SASKIA V. POPESCU, PHD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in both pediatric and adult acute care facilities.

Saskia v. Popescu, PhD, MPH, MA, CIC

This more transmissible variant is gaining more traction in the United States as it accounts for 

. This number grew from 50% in early July, underscoring the critical need for vaccines right now. Rochelle Walensky, MD, director of the Centers for Disease Control and Prevention (CDC) stated this week in 

, a publication out of the University of Minnesota, that “‘this is a dramatic increase, up from 50% for the week of July 3,’ Walensky said. ‘In some parts of the country the percentage is even higher, particularly in areas of low vaccination rates.’ Walensky explained that the pandemic in the United States was not affecting the unvaccinated.” As the Delta variant is estimated to be around 50% more transmissible than the original strain, the CDC has been emphasizing the need to improve stagnated vaccine rates. 

, 48.7% of the United States is fully vaccinated and 57% of those 12 and up.

As Iran currently experiences a surge in cases triggering lockdowns, many countries are also seeing spikes in cases causing public health interventions. As CIDRAP 

 “Today, the country [Iran] reported a record 27,444 new cases, topping the previous high from mid-April, according to 

. The steep rise in cases prompted a lockdown for Tehran and Alborz provinces, where 

only essential businesses are allowed to stay open. Iran is among the countries experiencing a slow vaccine rollout. Only about 2.7% of the country is vaccinated, and country officials have blamed US sanctions for limited supplies of vaccine and medical materials.”

Meanwhile, the United Kingdom takes a different approach. The UK has fully reopened despite surging cases and a worrisome third wave. Most of the COVID-19 restrictions have been 

 despite cases up 41% and a wave of Delta variant surging through the country.

 that “the move to phase four of the country's reopening plan means there are 

 on the size of social gatherings or events, and social distancing is no longer required. The government still recommends meeting outdoors when possible.

“Requirements to wear face coverings have been lifted, though masks are still recommended in crowded areas such as public transport. They 

on the London Tube. And the government is no longer instructing people to work from home if possible, though it anticipates a gradual return to the office.”

Nursing Homes Residents Prescribed Too Many Antibiotics

Vulnerable patients in nursing homes require additional interventions to avoid unnecessary antimicrobial use. CIDRAP reports that “according to the Centers for Disease Control and Prevention, an 

 of nursing home residents receive one or more courses of antibiotics a year. The primary reasons for such frequent antibiotic use in long-term care is that residents are often frail and have underlying conditions that make them more vulnerable to bacterial infections, especially those involving the skin, urinary tract, and respiratory tract.” Despite this, over half of antibiotics being prescribed in these facilities are likely not needed and can increase the risk for infections like 

 or antimicrobial resistance. More work should be focused on identifying successful interventions and ensuring access across all facilities.

Articles

As the Delta variant is estimated to be around 50% more transmissible than the original strain, the CDC has been emphasizing the need to improve stagnated vaccine rates.

Hot Topics in Infection Prevention: Unstoppable Delta, Lockdown v. Reopen, Antibiotic Overprescribing in Nursing Homes

Delta Variant Cases Increase in the United States

 is fully vaccinated and the Delta variant is increasing across all regions. In some areas, the Centers for Disease Control and Prevention (CDC) 

s increases in some regions to more than 45% of new infections. What’s starting to worry many in public health is that with a new, more transmissible variant (Delta) picking up speed and less than half the U.S. fully vaccinated, there’s a real potential for clusters and surges in vulnerable populations. “

, new daily cases in the United States have risen by 14.8% over the past 7 days, with significant increases in Nevada (55%), Wyoming (18%), Missouri (20%), and Arkansas (55%). New daily deaths still fell by 0.7% over the past 

week, and COVID-related hospitalizations fell by 4.7%. In Los Angeles, city health officials are recommending that people wear masks indoors, regardless of their vaccination status, the 

 reports, because of the growing threat from the Delta variant. (The World Health Organization recommended last Friday that even fully vaccinated people wear masks indoors.) Needless to say, we’re in a vulnerable position and need to continue to increase vaccination distribution.

