INFECTION PREVENTION
Pandemic drives broader roles and responsibilities
According to the IPs surveyed, COVID-19 has affected the profession in many different ways. The top impacts reported are work hours (92%), broadened scope of responsi- bilities (87%), job satisfaction (58%) and staff shortages (53%). “The COVID-19 pandemic has impacted
and challenged every infection prevention- ist in ways one would not have dreamed of,” said Muriel. “We have known that an infectious disease X was looming in perhaps the not-too-distant future. However, the daunting logistics and extreme situations of COVID-19 could not have been antici- pated.” “Infection preventionists have been work-
ing longer hours creating new policies and procedures to keep healthcare workers and patients safe during the COVID-19 pan- demic,” noted Swain. “We have taken on additional responsibilities including 24-hour call, personal protective equipment training and fit testing, and supplementary rounding on COVID units to answer any questions staff may have.” “Many infection preventionists jumped in to help in many different ways during the pandemic, often working many long hours and having many sleepless nights,” added Conley. “In my infection prevention depart- ment, we umped in to assist with fit testing staff, training staff on COVID-19 precautions and working with Employee Health to test and conduct contact tracing for COVID-19 positive employees. We continue to have a very active role in our Incident Command Center and worked with the PIO to speak with the media.”
When asked what aspects of COVID-19 have most impacted their work, the top response was the need to implement new infection prevention protocols (96%), fol- lowed by personal protective equipment (PPE) shortages (76%), patient volumes (52%) and staff shortages (52%). The majority of IPs surveyed (79%) said they have been asked to take on other roles and responsibili- ties during the pandemic.
Bassett describes how a large portion of each day is dedicated to answering calls and emails about COVID-19, reporting new COVID-19 infections to the health department, ensuring COVID-19 patients are properly isolated or ensuring their isolation is discontinued at the appropriate times, following up on clusters and potential outbreaks, meetings about COVID-19, pro- cess deviations, supply chain disruptions, immunizations, and educating staff and IPs themselves on changes to Centers for Disease Control and Prevention (CDC) guidance on the pandemic.
As Bassett points out, IPs have had to
manage COVID-19 on top of all of their other responsibilities, including mitigation and tracking of other dangerous and costly infections, as well as all of the other tasks that fall under an IP’s purview.
“Even though a large amount of time is devoted to COVID-related things, we still have all the same other IP duties to tend to like healthcare acquired infection (HAI) surveillance, National Healthcare Safety Network (NHSN) requirements, reporting to the Health Department, construction per- mits and Infection Control Risk Assessments (ICRA), regulatory activities, audits, Envi- ronment of Care (EOC) rounds, etc.” Bassett added. “We don’t have more time available in the day, so we have to be extremely effi- cient to get everything done, the days fly by so fast because we are constantly pulled in so many directions.” Among those surveyed, 37% of IPs say they perform duties related to employee/ occupational health, 33% NHSN require- ments, 25% immunization/vaccination (up from 9% in 2020), 18% quality performance management, and 17% Environment of Care (EOC) Safety management. “Unfortunately, the pandemic does not stop other infections,” said Swain. “IPs con- tinued to perform the required surveillance and reporting, as well as train and educate healthcare workers on basic infection pre- vention best practices. We also continued our Joint Commission regulatory readiness efforts throughout the pandemic.”
IPs throughout the care continuum With clinicians outside of the hospital (e.g., physician offices, clinics, longterm care sites, etc.) bearing much of the burden for testing and treating COVID-19 patients, and admin- istering vaccinations, the vast majority of IPs surveyed (80%) say they have been asked to assist with infection prevention efforts in non-acute settings. According to Harper, many long-term care facilities did not have a designated IP prior to the pandemic. Rather, the role was often performed by the Director of Nursing, Clini- cal Educator or other staff member. “I suppose the COVID pandemic has had some positive outcomes,” she says. “One is the recent CMS implementation of a nursing home training program for frontline nursing home staff and nursing home management. Both frontline caregivers and managers will be able to increase the knowledge they need to stop the spread of COVID-19 in their nursing homes. In the future, I hope CMS provides more definitive guidance regard- ing the number of IPs required for each organization based on size, patient acuity,
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and if they also have oversight of long-term care facilities, ambulatory surgery centers, urgent cares and the number of outpatient practices, etc.”
“In my infection prevention department, we have always worked within the hospital and in our ambulatory care practices, but the pandemic certainly increased our education, rounding and partnerships with the ambula- tory practices to help them plan and respond to the pandemic,” says Conley. Muriel explains how patients within
her community are cared for by clinicians throughout the continuum – from the hos- pital and out to physician offices and other sites. Therefore, it is critical for IPs to closely communicate and collaborate with all care locations.
“During this COVID-19 pandemic, com- munication across hospitals and physicians’ offices has become of the utmost impor- tance,” said Muriel. “The very patients who are seen in private physicians’ practices are the patients our maternity specialty hospital will care for in the delivery of their infants. It has been crucial for these practices to reach out to us to identify infection control and prevention needs for COVID-19. The outpatient clinics have also benefitted from a stronger enterprise with Infection Preven- tion, where there was a daily discussion with many of our clinics to provide guidance, and various other aspects of infection control issues. In this regard, this pandemic has incepted and strengthened ways of working amongst us all.”
Impact on PPE and other IP product categories
With healthcare organizations struggling with supply shortages over the past year, particularly PPE, it is no surprise that IPs reported strong involvement in product evaluation, education and training. Among those surveyed, 62 percent said they are part of a product evaluation committee, with 75% involved in determining product need (up from 56% in 2020), 78% performing product safety evaluation (up from 50%), 68% engaged in process improvement (up from 45%) and 50% involved in education (up from 30%).
Swain says her team participates on com- mittees that approve new products and equipment coming into the hospital to ensure they meet infection prevention standards. “Infection preventionists are involved in everything from choosing cleaning products, to assessing risk of construction, to monitoring hand hygiene, to reporting hospital-acquired infections and so much more,” she stated.
Conley notes how her medical center purchased a new temperature portal to
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