COVID-19 Highlights Crucial Role of Infection Preventionists

Mary Jean Ricci, MSN, RN-BC, has an extensive background in infection prevention. Ricci is one of the newer members of Infection Control Today^®’s Editorial Advisory Board, Currently, Ricci is the director of clinical education at Drexel University College of Medicine. She’s also a nursing supervisor at Fox Chase Cancer Center in Philadelphia. She recently spoke to ICT^®about the unique challenges COVID-19 presents to infection preventionists and how IPs can best function in hospitals. 

Infection Control Today^®:What is your background in infection prevention?

Mary Jean Ricci, MSN RN-BC:I was the director of education quality, regulatory risk and infection prevention at Good Shepherd Penn Partners. And throughout my entire career, I was always gathering data for either quality or infection prevention.

ICT^®: What would your advice be to infection preventionist who are out in the field doing helping patients with COVID-19?

Ricci: My biggest advice to infection control practitioners is just to remind employees of the importance of hand washing. But more so, what I see in the hospital in various settings and even on television on the news networks, people are touching their mask, people are taking their mask off. I would remind infection control practitioners to remind staff to not touch their face, not touch their mask, because the minute you’re doing that you’re contaminating your mask. And to be very careful when you’re donning and doffing the mask. Now as for patients, I would remind patients when they’re in the hospital to remember that all the surfaces may be contaminated. To basically try and remain in your room unless you’re mandated to ambulate the hall. And if you’re ambulating in the hall, remember, you should have a mask on as well.

ICT^®: In your experience with infection prevention, and infection prevention departments, what’s the best working relationship that infection preventionist can have with staff? 

Ricci: Well, when I was at Good Shepherd Penn Partners, we actually did all of our own education. I had a colleague by the name of Suma Chacko, and I believe she’s joining the Editorial Advisory Board as well. We went out to the staff and actually did all of our own education. Our relationship was very good. I had the pleasure and the privilege of being the director of education as well as in charge of infection prevention. Therefore, the staff saw me on a regular basis. I was able to combine mandatory education with our infection control practices.

ICT^®: Isn’t it a bit of a balancing act? Infection prevention for the staff, and infection prevention for patients? And how do you work that out?

Ricci: Well, I think until COVID-19 came out, there wasn’t as much emphasis on educating the patient unless it was something like washing your hands with C. diff. And the importance of knowing that bleach kills the spores and things like that. So, it was individualized attention with patients. Now we’re looking at it from a global perspective. Every patient needs to be educated because this is a novel virus and it is unknown. And I think the fact that we don’t have the same symptoms developing in patients. We’re having everything from the typical fever, cough. The other thing is people are touching their eyes and now we have the pink eye-like syndrome that people are getting. So, we have to educate them on that. And some of these lesions that are coming on people’s fingers and toes. We’re calling it, the COVID toes, trying to remind patients that should these develop when they go home, from the hospital, please treat it as though it’s contaminated. If you touch your toes, make sure you wash your hands again and things like that.

ICT^®: Why has hand hygiene been such a perennial problem?

Ricci: I don’t understand why people don’t want to wash their hands. I’m very conscious of washing my hands. A number of facilities that I go to, on a regular basis, have badges now that track people’s hand-washing habits. So, if I had my badge on and I go into a room and I don't use the Purell or I don’t wash at the sink, it’s recorded as I didn’t do hand hygiene and that report goes to a supervisor. So, we have the technology that would let us see who is or isn’t washing hands But why people don’t wash their hands? I think they’re in a hurry and they’re just running out. Like they do a task for somebody, then they want to run out or they think “Oh, I don’t want to use Purell. I want to use the sink.” So, I think that’s where we’re getting into problems. You know, we have to do further research. I don’t know that there are a lot of studies out there about why people don’t want to wash their hands. 

ICT^®: Do you think COVID-19 will change infection prevention forever?

Ricci: I do. It’s a novel virus. We don’t know if we’re going to get immunity from it. We don’t know how long, and I think because it is so virulent and pathogenic, that it has frightened some people. I do know that a lot of people think that it is fake news. Because they can’t see it, or because they didn’t get it or because they’re asymptomatic if they have it. And we won’t know that until there’s more antibody testing. I don’t think people who are unaffected actually believe in it in totality. But I do think for the people who have been affected by COVID-19, I think that we will be conscious and I think people will be fearful to go out without a mask. I just watch people in supermarkets. The other day I watched this woman clean her cart and she did it like three times before she even put her hand on the handrail of the cart. So, I do think it’ll change the way people behave.

ICT^®: It’s a nasty way to die, isn’t it?

Ricci: People are suffering from air hunger and then when they get on a ventilator, they may or may not make it. I think it’s a 30% survival rate. I believe the latest statistic I saw, and I can’t quote where I saw it, if you are on a on a ventilator. So, I do agree with you it is a nasty way to die.

ICT^®:How closely does do infection preventionists work with the hospital ministration?

Ricci: I think very closely. My experience has been whenever I had an outbreak of anything in my facility, not only did we generate PowerPoints and put the data in a graphic form for administration to see. We had weekly meetings, we had monthly meetings regularly scheduled for our accrediting bodies about infection prevention. But whenever we had an outbreak of anything, we met closely with administration. 

ICT^®: Do infection preventionists feel underutilized or underappreciated?

Ricci: You can’t control how somebody feels so if an individual feels underutilized…. But I cannot see in this day and age that an infection control person practitioner would be feeling underutilize because we still have to look at catheter associated infections, we have to look at central line infections, we have to look at C. diff.infection. I think that we are constantly tracking infections in the hospital. And I think that we are actually doing education also. I don’t know about feeling underutilized. I have never in all my years felt underutilized.

ICT^®: And you say that COVID-19 is going to make infection prevention even more important? 

Ricci: I can give you what I think’s going to happen. My master’s is in community health. I believe that we’re going to go back to boots on the floor, that descriptive epidemiology. We’re going to be tracking people. And even all the latest news with easing restrictions and self-isolation being lifted. I think that we’re going to actually be tracking contacts. A number of cities on the news have noticed that they will be hiring people in that area. I do think that we’re going to have a bigger role in the community versus just in hospital or clinical settings.

ICT^®: Do you think municipalities will start hiring infection preventionist or at least have intervention preventionists function as sort of go-betweens with the healthcare community?

Ricci: I don’t know how much with the healthcare community other than providing data. I think it’ll be more like the cholera 1800s with John Snowactually going out doing the contract tracing and all.

ICT^®: Do you have anything to add?

Ricci: Just keep reminding people to wash their hands.

This article has been edited for clarity and length.