In a country that has prioritized a “Zero COVID” approach to the pandemic through strict border restrictions, a lackluster vaccination strategy and the Delta variant have created a 

 where the disease could quick overrun public health efforts. With 80% of the Australian population living under restrictions, things are not looking good. BBC’s Frances Mao 

 that “Sydney—Australia's biggest and richest city—managed to avoid regular snap lockdowns helped by a “gold standard” contact-tracing system. But in the past 2 weeks or so, the Delta variant has managed to breach the city's defenses. In 1 week, positive cases have ballooned to more than 100. By June 25, officials conceded the need to put Sydney into lockdown. By the following Monday, the crisis had become a national one—with outbreaks in 4 states and territories.” In many ways, Australia is an unfortunate example of why border closures alone are imperfect, and a robust vaccination strategy is crucial—less than 5% of Australia is vaccinated and with Delta in circulation, it could easily spread like wildfire.

Much of our week this week at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC) will include reminders of the work infection preventionists do—this is truly inspiring but can also be triggering. As we often fall in the middle of the Venn diagram between public health and health care, it’s important to remember how vulnerable each group is and the 

significant symptoms of anxiety, depression, and PTSD that are being experienced

. Be kind to yourself and take a moment to acknowledge the work done in the past 18 months, but also that it’s OK to not be OK right now. Healing will take time and the entire infection prevention community is behind you.

While many infection preventionists are attending the annual APIC Conference, there’s been a lot going on in the world of COVID-19 and infectious diseases.

Hot Topics in Infection Prevention: Delta Variant Grows, Australia’s Woes, Time to Heal

Earlier this week I was talking to a colleague in infection prevention. Exhausted to our core and with that 

 we’ve all been reading about, we both shared the same sentiment—no one seems to know what infection preventionists (IPs) have gone through this year.

This got me thinking. COVID-19 has put a light on so much that we’ve been neglecting for so long – the hard work of essential workers, social and racial inequities, underserved areas and understaffed hospitals, underfunded public health, etc. There’s been much written on the role of 

 and the goal of this article isn’t to diminish that, but rather to honor a group that I’ve seen routinely neglected during public health emergencies. I may be biased as an infection preventionist and epidemiologist, but frankly, I worry that after Ebola in 2014 and now COVID-19, the field of infection prevention will see an exodus due to the continued neglect.

 (and talking) about how neglected infection prevention and control (IPC) is and what that means for health care, but also biodefense. This was pre-COVID, but as I hear the heartbreak of so many IP friends and colleagues, I think it’s important to write this. Before the first cases were even identified in the United States, IPs were worriedly watching and the moment the first case was announced in Washington, we began preparing. For many of us, the 24/7 on-call work began around this time.

We operationalize new guidance, relayed travel-related alerts, and prepared staff for what may come. When the surges hit, we were there—rounding on the units and doing training on all the units. From being trained to do N95 fit-testing to jumping into the count to partake in patient care, IPs took on many roles.

We had to navigate the changing guidance, establish overflow areas, ensure reporting to the health department was occurring, and do contact-tracing to make sure exposed staff were quarantined. We had to navigate PPE shortages and decontamination of masks. We faced politicization of masks and hesitancy around vaccines.

We’ve been attacked by people who didn’t understand our approach to isolation precautions. In the non-surging times, we were expected to go back to normal. To go back to the health care-associated infections (HAIs) that were being neglected but also to maintain readiness. Coming down from that exhausted panic of “just keep going” is not easy.

For most IPs, we work five days a week in under-staff programs and are frequently on call. Readiness for an infectious disease tends to fall on us and it’s our job to coordinate with all the internal partners—like clinical, lab, and environmental services—to ensure we’re prepared.

As COVID-19 began to surge across the world and the United States in 2020, IPs went into overtime, working continuously … and we haven’t stopped. Like public health, we’ve worked long weeks, weekends on call, and have been expected to manage our day-to-day duties. 

For many of us, it’s isolating, and few understand this

. Few even know what IPs are, let alone acknowledge our role in this.

often-frustrating isolation we feel as the U.S. seems to go back to “normal,”

 I want to acknowledge IPs. You all inspire me daily and I’m eternally grateful to work among you. We work to protect our health care personnel and patients fiercely and often to the point where we are burned out. Now is a hard time for so many and ultimately, it’s important to know that it’s not a light switch. That feeling of exhaustion and inability to just recover from it all is not instant. Our roles have been the underdogs and will likely continue so.

Many may not know the dedication we put in during this all but please know, our patients and staff are safer due to the work you do daily. Now is the time we try to pick up the pieces—care for the caregiver, right? Working through this challenging time won’t be quick but know that you’re not alone. Infection prevention is a critical field and like public health, it often is neglected until it’s necessary. Just know that you played (and continue to do so) a vital role in the COVID-19 response and as we work to raise awareness for our field, this is the time to revitalize and shape the future of infection prevention. This means we need new ideas, innovative approaches, but most importantly—we need you to recover and heal. We still have a long road ahead but surrounded by some of the best people one could hope for, I know infection prevention will be OK.

