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Though tough months lie ahead for infection preventionists and other healthcare professionals, hope remains that at some point in 2021 things will begin to settle down. In the end, it comes down to a simple formula: We win, COVID-19 loses.
We can say that we didn’t see it coming, but we can’t say that we weren’t warned. Healthcare experts for decades have been telling us that it’s a question of when, not if, we’ll be hit with a worldwide pandemic. And though coronavirus disease 2019 (COVID-19) technically—as the name suggests—reared its spiky head in 2019, most of us didn’t know about it until 2020. Those who did know about it, could only guess what havoc SARS-CoV-2 would cause. As the timeline below of articles that appeared in Infection Control Today® in 2020 makes clear, even the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) were caught somewhat off-guard.
Here’s where things stand as of yesterday, December 22. There were about 195,000 new cases of COVID-19 reported in the United States, making the 7-day average about 215,000, according to Johns Hopkins University. Meanwhile, 3401 people died from the disease. That’s the second-highest number of deaths from the novel coronavirus in a single day.
According to the COVID Tracking Project, 117,777 people were hospitalized for COVID-19. Again, another record; the most hospitalizations for one day since the pandemic began. In addition, 22,213 Americans were in intensive care units and 7830 were on ventilators, according to the COVID Tracking Project.
More grim records will almost certainly be broken, according to President-elect Joe Biden. “Our darkest days in the battle against COVID are ahead of us, not behind us,” Biden told reporters.
And yet, though tough months lie ahead for infection preventionists and other healthcare professionals, hope remains that at some point in 2021 things will begin to settle down. Vaccines have been rolled into the battle, and the healthcare system in general has a better grasp of just what we’re dealing with and how to treat it. Many healthcare experts predict that infection rates, hospitalizations, and deaths will recede into a past that we’ll be all too happy to be done with. It might take until the end of the year, but it will happen.
In the end, it comes down to a simple formula: We win, COVID-19 loses.
January 21: CDC Officially Confirms First Case in the US
The patient had apparently researched the virus online, and upon developing symptoms reached out to his healthcare provider on January 19. The novel coronavirus was confirmed on January 20 using samples shipped overnight. Public health officials from Washington indicated that the patient was hospitalized out of precaution but in overall good condition.
But it may soon become one, warned Tedros Adhanom Ghebreyesus, PhD, director-general of the World Health Organization. The decision was made based on the fact that public health efforts are being implemented to try to contain the disease and a low number of case counts overall.
It occurred in the spouse of a Chicago woman who caught the virus when traveling to Wuhan. “In most patients, symptoms are milder, but approximately 1 in 5 individuals have experienced severe illness including severe pneumonia and respiratory failure.”
Responding to infectious disease outbreaks is not a novel part of infection prevention and control (IPC) work. In fact, many infection preventionists (IPs) are epidemiologists, trained in outbreak response. While IPs normally deal with outbreaks of drug-resistant organisms or norovirus, often emerging and novel infectious diseases occur that challenge our day-to-day activities.
The FDA’s emergency use authorization (EUA) rolls the CDC’s 2019-nCoV Real-Time RT-PCR Diagnostic Panel into the battle against the coronavirus. The test had previously only been allowed to be used in CDC labs. It provides presumptive detection of 2019-nCoV (also known as the Wuhan coronavirus) from respiratory secretions, such as nasal or oral swabs
Health officials say that this is a particularly bad year for an extended influenza season since flu symptoms and some of the symptoms of the novel coronavirus, COVID-19, are the same (fever, cough, shortness of breath).
The US Centers for Disease Control and Prevention (CDC) has a more pessimistic view of just how disruptive the novel coronavirus COVID-19 can be than the World Health Organization (WHO). Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters yesterday that she expects the virus will soon begin to spread at the community level in the United States.
There’s a dwindling supply of personal protective equipment (PPE) available for infection preventionists and other healthcare workers that hampers their ability to contain COVID-19, warns Tedros Adhanom Ghebreyesus, PhD, the director-general of the World Health Organization (WHO).
National Nurses United wants hospitals to establish protocols in which nurses are immediately notified when a patient who might have COVID-19 is admitted.
Connie Steed, MSN, RN, CIC, FAPIC, the president of the Association for Professionals in Infection Control and Epidemiology (APIC) told Infection Control Today® that the IPs would be functioning under the Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel (HCP) with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19). The guidance was modified on March 7 by the US Centers for Disease Control and Prevention (CDC) as part of its response to COVID-19.
SARS-CoV-2 stays active in or on aerosols for up to 3 hours, copper for up to 4 hours, cardboard for up to 24 hours, and plastic and stainless steel for up to 2 to 3 days.
March 20: Fight COVID-19 With Telemedicine
One of the barriers that has been addressed in recent years was just how providers are to be paid for using telemedicine.
