Infection control
effort, curbing transmission rates considerably. In 2022, the World Health Organisation (WHO) declared that 70% of hospital-acquired infections can be prevented through good IPC practices. Dr Tedros Adhanom Ghebreyesus, WHO director general, remarked that while the pandemic had exposed many gaps in infection control, it also gave healthcare systems the push they needed to improve. “It has provided an unprecedented opportunity to take stock of the situation and rapidly scale up outbreak readiness and response through IPC practices, as well as strengthening IPC programmes across the health system,” he said. Nearly four years since Wuhan went into lockdown, healthcare is to all intents and purposes back to ‘normal’. While Covid-19 is still a threat, it is no longer classed as an international emergency and the rules around it are mostly a thing of the past. The question remains: to what extent have lessons truly been learned? Has IPC returned to its pre-pandemic baseline, or has Covid-19 changed the status quo for good?
How did IPC change during the pandemic?
If we think back to the early days of the pandemic, it’s easy to recall the sense of urgency. Hospitals rose admirably to the challenge, adapting their IPC procedures very fast.
While the exact guidelines varied from country to country, some procedures looked much the same across the board. Hospitals would triage patients on admission, isolating Covid-19 patients until the infection risk had passed. The doctors and nurses treating them wore fluid-resistant gowns, gloves, face shields, eye protection, hair covers, shoe covers and high-quality masks. Visitors, once allowed, needed to wear face masks and use hand sanitiser. Triage areas were partitioned, physical barriers were placed around reception areas and nurse stations, and anyone walking around the hospital would have found one- way systems in place.
Meanwhile, cleaning protocols, hand hygiene practices, and ventilation procedures were stepped up. Some hospitals started using ultraviolet light to check that surfaces were properly cleaned, while others invested in air purifiers. At the very least, they kept the windows open and were regimented in their use of disinfectants.
Where did the challenges lie? While these kinds of practices sound uncontroversial, this was also a time when SARS- CoV-2 was incompletely understood. Professor Lyn Gilbert is an Australian infectious diseases physician and microbiologist who served as chair of Australia’s Infection Control Expert Group (ICEG)
Practical Patient Care /
www.practical-patient-care.com
from February 2020 to March 2021. She remembers the early days of the pandemic as being a time of fervent debate among IPC teams.
“There were wide variations in IPC guidance and protocols, despite what we had hoped would be a single ‘source of truth’ – as much as anyone could claim to know the truth as the situation evolved,” she recalls.
One hot-button issue was the question of masking.
Very early on in the pandemic, the WHO warned that there were global shortages of personal protective equipment. This applied specifically to N95 respirators – high-grade medical masks designed to filter viruses. Healthcare workers were permitted, albeit controversially, to use surgical masks instead. “ICEG recommended use of N95 respirators for aerosol-generating procedures, and surgical masks for most other situations,” says Gilbert. “This was consistent with both the epidemiology at the time and what bodies like the World Health Organisation were recommending. However, the people recommending routine use of N95s were very vocal and many healthcare workers were confused, fearful for themselves and their families, and angry because they felt they were being denied adequate protection.” She adds that, while there was a strong emphasis on the respirator issue, few people were using eye protection (which ICEG had recommended). There were also arguments about the role of surfaces and hands in transmission, and what types of gowns should be used.
For most healthcare workers, none of the IPC practices they were being asked to follow were completely new. However, Gilbert points out that (for Australian healthcare workers at least) there had been little routine IPC training in the preceding years and the level of knowledge surrounding PPE was poor. What’s more, she suspects that other routine IPC measures, like hand hygiene, may have been partly neglected as hospitals became busier and staff absenteeism increased.
Where possible, healthcare professionals were told to wear N95 masks, but many had to settle for surgical masks due to shortages.
70%
The percentage of hospital-acquired infections that can be prevented through good IPC practices.
WHO 45
Maridav/
Shutterstock.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61
