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Infection preventionists have the skill set to provide guidance beyond the health care setting. We know how to select PPE and how to use it. Cleaning and disinfection are like breathing to us.
It’s almost hard to believe the United States has been dealing with coronavirus disease 2019 (COVID-19) since January 20, 2020. The virus is still raging around the world. Health care is still struggling to keep up. Many businesses, large and small, have closed for good. Everyday activities such as getting your hair cut, going to the grocery store, gathering with friends, going to school or work, and eating at your favorite restaurant have changed drastically. These struggles and changes, in the health care and non–health care sectors, may affect things forever, at least in some ways. Fortunately, COVID-19 vaccine distribution has already started for frontline workers and long-term care/congregate facilities. Essential workers will be next in line for vaccination to help to revive the struggling non–health care sector. However, it will be too late for many working in restaurants and other businesses that lacked the same resources and level of preparedness as the health care industry.
Those working in health care have learned a lot during the pandemic about keeping patients and staff safe; managing supply chain items such as personal protective equipment (PPE), disinfectants, and other critical supplies; and preparing for shortages of staff and their emotional needs. Preparedness planning was something most facilities reviewed annually. Now, they are reviewing plans to determine when it might be safe to resume elective surgeries and other procedures placed on hold, as the pandemic becomes more manageable due to vaccination. Health care relies on specific guidance from the Centers for Disease Control and Prevention (CDC), and state and local agencies. They have plenty of resources available, including staff such as infection preventionists (IPs) to safely guide them along the journey to reopening and fully resuming care.
Dentists and Veterinarians
Dentistry has a very strong COVID-19 program guided by the CDC in collaboration with the American Dental Association (ADA). And they should have, as most of what they do involves performing aerosol-generating procedures, placing dentistry into a high-risk group category. The
ADA offers a robust Return to Work Interim Guidance Toolkit and a COVID-19 Hazard Assessment & Checklist with recommendations for before, during, and after appointments to protect dentists, patients, and staff.1 Dentists and their staff were already well versed in using PPE and cleaning and disinfecting patient care equipment. Typically, they designate someone as their infection control person who can answer questions and provide guidance and training. They were able to ramp up procedures and see patients safely, gradually resuming the provision of dental services.
The American Veterinary Medical Association (AVMA) also had a tremendous number of resources for safely managing their practices and patients during the pandemic.
They produced a comprehensive risk management guide, Resuming Veterinary Practice Operations During the COVID 19 Pandemic (described as a “playbook to help our veterinary practices recover by addressing specific issues that relate to your team, patients and clients, property, and the practice’s profitability”).2
The CDC also provided additional guidance for veterinarians, including specific recommendations about companion animal practice, recommending screening companion animals for exposure to people with COVID-19. Additionally, veterinarians are familiar with PPE use, cleaning, and disinfection,3 and had many resources to guide practice and answer questions. Their practices were up and running fairly quickly with mitigation procedures in place to keep staff, clients, and pets safe.
Health care, be it for animals, humans, or teeth, had plenty of experience with the nuts and bolts of providing care. They had PPE use, disinfectants, and a wealth of resources at their fingertips, including financial ones.
However, the non–health care sector—corporations, schools, fitness centers, libraries, hair salons, restaurants, and other businesses—was not so fortunate. They did not have access to an abundance of resources, exposing a huge, glaring knowledge and resource gap that threatened their existence. Very few, if any, had a preparedness plan. Their guidance has been general, mostly “one size fits all,” at best, from the CDC, the World Health Organization, and state and local agencies.
This is not to fault any agency, because saving lives was and still is the priority; health care was overwhelmed with patients, so resources were naturally directed to patient care. But the non–health care sector was left to struggle more or less on its own, interpreting guidelines that were ambiguous at best, with terminology and processes that few were familiar with, such as contact time and PPE. Their experience was not in PPE or pandemics but in cutting hair, preparing food, providing fitness classes, teaching children, and helping you find a good book. And we thought health care had been turned on its head!
