APIC President Connie Steed Talks About What COVID Has Wrought

It might not have seemed possible for Connie Steed, MSN, RN, CIC, FAPIC, to get any busier, but then coronavirus disease 2019 (COVID-19), struck. Steed is the president of APIC, the Association for Professionals in Infection Control and Epidemiology. She also oversees the infection prevention program for two academic medical centers, nine community hospitals, one long-term care facility, a psychiatric hospital, and more than three hundred MD practices and ambulatory care locations in South Carolina. That’s one of the states that’s seen a surge in COVID-19 cases lately and Steed took a quick break from her rounds recently to talk to Infection Control Today®. She explained the challenges of being an infection preventionist in the pre-COVID world and what it’s like now, as the pandemic rages. Steed also talked about how the COVID experience will forever change healthcare, and also change IPs’ place in the healthcare system.

Infection Control Today®:Do you see a lot of restructuring in infection prevention and control departments happening in the near future because of COVID-19?

Connie Steed, MSN, RN, CIC, FAPIC:Well, one thing for sure is COVID-19 has brought infection prevention front and center. That’s especially true in hospitals and nursing homes. My very strong speculation is that nursing homes will have a tremendous change in infection prevention and control staffing. I think COVID-19 has identified a vulnerability in this area as it relates to infection control, and there is a strong, dire need for infection preventionists that are knowledgeable in these facilities working all the time, fulltime, to ensure they have effective programs. That being said, as far as restructuring, what I would say is that long-term care facilities right now are expected to have an infection preventionist. Most of the time, it is not a fulltime individual. It may be .2 of an individual. And I believe that it should be more than that. In many nursing homes it should be at least one fulltime infection preventionist. Many times, you have people in these nursing homes that share many hats. They’re the associate director of nursing, they’re the wound care nurse, the employee health nurse, and also the infection preventionist. It’s very challenging to be stretched that thin.

ICT®:I mentioned in your introduction that you’re on the frontlines. As a matter of fact, you told me before we started that you're dealing with a surge right now, aren’t you?

Steed:Yes, so we’re in South Carolina and we are truly experiencing a surge in COVID-19. And the interesting thing is we’re seeing it in young adults. That’s where the most significant increases have been, in individuals that are 20 to 30 years of age—in that age range—about 25% of our cases are there. However, we’re also still seeing cases in our long-term care, elderly, skilled facility population. And in our organization, we do have one long-term care facility which right now has no COVID-19 cases. It’s because I think the infection prevention program is very effective. But we have a lot of nursing home partners in our community that our organization is reaching out to and helping. We have sent some of our infection preventionists into these term-care facilities to help with education, to do a clinical assessment of the effectiveness of what they’re doing. And to help them improve what they’re doing. Now, I will also say that nursing homes have had trouble with supply chain. And so, our healthcare organizations supply chain executives are also trying to help these long-term care facilities and ensure they have gowns and gloves and mask and the things they need to actually protect themselves and residents.

ICT®:I’m going to make the assumption that the institution that you’re affiliated with— Prisma Health—the leaders there are true believers in infection preventionists and the jobs that infection preventionists do.

Steed:Yes.

ICT®:Why doesn’t that message carry over to a lot of institutions that don’t seem to buy into infection prevention as much as they should?

Steed:Well, I think that that is changing a little bit. I think that with the CMS requiring publicly public reporting of healthcare associated infections, the spotlight has been on infection prevention for a while as it relates to healthcare associated infections. And I think that that’s actually helped in many ways. This COVID-19 is extending that spotlight even more. I think that the C-suite has had to really look at the effectiveness of infection prevention and control programs, and make sure that their organizations are functioning effectively to get those HAIs down. Now, on top of that, you have COVID-19, which is a pandemic; one like we’ve never seen before. And I think that the importance of infection prevention can be heard and seen clearly by organizations today. Even with that said, there are some organizations that still do not put the focus on infection prevention like they should. And one of the things that APIC is doing is trying to give the infection preventionist a voice at the national level to promote infection prevention, but also to ensure they have the competencies that they need, not only in the area of infectious diseases, but also in leadership and communication and facilitation skills that are helpful in communicating with those leaders in the C-suite.

