REBECCA LEACH, RN, BSN, MPH, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a member of Infection Control Today®’s Editorial Advisory Board, currently works at a healthcare system in Phoenix, Arizona, that includes 5 hospitals and more than 100 outpatient treatment centers.

Rebecca Leach, MPH, BSN, RN, CIC

“Infodemic” combines the words “information” and “epidemic,” typically referring to rapid, far-reaching spread of both accurate and inaccurate information about a 

. The word first appeared in 2003 but has seen increased use during the 

The volume of information disseminated since the beginning of the pandemic has been tremendous. In addition to scientific articles and journals based on research about the novel virus and its impact, there have been government statements, health agency advisories, news articles, opinion pieces, and a tidal wave of social media postings and commentary.

Under the infodemic umbrella we have 3 categories: information, misinformation, 

.3 Information is considered accurate at the time based on current knowledge. Because of the ever-changing nature of the pandemic, information was updated regularly; many members of the public and some within the health care industry began to have doubts about how much of it was accurate.

This provides an excellent illustration of how science works. New ideas are tested and more data are gathered to continually improve upon prior hypotheses. Such rapid information updates in a situation involving a novel pathogen are expected, with new knowledge shared as it is uncovered. This does not necessarily mean earlier information was bad. Instead, the best information is shared in real time based on evolving knowledge.

Misinformation is false information without intent of causing harm or challenges to care. It often comes from individuals trying to understand something but not having all the data or not being able to interpret that data correctly.

Disinformation is false information created to cause harm or delay care, for various reasons. It is strategic and intentional and can have severe repercussions.

During this pandemic, we have seen many examples of misinformation and disinformation. The deluge of information makes risk communication and public health messaging more challenging. The social media aspect of this pandemic is unlike anything health responders have experienced previously. The level of expertise for social media postings is not regulated and public figures can exacerbate confusion by promoting misinformation and disinformation.

Early in the COVID-19 response, infection preventionists (IPs) scrambled to get as much credible information as they could to share with hospital leadership, staff, and patients. The days were filled with updates from the CDC, White House staffers, international health organizations, and the news media. Topics covered by IP education included isolation guidance, personal protective equipment information, modes of transmission, viral transmissibility and virulence, risk factors, and risk reduction strategies.

Sifting through the data was a full-time job. Then came the need to organize the information and package it in a shareable manner that could address all concerns and questions. Much time was spent talking through fears, unknowns, what was known, or even best guesses.

A challenge was the frequency with which information was updated. One of the best ways to address that is to let individuals know from the beginning that in pandemic response, we learn as we go and we make decisions based on the best evidence known at the time. We must be open to changing course and being flexible as new data become available.

Infodemiology is an emerging field in public health and has some basic tenets that can be used by IPs in navigating the pandemic. One author has described 4 pillars of infodemic management: (1) facilitating accurate knowledge translation, (2) refining, filtering, and fact-checking, (3) building online health literacy, and (4) monitoring and 

.4 All 4 pillars were utilized by IPs during the initial COVID-19 response and continuously since.

An example of the ripple effects of misinformation involves the antiparasitic drug ivermectin. A preprint journal article indicated a huge reduction in risk of death for patients with COVID-19 who were receiving ivermectin. As other academics and researchers began reviewing the data behind the conclusions, concerns were raised. The content was pulled from the server based on those concerns, but not before it made an impact. It had been viewed more than 150,000 times and cited more than 30, including meta-analyses that concluded ivermectin was effective in 

Ivermectin was being prescribed as treatment and, for many, as prophylaxis for COVID-19. This example highlights how quickly information spreads digitally, and the desperation for providers to find something that could help patients before vaccines were available. Even now, as the controversy continues, studies have been inconclusive as to the true efficacy of ivermectin, yet there are calls from the public for prescribing it.

At the time of this writing, our department was called by a concerned patient with COVID-19 who wanted a friend to bring ivermectin to the hospital to help treat her. This situation is a great opportunity for providing education and resources, but it also goes against medical advice of providers across the country who are using more proven methods to treat COVID-19.

The World Health Organization has published steps for navigating the infodemic to help the public in using self-assessment tools; however, these can be applied to IPs as they help staff 

.3 The steps are: (1) assess the source, (2) go beyond the headlines, (3) identify the author, (4) check the date, (5) examine supporting evidence, (6) check your biases, and (7) turn to fact-checkers.

