How do infection preventionists navigate the many—and often contradictory—requirements that fighting the COVID-19 pandemic has brought upon them?
As we engage in the world, it appears the public considers the COVID-19 pandemic to be over or not as pressing. For those still working the front lines of COVID-19 response, we know that it is not over and could very quickly escalate again. Additionally, the threat of a tripledemic is very real for many health systems, with increasing influenza and respiratory syncytial virus cases across the country.1
Since the beginning of 2020, infection preventionists (IPs) have been tackling the pandemic, working as subject matter experts for their facilities to educate staff and providers on the latest guidance, training on the continuously changing isolation and personal protective equipment (PPE) guidance, and working with administrators to coordinate operational efforts to handle massive influxes of infectious patients. As the initial months of pandemic response moved forward, the work of IPs also transitioned into sustaining efforts while considering how COVID-19 would become a routine part of health care.
As IPs were working tirelessly on the front lines, state and federal requirements started trickling out. Often the responsibility of responding to those requirements fell under the role of the IP. Federal reporting mandates for daily numbers of patients, deaths, admissions, discharges, PPE burn, and supply and ventilator utilization all became something the IP was tracking and reporting. These federal reporting requirements continue for the foreseeable future and have been transferred to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network.2 This move into the NHSN—where all other mandatory patient and health care worker safety measures are submitted—squarely puts the IP at the center of this federal reporting.
Many states have also instituted mandatory reporting. Communicable disease reporting is already a responsibility of IPs, and COVID-19 cases were included in that daily reporting. This created a large burden, especially during the surges, as daily case counts multiplied. Additionally, the Occupational Safety and Health Administration had set forth a temporary ruling that left IPs scrambling to pull together and implement the guidance, which included specifying all measures taken by the health care institution to protect employees, reporting of employee exposures, and employee hospitalization and mortality.3
IPs often shuffle priorities as part of daily workflow management. However, during the initial COVID-19 response, all efforts and time were focused on that one issue. All other initiatives and workloads were put off as much as possible. Now, with pandemic response in the sustain-and-maintain mode, we’re noticing that all these other responsibilities are showing signs of neglect.
Vaccines—the long-awaited tool that brought hope—also came with reporting and tracking requirements. COVID-19 vaccination administration and tracking for health care workers were required, as well as a Center for Medicare & Medicaid requirement to report, at minimum, a monthly count of all staff, providers, contractors, students, and volunteers who have received a COVID-19 vaccine.3 As the booster doses and vaccine eligibility change, the components of required reporting also change. The result: What was collected one month will have to be amended for the next month. This
creates challenges with developing reliable reports and data collection methods, pulling from several sources to gather the aggregate data.
Many of these additional reporting requirements are still in place, and all this does not begin to consider local or facility-specific reporting and surveillance that the IPs are performing.
The news released from the CDC about the significant increase in health care–associated infections during the COVID-19 pandemic likely came as no surprise to IPs working in the field.4 In my own practice, I saw an increase of central line-related bloodstream infections and catheter-associated urinary tract infections in our patients being treated for COVID-19. Ventilator-associated events were a major concern because the patients were often on ventilators for extended time and secondary bacterial infections were common. Patients were placed in the lifesaving prone position, which has an impact on the ability to maintain a central-line dressing and keep it clean, dry, and intact. Foley catheter utilization increased as the acuity of patients increased and the need to monitor strict input and output continued.
IPs often shuffle priorities as part of daily workflow management. However, during the initial COVID-19 response, all efforts and time were focused on that one issue. All other initiatives and workloads were put off as much as possible. Now, with pandemic response in the sustain-and-maintain mode, we’re noticing that all these other responsibilities are showing signs of neglect. All the other work and responsibilities of an IP storms back into focus and require attention, so again, IPs are overwhelmed. Further, a frustrating effect of the pandemic is that much progress that had been made in years prior was lost, and it feels as if efforts must start from the beginning.
Triage of work often will follow a pattern—first, anything related to regulatory bodies or government requirements. This includes all public reporting efforts, followed by The Joint Commission or other accrediting bodies requirements as well as maintaining surveillance for communicable diseases. Second, what are the priorities of your local facility? An annual risk assessment is to be completed by the infection prevention program, and if that risk assessment is used to truly drive action, then the priorities need to be reflected in that risk assessment document. This is an opportunity to make some of these administrative tasks of an infection prevention program actually work in favor of the IP team. Third, tackle the fires that come up every day, and be very selective of what the team agrees to take on. Many times, infection prevention can be a catch-all for issues not under the umbrella of the program. This is the time to learn to respectfully decline or suggest a more appropriate department to address.
If a new project is requested that must be taken on, it is imperative that the IP advocate for their program and make it clear that a shift away from other work will be required. Burnout of IPs is just as big of an issue as with other clinical health care staff.5 Electronic surveillance programs and medical records need to be optimized to decrease manual efforts of surveillance and increase efficiency. Working with local clinical informaticists can help drive efforts to improve the capabilities of electronic reporting. Tying these requests to the organizational goals will also give some importance to the requests.
As with other large-scale biopreparedness events in the recent past (ie, Ebola virus, novel influenza A, and anthrax terrorist attacks), this is a time for the larger infection prevention force in the United States to advocate on behalf of local practitioners.
The COVID-19 pandemic has been a time for IPs to show their value in their organizations. And with this recognition comes an opportunity and platform for the often-overlooked needs of the infection prevention program to be brought forward for discussion.
Also, how does infection prevention integrate with other facility initiatives? How can we piggyback with those efforts to put an infection prevention spin on it? Resources are tight across the health care industry with many organizations laying off workers and cutting hours. Infection prevention programs need to be strategic and find partners to collaborate with, help drive efforts in HAI prevention bundle implementation, and find innovative ways to tackle the increase in health care–associated infections. Sepsis teams, pressure injury teams, and even patient experience teams provide opportunities for an IP to become involved and influence change.
As with other large-scale biopreparedness events in the recent past (ie, Ebola virus, novel influenza A, and anthrax terrorist attacks), this is a time for the larger infection prevention force in the United States to advocate on behalf of local practitioners. Our professional organizations need to step up and work with agencies to address the diminishing workforce and the increased workload and expectations.
Because the pandemic influenced so many aspects of our professional lives, the role of an IP seems to be at an evolutionary point. No longer are we just the hand hygiene police, but we have emerged as key leaders for our organizations and gained social capital as experts and guides through the pandemic. Now with this increase in workload and decrease in resources, we must be selective and creative in how we navigate the short-term future of infection prevention, and we must focus efforts on where we can make the most impact in patient safety and contributions to overall improvements in health care quality.