Infection control
The sight of healthcare workers kitted out in full personal protective equipment has become a hallmark image during the pandemic.
“Even before Covid, there was an unmet need for greater awareness of IPC and regular refresher training for hospital staff in the use of PPE,” she says. “I doubt this need has been addressed and I suspect it will not be long before there is a return to baseline.”
Which changes have persisted? The IPC guidance evolved throughout the pandemic, in keeping with a fast-mutating virus. By 2022, many countries were relaxing their Covid- specific guidelines, with a view to freeing up capacity and tackling the treatment backlog that had accrued.
For instance, NHS England published its revised guidance in April 2022. It stated that healthcare workers would no longer need to adhere to physical distancing measures or special cleaning protocols. Instead, they should carry out risk assessments to determine whether extra precautions were needed. In Australia, the requirement to wear a mask persisted until August 2023, marking the end of the winter flu season. Since then, many healthcare facilities have been mask-free zones. In general, Gilbert believes that most Australian hospitals have reverted to business as usual, except when caring for known Covid patients.
“Even then, many staff probably feel they are no longer at risk because they have been vaccinated, and they are likely to revert to often not wearing masks even when they are supposed to,” she says. On the other hand, it seems likely that rapid diagnostics (an integral part of infection control) has changed for the better, for good. Many hospitals have also implemented new procedures for tracking outbreaks and are embracing rejigged ward layouts and new approaches to ventilation.
What still needs to change? All this said, Covid cases are no longer being tracked as they once were, which means it’s difficult to gauge how successfully hospitals are minimising its spread.
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What is clear is that, in the absence of strict rules, a hospital’s ability to curb nosocomial infections will depend on other factors. Organisational culture is surely at the top of the list. In a 2022 research paper, Gilbert argued that doctors and nurses tend to operate differently when it comes to IPC procedures, with some nurses tending towards the rigidly rule-driven and many doctors hating to be told what to do. These ‘interprofessional differences and inconsistencies’, she thinks, can turn IPC into something of a minefield. In practice, the different professions need to meet in the middle and develop a context- specific set of rules, consistent with IPC guidelines but still practicable.
“Covid may have helped to facilitate this in some places, but trying to change entrenched attitudes and behaviours in the middle of a crisis is not ideal,” she says.
On top of that, she thinks hospitals ought to implement regular refresher training and to track at least some types of healthcare-associated infection. Hospitals also need strong leaders at all levels who have the time and resources to focus on these issues. “All healthcare workers need to believe in the importance of IPC. Senior clinicians need to be role models by adhering to IPC practices themselves, and to make it clear that they expect their teams to do so as well,” she says. “This may seem naïve, but I know there are some hospitals where it happens. It takes a lot of effort to change the culture, raise the priority of IPC, and allocate adequate resources in the ones where it doesn’t.” None of this will be easy, given entrenched staffing shortages and a general lack of interest in IPC. However, if nothing else, the Covid pandemic underscored the importance of trying. According to some estimates, the world faces a 27.5% risk of a new Covid-like pandemic within the next 10 years. That means it’s vital to integrate the lessons Covid has taught us while we have a bit of breathing space.
Practical Patient Care /
www.practical-patient-care.com
Andy Dean Photography/
Shutterstock.com
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