The final 2 steps are of particular interest for IPs. We all have unrecognized biases that we need to acknowledge, especially when it comes to infectious disease prevention, because this is our area of expertise. It can be easy to forget that the public and even health care workers are not as familiar with terminology associated with infectious disease and disease transmission. IPs can approach staff with a certain empathy as they try to better understand risks based on all the information.

Fact-checking is a role that IPs have embraced as part of the research-based and data-based foundations of the field. Evidence-based care is the goal, and the same goes for COVID-19 response. IPs know the reliable sources and are familiar with reading scientific studies and being able to translate those findings to staff in an understandable way. Again, IPs should utilize the 4 pillars and incorporate skills many have learned from prior outbreaks and epidemic experiences.

Another way IPs can help fight the infodemic is to gain the trust of the staff they serve. Individuals are more likely to listen and accept information from a source they trust. IPs are collaborative, striving to facilitate and build relationships to promote behavior change and implement interventions to combat health care–associated infections.

IPs can also be creative with messaging. Infographics, using common language like “flatten the curve,” and combining public health messaging with storytelling are all ways IPs can bring innovative methods 

.6 Storytelling is used when reviewing cases of health care–associated infections or other patient safety events. Using stories of patients or from IPs’ personal lives to help others understand the risks and benefits associated with COVID-19 treatments and vaccination can be an effective way of overcoming emotional and fear-based decision-making that we see among the public.

IPs must also craft their messages to ensure the audience is appropriate. Typically, those with set beliefs about vaccination or the existence of COVID-19 are 

. Instead, the focus should be on those displaying hesitancy; those questioning but who have not fully committed one way or another. This group will be more open to credible information from a trusted source. Utilization of social media and other digital methods to convey infection prevention messages is an opportunity for health care organizations. Screen savers, social media posts, scannable QR codes that link to health messaging, and digital town halls are all innovative ways of engaging audiences.

Finally, a core competency for IPs is the need to emphasize pandemic response skills, risk mitigation strategies, infodemics, and risk communication. These skills are difficult to master but should be a part of every IP’s toolkit. As in any crisis, communication is a key to achieving the best outcome. The COVID-19 response is an ongoing crisis with no end in sight. IPs are tired but many have developed skills to help staff, providers, and patients navigate the course. They serve as a beacon for keeping science and evidence at the front of minds as information is shared.

REBECCA LEACH, MPH, BSN, RN, CIC, has been an infection preventionist since 2010 with a background in nursing and epidemiology. Leach, a member of the 

® Editorial Advisory Board, works at a health care system in Phoenix, Arizona, that includes 5 hospitals and more than 100 outpatient treatment centers.

Articles

IPs know the reliable sources and are familiar with reading scientific studies and being able to translate those findings to staff in an understandable way.

How Infection Preventionists Can Battle Misinformation

COVID-19 could now be considered a vaccine-preventable disease (VPD), and with that designation comes an issue we have with other VPDs: vaccine hesitancy. The COVID-19 response has been rife with misinformation; what has been coined “the infodemic” has impeded effective and coordinated response efforts since before the virus was identified.

One year ago as of this writing, the idea of a COVID-19 vaccine was a hope on the horizon. When one was finally available, health care workers had a powerful tool that could help bring the pandemic to an end. I recall how I felt after receiving my first dose. Sitting in my car in the vaccine drive-through clinic, waiting for the obligatory 15 minutes after administration, I burst into tears. Months of anxiety, stress, fear, and hopelessness were released in that moment. I know many other health care workers who felt the same.

Now it is almost 9 months since the vaccine became available, and the nation is still struggling to reach high enough levels of vaccine uptake to meet population-level immunity. We are currently experiencing yet another surge, pushed on by the Delta variant, and health care as an industry is strained once again. There are some differences from our prior experiences: Hospitals are struggling with staff shortages, Delta is more contagious than earlier variants, and patients are younger and sicker. But perhaps the most significant difference in this surge is that we have a powerful weapon available at any drug store or provider’s office and many grocery stores: vaccination.

More and more states are making other preventive moves, such as masking, social distancing, and minimizing indoor groupings, obsolete through legislation and lack of enforcement. Vaccination is seen as a silver bullet that will end the pandemic. And yet public mistrust of the vaccine continues to pervade and affect public health care efforts. Individuals in states with lower vaccination rates have 4 times the risk of hospitalization with COVID-19.

