How COVID-19 Spread the Word About Infection Prevention

Sharon Ward-Fore, MS, MT(ASCP), CIC: "We’ve learned the hard way that restaurants, office settings, hair salons, fitness centers, and schools have really suffered for the lack of guidance by professionals like infection preventionists."

Sharon Ward-Fore, MS, MT(ASCP), CIC, has been “there” and done “that.” There, in this case, was being a working infection preventionist (IP) who made the rounds in the hospitals where she worked. That, included interacting with other departments—environmental services (EVS), sterile processing, vascular access teams, laboratories, operating room nurses—and anybody in a hospital setting that needed to know the basics of infection prevention and control and, as coronavirus disease 2019 (COVID-19) made clear, that means everybody in a hospital, including patients and visitors. Ward-Fore, who is a member of Infection Control Today®’s Editorial Advisory Board, predicts that the demand for IPs will extend beyond the health care setting, something that she wrote about for ICT®’s March issue and which she reiterates in this discussion. “We’ve learned the hard way that restaurants, office settings, hair salons, fitness centers, and schools have really suffered for the lack of guidance by professionals like infection preventionists,” Ward-Fore says. That presents a problem, however. There are not enough IPs to go around to fill the growing need in health care, let alone non-health care settings.

Infection Control Today®: What about infection preventionists and their roles in hospitals? Do you see that changing in a major way? Or in any way?

Sharon Ward-Fore, MS, MT(ASCP), CIC: I’m hoping that over the course of COVID, this long haul of a year, that relationships have been established. That IPs are out on their units, and they’ve been meeting with people and talking with people. I think they’re seen now more as a valued partner, and a resource. Sort of that person for the source of truth to help wade through the mountain of information on COVID-19. I think they’re seen more as the person who can provide proper education and training on all things related to COVID, which is PPE [personal protective equipment], hand hygiene, things like that. Regarding your second question, I think there are more opportunities now that exist outside of acute care for infection preventionists. I think they can move to the public sector, because their skills can be used in other health care settings. There’s long-term care, which is now…. There are eyes really on long-term care. And the need for IPs in that sector are great. Dental. A lot of dental infection prevention is done by hygienists, and maybe it’s time for IPs to step in and be consultants and take some of the heat off of the hygienist. Standalone clinics and surgical centers can also benefit from infection preventionists. And then I’m a big proponent of IPs stepping out into the private non-health care sector. We’ve learned the hard way that restaurants, office settings, hair salons, fitness centers, and schools have really suffered for the lack of guidance by professionals like infection preventionists. I think this is a time for the IP to look for opportunities outside of acute care and see what’s out there.

ICT®: Where were their turf wars? Will there be a truce and IPs will be allowed in to take a look?

Ward-Fore: I think three things came to light during COVID that work in favor of infection preventionists in all areas. Surgical services as well as throughout the hospital. I think everyone’s learned how important hand hygiene is. How to do it correctly. And when you do it correctly, you can stop contamination of the environment, patients, staff, and visitors. I think everyone’s learned about the importance of PPE. How to put it on. How to take it off. And how the spotlight may be

on the need for more frequent hands-on training. That applies again: Surgical services they wear PPE when they have patients that require precautions. And I think the main thing is how EVS and an IPs are tied together. Environmental services was pushed to the forefront in the beginning as a way to help reduce contamination in the patient environment from COVID. And that still is true today. A good EVS team with really thorough cleaning and disinfection can actually lead to fewer HAIs [health care-acquired infections] and better patient outcomes. I think all these things in concert with infection prevention will lead to better outcomes for patients and better relationships because we all know how important these things are and how they help to keep everybody safe during COVID.

ICT®: Are there enough IPs to go around? We answered that question in a couple of articles [here and here] on the Infection Control Today® website that said “no.” Is that a correct assumption? And if it is a correct assumption, what can be done about it, if anything?

Ward-Fore: I still think there aren’t enough IPs that are purely IPs. In a lot of health care institutions, the IP wears the employee health hat. Infection prevention done correctly in all areas of the hospital, that on its own is a full-time job. I think it’s difficult to be an IP and an employee health person and do both well. And I think the certification; how there are different facets to it now reflects the need for more IPs, and maybe this is how we fast-track people into infection prevention. And it’s not a bad thing. I’m just hoping that we’re not losing our focus, which is the skillset needed to understand all these different processes that go into infection prevention. So yes, there is a shortage. Maybe this is how we fix it. And then once people are in the hospital, they learn on the job like most of us do.

