phone calls, answering emails, being at meetings, doing the surveillance.

Is there anything that I neglected to ask you that you think is pertinent and that you want your fellow infection preventionists and other health care professionals to know?

I think it’s important that while we do have an opportunity during COVID-19 that has put the [spotlight on] infection prevention and control practices to support one another in advocating for more resources, whether that be, as mentioned earlier, pursuing certification and having that supported by your organization to obtain such and offer the appropriate education to study for that exam to be successful. And I think that the other piece is so critical that as we see across many professions an aging profession that is close to retirement, to support and build that capacity when we are ready to retire. That we’ve built a strong team, or we’ve supported infection preventionists in that role, and not just blindsided them: “Here’s the job and just kind of learn as you go.” Because it is such a vast specialty and covers so much involvement within an organization, whether it be a hospital acute care setting, or an ambulatory setting, home care … it’s very vast. It’s overwhelming for a novice that has just embarked upon this profession that we need to not eat are young, but we need to build capacity and enthusiasm to even go into this profession. And then mentor and grow those infection preventionists to stay in this profession that’s very exciting, very dynamic, very “go to work and don’t know what you're going to get that day.” It’s definitely something for someone who is seeking a lot of different experiences and wants that type of excitement and knowing that it’s not going to be the same-old same-old each and every day. It’s just such a growing field and I hope that we can support one another along the way.

This interview has been edited for clarity and length

Lisa Waldowski, DNP, RN, CIC, of Kaiser Permanente: “There will always be a role for infection preventionists. I don’t worry about job security, so to speak. There are so many elements within infection prevention and control.”

Infection Preventionist Role Needs to Be Spotlighted

A bit of encouraging news for infection preventionists and other health care professionals on the frontlines battling the current Omicron-fueled surge of COVID-19 can be found in the latest 

 by the Bureau of Labor Statistics (BLS). The health care industry added more than 18,000 jobs in January, even while COVID-19 infections, hospitalizations, and deaths reached record levels.

Omicron may have reached its peak and will soon start to recede, many health care experts believe, but the variant remains troublesome nonetheless. Yesterday saw 291,998 new infections, and 2461 individuals died from the disease, according to the 

Johns Hopkins Coronavirus Resource Center

. About 65% of Americans are fully vaccinated.

Though the rise in hiring in the health care sector comes as a pleasant surprise, there’s still a long way to go before the industry returns to pre-COVID-19 employment status—if it ever returns there. The BLS notes that employment in health care “is down by 378,000, or 2.3 percent, from its level in February 2020.” The health care industry has lost about 20% of its workers since the pandemic hit in March 2020. Nursing homes have been 

Health care’s hiring helped produce an overall jobs report for January that came in much stronger than most economists expected, with the economy adding about 467,000. Most economists had predicted that the United States would add about 150,000 jobs.

Wells Fargo economists Sarah House and Michael Pugliese said in a 

 to clients that “the labor market’s recovery easily leapt over the hurdle thrown up by the Omicron wave in January. Nonfarm payrolls bested even the top end of expectations, rising by 467K. The net 709K revision to the prior two months' gains was also impressive.”

House and Pugliese added that the “solid employment gains despite the Omicron variant’s emergence give Fed officials more evidence that the U.S. economy is getting better at dealing with the bumps in the road from the pandemic.”

While the increase in hiring in the health care sector comes as pleasant news, the competition for health care professionals among hospitals has become anything but pleasant, Kaiser Health News (KHN) 

“Already strained by the covid-19 pandemic, hospitals around the country are desperate to staff their facilities as the highly transmissible omicron variant spreads,” KHN reports. “Governors in states such as Massachusetts and Wisconsin deployed the National Guard to help hospitals combat the surge. Six hospitals in Cleveland took out a full-page ad in the 

 with a singular plea to the community, ‘Help’.”

) noted that “the retention and development of employed IPs should be a priority to increase staff tenure (eg, length of employment), engagement, and to decrease turnover. Some turnover cannot be controlled, such as the anticipated retirement of nearly 40% of current US IPs. However, other causes of turnover, such as burnout, poor work environments, and a lack of professional opportunities, can be influenced. Retention of current staff is critical as many open IP positions stay vacant for months, suggesting there may not be enough IPs to fill the current need.”

There’s a long way to go before the industry recovers from the mass worker exodus from health care during the COVID-19 pandemic. Infection prevention especially faces daunting challenges.