Health care workers have been pushed to the brink in this marathon of pandemic response. Frontline and behind-the-scenes workers, mentally and physically at their limit, are again being relied on to take care of an influx of patients with COVID-19 as well as ones without the disease. As the Centers for Disease Control and Prevention (CDC) reports, this surge in hospitalizations is being driven by people who are not fully vaccinated. Does this perceived nonadherence affect providers’ ability to be compassionate to patients? If the means to prevent infection is freely available and people voluntarily refuse it, then do not take other measures to protect themselves and prevent infection, how can health care workers maintain professionalism and treat all patients equally?

We are here not to judge but to care for our patients. We often hear this comment now, as the talk at nurses’ stations and in break rooms can move to anger and apathy toward those who did not get vaccinated and are now filling the hallways of the hospital. Compassion fatigue, although not a new concept, may be more of an issue during this pandemic response. It is the emotional, physical, cognitive, and spiritual drain that results in the decreased ability to provide empathetic care to patients.

 Compassion fatigue can affect even the most dedicated health care workers and results from continued stress and long-term exposure to another’s suffering. Over time, without ways to cope with the stressors, health care workers can become detached and have trouble experiencing empathy and emotions when caring for patients. Results from prior studies, conducted prepandemic, found that nearly 40% of nurses had symptoms of compassion fatigue.

 One can imagine that percentage has increased dramatically throughout the past 18 months.

Empathy is a key piece in the healing and caring process for patients.

 Not only does empathy improve patient outcomes, it can also increase caregiver satisfaction.

 Unfortunately, health care workers who are experiencing compassion fatigue report distancing themselves from others, shielding from emotional connections with patients and families, and isolating themselves from others in their lives.

 All these symptoms directly affect their ability to have empathetic connections.

As health care professionals, we are taught to treat the disease and the patient and refrain from judging patients for the behaviors that led to their current situation. But over these past 18 months, with the continued bombardment of fear, anxiety of the unknown, and the struggle to regain some sense of pre–COVID-19 habits, health care workers have not been immune to the emotions the public is experiencing. And yet we are held to a higher standard. We have to set personal opinions aside and provide the best care for all patients, as well as, hopefully, some science and research–based education to help prevent future infection.

News articles and interviews are touching on compassion fatigue and some brave providers have spoken openly about these feelings.

 It is important to normalize and address the subject and the frustrations that are permeating the entire health care industry, not just the frontline staff. All the ancillary and support staff, including infection preventionists (IPs), have been called upon to support the work of frontline caregivers and are subject to the same stressors and potential for burnout.

IPs, as the subject matter experts, have similarly been called upon for other major disease outbreaks and pandemics, such as the H1N1 influenza and the Ebola virus. But the sheer duration of the pandemic response and its impact on all aspects of daily life have made this COVID-19 situation unique for many IPs.

Vaccination hesitancy among some health care workers is a topic that is not always addressed. It can feed into workplace stress and the formation of in and out crowds among health care teams. As more health systems mandate COVID-19 vaccination, the protests and complaints grow. Nurses and other staff members are quitting, with some suing, over vaccine mandates. Vaccine uptake among health care workers varies, with one health system reporting that more than 90% of physicians have taken the vaccine but only 50% or fewer nurses and aides have.

 What is sometimes forgotten is that health care workers are humans too, and although they have worked through these surges, a significant number do not trust the vaccines or may have concerns about their efficacy and adverse effects. Those who are angry about patients who refuse vaccination may also find it difficult to empathize with colleagues who refuse vaccination. Such divisiveness on hospital units can lead to communication and trust errors, which can directly affect patient care.

IPs have been trying to educate about vaccination as a public health tool for decades and are no strangers to the concerns raised about vaccines and mandates. Again, IPs are needed to help weed through the myths, misinformation, and political slants to make sure they can help patients understand the facts. But it’s not just patients who need the education, it is also staff and providers.

Media reports that sensationalize vaccine breakthrough infections and adverse effects and downplay the long-term effects of COVID-19 may also have an effect on the urgency people feel to get vaccinated. Sanjay Gupta, MD, chief medical correspondent for CNN, recently addressed the concern with the term 

, explaining how it has muddied the true purpose of vaccines and how effective the COVID-19 ones really are.