I want to acknowledge [infection preventionists]. You all inspire me daily and I’m eternally grateful to work among you. We work to protect our health care personnel and patients fiercely and often to the point where we are burned out.

Hot Topics in Infection Prevention: Thank You, My Fellow Infection Preventionists

Long-term care facilities (LTCFs), particularly nursing homes, received a lot of unwanted attention and not enough desperately wanted assistance during the COVID-19 pandemic. In the United States, COVID-19 has caused 655,110 cases in nursing home residence and 132,608 deaths, 

 to the Centers for Medicaid and Medicare Services (CMS). Among those staff working in nursing homes, there have been 583,756 cases and 1931 deaths. It has been estimated that of those living in LTCF within the United States, 8% died of COVID-19.

The coronavirus’s sieges and surges underscored 

 in the facilities. One of those problems is that states do not as yet mandate that a fulltime infection preventionist (IP) be assigned to nursing homes, something that the Association for Professionals in Infection Control and Epidemiology 

. Adding to the problems, since COVID-19 there’s been an 

The impact to this particular patient and health care worker population is astounding and one that wholly underscores a deeply-rooted vulnerability. 

 has reported on ways nursing homes and other LTCFs can shore up systemic problems in a 

 on methods one nursing home used to keep COVID-19 for the most part at bay during a surge.

Early in the pandemic, testing was a hurdle that the health care system struggled to overcome. If testing was more widely available though, what would transmission be within nursing homes? Moreover, what about cohorting patients and staff who had recovered from COVID-19 with those who were susceptible?

A new research study from researchers at Harvard Medical School, Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, 

 The goal was to understand and evaluate transmission of SARS-CoV-2 within nursing homes when certain interventions were in place—specifically routine screening testing and pairing staff/residents who were recovered with susceptible residents to help reduce transmission.

The goal was simple—pair those susceptible staff and residents with those who were recovered and felt to have protective immunity. For recovered residents, they were moved back into non-COVID-19 cohorts once they were recovered and were prioritized for new roommates.

For staff, this meant that those considered immune (recovered) were placed in the non-COVID-19 unit, “leaving susceptible staff to work in the COVID-19 unit” with adequate personal protective equipment (PPE). Meaning, by breaking up susceptible groups who could spread it between each other and by replacing susceptible contacts with recovered contacts, they could cut transmission.

Utilizing an agent-based susceptible-exposed infectious-recovered model between July and September of last year, the simulation included 100 residents and 100 staff across 3 shifts. Residents were categorized based upon COVID-19 diagnosis. Screening was done with two types of tests (rapid antigen and PCR) done at varying frequency.

The authors noted that “among the simulated cohort of 100 residents and 100 staff members, frequency and type of testing were associated with smaller outbreaks than the cohorting and staffing interventions. The testing strategy associated with the greatest estimated reduction in infections was daily antigen testing, which reduced the mean cumulative incidence proportion by 49% in absence of contact-targeted interventions.

Under all screening testing strategies, the resident cohorting intervention and the immunity-based staffing intervention were associated with reducing the final estimated size of the outbreak among residents, with the immunity-based staffing intervention reducing it more (eg, by 19% in the absence of testing) than the resident cohorting intervention (eg, by 8% in the absence of testing). The estimated reduction in transmission associated with these interventions among staff varied by testing strategy and community prevalence.”

As the authors note, utilizing routine screening testing for not only residents, but also staff could help reduce the spread of COVID-19. Furthermore, utilizing an immunity-based approach to staffing could also help reduce transmission. These findings are particularly important and while they may require some operational hurdles for nursing homes to recover, they offer alternatives for reducing transmission within these high-risk environments.

Here's one method of containing COVID-19 at nursing homes: Pair long-term care facilities (LTCF) staff and residents who've recovered with susceptible residents to help reduce transmission. It seems to work, says a study.

Saskia v. Popescu, PhD, MPH, MA, CIC

Articles

Hot Topics in Infection Prevention: Unstoppable Delta, Lockdown v. Reopen, Antibiotic Overprescribing in Nursing Homes

Hot Topics in Infection Prevention: Delta Variant Grows, Australia’s Woes, Time to Heal

Hot Topics in Infection Prevention: Thank You, My Fellow Infection Preventionists

One Method to Contain COVID-19 at Nursing Homes