ICT®:In terms of what CMS did with HAIs; the Joint Commission followed suit, correct?

Steed:Oh, absolutely. Remember Joint Commission gives deemed status for following CMS regulations. So, whatever CMS does, the Joint Commission also looks at. And, of course, the Joint Commission was already focusing on healthcare associated infections, but the Joint Commission’s focus on infection prevention has tremendously increased over the past several years. Not only HAIs, but other preventive strategies that can help reduce those infections like sterilization and disinfection. And part of that is in response to the outbreaks we saw five to seven years ago with endoscopy. Colonoscopies related to drug resistant organisms and the fact that we kept on seeing clusters of drug resistant infections in patients who underwent ERCP scope procedures. So, there’s been a focus for that reason as well by the Joint Commission and CMS.

ICT®:Did those initiatives by CMS and the Joint Commission help prepare infection prevention for COVID-19?

Steed:I think that they have, but I think we’ve learned that we need to do more. I think that it’s very clear that we have to do better with supply chain and making sure that we have supply stocked if this ever happens again, because that’s been one of the biggest opportunities that we’ve seen in this country and actually worldwide. We've run out of N95s and masks and disinfectant wipes and things like that. We have to make sure that we have a plan related to supply chain and surge capacity is up and in and very well planned. So that when this happens again—we’re still in the middle of it, I’m not sure we’re through our first wave—that we will be better prepared than we are right now. I think that we still have some work to do.

ICT®:How will you know when the second wave hits, if it does hit?

Steed:Well, first of all, when I’m not sure we’ve seen our peak. We thought we saw our peak, and then New York went down and because it’s so densely populated, we started seeing reductions in the United States. But now we have a surge, a tremendous surge. And if you look at the United States map, it’s all the Southeast the Western coast. There are many of us, including the CDC, who feel that our first wave is not complete. Before we can have a second way, we’ve got to get through the first and we’re very unsure as to when that’s going to occur.

ICT®:Do you ever see a point where this is dies down to the point where infection preventionists are not held in the high regard they’re currently held in? You’re sort of like rock stars at the moment.

Steed:Well, I think that IPs are part of a rock star team at each organization. Infection preventionists are the backbone of preventive and risk mitigation measures for COVID-19. But it’s only successful with a good emergency management incident command that includes an operations leader, a medical director, nursing leaders. Just to help make sure that you are doing everything you can to address the emergent need, which in this case is the COVID-19 pandemic. I think infection preventionists need to be part of that team. Within my organization, I’m also the safety officer for incident command. I have a tremendous level of responsibility. In most hospitals around the country, infection preventionists are right there in incident command with everyone else. The concern is that there are still hospitals that do not have infection preventionists readily involved. So, to me as the president of APIC, what I would challenge all IPs to do is to ensure that they’re at the table. And as I talked to infection preventionists around the country, 99% of them are. They’re working hard. We need to support them. Many of them are dealing with fatigue that you see from continuing to have to deal with ongoing chaos and issues related to PPE exposures and so on and so forth. We need to take care of ourselves. Infection preventionists do self-care. Understand that we’re also going to see PPE fatigue in our healthcare providers who have been wearing PPE for so long. And so that’s why the infection preventionist’s job is not over and it won’t be over for a long time. We’ve got to motivate our staff to take care of themselves and practice safely, so that we can successfully get out of this pandemic. We also have to work with the community and get them to wake up and socially distance, wear their masks, clean their hands. And if they’re in a high-risk room, they really need to try to stay home.

ICT®:Every company that’s been closed and that has to open up has to be thinking about infection prevention. Government institutions have to think about infection prevention. Do you see this as maybe they’ll be hiring infection preventionists?

Steed:I think that’s a very good question. And I don’t know the answer, but I think some consideration should be given for infection preventionists to be out in our community businesses. I know that many infection preventionists have been consulted by restaurants, school systems, and governmental agencies. Seems to do exactly what you’re saying, because they need that expertise. I think that we may see a trend in that direction. I know especially right now, there are infection preventionists doing consulting work with those individuals to ensure these companies that they have a safe environment for their employees, but also for their customers.

ICT®:I know you very much want to see anybody who practices infection prevention to be certified.

