Infection Prevention

Infection prevention and control in the time of COVID-19 has been the beneficiary of both challenges and opportunities. The challenges have involved implementation of best practices in the areas of personal protective equipment (PPE) use, performance of hand hygiene, early recognition of infection, isolation, patient placement and cohorting, and environmental infection, just to name a few.

We have learned that healthcare personnel and healthcare systems lack a level of precision in the many aspects of patient care that serve to prevent transmission and acquisition of infection. The gaps in our precision approaches have led to transmission of illness within healthcare facilities and have resulted in disease in patients/residents and healthcare personnel. Lack of adequate supplies of personal protective equipment, routine supplies, and reusable medical devices magnified the gaps and personalized the risks of exposure, illness, and the stresses that are now recognizable parts of the COVID-19 pandemic response.

However, the innovation and unrelenting persistence in healthcare worker response to the pandemic are reasons to celebrate and form the basis for opportunities that are emerging, and will continue to emerge, as the pandemic progresses.

Despite those challenges, there have been many recognized opportunities. Innovation has been demonstrated in areas such as PPE decontamination, 3D printing of PPE items, and scarce patient testing and care items, production of alcohol-based hand sanitizers by Kentucky’s bourbon distilleries, and conceptualization of how ventilator use can be expanded. Further, infection control interventions such as rates of hand hygiene have reportedly soared and it is reasonable that rates of healthcare-associated infection may be reduced as a direct result of this practice improvement. There is a renewed interest in infection prevention and control, infectious diseases public health, and laboratory sciences as the critical importance of these areas of expertise have been recognized. This renewed interest has fostered a sense of teamwork and desire to collectively address the needs of our communities and this has led to research and dissemination of new knowledge around the world.  As disciplines steeped in science, we have learned that politics can best be managed when there is evidence.

So how do we maintain this forward momentum when are simultaneously addressing challenges and identifying opportunity in the midst of this pandemic? As with every journey, one must have a roadmap. The roadmap that can take us toward ideal healthcare worker and patient outcomes may continue these ten steps:

  1. Do a careful inventory of your current practice competence. What do you do well, what needs to be improved, and what needs further investigation?
  2. Create and action plan. Once this inventory has been developed, establish a specific plan of action that has at least one intervention for each of those deficiencies.
  3. Apply a timeline to the plan of action. Establishing accountability may help you stay on track.
  4. Identify, and invest in, the resources you will need to implement and sustain your plan of action. Consider this an investment in yourself as well as the patients you serve.
  5. As you are developing this accountability timeline, stop and perform a pulse check on your individual stress level. Recognize that stress, anxiety, and depression may be present in your life even if you have long considered yourself resilient.
  6. Catalog your successes. These might be clinical practice successes or they might be successes in your creative approaches. You may have an idea regarding a new approach to a problem or care activity. Take credit for your innovation and think about how you can move that forward, if that is a consideration.
  7. Reach out to others for support. This includes support involving stressful situations as well as support when considering and implementing your plan of action.
  8. Devote time to your physical health. This means exercise, nutrition, sleep, and social interaction (safe ones!).
  9. Identify a mentor. This may be someone with expertise in areas you are seeking to improve or in an area that will provide you with strength. For example, you might want to find a mentor that can help you with leadership skills or time management skills. You might seek more than one mentor; don’t limit yourself.
  10. Remember to protect yourself from infection. Make sure you are implementing sound infection control practices, including the need to stay home when ill; perform hand hygiene frequently, regularly, and effectively; maintain social distancing as a means to prevent transmission from other to you as well as from you to others; use PPE correctly, including the wearing of respiratory protection when in public areas and avoidance of wearing gloves as a substitute for hand hygiene; and make sure you are well immunized, which means preparing for immunization as flu season gets closer.

Although these are but a few steps for healthcare workers to take, they are important ones.  Remember that our patients and our communities depend upon us to provide them with safe care.  To do that, we have to be attentive to our practice as well as ourselves.