Q&A: No Guarantee Healthcare Workers Will Take a COVID-19 Vaccine

July 14, 2020

Mary Jean Ricci, MSN, RNBC: “There’s also the question of how do we encourage staff to get the vaccination, if there is a vaccination, for COVID-19? Currently, we have employees in facilities caring for patients who do not get the flu vaccine and don’t have a medical reason for not doing it…. I think that that’s a big area where infection control practitioners are going to have to focus their energy to encourage receiving the vaccination when this is over.”

Many Americans—about a third—say that they will not take a COVID-19 vaccine when one comes along. That’s generated some dismay among healthcare experts and policy makers. Well, here’s another distressing possibility: Many healthcare workers won’t take a COVID-19 vaccine either. At least that’s what Mary Jean Ricci, MSN, RNBC, predicts. Ricci is the director of clinical education at Drexel University College of Nursing and Health Professions. She’s also a member of Infection Control Today®’s Editorial Advisory Board. She recently sat down with ICT® to discuss what she thinks will be some of the main challenges in a post-COVID-19 healthcare system. In addition to her concern about healthcare workers not taking a COVID-19 vaccine, Ricci would like to see better data collection and surveillance methods installed to track and prevent antibiotic resistant organisms. She also hopes that environmental services (EVS) teams will do a better job cleaning and disinfecting high contact areas. And, of course, hand hygiene. That’s a big issue with Ricci and she hopes that the COVID-19 experience will finally move the compliance needle.

Infection Control Today®:What do you think will be the main challenges in a post-COVID world?

Mary Jean Ricci, MSN, RNBC: Well, I think that our antibiotic resistant organisms are still going to be prevalent. And we’re still going to need to complete our surveillance and our data collection methodology. We need to really start thinking about how we can develop networks to prevent these infections by sharing the strategies that are working within the hospitals to protect the patients. I think that we’re going to have to also look at how we can improve antibiotic use and I think networking may help in that area. We all have committees: pharmacy committees in hospitals, antibiotic use committees. But maybe somebody has a strategy where they’re seeing great results. So maybe if we start sharing that and developing stronger networks. The other big issue that’s out there, of course, is hand hygiene compliance. That’s one of my favorite topics, because for years, we’ve been saying, we need to get employees to wash their hands. But yet our numbers still are not 100%. It should be one of those never events where we always wash our hands. We need to change our education practices. We need to change our messaging to reduce the infections through hand hygiene compliance. I think we’ve reached the point where it has to become a never event. We have to be up there at the 100% level in order to prevent the infections that are occurring, and COVID is an example. The other thing is environmental hygiene. Do we have the resources to go into our environment with our current EVS or environmental service workers and actually clean the high contact area surfaces as frequently as we should? The toilet handrails, the light switches, the doorknobs. We clean the patients’ rooms, we’ve removed the trash. But are we doing the high contact areas at the nurses station and the patients’ rooms as often as we should? We have strategies in place that mandate ORs to keep data on sterility and cleaning the ORs, but we don’t have strategies, or we do not have to even report on room cleaning to the degree that we do in the OR. So, we need to think about that. I think C. diff remains a prevalent disease where we have to get it under control. It’s still spreading in units. Are we doing the patient high contact areas frequently with bleach to reduce the scores on the immediate patient environment? They’re big things that I think we need to look at, in addition to how do we prepare for the next pandemic.

ICT®: And I noticed that you say, “we” need to do this, “we” need to do that. Are you talking about infection preventionists basically?

Ricci: I think it’s the infection prevention personnel’s responsibility to educate the administrative arm of the hospital so that they can put the financial resources into hiring more EVS workers, to hiring more infection prevention personnel so that they can track and do the data of surveillance that we need to do.

ICT®: Why does hand hygiene remain such a problem decade after decade?

