During COVID, Telehealth Can Be an Infection Preventionist's Friend

Thinking of teleworking? Not in a million years, we would have guessed, but yes, it is happening. Infection preventionists (IPs) are boots on the ground and people think we’re everywhere, but this morning as I write this, I am at home, in my office, getting ready to start my day. How will the units survive? How will I survive?

I begin my day just as if I were in my “hospital” office. I have my coffee and fire up my computer. Will start to look at emails and then dive right into surveillance and reporting, only stopping for the occasional Skype meeting or call from the hospital. I know my teammates (all incredibly bright master’s prepared nurses) at the hospital will take care of rounding and putting out fires, and when I return next week and someone else works from home the roles will be reversed. While some may have questioned our ability to telework, the reassurance of support provided comfort. We also had to deal with the very real possibility if one member went into quarantine, we could lose the entire team.

I can tell you; we have all admitted it takes a little getting used to. It’s a different routine yet we remain intensely focused even when we are not there, I know (as do my staff) that I am protecting and serving our valuable customers. I was asked last week “what made it difficult to get used to” and I think it’s the sense of releasing some control. I know when I am there I can respond quickly and can be there to help if things get out of control. There’s also a sense of comfort for myself and my staff knowing we have each other’s backs Infection prevention is a hands-on, eyes-on-the-hospital job. The idea of working from home may fill you, the hard-working IP, with anxiety. I know I have an incredibly strong team and becoming anxious about something I cannot control remotely is wasted energy.

What will they do when they know you can’t appear around any corner? How can you provide just-in-time advice? The coronavirus disease 2019 (COVID-19) pandemic has upended so much about our lives and ways of conducting business, everything is vulnerable to change. Though potentially an afterthought to the busy IP, the IP’s health and well-being is critical during this marathon pandemic. Furthermore, a telework-ready IP is an IP that continues to support their facility if they also end up in quarantine. Teleworking like so many other aspects of nursing are something we just needed to jump into. No training, no guidebook, no manual. We take our daily routine and model it into practice from our homes and offices. Like so many other things in life, attitude is everything. As nurses we must be flexible and fluid in our practice. Our primary mission is to save lives and to adjust to what may get in our way.

At the beginning of the pandemic we were all working “inside” the hospital. As information and guidelines became available, we quickly realized we would not be able to sustain social distancing within our current space.

And did we all need to physically enter the hospital every day? Especially when we were asking other departments to minimize the staff (and therefore exposures) in the hospital? Being outside felt kind of odd at first, but again we must focus on our mission to protect our patients and staff. It can’t be about us, really a no-brainer.

Technology today connects us not only to each other, but to the hospital intranet and, with it, the patient’s electronic health record. It enables us to still maintain important meetings electronically from the comfort of our desk or home (when thinking about the meetings we are no attending in person—there are many). We start the day with the morning IP huddle to discuss calendars, important meetings or rounds that might need to be covered. Other meetings include hospital incident command, construction updates, meetings with environmental services, surgical processing, and facilities. Meetings are led by who would have led them in person, making do from their home office.

When preparing for the pandemic, nursing leadership and top officials discussed how we can keep our doors open and provide the highest level of care safely. Since standing up a COVID-19 ward and locking down the hospital (restricting visitors and cancelling all non-urgent surgical cases), we meet to discuss “reopening.” This term is a bit misleading, more of a calculated and planned phasing to develop a “new normal.”

The level of collaboration or questions presented depends on the party asking and on the meeting. Some may just need updates on CDC guidelines, others need advice on proper containment for a construction project, and environmental services may ask if a specific chemical can be used as a substitute for something harder to obtain. Routine business is conducted, like the storing of surgical trays and purchasing storage solutions.

Even at the hospital, most meetings are telemeetings. Face-to-face meetings are not recommended unless absolutely necessary.

Payroll and administrative functions can be completed remotely, electronic training modules are the norm, and policies can be updated from home—perhaps with fewer distractions. The IP’s teleworking would update policies to decrease the workload of the staff at the hospital. Hospital staff are rounding and putting out the daily fires that crop up even more with the coming of COVID-19. Surveillance and reporting of hospital-acquired infections (HAI’s) has long held the IP captive to their computer, and thus is easily accomplished at a home work station. If in-house, the split would be about 50/50. Teleworking is 100%; so you need to get used to that.

The ideal balance may be to have a portion of the IP staff working within the brick and mortar facility, responsible for face-to-face interactions, environment of care rounds, assessment of construction sites, perform daily rounds, assess compliance with infection control policies (hand hygiene, precautions), and provide hands-on staff education. The physically present IP can answer questions, offer reassurance, and provide comfort in a way that a remote presence cannot. As much as people say they “dread” seeing the IP, they rely on us as experts to provide guidance on critical decisions related to COVID as well as other infectious diseases. Talking with staff in person (while maintaining social distancing) helps staff know they are supported and heard.

Our current process is to rotate staff weekly to telework. Each Friday we review who will be working from home the following week and what is included in their responsibilities. To date it is working.

Our world has changed significantly, and the IP is not immune to a new paridigm. In our facility a hybrid model of telework and face-to-face infection prevention is the best balance between allowing social distancing and safety while maintaining the same high standards we expect from the tireless, essential IP. Our colleagues rely on our expertise and we cannot let them down.

JODY FEIGEL, RN, MSN, is the Nurse Manager of Infection Prevention at VA Pittsburgh Healthcare System in Pittsburgh.