As an IP, I was shocked and worried about my safety and others’ when I ventured out to a grocery store or small business. I saw single-layer bandanas open at the bottom, gaiters soaked in water in hopes of preventing virus spread, a homemade face shield made from a plastic page protector attached to a cloth headband, face shields without masks, welding helmets, and even a swim mask with a snorkel attached—I kid you not. The vast, creative interpretation of PPE took my breath away. And everyone seemed to touch or adjust their mask every few seconds. It was maddening. And don’t get me started on social distancing.
Human resource departments, store managers, librarians, hair stylists, and restaurant owners were thrown into the role of figuring out for themselves how to continue to operate safely for their employees and clients. No 2 businesses are alike. There are lots of similarities, but just enough differences to make many physical setups unique. Most businesses, unlike health care, had no one to walk through their space with them and talk through risk mitigation strategies such as using physical barriers, adequately spacing out tables and chairs, establishing occupancy limits, and setting up or improving ventilation so they could safely continue to operate.
They had no one trained in hand hygiene, respiratory etiquette, cleaning and disinfection, or PPE selection and how to wear it, and who could work with their staff. There was no one to call or page in the middle of the night with questions. They were essentially figuring it out for themselves to the best of their abilities. As the pandemic wears on, the toll it has taken on businesses of every kind, both large and small, is enormous. Livelihoods are at stake. The non–health care sector needs more than a bunch of guidelines to help them.
In response to this need, some programs became available for businesses or individual employees, such as an online course covering what COVID is and how it spreads; masking, hand hygiene, and cleaning; and basic safe workplace practices. Upon completion of one 50-minute course you can be “COVID certified.” These basic courses are a good start but may also lead to a level of competency that isn’t really there. Passing a computerized course, putting what was learned into place, and making sure it “sticks” are not easy to do.
As an IP, I know that practices drift, not everyone learns in the same way, and auditing practices are vital, especially those you are unfamiliar with.
What is required is a more robust program specifically fine-tuned to a particular business. A relationship such as the one IPs have with their units—someone designated to guide them, answer questions, and be there for them—would be ideal. And there are IP consultants who work with non–health care sectors in exactly this way.
They provide hands-on training, auditing, and protocols, and act as a resource to help those in the non–health care sector operate safely during the COVID-19 pandemic.
I spoke with Phenelle Segal, RN, CIC, FAPIC, the president of Infection Control Consulting Services, LLC, to get her take on the struggles of the non–health care sector. She said, “The challenge for the non–health care industry has been the extensive volume of guidance coming from nationally recognized agencies. Guidelines are often confusing, and the non–health care sector has done a good job of interpreting general guidelines and adapting them to the best of their ability. The gray areas subject to interpretation and finer details are definitely challenging, and that is where external assistance is needed.
“Our experience has been very positive as these industries rely on our expertise to guide them to…keep their employees and customers or clients as safe as possible. We are amazed at the conscientious approach of our non–health care clients and their level of involvement to do the best for their employees and customers or clients. Several clients had already implemented policies and procedures…and needed us to validate and provide further guidance.” This is what is needed to help the non–health care sector survive and thrive during COVID-19—an ongoing relationship with an expert who is there for them every step of the way.
Unfortunately, there will be other pandemics and outbreaks in the future. So, I see this as an opportunity for IPs, specifically, to use what they have learned in their health care roles to help guide the non–health care sector to success. IPs have the skill set to provide guidance beyond the health care setting. We know how to select PPE and how to use it. Cleaning and disinfection are like breathing to us. Issues concerning construction and renovation, including heating, ventilation, and air conditioning systems and the importance of air exchanges, are something we deal with all the time. We routinely train others, answer questions, and provide guidance and resources. We can and should begin to look at helping the non–health care sector so they can safely thrive now and in the future. Perhaps, working with our local public health departments, we can model the approach health department inspectors use for restaurants, salons, schools, and businesses, focusing on COVID-19 mitigation and staff training. We can visit businesses and help them make a plan. The need is there: we can help guide the non–health care sector and validate their best practices so they can safely open their business, school, or church during the pandemic. Their employees need us. Our economy needs us. We should think about how we can step up and help because this is what we are good at. We can do this.
SHARON WARD-FORE, MS, MT(ASCP), CIC, is an infection prevention consultant located in Chicago, Illinois. She is also a member of the Infection Control Today® Editorial Advisory Board.