ICT®: Do you think infection preventionists worry about being underappreciated and undervalued once again when COVID-19 goes away (knock wood)?

Ward-Fore: I’m hoping that the administrators saw the value in IPs during COVID. And they’ll remember that, but people have short-term memory. We will have another next big thing, and then IPs will come into play. But in the IP world an outbreak is an outbreak, so they’re prepared for anything. It’s just what that next big thing is we don’t know. You know, I think there will always be value for IPs. And it’s a role that doesn’t touch just inpatient units. It touches everything. It’s involving construction in the hospital, linen handling, waste handling, just the environment in general. I think IPs will continue to play that role. And whether it’s seen as more valued or not depends on the administration. I hope it will be seen as valuable. But you know, everybody sees things differently.

ICT®: I’m trying to paraphrase one of your prior responses: If the IP influence does expand, it will probably expand first in environmental services. Is that a correct assumption? And then second, where could it possibly expand next?

Ward-Fore: So, you said environmental services, right?

ICT®: Yes.

Ward-Fore: Environmental services and infection prevention work hand in hand. And in a lot of facilities, that’s not always the case. I’m hoping that IPs will see that they need to work very closely with their environmental services people in health care. But I also see IPs working with outside cleaning facilities. There are standalones. Some places contract out there cleaning and disinfection. I can see IPs being consultants for those kinds of things. I see a huge opportunity in public health for infection preventionists, I actually volunteer for the City of Chicago Department of Public Health, doing contact tracing during COVID-19. And it’s been really great. But now there’s going to be a permanent need for IPs to help with long-term care facility inspections, and audits and lots of other opportunities in the public health sector. I actually encourage IPs to look toward that if you’re looking for something different. There’s always a need for public health. They’re the first ones on the ground for the next big thing. And you know, now we’re looking at Ebola. And we’re starting to prepare for that. Is that going to ramp up? Or can we contain it? There are IPs that are needed for screening at airports and contact tracing of those people that come into those airports. If you think outside the acute-care box, there are lots of opportunities.

ICT®: In October last year the CDC launched Project Firstline, whose aim is to give everybody in health care—especially those on the front lines fighting COVID-19—an education in infection control and prevention. Can IPs in some way feel threatened by this? Or are there some things that only an IP can do?

Ward-Fore: The intent of that project—as I remember reading about it—was to train people on the importance of hand hygiene, PPE, and how organisms are spread. And I think that’s basic education that anyone who works in health care should get, from EVS all the way on up. Because if you understand that those things aren’t meant to be a form of punishment, when you’re being observed, but it’s something that we all need to do correctly in order to reduce the spread of disease. And I think that’s a great first step in helping everybody in health care. Understand, this is a component of infection prevention. And I don’t think IPs should be threatened by it. I think they should embrace it, because it would hopefully make our job easier. People tend to listen to us for a while, but maybe they’ll listen to an outside source more. It’s sharing the same information. But maybe the message comes across a little different.

ICT®: Is there anything I neglected to ask you, Sharon, about the IP’s place in health care—after COVID-19 finally leaves—that you think is pertinent and that you think people should know about?

Ward-Fore: I think IPs like all other health care providers during this have a certain level of fatigue, and I think we need to recognize that. But I also think we need to understand that, as I said before, IPs are used to outbreaks. This was an outbreak like none we’ve ever seen before. They were quite well prepared to handle it. I think IPs just need to continue to do the great job they’re doing, build those relationships, and continue to learn. Because one beautiful thing about being an IP is that every day is different. And there are always opportunities for learning. I think there’s a lot to be learned from this, and that we should just keep our eyes on the prize and be prepared for the next big thing. But also start focusing on the things that were pushed to the side: the hospital acquired infections, the surgical-site infections, those multi-drug resistant organisms that are still there. And now we need to get back to those.

ICT®: I couched that as the last question, but I do have one more. You mentioned long-term care facilities. What are the chances of states mandating that a long-term care facility has to have a licensed IP on staff? And can they afford it? I mean, long-term care facilities have been knocked, but they just don’t have the financial resources that acute care has, right?

Ward-Fore: You’re right. It’s a financial drain on them. But I believe it was mandated quite a while ago to at least not have a full time IP, but at least someone there to oversee things. But now because of COVID, I think that’s going to be enforced. You receive money from CMS. So that’s mandated. We will start to see that and even in the public health sector, there is going to be more oversight of long-term care facilities and rehab facilities. And to be honest with you, it’s way overdue, that IPs have a place at the table in those kinds of facilities.

This interview has been edited for clarity and length.