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"We had to everyday kind of make some changes. Every morning there were huddles and we tried to figure it out."
Suma Chacko, RN, CIC, has an extensive background in infection prevention. Chacko is one of the newer members of Infection Control Today®’s Editorial Advisory Board. Currently, Chacko works as an infection control specialist at the Hospital of the University of Pennsylvania in Philadelphia. During the COVID-19 spike, Chacko routinely worked 16-hour days, answering questions and addressing concerns from a variety of fellow healthcare workers: hospital administrators, doctors, nurses, environmental services staff, laundry teams, food service workers-you name it. She recently spoke to ICT®about some of the lessons she and other infection preventionists can take from the COVID-19 pandemic.
Infection Control Today®: You are in fact infection promotions for many years, right?
Suma Chacko, RN, CIC: That is correct. My background is nursing. I had been a nurse at the Hospital of University of Pennsylvania for 20 plus years, and then I switched into infection prevention. I worked at Good Shepherd Penn Partners, for two and a half years as an infection preventionist. I came back to HUP and I had been an infection preventionist there for about eight to 10 years.
ICT®: Were you keeping an eye on the COVID-19 pandemic?
Chacko: Yes, absolutely. We got our first patient on March 7. Before that we had a lot of PUIs, that is persons under investigation, but none of them tested positive. The first patient was transferred to us from another hospital on March 7. Since then, we have been on trend lines. Even before that, preparing for this oncoming COVID-19 had been in the works since the beginning of March. March was when it really became real. And we had been in the forefront trying to figure out how we would be answering the questions from the multiple [healthcare workers] like the physicians, the nurses. As patients come with signs and symptoms. I mean, what should they be looking for? What should they do with that patient? How do they order testing? Now it’s stabilized a little bit. We have gotten over the hump, It had been a process that evolved over time. In the past few months. it’s been hectic.
ICT®: You and I are talking right now in early May. It is it is slowing down a little bit.
Chacko: Yes. For at least in our hospital, what we are saying is definitely the patient numbers are stable or coming down very slowly this week.
ICT®: What was a typical day like during the rough period?
Chacko: Well, basically probably about 16 hours or more. Really trying to figure it out. Because things are changing every day. Things are changing, because you’re starting with what you know with the PPE. Or, you know, what are the guidelines? Who do you test? And trying to figure it out. Every day things changed. We had to go with what the recommendations from the CDC [US Centers for Disease Control and Prevention] or from what was happening at the frontlines. What staff were telling us. Or what we were seeing with patients. We had to everyday kind of make some changes. Every morning there were huddles and we tried to figure it out from each department. How many masks do we have? What are our supplies like? Or what is EVS [environmental services staff] going to be doing or can they go into these patients’ rooms when they have tested positive? Who goes into that room? What would the nurses be wearing if there are aerosolized procedures? What should be the precaution? Do we allow any visitors at all in the hospital? It has been so many questions every day. Who gets tested? Who gets priority? We didn’t have enough testing supplies to begin with in early March. Trying to get those testing supplies and testing the most appropriate individuals. Those were all challenges. The IV team kind of led that [testing] along with other things that we were working on in our infection prevention office. We had the office going all hours, pretty much up until late at night. They were long days.
ICT®: You were interacting with every department. You mentioned environmental services.
Chacko: Yes, of course. All departments had to work together. It was definitely amazing teamwork. Everything, including food services, EVS. EVS was at the forefront because they have to help us with the cleaning and disinfecting the environment and making sure the employees are safe. Waste disposal. That’s a big, huge thing. We didn’t know enough about how things needed to be disposed. Again, questions came up with what is the level of biohazard. Even linen. Our regular laundry did not want to take the linen that was used for the COVID patients with the regular linen. Because they didn’t believe that that could go together. There were a lot of challenges with that. Trying to make sure that people are fed and not just the COVID patients, but more so with the employees on the frontlines. So, again, working with them. So, all the departments physicians, nurses, and safety and every department had to come together. Oh, and of course, materials management. Huge key to getting supplies. How much PPE do we have? What do we need to acquire? Where do they get it? If they ordered it … a lot of things were not available when we ordered it. And it became a problem. They had to figure out multiple ways of getting supplies…. Even people who were not admitted in the hospital who were calling to see if there was testing available. Because initially, there was no testing and then the testing roundup of course. Then different sites became available, which was all very helpful to make sure that people got tested. That was great.
ICT®: Everything sounded very challenging. Is there one thing you can pinpoint was the most challenging thing?
Chacko: The most challenging was probably the availability of the personal protective equipment. Securing that. Making sure the employees are safe. The other thing was once people testing positive exposure: tracing. Who all were exposed to a particular person? Maybe if it was a patient. Or maybe it was an employee who came in and got tested. They could have gotten this outside of work. And then who did they come in contact with? So that’s another one of our major areas, helping occupational medicine with contact tracing and exposure workup. And that’s also another challenge at this point, which we are continuing right now.
ICT®: Do you think that infection preventionists will be seen in a whole new light among other healthcare professionals?
Chacko: Infection prevention is what always looked upon for guidance, whether it’s isolation guidelines, PPE, multiple different areas. But yes, absolutely. Sure. Because now people are more aware of simple things such as hand hygiene. It has become so important. Before when we did audits and people … did not like the fact that we were watching. And even wearing certain PPE, people kind of did not want to do that. Didn’t think that it was that important. But, but once [COVID-19] hit everybody wants everything. I think that there is more of an awareness about the different kinds of protection that people need to wear. If anything, that would be a huge thing that people take away from this whole pandemic.
ICT®: Another expert I spoke to said that infection preventionists are often looked upon almost like the hall monitors in high school. Is there some truth to that?
Chacko: There is some, because people look at you like “OK, so now what did we do wrong?” Or what are you looking for? Because, you know, we’re always auditing for compliance to certain things. Are they doing their hand hygiene compliance or are they wearing appropriate PPE? Are they following it? To an extent, maybe they look at as like maybe the big brother, somebody who comes in to see whether they are doing everything that they should be doing or they’re supposed to do. And, so, there is some truth to it. Yes, I would agree.
ICT®: Possibly that culture is going to change now after this, right?
Chacko: I really hope so.
ICT®: Will COVID-19 change how infection prevention is done in hospitals now?
Chacko: I think so. I think because there is more involvement from different departments, including nursing, who are really engaged in infection prevention initiatives. I think, even for example, right now we are doing fit testing. N95 respirators: We have different kinds now. Because the one kind that we had always available is not enough. We do have other kinds that we need to also test for. We have a lot of people coming in and training other people to do the fit testing because we can’t accommodate the volume that needs to be done. Our nursing professionals help. Because the ORs weren’t taking regular cases. Our patient census in general was decreased to increase the volume for the COVID patients. For that surge. We were preparing for that. So, the number of patients were less so. More nurses were available to help us with these things. I think they have kind of worked with us now. There is definitely more understanding and cooperation. There’s more of a collaboration with other disciplines.
ICT®: Is that going to stay?
Chacko: Yes, I would think that would be something that we would go forward with. With all the talk of how we need to be prepared for different things. It’s not easy when something comes up that you can’t be ready for. Especially a pandemic, which none of us have seen really in our lifetimes. Nobody was really ready for it. We had to learn as we as we went along. We learned a lot, and fast. And trying to work together was the only way to get there as a team. To keep the staff safe, and also the patients safe, we had to all work together.
This interview has been edited for clarity and length.