 According to Gupta, the term “doesn’t seem nuanced enough to describe what’s going on; it only serves to alarm those of us who are already vaccinated and potentially discourage those who are hesitant.”

The infodemic surrounding COVID-19 remains a challenge for IPs.

 Risk communication is a skill that many working in pandemic response have found valuable. One lesson from this deluge of misinformation is the importance of learning how to communicate during emergencies and become a reliable source of information. Risk communication is a skill that should become part of the core competencies of infection prevention programs.

IPs continue to be a source of knowledge about the epidemiology and prevention of COVID-19. They must find ways to share consistent and reliable messaging with staff and patients about how to stop disease transmission, the benefits of vaccination, and other public health efforts to control transmission. As Delta rips through the country and the fear of more mutations and variants of high consequence takes hold, we are working on borrowed time to push back against the virus and regain the public’s trust. The US Food and Drug Administration’s full approval of the Pfizer-BioNTech COVID-19 vaccine (other approvals may have followed after this writing), may help sway some of the public to get vaccinated, although it will not be enough to stop the current surge. IPs can help staff with compassion fatigue by having crucial conversations and speaking about the anger and betrayal they may be experiencing, all while being the calm in the Delta storm.

REBECCA LEACH, MPH, BSN, RN, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a member of Infection Control Today®’s Editorial Advisory Board, works at a health care system in Phoenix, Arizona, that includes 5 hospitals and more than 100 outpatient treatment centers.

Pearson C. It’s not just your body that affected by your choice not to get vaccinated. Huffpost

August 23, 2021. Accessed August 24, 2021. https://www.huffpost.com/entry/not-vaccinated-covid-elective-surgeries_l_611eefe3e4b0e5b5d8e80dad?ncid=APPLENEWS00001

Understand & overcome your compassion fatigue: an online guide. EduMed. July 27, 2020. Accessed August 21, 2021. https://www.edumed.org/resources/compassion-fatigue-online-guide/

Berger J, Polivka B, Smoot EA, Owens H. Compassion fatigue in pediatric nurses. 

. 2015;30(6):e11-e17. doi:10.1016/j.pedn.2015.02.005

Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S. The role of empathy in health and social care professionals.

2020;8(1):26. doi:10.3390/healthcare8010026

Nolte AG, Downing C, Temane A, Hastings-Tolsma M. Compassion fatigue in nurses: A metasynthesis. J Clin Nurs. 2017 Dec;26(23-24):4364-4378. doi: 10.1111/jocn.13766. Epub 2017 Apr 20. PMID: 28231623.

Karkowsky CE. Vaccine refusers risk compassion fatigue. 

August 11, 2021. Accessed August 21, 2021. https://www.theatlantic.com/ideas/archive/2021/08/health-care-workers-compassion-fatigue-vaccine-refusers/619716/?utm_source=email&utm_medium=social&utm_campaign=share

Stone J. Covid-19 vaccination rates are poor among healthcare workers – how can we do better? Forbes. June 28, 2021. Accessed August 22, 2021. https://www.forbes.com/sites/judystone/2021/06/28/covid19-vaccination-rates-are-poor-among-healthcare-workershow-can-we-do-better/?sh=2e9744d5589e

Gupta S. What’s in a name? The term ‘breakthrough infection’ raises doubts about vaccines, but it shouldn’t. CNN

 August 12, 2021. Accessed August 12, 2021. https://www.cnn.com/2021/08/12/health/breakthrough-infection-covid-vaccine-misleading/index.html

Sauer M, Truelove S, Gerste AK, Limaye RJ. A failure to communicate? How public messaging has strained the COVID-19 response in the United States. 

. 2021;19(1):65-74. doi:10.1089/hs.2020.0190

All the ancillary and support staff, including infection preventionists, have been called upon to help support the work of the frontline caregivers and are subject to the same stressors and potential for burnout.

Vaccine Hesitancy and Compassion Fatigue: Infection Preventionists Battle Both at Once

Creating vaccines for coronavirus disease 2019 (COVID-19) and getting them approved by the US Food and Drug Administration (FDA) proved to be an arduous task fraught with scientific and logistical hurdles. Now comes the hard part: Getting those vaccines widely distributed to the right people. Where do infection preventionists (IPs) fit into this part of the pandemic response?

