Q&A: Infection Preventionists Will Get Us Through Fall, Winter

October 6, 2020

Bilal Naseer, MD: “Nurses who are kind of at a point where they cannot do bedside care, they should consider infection prevention. We need more infection preventionists.”

Despite the fact that there’s no vaccine and no cure for coronavirus disease 2019 (COVID-19), physicians are getting a better handle on how to treat patients with the coronavirus. And that might possibly help us avoid the brutal fall and winter—one featuring COVID, influenza, and other respiratory infections—that many healthcare experts fear we’ll experience, Bilal Naseer, MD, the infectious disease specialist, at the not-for-profit healthcare system CommonSpirit Health tells Infection Control Today®. Doctors will need an assist from infection preventionists (IPs), not only in hospitals but out in the community as well, says Naseer. IPs need to keep hammering home the message of the importance of social distancing, masking, and hand hygiene. “The more people are educated about the importance of infection prevention, the better equipped we will be to fight COVID-19 and influenza,” says Naseer.

Infection Control Today®: What do you think is the most important thing infection preventionists need to keep in mind these days?

Bilal Naseer, MD: You know, infection prevention is the best way to fight respiratory viruses for which we have not yet developed a vaccine. And because prevention is the key in these cases, that is why infection preventionists and infection control has taken the front seat when it comes to our fight against coronavirus disease 2019 (COVID-19).

ICT®: I’ve always had the feeling that infection preventionists felt a little bit pushed to the sidelines until something like this happens down. Do you think this will raise their status in the healthcare system hierarchy for good?

Naseer: Yes. And actually, in hindsight we all know that we all could have been better prepared had we taken the steps in terms of our preparedness for a lethal respiratory virus. If you look at the history of pandemics in Spanish Flu from 1918, respiratory viruses continue to pose a significant health risk to us. And they change. They evolve. Examples include the influenza virus that does small changes every year. We call them antigenic drift. And then it does a major genome shift every eight to 10 years which is called an antigenic shift. They are very smart. And we as healthcare team members, as well as the community in general, need to acknowledge that infections, especially respiratory infections, can potentially be life threatening for masses and they are extremely contagious. I think that we all have learned this lesson now kind of the hard way. But that prepares us for the future. Because we all believe that this will not be the last respiratory virus that humanity will be fighting. The more prepared we are, the more educated the general public is about infection prevention and the importance of vaccines, the better we will be at handling future pandemics.

ICT®: We everybody knows that we weren’t prepared as far as supply of PPM and N95 masks. What about elsewhere? Was the entire healthcare system caught a little flatfooted?

Naseer: I think the overall awareness of the general public about the lethality of these viruses needs some work. I think from a day-to-day.… I know that coronary artery disease and stroke take the front seat and everybody kind of is always focused on how they can keep themselves healthy. But respiratory viruses actually can cause mortality even in the healthiest. I think from an educational standpoint, the more the general public knows about how to keep themselves healthy and safe, the better. How the importance of simple things such as hand hygiene, the importance of simple acts such as staying home when you’re sick. You know, these are simple things that cannot only prevent SARS-CoV-2 and influenza, but all respiratory viruses. I think that we have come a long way in terms of our understanding kind of the hard way, but that prepares us for the future. I feel very good about how we enter the flu season because even though it’s not perfect, but the general public’s knowledge of the importance of masking and hand hygiene and social distancing is far higher this year than it has been in any year before.

ICT®: As we enter the fall and winter, do you have some misgivings about how we’ll handle COVID, but not so much about the flu?

Naseer: I would say that we haven’t yet reached the peak of the flu season. It’s kind of reassuring that countries like Australia did not see as big of a flu season as they did in years before, largely due to social distancing and avoiding gatherings and still kind of a semi-lockdown state. Their essential businesses are open, but a lot of people are working from home. Those things definitely help. But I think that influenza; we would have to be very cautious, because it still has a long way to go. Sacramento, where I am located, we get the majority of our flu peaks around Christmas time or New Years, sometimes going into January and February of next year. I think we still have a ways to go, but I think the importance of vaccine against influenza cannot be overemphasized because we know respiratory viruses attack weaker hosts. If a lot of patients actually get influenza and never really truly get ill, but if they get vaccinated, they will stay healthy and their immunity will be the best bet against an infection for which you don’t have the vaccine, such as SARS-CoV-2. I’m pretty sure a lot of your audience knows that 3% was the number the meta-analysis showed us for respiratory virus coinfection. The RSV, which is respiratory syncytial virus, as well as influenza virus, when they coexist in the same patient, it can be up to 3% of the patients, which is a pretty significant number, if you count the people that are at risk for these viruses.

