COVID-19 Surges Stress Infection Preventionists to the Breaking Point

Infection preventionists (IPs) face myriad challenges during COVID-19 surges, including changing IP guidance, acute shortages in personal protective equipment (PPE), understaffing, increased workloads that lead to burnout, and a rise in health care–acquired infections (HAIs). These problems affect all health care settings but hit nursing homes and other long-term care facilities (LTCFs) particularly hard, according to a study published in the American Journal of Infection Control\(AJIC).¹

Judging by what investigators with the University of St Louis found, the government’s allocation of $2.1 billion to bolster infection prevention²—with emphasis on improving care at LTCFs—will likely be welcomed by IPs everywhere but especially those at LTCFs. The findings also underscore the critical role IPs play in COVID-19 response.

The AJIC study “identified challenges IPs faced during the COVID-19 pandemic, including rapidly changing and conflicting guidance, lack of recommendations for nonacute care settings, insufficient PPE, PPE complacency, and increases in HAIs and workload. The identified gaps in pandemic response need to be addressed to minimize HAIs and occupational illness. In addition, the educational topics identified by participating IPs should be developed into new educational programs and resources.”

Investigators conducted 7 focus groups comprising members of the Association for Professionals in Infection Control & Epidemiology in September and October 2020. The IPs in the focus groups were drawn from LTCFs, acute care, outpatient, and rural health care settings. Participants included new (3 or fewer years’ experience) and experienced IPs (more than 10 years’ experience). The focus groups occurred over Zoom and participants were asked open-ended questions about
their experiences.

A total of 73 IPs participated from across the United States. Nearly all (70) were female, with 40 individuals holding bachelor’s degrees and 32 with certification in infection prevention and control (CIC), and 1 had neither. Forty-nine worked in hospitals, 26 worked in LTCFs, and the rest worked in outpatient or other settings.

One IP says in the study, “We were heroes at first, bringing in the PPE that everyone wanted, but then we were the much-hated enforcers making [individuals] wear PPE, especially the face shields and goggles.” Respondents also discussed dealing with changing guidance. One IP relates how “CDC comes out and says ‘Use N95s,’ and then a couple weeks later they say, ‘Oh, if you just wear face masks, you’re OK, but N95s are preferred.’ It was very frustrating.”

The focus on COVID-19 forced IPs to forego their regular infection prevention duties. One explains, “There is no Monday through Friday. It is literally 24 hours a day, 7 days a week.”

Although they were desperately needed in the wards, IPs said they too often were left out of the decision-making process. This created a ripple effect, one says: “Decisions were being made in organizations without their [IPs], which were resulting in extreme difficulties in coordinating throughout the county.”

IPs also noted an increase in HAIs. “The IPs in this study noted several factors they believed contributed to the increase in HAIs, including frequently changing protocols, staff turnover, lack of resources for training new staff, and visitor restrictions,” the study states. “Some IPs also described an increased placement of femoral central lines, which could increase risk for CLABSI [central line–associated bloodstream infection]. Increased workloads reported by the IPs to address the pandemic may have also adversely affected routine surveillance and practice observation, which could have contributed to higher HAI rates.”

LTCFs struggled the most. The study states that “IPs in LTCFs faced unique challenges not identified by their colleagues in acute care and outpatient settings. They were significantly more likely to run out of N95 respirators, reported challenges with COVID-19 testing not seen in other settings, experienced low staff morale, and saw high staff turnover. All of these factors exacerbated existing challenges to safe LTCF health care.”

LTCFs were devastated by COVID-19 outbreaks among staff and residents. The morbidity and mortality rates remained high even after vaccines became available, the study states.

References:

1. Rebmann T, Alvino RT, Mazzara RL, Sandcork J. Infection preventionists’ experiences during the first nine months of the COVID-19 pandemic: findings from focus groups conducted with Association of Professionals in Infection Control & Epidemiology (APIC) members. Am J Infect Control. 2021;49(9):1093-1098. doi:10.1016/j.ajic.2021.07.003
2. Diamond F. $2.1 billion to be invested for infection prevention and control efforts. Infection Control Today®. September 20, 2021. Accessed September 28, 2021. https://www.infectioncontroltoday.com/view/-2-1b-to-be-invested-in-infection-prevention-and-control