There are 2 overarching levels of vaccine implementation: regional public health mass vaccination planning and local, targeted efforts for specific populations. In both areas, IPs need to be involved in planning and implementation. IPs have both education and training in public health and outbreak response as part of their core concepts to become an IP. Also, many IPs work closely with local, regional, and state public health partners on a regular basis, so the relationships are already built.

The first wave of vaccination is focused on large-scale public health-driven efforts. These are being implemented at the state level for distribution to focus on healthcare workers and residents of long- term care facilities. These efforts clearly must be multi-disciplinary in order to have effective planning and viewpoints that can bring creativity to solve the problem of how to effectively distribute millions of doses of a vaccine that require very specific handling and storage parameters.

For example, the Pfizer-BioNTech vaccine requires ultra-cold storage and will be allocated in large dosage counts, requiring vaccination of large groups over a short time period. The teams need to include providers, pharmacists, public health, healthcare facility leadership, emergency management, and other local leaders. It is likely that members of these groups have not worked closely together before on such a large-scale task. It will be crucial to function with a hospital incident command system to keep the group moving forward with the same objectives and bring obstacles to the forefront quickly for rapid problem solving.

IPs have been working scenarios of mass vaccination for years, in preparation for pandemic flu primarily, but also with potential biological threats (anthrax, smallpox) and other outbreaks such as measles and pertussis. These skills and insights make IPs and their public health colleagues subject matter experts on the nuances of mass vaccination. For example, some hospital systems would take the opportunity to turn annual employee flu vaccination into a drill and treat it as if it were a mass vaccination event in collaboration with emergency management colleagues. These events would teach valuable lessons in the best way to reach all staff, including having multiple vaccination administration locations and the best way to handle the data collection necessary to track large scale vaccination efforts.

Infection prevention needs to be a partner in the large-scale planning that is occurring currently in most states and local healthcare facilities. These efforts are largely being led by public health on state or regional levels, but the local hospitals will also need to plan when vaccine is distributed in future tiers for local administration. Not only to help with logistics of vaccine storage, administration, documentation, and data collection and reporting, but also to focus on safety of the workers and vaccine recipients of the vaccine clinics. Staff use of personal protective equipment (PPE), workflow to ensure social distancing and decrease crowding, and cleaning and disinfection practices of the clinic site are all logistical concerns that should be addressed in the planning stage to avoid potential exposures or contamination concerns.

Another area for concern is the cold storage and transport of the vaccine. Specialized freezers and transport companies that can safely move vaccine shipments from distribution sites to clinics are necessary to maintain that cold chain delivery system. Specialized transport companies that have experience in this type of system will be in high demand and IPs can help evaluate the processes of these third-party vendors to ensure they will be able to accommodate the level of transport needed and maintain the storage parameters of the vaccines.

Data collection for the large-scale clinics will likely be mediated through health departments, but the details of tracking, knowing which employees did receive the vaccine, and communicating that to the local healthcare facilities will need to be addressed. Each state will likely have to determine the best way to communicate vaccine administration, but it will also be the responsibility of each employee to report their vaccination status back to the healthcare facility.

Hospital vaccine programs are historically a collaborative effort between infection prevention and employee health programs. As COVID-19 vaccine efforts continue, there will need to be consideration of how that will be managed within the context of the current hospital-based vaccination programs. How will a COVID-19 vaccine be handled at each facility? Will it be mandatory? Will it be given annually? Will it be a condition of employment? These are all questions that will need to be addressed. There are some unknowns at this point, including the need for annual boosters, required storage needs, and data reporting.

Infection prevention is also a key partner with employee health programs to promote vaccine uptake and educate on the mechanism of how the vaccine works and potential side effects. As these new vaccines are approved for distribution, it will be key for IPs to learn about the studies completed to date to have an understanding of these key points to help with staff education. Reviewing the articles published during the trials, as well as the recommendations from the federal programs will help IPs become knowledgeable about the vaccines. Also, key information that IPs will likely need to address will be side effects, efficacy, and recommendations of priority risk groups (such as healthcare workers, elderly, essential workers, etc). IPs can help address these questions through rounding and education opportunities, published newsletters and new employee orientation.

Planning for the logistics of how vaccine will be distributed locally will take much effort. Some items to consider are the timing of when staff will receive their dose and when they work their next shift. As virtually all healthcare facilities are screening for COVID-19 symptoms, the reactions to a vaccine may potentially meet some of those criteria, such as low-grade fever or malaise. It will be important to plan for this as an organization, to consider that with screening or plan for staff to have 24-48 hours after their dose before their next shift. The calculations will also need to include the fact that the vaccines are given in 2 doses.