Ricci: I think it’s a multitude of problems. We’ve studied it. It’s everything from dizziness, forgetfulness, lack of convenience, not having the hand hygiene alcohol-based dispensers in the appropriate place. Some of the employees don’t want to use the alcohol base because it’s drying to the hand. They want to go to the sink then they forget. They get caught up going into another patient’s room. I think there’s a multitude of reasons why people don’t wash their hands. I think that one of the biggest strategies that we need to consider as infection prevention personnel is how do we educate the physicians, the nurses, respiratory therapists, general hospital personnel, nursing home personnel, about the importance of it. We have to change the messaging. It’s kind of like back in the ’70s and ’80s, wearing the seatbelt, stopping smoking. I mean, it almost has to be creative continually. There has to be—for lack of a better way of saying it—like digital reminders everywhere. And you have to change that so that it’s not like just a blank white screen when it comes up. Wash your hands when you turn on your computer in the morning. I think we have to be really creative so that people see the message in different areas. I think we need to change our messaging. And I think we need to change where the messaging is occurring.

ICT®: Do you think there are enough infection preventionists to go around?

Ricci: No. I think that there are new organisms that the pandemic right now with the coronavirus, has proven that we’re not only keeping the data on all the current infections, all the MDROs, but now we’re tracking who’s dying, who is not recovering, who’s in the ICU. We need more people to do the data surveillance and the tracking of information to prepare reports for administration. I think we need additional help in those areas. Most facilities only have one or two people unless you’re a large, major institution where you may have more. Usually in long-term care, the infection control practitioner is also the educator, or maybe the director of nursing or maybe a nurse manager. It’s an area where we haven’t put a lot of resources.

ICT®: Do you see state governments perhaps mandating that nursing homes need to have a full-time infection preventionist on staff?

Ricci: That would be ideal. I think that we probably should think about it. Now is the time after COVID to start lobbying our state representatives and legislators to actually mandate certification in these facilities.

ICT®: What would you tell a young person now after COVID who wants to be an infection preventionist?

Ricci: Well, the first thing I would say is you have to have a real serious understanding of infections and how their passed on or transmitted in the hospital. And then basically, try and be certified. Try and pair up with an infection control practitioner so you can see what the job is really like. Also, I think the person has to be pretty dynamic. They have to be willing to not only collect data, come up with plans to eradicate infections or mitigate. They have to also be the person who’s going to be able to go out there and do education with the staff and do it in a meaningful way so that it leaves a lasting impression.

ICT®: You strike me as somebody that wherever you work, you’re always listened to by the administrators. Does every infection preventionist have that kind of clout?

Ricci: I would hope so. I can’t say that everyone does. But I think with the fact that we have to give data on qualities and CLASBIs and things like that, that administration is listening to our infection preventionists now. Because reimbursement is also tied to infections, as you know.

ICT®: And what about the whole area of personal protective equipment?

Ricci: I think the biggest thing that we are learning in this pandemic is that we don’t have enough. We did not stockpile. There’s no strategic center where people can get PPE to stockpile it for the next pandemic, whether it be a resistant strain of flu. I mean, everybody’s anticipating that the flu is going to be bad this year on top of COVID. I think that the lack of PPE is a big problem. There’s also the question of how do we encourage staff to get the vaccination, if there is a vaccination, for COVID-19? Currently, we have employees in facilities caring for patients who do not get the flu vaccine and don’t have a medical reason for not doing it. And most facilities—because we need employees to care for patients—will mandate the use of the mask from December 1 to March 30. So how are we going to encourage employees to get the COVID vaccine even? I think that that’s a big area where infection control practitioners are going to have to focus their energy to encourage receiving the vaccination when this is over. Because I look at the number of people who can get flu shots who don’t get flu shots for many, many different reasons. Our healthcare workers—not just the public—are not going to take the vaccine, especially with it being novel.

ICT®: You think it should be made mandatory?

Ricci: It probably will be.

This interview has been edited for clarity and length.