Steed:Absolutely.

ICT®:Do you see more of a push among institutions to have certified infection preventionists, rather than what happens now? And I assume some institutions—as you alluded—just kind of have somebody do the job, but that person is not necessarily certified to do the job.

Steed:I think that this kind of experience will push that needle a lot. I think that has been very clear; that you need competent infection preventionists. And the credential we have to validate that competency is certification. I’m a strong proponent of that, of course, as well as APIC and I do see an extensive focus on certification as we move forward

ICT®:Do you think what someone needs to know to be certified will change or will it basically be the same certification that you have in place?

Steed:Well, the certification exam changes based on what the infection preventionists are doing. What they spend their day on. And every so many years, I don’t know the exact frequency, the certification board of infection control does an assessment or a survey to ask about the practice of infection prevention to see if it’s changed. And if they’ve seen changes in what infection preventionists do, then competencies and testing gets added to the certification exam. As an example, there is an extended focus right now on the environment of care. You know, ventilation and all those kinds of things and also on disinfection. High level disinfection has been expanded a little bit. Sterilization has always been there. High level disinfection has because there’s been so many opportunities related to high level disinfection. There’s been some additional questions, I think, and content added to certifications specific to that area. And there are others, like leadership. Leadership is an extremely important competency of infection preventionists. They need to know disease transmission and all the policies and procedures about sterilization, disinfection, hand hygiene. Infection preventionists are more effective when we can effectively communicate and lead within their organizations.

ICT®:What departments do you personally interact with on your day-to-day job?

Steed:Actually, in my role, I am the system director of infection prevention. I am responsible for all those facilities that you talked about. My day-to-day communication is, of course, with infection preventionists, but I also interact with vice presidents specific to quality. I actually report up through the quality of service line. But I also communicate with administrators, CEOs, and operations, engineering, EVS. All those folks because they all are important and integral to an effective program. The best infection prevention programs are based on collaboration and teamwork, not just about what the IP does. It’s about what the team does better for the betterment of the organization,

ICT®:Have infection preventionists had to labor in the past against the idea that maybe they’re the hall monitor or the police officer coming around making a list and checking it twice?

Steed:Absolutely. I, for years, was labeled as the clipboard nurse. In my early days. I’ve been doing infection prevention for a little over 40 years since 1978. I can’t believe I’m even saying that. I was really young of course. I actually was in my 20s when I began my career, and I think it’s really important to understand that a key part of the infection preventionist role is to communicate with frontline staff and do just-in-time training. So monitoring is important, but it’s about more things than just monitoring. It is about that ongoing communication and collaboration with people. And to me that takes a little bit of a higher level of competency than just carrying a clipboard around and monitoring. You can monitor all day. But you’ve got to take what you find and you’ve got to analyze it and then implement improvements within your organization. And that’s what an infection preventionist does.

ICT®:What kind of questions are you getting from members of APIC or any other infection preventionists during this pandemic?

Steed:Well, that’s also another very good question. We have a great support network for our infection preventionists. We have APIC list-serves that APIC members can get on so that they can talk to each other and ask questions specific to infection prevention. And we also have educational materials, a COVID site that people can go to and get information. There’s also a way in which they can send us questions. And many of the questions that we have received, I’m able to ask of the Centers for Disease Control and Prevention. Because I and other ID leaders around the country have a weekly meeting with CDC. So questions that our membership have that there’s no clear answer for, we have an audience with CDC so that we can get those questions answered and addressed. And then of course, our COVID site helps us get that message back out to them. Clearly the IP network…. It’s a family. Infection preventionists are one big family. One of the strengths of infection preventionists is that they do share with each other and they support each other. And that’s what we’re seeing right now with COVID.

ICT®:Any final words for your fellow infection professions, or anybody out there that’s working in healthcare?

Steed:I think infection preventionists are valuable to the patient safety efforts within our organizations. Our goal at APIC, which is the goal of all IPs, is to have healthcare without infection. That’s an arduous task, but that is our vision and goal. And the infection preventionists’ role will help drive that vision. We’ve got to take care of each other. IPs need to make sure that they self-care and they can’t help protect others and educate without making sure that they’re doing OK as well.

This interview has been edited for clarity and length.