We asked Linda Spaulding, RN, CIC, BC, CHEC, CHOP, to list what infection preventionists need to know to get through this suddenly thrusted upon us Era of COVID-19.
More data to underscore a problem that infection preventionists and other healthcare workers battling the new coronavirus know too well: quickly depleting stores of personal protective equipment (PPE).
In efforts to prepare your healthcare facilities for potential COVID-19 patients, it often feels like there is an onslaught of information. Below are resources which, as an infection preventionist, I found helpful in establishing plans, training methods, and more.
Most of the news about N95 respirators deals with quantity: There’s a shortage, and too many healthcare workers enter the battle against COVID-19 unarmed. That shortage still exists but, thanks to recent rulings by the US Food and Drug Administration (FDA) that approves decontamination processes for the masks, quantity will hopefully become less of a pressing problem as the battle against COVID-19 moves forward and the curve flattens.
Michael L. Millenson: “As we emerge from the COVID-19 crisis, it’s very important for infection control professionals to think, ‘How do we take this crisis and use it as a lever to cause the change that we care about so much?’”
Look to our own practices in hospitals. Are meetings occurring with lots of people for a prolonged period of time without PPE? Breakroom clusters of staff to eat? Exposure is not limited to the patient-caregiver interaction.
April 25: Cloth Masks Are Useless Against COVID-19
Lisa Brosseau, ScD: “What we’re seeing is a lot of magical thinking. A lot of wishful thinking. Cloth masks are wishful thinking.”
“Operation Warp Speed,” a federal project that some are likening to the Manhattan Project that developed the atomic bombs that ended World War II, seeks to develop and disburse 100 million doses of a COVID-19 vaccine to the public by the end of the year.
Mary Jean Ricci, MSN, RN-BC: “Now we’re looking at [infection prevention] from a global perspective. Every patient needs to be educated because this is a novel virus and it is unknown.”
For those working in healthcare, the relationship with the supply chain department was an increasingly important one. Between daily mask utilization and supply reporting to scrambling to find more supplies, those working in healthcare supply chains were working exceedingly hard to keep our heads above water.
Brooke Decker, MD: “Keep in mind that right now you’re generating those stories that you’re going to be telling junior colleagues for decades to come.”
Charles Gerba, PhD: Environmental services plays a crucial-and often unsung-role in infection prevention. “Unfortunately, we don’t honor people enough for things they prevented or that never happened.”
While starting to perform elective surgeries, hospitals should also keep an eye on COVID-19 in their communities and have the resources available to respond to a surge in COVID patients without having to resort to a crisis standard of care.
Over 100 prominent healthcare experts have sent a letter to the United States’ governors to recommend that the public wear fabric masks, and combined with other measures, the epidemic’s R0 can be driven below 1, halting the spread of the virus. And over 100 countries now recommend the wearing of cloth masks by the public.
Kevin Kavangh, MD: “What worries me the most about reopening is that people are going to say, ‘Oh, it’s over with’ and not do any sort of protection, whether it’s social distancing, wearing masks, not gathering in crowds. I really think that people will think, ‘Well, we got this beat.’”
Sharon Ward-Fore: “Rather than reusing gowns, consider bundling patient care activities to conserve gowns. Donning a gown that has already been used can be tricky, and a source of contamination to the user.”
Rebecca Leach, RN, BSN, MPH, CIC: “Infection preventionists had to work very closely with our supply chain and look at all of our options and really keep track of it. I also think working with lab more closely will be important in the future, to understand testing modalities, understanding our abilities to test and interpreting those tests.”
Decontaminated respirators should only be resorted to when unused devices are not available, but that happened a lot in the last few months.
A portable anteroom can be used as an extra layer of protection between the isolation space and the rest of the hospital. A positively pressured anteroom, for instance, lets staff don PPE in a protected environment.
Sharon Ward-Fore, MS, MT(ASCP), CIC: “It is a collaboration, and I think the most successful environmental services department has an infection preventionist who really enjoys working with EVS.”
The common method used to determine IP staffing-using a ratio of IPs to the number of beds or the number of patients-might not be the best way of determining just how many IPs an institution needs.
Those of us in healthcare and infection prevention must focus on sustainable efforts to combat COVID-19. How do we maintain readiness and response without burnout? There’s no solid answer to this, but a big piece really goes into the establishment of plans and education.
Ann Marie Pettis, RN, BSN, CIC, FAPIC, president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC): “If indeed flu comes at the same time a second wave of COVID comes, that’s going to be difficult—unbelievably difficult because the symptoms obviously are somewhat similar. We’ll be trying to rule both of those things out. It will create more of a risk for a surge, and it will put more taxing on our PPE supplies.”