Planning for this process should already be starting. As many healthcare facilities are operating under the hospital incident command system, the vaccine administration can be brought under that structure and would already have all the key departments at the table to help coordinate.

Data reporting for COVID-19 vaccination will likely be extensive. Many employee health programs may not have the reporting capabilities to handle the level of data collection and tracking that will be necessary for this initial wave of vaccination. Often employee health programs do not have electronic systems that integrate with other reporting programs or link to state health departments, therefore much of the work will be manual. Infection prevention needs to advocate for improved data systems for employee health tracking, which will not only be beneficial in the COVID-19 vaccine process but, going forward, for all other employee health activities.

One thing that IPs must remember: Vaccination is not the end of this pandemic. Most likely, the vaccination rate needed to provide sufficient population immunity to control spread is around 80%.1 It will take years to achieve that level of vaccination, if at all. So, the vigilance of basic infection control measures will need to be maintained in some fashion until such a point. This is part of the IP toolkit.

Having worked with vaccine preventable diseases for decades, IPs understand that vaccination is not the only way to prevent disease transmission.

Behavior modification, engineering controls, such as modifying traffic patterns and increasing ventilation air exchanges, and other active processes are key to a multi-focal prevention plan. Universal masking will continue in healthcare facilities and hopefully on a community level for some time, until population immunity is of a sufficient level or community spread is low to minimal.

1. Bartsch SM, MPH, O’Shea KJ, Ferguson MC, et al. Vaccine efficacy needed for a COVID-19 coronavirus vaccine to prevent or stop an epidemic as the sole intervention. Am J Prev Med. 2020;59(4): 493–503. doi: https://doi.org/10.1016/j.ajic.2020.10.018

How will the COVID vaccine be handled at each facility?  Wil it be mandatory? Will it be given annually? Will it be a condition of employment? These are all questions that will need to be addressed.

Infection Preventionists to Play Crucial Role in Vaccine Efforts

The monitoring and tracking of healthcare-acquired infections (HAIs) has evolved over time based on national and local guidelines and regulations. Formal standard definitions for HAIs were first developed by the Centers for Disease Control and Prevention (CDC) through the network of hospitals that participated in the National Nosocomial Infection Surveillance (NNIS) program.

 This network was a voluntary group of facilities that used the definitions to standardize the collection of HAI data and also report to a national database where analysis was completed and disseminated. This national data surveillance program provided a method for benchmarking HAI events with the advantage of having consistent definitions and data collection methodologies.

Facilities could determine what HAIs they would actively track and report, leaving it to the discretion of the infection control program, facility leadership, and assessment of specific population risk factors. Therefore, each facility could be tracking different infections, but all would be using the same definitions for data collection and determination of HAI status. Eventually, the NNIS evolved into the National Healthcare Safety Network (NHSN) and the HAI definitions transitioned over to the NHSN division of the CDC. Currently, HAI definitions in the United States are standardized to the NHSN criteria and infection prevention (IP) programs to use those definitions as their surveillance strategy.

Over time, the tracking of HAIs became more regulated. State governments were passing legislation mandating public reporting of select HAIs, thereby forcing IP programs to focus efforts on those particular HAIs that were publicly reported. Each state would have different HAIs required, however the majority focused on device associated infections, such as central line associated bloodstream infections (CLABSIs), or various surgical site infections.

 As the risk and impact of HAIs became more noticed in the public media, the federal government established the reporting requirements through the Centers for Medicare and Medicaid Services (CMS) of several HAIs, starting with CLABSI and adding more indicators.1 Currently there are 6 HAIs that are federally publicly reportable: CLABSI, catheter associated urinary tract infections (CAUTI), surgical site infections (SSI) for colon procedures, SSI for total abdominal hysterectomies, and laboratory based measures for 

 (MRSA) bacteremia infections. The public reporting of these HAIs impacted the way IP programs define their surveillance plans and tied hospital reimbursement directly to performance on these indicators.

As public reporting became a reality for IP programs, the focus of the surveillance shifted from what would be more individualized to each facility to these 6 specific HAIs. The efforts of IP programs had to meet the reporting need, and also were more visible as a financial impact to hospitals. IP programs also were pressured from hospital leadership when reviewing cases to determine if they met NHSN definitions, and would then be reported and potentially result in CMS penalties.

