COVID-19 Underscores Nurses’ Role in Infection Prevention

The COVID-19 pandemic thrust everyone deep into the world of infection prevention, probably more than anyone other than an infection preventionist (IP) cared to venture, and kept us all there longer than we wanted to stay. But nurses would be remiss not to take some lessons from this experience to explore what our role is and should be in infection prevention.

The key lesson is that nurses can be effective only when their basic physiologic and safety needs are met. The global disruption in supply of personal protective equipment (PPE) dealt a devastating blow to our safety efforts and eroded the trust nurses have in the system. The reuse

Amber Wood, MSN, RN, CNOR, CIC, FAPIC

and decontamination of single-use PPE, although necessary in some dire situations as part of critical strategies to conserve PPE, led nurses to feel they were left unprotected, at risk of infection, and putting their patients at risk of infection and that their respiratory health was at risk from chemical exposure. Nurses who attempted to supply their own PPE were rejected and, in some cases, reprimanded for trying to meet this perceived safety need, which nurses interpreted as a lack of concern for their health.

Although the situation may seem bleak, IPs must identify what went wrong and prevent recurrence to build back trust. To that end, nurses need a seat at the table when discussing PPE stockpiling and purchasing practices to share their lived experiences and help the team discover where practice deviated from plans. IPs should support the nurses in these discussions as allies, informed advisers, and advocates for patient and health care worker safety.

Nurses have been on the front line of the battle against COVID-19 and are often hailed as our first line of defense against infection. However, declaring that nurses are on the front line implies that there is backup on the way. If there is anything this pandemic has taught us, it is that there is no relief crew coming—nurses are our front, back, and only lines of defense regardless of the setting, whether it is the emergency department, inpatient unit, operating room, nursing home, or behavioral health. Because of this, the health and safety of nurses and other frontline clinicians and health care workers must be the top priority if we are going to win the war against pathogens.

We also learned that meeting the psychological needs of nurses is critical to their ability to be effective. Making difficult decisions about PPE management, COVID-19 protocols, and patient care prioritization has taken a toll on the mental health of IPs, occupational health professionals, and health care leaders (Figure). It is essential to acknowledge the impact this pandemic has had on our mental health as we find our path forward.¹ Simply seeing the IP in the hallway may trigger a nurse to recall a mixed bag of emotions and traumatic memories of COVID-19 training days that they would rather forget. Offering a forum for peer support and grief counseling can help bridge the divide and move individuals toward healing. Pastoral care can also be a great resource for restoring the emotional well-being of nurses and IPs.²

Perioperative Nurses

The nurse’s role in infection prevention is also that of an expert adviser. In the earlier stages of the pandemic, elective surgery was canceled across the country. This left a large portion of the nursing workforce being laid off, working at testing centers, or being deployed to other areas of the hospital to support or provide care to patients with COVID-19. The full impact of the delay in elective surgical procedures on patient outcomes may not be known for years. Delays in elective surgery may have led to worsening patient conditions that necessitated an urgent or emergent surgical procedure. The cancellation of elective surgery was also a huge setback to the pocketbooks of hospitals and surgery centers, from which many facilities may never financially recover. In future events, we may see increased resistance to cancellation of elective surgery, and in anticipation of this, hospitals and surgery centers need to start planning now to be prepared to continue surgery safely. This is a prime opportunity to call in perioperative nurses who are skilled in the use of PPE and preventing surgical site infections. The perioperative nurse will be the key partner to the IP for successful planning.

Implementation Experts

As problem-solving MacGyvers, nurses are the premier implementation experts. IPs can count on nurses for practical advice when implementing new practices and processes. For example, external female catheters have been a game changer as an alternate to indwelling urinary catheters for women to prevent catheter-associated urinary tract infections (CAUTIs). However, there are some practical issues that can be a barrier to implementation, such as leaking. Nurses troubleshoot these issues every day and can provide expert advice for improvement like adjusting the level of suction. When clinicians began placing patients in prone position to improve ventilation because of COVID-19 infections, nurses thrived in the role of implementation experts and patient safety advocates by continuing to support using external female catheters for CAUTI initiatives and also advocated for preventing pressure injuries from the tubing.

IPs as Educators

Nurses are the portal to the patient and the community. In this position, the nurse’s role is to be a champion and advocate for health and wellness in each interaction. This role is not limited to the nurse’s interactions with a patient. It permeates their being and exists in every interaction they have with family, friends, colleagues, and members of their community. Because of this role, nurses should be a source of credible, evidence-based information, especially in an era of prevalent misinformation and fake news. The IP can support nurses with prepared information on COVID-19 infection, testing, and vaccination in a question-and-answer format to equip nurses with credible speaking points.

Moving On

It may be difficult to imagine how to begin healing and planning for future events when we are still living in a pandemic. But grief is a funny creature; the more we ignore it, the longer it seems to continue. You cannot just tuck it away deep inside and pretend it never existed. Grief and healing take hard work, but you are not alone. We have a shared experience that bonds us all, for better or for worse. If you are struggling, please talk to someone, and if you are in crisis, get immediate help. Your physical and mental health are of the utmost importance.

AMBER WOOD, MSN, RN, CNOR, CIC, FAPIC, is a senior perioperative practice specialist at the Association of periOperative Registered Nurses (AORN), where she has served as lead author and editor for several AORN guidelines. Wood offers clinical information to members via the AORN Consult Line and contributes regularly to the Clinical Issues column in the AORN Journal. She has served as the AORN staff liaison to the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee, is a member of the ASTM International committee on personal protective equipment, and is a fellow of the Association for Professionals in Infection Control and Epidemiology.

Resources

1. Coping with Stress. Centers for Disease Control and Prevention. Updated January 22, 2021. Accessed March 22, 2021. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html [This link is expired. Please read https://academized.com/coping-stress-covid19 for similar information.
2. COVID-19 Resource Center: Well-Being Initiative. ANA Enterprise. Updated March 23, 2021. Accessed March 25, 2021. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/the-well-being-initiative/