Best practices and protocols from an infection preventionist
Introduction
The response to the COVID-19 pandemic from medical caregivers has been heroic, said Caitlin Stowe, clinical affairs research manager at PDI Healthcare. “It’s highlighted the everyday work that nurses and physicians do. Everybody in the hospital plays a key role in the prevention of infections, and I think it just goes to show that healthcare workers are the heroes right now. We have to keep our caregivers as safe and healthy as possible so they can be on the front lines saving as many lives as possible.”
Share Moving Media, publisher of The Journal of Healthcare Contracting and Repertoire Magazine, asked Stowe for her insights into how best to keep those healthcare workers safe amid the risks associated with the coronavirus.
Stowe has been an infection preventionist since 2009. She started her career at a cancer center, and worked her way up through various care settings. Stowe was a system director for a couple of years before she made the jump to industry back in 2016. She has a master’s degree in public health and global communicable disease and a certificate in infection control. Stowe is currently working on her PhD in health science and she is certified in infection control, health care quality, public health and vascular access.
In the following article, Stowe highlighted the infection prevention products that will be key to healthcare facilities’ efforts, short-term challenges providers will need to navigate, and the long-term planning that will be needed to maintain an adequate supply.
Infection prevention products hardest hit
There are a lot of hard decisions that healthcare facilities are having to make in regards to supplies, Stowe said. The biggest one is the use of personal protective equipment (PPE).
How much protective equipment does each provider have for its staff to adequately protect the healthcare workers and patients? “The supply chain has a really hard job right now working with their distributor partners and having open communication with their leadership in infection prevention to ensure that they are maintaining adequate supply levels.”
Another supply category that supply chain teams need to be concerned about is surface and equipment disinfectants. “Do healthcare facilities have an EPA-registered disinfectant on list N, which means that it has an emerging pathogens claim? This way we can feel comfortable in knowing the disinfectant is killing the coronavirus.” The coronavirus is an enveloped virus, on the lowest level of the hierarchy of pathogens, so it’s fairly easy to kill.
“Some of the latest research that I’ve been reading says it lasts in aerosol form for a couple of hours, and can last on a surface for two to three days. So it’s really important that not only are we making sure that we have enough protective equipment to help our team members and staff care for patients, but also making sure we have enough disinfectant to appropriately wipe down the surfaces, because we don’t want that to perpetuate the spread of this in the healthcare setting. We need to ensure that we’re also doing really good surface and equipment disinfection.”
Indeed, cleaning personnel play an important role when it comes to preventing any kind of infection. “The No. 1 way to prevent infection is hand hygiene,” she said. “The No. 2 way, in my opinion, is adequate surface and equipment disinfection, because 80% of infectious diseases are spread by touch.”
Once the needed supplies are identified, if healthcare facilities don’t have adequate supply levels, or supplies are back ordered, is there a contingency plan in place? “Providers need to work with their infection prevention leadership, their nursing leadership, and the C suite in general to ensure that there’s not going to be a delay or a gap in care because they don’t have the equipment and/or supplies needed to do their job safely.”
Stowe said supply chain teams must work with their infection prevention team and their nursing leadership to estimate usage. “And with the situation so fluid it’s obviously subject to change,” she said. “But in a worst case scenario, what’s the par level or what’s the daily supply that you’re going to need in order to take care of your patients safely?”
To help with this, the Centers for Disease Control & Prevention (CDC) has issued some guidelines for reuse of PPE, for alternative PPE to ensure that people are still being protected. (Visit www.cdc.gov/coronavirus/2019-ncov/index.html)
Short-term challenges and long-term planning
Staffing will be a major short-term challenge for providers, which makes keeping caregivers safe and their work environment infection free critical. “We have to make sure that we’re protecting our staff, because if they are exposed they have to self-quarantine – usually a minimum of 14 days if they have high risk exposure. The CDC has changed their guidance on this a few times, but right now if you have a high risk exposure, meaning you were not wearing the right PPE when you were caring for a confirmed patient, you cannot work for 14 days minimum,” Stowe said.
Once supply in teams have an adequate supply for the organization’s day-to-day needs, Stowe said the focus should turn to proper maintenance of that supply. “Not a stockpile of that supply, because that’s not going to do anybody any good, but building up a day or two extra worth of their supplies to ensure that there’s not going to be a break,” she said.
Also, there is the human element to think about. Supply chain teams should check in with their staff. Is their staff mentally and physically doing okay? “Everybody’s stressed,” Stowe said.
“Ensuring that you’re supporting your team members through this long-term marathon is important. It’s not a sprint. This is a pandemic that’s going to go on at least for the next few months at a high level. And I’ve seen forecasts from the CDC where if we don’t do the social distancing and all those other public health measures we’re trying to implement now, it may go through 2021.”
Protocols to follow
Stowe recommended the following protocols as they relate to infection prevention for healthcare facilities:
Visitor restrictions. The visitor restrictions that a lot of facilities have been implementing are necessary, Stowe said. To that end, hospitals and health systems can check that policies and procedures related to the appropriate use of PPE are in place, that they are being educated to and communicated, and that there are spot checks to ensure that their staff are doing the right thing. “Everybody must know when they need to wear a mask, when they need to wear a N95, and when equipment and surfaces need to be cleaned.”
Cleaning. Every multi-care patient use equipment should be cleaned in between each patient, Stowe said. The equipment should also be cleaned at regular intervals. “How often is a patient room getting cleaned, or the high touch surfaces getting wiped down on a regular basis?” Doing those enhanced cleaning procedures will definitely help reduce the bioburden of this virus in the environment.
A supply chain team checklist
First and foremost, Stowe recommended that supply chain teams maintain an open dialogue and good relationship with their organization’s infection prevention team. “The infection prevention team has the most up-to-date guidance from the CDC, the WHO, their local health departments and they really are the subject matter experts that can help the supply chain prioritize what they need,” she said.
Stowe said open lines of communication – and “frank” discussions – will be needed with their industry and distributor partners. “Have really frank discussions with your distributor partners and say ‘This is what we need. Do you think you’ll be able to fulfill it? If not, help me find somewhere that can give me the supplies that I need.’”
Providers and suppliers alike are working day and night to ensure that we have adequate supply for the facilities so that the supply chain isn’t disrupted. “However, it works both ways,” Stowe said.
“Facilities should not be hoarding supplies, or building stockpiles because that doesn’t benefit anybody. One reason is because the expiration dates of disinfectants are fairly short. So if you stockpile hundreds and hundreds of cases and then you don’t use them, that’s just product that’s going to expire.” Stowe likens the situation to a Seesaw, “a little give and take on what’s the appropriate amount to use and extra to keep in stock. But also we don’t want to hoard because other providers will need these supplies. We don’t want them to expire before you can use them.”
What we can learn from the COVID-19 response?
As a public health professional, Stowe said the COVID-19 pandemic highlights the need for more public health funding. “We’ve been cutting funding to public health services for years so from a public health standpoint, we’re so strapped for resources that maybe they weren’t as effective as they could have been in the initial stages because we really just, we didn’t have the staff or the resources.”
Stowe said like a lot of infection prevention suppliers, PDI Healthcare is working hand in hand with its infection preventionists and hospital supply chain departments. “We’d never want care to be delayed or not given because of a failure or a lack of supplies when it comes to PDI, and like I said, surface disinfection of equipment and areas are some of the most important things you can do after hand hygiene. We are working hand in hand with our partners to ensure that we’re addressing all their questions and concerns and making sure that they feel as comfortable as they can with the current situation.”