Just-in-time (JIT) fit testing allows a healthcare organization to offer evaluation, training, and fitting of healthcare professionals during rapid intervals, as needed, based on specific patient care assignments.
Many healthcare facilities, not only LTCFs, have turned to online training for staff and then designate the employee as competent to do their job. Online training does not prove competency; it provides training.
The Infectious Diseases Society of America updated its position statement to educate its membership on the use of telemedicine and telehealth technologies to provide “evidence-based, cost-effective, subspecialty care.”
The swiftness and severity of the COVID-19 spread meant some hospitals were scrambling to adjust. Environmental services often led the way.
To enact social change such as better hand hygiene, only about 25% of a group needs to adopt the change and move the rest of the group forward.
After decades of reluctance to implement a national reporting system, when COVID-19 came along we witnessed almost overnight the formulation of case definitions and comprehensive national reporting from all healthcare facilities.
Infection control at LTCFs needs to be a balanced approach that addresses the risk of infection, and not just the treatment of infection. Money is saved when this approach is used.
August 14: Handwashing: Is a New Normal Possible?
Professional development educators and infection control specialists need to design educational programs that create a lasting behavior change when it comes to hand hygiene.
It will also be necessary to again train other professionals the way IPs have historically trained them about infection prevention, because a lot of the old rules had to be set aside when COVID-19 surged.
Supply chain issues are a larger, more systemic aspect of healthcare and national preparedness. Although IPs may not be able to fix them individually, there are ways we can ensure the safety of our hospitals.
September 3: Q&A: COVID Presents Unique Challenges to NICUs
Jenny Hayes, MSN, RN, CIC: “Asking the patient to wear a mask, which is something that we do in our facility, can be challenging at that point, especially as labor progresses, and you’re to the point of pushing. That right there offers a set of unique challenges for both the patient and the staff in the room.”
September 8: HAIs Didn’t Go Away When COVID-19 Came Along
As the pandemic seems not to abate, patients will start to present to the hospital after delaying crucial primary and preventive care visits, meaning sicker non–COVID-19 infected patients, with the potential for increased CLABSI and CAUTI rates.
Many factors make the isolation precautions for diseases like COVID-19 more complex than typical droplet or airborne definitions.
September 20: Continuously Active Disinfectants Can Keep COVID at Bay
Charles P. Gerba, PhD: “Unfortunately, standard procedures for testing and registration by regulatory agencies of CADs (continuously active sanitizers or disinfectants) as disinfectants useful in preventing exposure to disease causing microorganism transmission has only taken place in recent years.”
A telework-ready infection preventionist is an IP who continues to support their facility if they also end up in quarantine. Teleworking like so many other aspects of nursing is something we just needed to jump into. No training, no guidebook, no manual.
As the COVID-19 pandemic continues to surge, it is unlikely that contact tracing within healthcare will become anything less than critical.
Infection preventionists are of utmost importance to work with school systems and provide the safest strategies and environmental modifications which can suppress the transmission of the SARS-CoV-2 virus.
Much of the care for the spread-out and isolated patient population is home care. The hospital has a 3-person HIV team and about 6 public health nurses who visit patients in their homes. They all speak Navajo. (COVID-19 is Diko Ntsaaígíí-Náhást’éíts’áadah.)
One example of a way that IPs can collaborate with other departments to implement a vaccination program is to work with occupational health and emergency response departments to have a mass vaccination drill.
If you see something, say something. Let coworkers know when they may have breached infection control practices such as forgetting to wash their hands, not wearing PPE properly, or missed opportunities to clean high-touch surfaces.
October 26: Infection Preventionists Need to Monitor PPE Use
Sharon Ward-Fore, MS, MT(ASCP), CIC: “Practices drift. You can become complacent and maybe your level of awareness has decreased…. So, infection preventionists need to be really aware of what’s happening in the areas they cover as far as PPE usage is concerned.”
Although both vascular access and infection prevention have their own focus, our commonality is in ensuring patients get the care they need while minimizing their chances of nosocomial infections.
Melinda Benedict, MS, CIC, CFER: “I think for infection preventionists: If you’re not already involved in your endoscopy department or you haven’t been invited in, see if you can get in and just continue to check it out and see what’s going on, especially if the reprocessing and cleaning of the scope is actually done within that clinic.”
Infection preventionists should know that these technologies are available to add to their toolboxes of best cleaning and disinfection practices when they need them but be aware of the caveats for their use.
Cedric Steiner: “We had to address the ability to say good-bye to loved ones. A big guy, with tears in his eyes. He was so thankful that they had a place to go for their mother, because at the hospital they couldn’t see her. He wanted to give me a bear hug, but we did the ‘elbow thing’ instead.”
