Infection control
Urinary catheters are common threat vectors for infection in hospitals.
“[In Canada] Infection prevention and control
(IPAC) became the main source of information during the Covid-19 pandemic, and the source of safety and control measures,” says Erica Susky, an infection control practitioner based out of Toronto. “Our role in communication became more crucial as new information and guidelines emerged from week to week, and sometimes from day to day.” The risk of healthcare workers catching the SARS-CoV-2 virus that causes Covid-19 was a significant concern, and one shared by Babcock, who points out that healthcare employees live in the community just like patients, and when a wave of Covid-19 comes through, employees inevitably get sick, meaning hospitals have fewer staff during a spike. To further compound an already significant challenge, infection control practitioners had to maintain the infection control protocols required to tackle the usual suspects.
The reality of coping with all these demands was that the standard daily work of an infection prevention programme suddenly skyrocketed as practitioners struggled to find the capacity for their usual daily observations, audits and monitoring. “Our real challenge was in maintaining the standard practices we know are necessary to keep infections at bay, to be sure that not just the Covid-19 patients, but all the other patients coming through the doors for other things were protected and taken care of safely,” explains Babcock.
Other infections
Prior to Covid, hospitals were most concerned about device-related infections, such as catheter- related bloodstream infections or catheter- associated urinary tract infections; surgical site infections; and clostridium difficile (C. Diff) – a bacterial infection that can result from antibiotic use. During the pandemic, numbers of these and other non-Covid-19 infections actually spiked. Hospitals are seeing more cases of central line-
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associated bloodstream infections, but also C. Diff; fungal and bacterial pneumonia; and ventilator- acquired pneumonias. With Covid-19 in the equation, not only have these risks remained, they’ve become intensified. “Having Covid-19 can affect your immune system and the integrity of your lungs,” Susky explains. This may make patients susceptible to having superimposed pulmonary infections. And anytime someone is hospitalised with indwelling medical devices (like central venous catheters or ventilators), this increases infection risk, too. “People hospitalised for a greater amount of time remain vulnerable to hospital-acquired infections. Indwelling devices remain a potential portal of entry for infections as long as they are in place,” adds Susky. Babcock adds that with workers being pulled in multiple directions, important infection prevention tasks, like cleaning a central line, can go unfulfilled. This is especially true if patients are lying on their stomachs for sanitary reasons and accessing indwelling devices like central lines becomes more difficult.
The ‘Great Resignation’
A major challenge throughout the pandemic, according to both Susky and Babcock, has been the impact that the extra demand has had on healthcare professionals. “Staff fatigue and resources are the biggest current struggles,” Susky says. In many cases, the experience of the pandemic has led to workers leaving the field entirely. One in five have quit their jobs since the beginning of the pandemic, leading the U.S. Bureau of Labor Statistics to dub the situation the “Great Resignation”. While the number of employed healthcare workers has been going down, patient volumes have remained high, and Susky explains how this puts pressure on the healthcare system. “Covid-19 is not going anywhere and is still a transmission risk in hospitals, which demands further diligence from staff. Many healthcare facilities have shared rooms, and with increased patient volumes, hospital rooms will be at capacity which increases the risk of transmission.” According to Dr Babcock, hospitals have also struggled to “operationalise the things that changed.” Government requirements and recommendations surrounding the virus have been continually changing over the last few years. Hospitals and other healthcare organisations have needed to stay agile, taking these changes and weaving them into their operations as soon and as smoothly as possible. For example, when the vaccine was made available for healthcare workers, Dr Babcock explains how the university and healthcare system for which she oversees infection control needed to get all 45,000 of its employees to vaccine clinics. “[The clinics were] an amazing
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www.practical-patient-care.com
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