ICT®: Do infection preventionists interact more with patients or their fellow healthcare workers or is it fifty-fifty?

Naseer In:fection preventionists are, I would say even before this pandemic, one of the key members in any hospital because not just the respiratory viruses, they look at infections such as Clostridium difficile which is one of the leading nosocomial infections in United States hospitals all over. And central line infection. They set up mechanisms, how we keep patients safe, and how we provide great healthcare without putting our patients at a high risk for infection. Their day-to-day job, because I’ve worked pretty closely with them, it involves both interactions with the nurses as well as the patients. They work with infectious disease physicians like myself. In most hospitals, they do attend the department meetings. They interact with a lot of healthcare team members, sharing the data of where we are in terms of infection prevention, and what are the ways for us to be even better.

ICT®: You seem to imply that infection preventionists will be needed more in the non-hospital setting, out in the community. How deep is the advice that they can give beyond social distancing, masking, hand hygiene?

Naseer: I think those are the three core measures. I would say hand hygiene. It’s extremely important because we know that both alcohol-based hand sanitizers as well as soap and water are incredibly effective against viruses and bacteria. And masking helps because a lot of transmission of respiratory viruses actually occur in the incubation period when the carrier does not even have symptoms. You may be interacting with them and you may not know that you are at risk, but if they wear a mask and you’re wearing a mask, the risk of transmission goes significantly down. I think knowledge like this. Because it’s very easy to get relaxed, because we cannot expect the public to be 100% with these new ways of living, which they have been doing since I would say like March of this year. Late February or March, right? And the more months that go by the importance of these need to be continuously communicated. Especially, I get worried about the young—teenagers, and the youth because they want to hang out. They want to have fun. And they may not understand that this is the best way … most of the transmission happens outside the hospital. So that is when infection prevention is really, really crucial.

ICT®: One expert told me that about 40% of infection preventionists will retire in the next 10 years. What would be the best medical background for an Infection preventionist?

Naseer: I think that the nurses are the best because they actually spend more time with the patients and families than physicians. So, they know. They’re important. And they actually are one of the best people to make this a career. I work in ICU, because I’m an ICU physician, as well. As the nurses age, providing that type care is actually more difficult than doing infection prevention. Because the nursing shifts usually are 12 hours or sometimes even longer. Nurses who are kind of at a point where they cannot do bedside care, they should consider infection prevention. We need more infection preventionists. I’m in an area where we do have quite a sufficient number of infection preventionists. But I think your point is very valid. That more and more people should consider this as a career. Because in their role, they can actually prevent a lot of what’s happening right now. The more infection preventionists our hospital has, and then they can actually educate the public also. I think it’s a great career, and we would also benefit from them as a community as well as in healthcare teams.

ICT®: I gathered from that earlier response that you’re hoping that the fall and winter won’t be that bad as far as influenza is concerned?

Naseer: For a number of reasons. One is—again, we would have to wait and see the numbers—but I expect our influenza vaccination rates to be higher this year than the years before. CommonSpirit Health has done a lot of media campaigns, and I’m sure other healthcare systems have also done.

ICT®: We were talking about the flu vaccination here, right?

Naseer: Yes. Because the less influenza we have, the more resources we would have for COVID-19. That’s one of the key initiatives is to really vaccinate in high numbers this year. As well as social distancing and masking and hand hygiene; they should prevent all respiratory viruses. We also are in a much better position in terms of management of COVID-19 now than we were at the beginning of the year. The more time physicians spend with patients with a particular disease, we actually learn how to manage it. The collaboration between physicians across the world has been incredible. And we all have learned from our experiences on how to better manage COVID-19. Our mortality is exponentially low compared to what it was at the beginning of the year. And that’s thanks to our knowledge of the disease. Because COVID-19 numbers and mortality are trending down, and there is awareness in the public about the importance of prevention, I expect us to see milder COVID-19 and possibly a smaller influenza season this year. Again, these are my personal predictions.

ICT®: Any final words of advice for your fellow infection preventionists?

Naseer: I think that as healthcare team members, we have a big responsibility to educate our community in general not just people in our hospital. We interact with our families, my kids, parents, so we infection preventionists, as well as infectious disease physicians like myself, have a role to continue this education. The more people are educated about the importance of infection prevention, the better equipped we will be to fight COVID-19 and influenza.

This interview has been edited for clarity and length.