Data show none of the treated volunteers to develop COVID-19 experienced a severe form of the disease, versus 11 given placebo.
IPs have not only that frontline experience, but also the ability to pivot and evolve with recommendations. In fact, our very jobs are about translating continuously evolving evidence and guidance into practice.
Patients afflicted with COVID-19 have an increased susceptibility to antibiotic resistant infections both from prolonged hospitalizations and the use of immunocompromising agents such as dexamethasone.
COVID-19 possibly hindered the prevention of healthcare-acquired infections (HAIs) because infection preventionists have less time to do rounding and focus on the elements that contribute to HAIs.
November 23: Innovations Needed for Personal Protective Equipment
Perhaps now is the time that innovation begins to rely more heavily on infection preventionists and our valuable insight into the world of healthcare PPE. The changes we help guide now, can help make healthcare safer and infection prevention easier.
November 24: Next Course? COVID ‘Surge Superimposed Upon a Surge’
The CDC warns that it’s possible that the number of hospitalizations due to COVID-19 are likely to rise every day for the next 4 to 10 weeks, further straining an already strained healthcare system.
November 30: Moderna Submits COVID-19 Vaccine for FDA Approval
Efficacy against severe COVID-19 is 100%—based on the benchmark of 30 total severe cases, all in the placebo group. Consistent efficacy was seen across patient age, race and ethnicity groups, as well as gender demographics.
December 2: Q&A: ‘Arguing’ Before the Supreme Court
Kevin Kavanagh, MD: “I would tell the Supreme Court that it’s very important that all high-risk venues are treated equally, but the remedy isn’t opening up one high-risk venue, the remedy should be closing down all high-risk venues.”
When an 850-bed urban hospital fought off COVID-19 in part by having to relax infection prevention protocols, the opportunistic and deadly carbapenem-resistant Acinetobacter baumannii (CRAB) struck.
Rebecca Leach: “I think the biggest thing is just having support, whoever it is. If it’s a fellow infection preventionist…. It really is that emotional support of being able to talk to each other about your experiences and really process your feelings.”
Compare transmission data for patients on contact precautions using the recommended full complement of PPE versus transmissions for patients on contact precautions when PPE was being utilized differently or not at all.
Sharon Ward-Fore, MS, MT(ASCP), CIC: “If it were my institution, I would make sure that infection preventionists are educated on everything they need to know about the COVID vaccine, as well as the flu vaccine side effects.”
December 11: How to Train Environmental Services Teams
Infection preventionists can work with environmental services (EVS) leadership to implement a routine practice for quality assurance checks that EVS leadership can follow. These metrics can then be reviewed as an aggregate with the IP department to target whether further education may be beneficial.
Angela Rasmussen, PhD: “Even if you are in the first group to get the [Pfizer/BioNTech] vaccine, even if the vaccine becomes available widely beyond the first groups that are going to get it, we still need to be wearing masks, social distancing, thinking about ventilation, and avoiding large gatherings for some time to come.”
How will the COVID vaccine be handled at each facility? Will it be mandatory? Will it be given annually? Will it be a condition of employment? These are all questions that will need to be addressed.
In essence, infection prevention and control isn’t just one measure, like personal protective equipment (PPE), but all of these layers. Each layer is imperfect but plays a critical role in reducing risk.
December 17: Q&A: ‘Are You Going to Get the Vaccine?’
Bruce Y. Lee, MD, MBA: “I would like to see data for a longer period of time to make sure that we have a better handle in terms of efficacy and the safety of the vaccine.”
Officials at the Children’s Hospital of Philadelphia have the ability to convert several floors into airborne infection isolation rooms, or more commonly termed negative pressure rooms, with the flip of a switch.
December 21: Moderna’s COVID-19 Approved by FDA
Unlike traditional forms, Moderna’s mRNA-1273 vaccine does not put weakened or inactivated germs inside the body. Rather, it teaches cells to make proteins that will trigger an immune response by injecting ribonucleic acid into cells which gives them instructions.
December 21: As Vaccines Roll Out, New COVID Strain Rolls In
Healthcare experts around the world worry that the COVID-19 mutation—called VUI–202012/01—might be 70% more infectious than the standard SARS-CoV-2 strain. There are no indications yet that it may also be more lethal or that vaccines can’t neutralize it.
December 22: How COVID-19 Vaccination Effort Should Proceed
When it comes to COVID-19 vaccinations, it’s important to consider ancillary staff. Employees in environmental services, lab, respiratory therapy, physical therapy, and food services who have been working in high-risk areas.
December 22: Vaccines Should Work Against New COVID-19 Strain
We must treat this strain with the respect it deserves, but we must not panic. There is no doubt that increased infectivity equates with increases in deaths, but it does not mean the vaccines will not work.