These aspects of the mandatory reporting were new experiences for IP programs, and the task of describing an event as hospital-associated or not, suddenly became much more at the forefront of the role performed by infection preventionists (IPs). Meanwhile, the requirement for public reporting meant that surveillance became more important and a higher priority for IP programs; therefore, other important program functions, such as rounding, education, process improvement projects, construction and biopreparedness all had to be set aside for the time to monitor and report HAI data.

Resources need to be provided for IP programs that can help ease the burden of reporting, and also free up time for IP staff to perform other tasks. Surveillance and data mining systems that can automate much of the reporting requirements would be ideal for IP programs. Also, as mandatory reporting continues, it would be essential to have input from IPs on what items should be included or added to the reporting requirements. IP staff input would allow federal and state legislators to understand the time and resource requirements of mandatory reporting and be a voice to advocate for changes in legislation that would improve reporting.

The coronavirus disease 2019 (COVID-19) pandemic has impacted HAIs across the country. Not only were IP programs stretched during the pandemic as part of the public health response, but also the HAI reporting was still being done. IP staff had to figure out how to manage all the workload of the pandemic response and continue to keep surveillance and data reporting current and active.

The work of HAI prevention was also impacted similarly, with less time for IPs to do rounding and focus on the elements that contribute to HAIs. As the national data is analyzed and released in coming months, it will be interesting to see if HAIs were impacted by COVID-19 and to understand exactly how a pandemic influences HAI prevention efforts. Anecdotally, patients with COVID-19 were seen to be high risk for HAIs, particularly CLABSI and CAUTI, due to long lengths of stay, duration of ICU admissions, proning treatments to help with respiratory function and other unique aspects of care.

As IPs work toward a future that includes COVID-19, there will continue to be a resource pull away from traditional infection prevention work to help focus continued efforts toward pandemic response, vaccination of staff and patients and public health collaboration. Compounding this work is the increased risk for HAI events with COVID patients. IP programs can work with nursing and medical staff to develop COVID-19 pathways for patients to help address concerns around HAIs and other healthcare-associated complications, such as pressure injuries and falls. These pathways can include specific interventions that are based on current best practice, such as chlorhexidine bathing, daily assessment of devices, and use of external urinary catheters, but make modifications that would further help mitigate risk for these patients who are at increased risk.

The impact of COVID-19 on HAI identification and reporting is still to be seen. Perhaps more reporting will be required of other respiratory illnesses, such as influenza or pertussis, as well as hospital onset COVID outbreaks. Perhaps COVID status will be part of routine reporting to NHSN as a risk factor. However, the regulations around reporting may change, IP programs will need to continue to incorporate pandemic response into their daily routines, while working to maintain a presence with HAI prevention. All this puts a strain on IP programs, and increased resources or new collaborations and partnering across programs will be essential for success, and ultimately for patient and staff safety.

REBECCA LEACH, RN, BSN, MPH, CIC, has been an infection preventionist since 2010, with a background in nursing and epidemiology. Leach, a member of Infection Control Today®’s Editorial Advisory Board, currently works at a healthcare system in Phoenix that includes 5 hospitals and more than 100 outpatient treatment centers.

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Infectious Disease Advisor. Mandatory public reporting of hospital acquired infections. Accessed September 12, 2020. 

https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/hospital-infection-control/mandatory-public-reporting-of-hospital-acquired-infections/

Bean M. How the pandemic is affecting HAI rates: 5 things to know. Becker’s Hospital Review. Published August 5, 2020. Accessed September 12, 2020. 

https://www.beckershospitalreview.com/infection-control/how-the-pandemic-is-affecting-hai-rates-5-things-to-know.html

COVID-19 possibly hindered the prevention of healthcare-acquired infections (HAIs) because infection preventionists have less time to do rounding and focus on the elements that contribute to HAIs. 

Rebecca Leach, MPH, BSN, RN, CIC

Articles

How Infection Preventionists Can Battle Misinformation

Vaccine Hesitancy and Compassion Fatigue: Infection Preventionists Battle Both at Once

Infection Preventionists to Play Crucial Role in Vaccine Efforts

Tracking of Healthcare-Acquired Infections Continues to Evolve