How Infection Preventionists Work Outside of Healthcare

Infection preventionists were thrust into the spotlight this year thanks to coronavirus disease 2019 (COVID-19). They’ve been manning—and continue to man—the frontlines in hospitals against the novel coronavirus. But their expertise is being sought outside of healthcare settings. Businesses, school districts, public health agencies, sports franchises: you name it, they’re all suddenly very interested in infection prevention. That might create employment opportunities outside of healthcare. That’s a career move that Susan E. Campbell, PhD, CIC, made years ago. Campbell is an infection control coach who recently sat down with Infection Control Today® to discuss what such a career move might entail. “It’s a little more difficult than you might expect. Largely because we don’t have a megaphone…. And I think one of the things you’re seeing, as this pandemic develops, is that epidemiologists are in fairly high demand and infectious disease doctors, because they get the platform…. [I]f you’re an infection preventionist, you have a lot harder time reaching your audience.” But it can be done.

Infection Control Today®: What’s the market for the services that you offer through Infection Control Coach LLC?

Susan E Campbell, PhD, CIC: Well, we really can work with anyone, whether it’s in the healthcare domain or out in the rest of the world. Our target market is businesses and schools, assisted living. Organizations that typically are not supported by hired infection prevention and control experts.

ICT®: Do you see your type of business growing as a result of the COVID-19 pandemic?

Campbell: Well, I do think there is a market there. It’s a fairly difficult one to shape. Because organizations somehow have the impression that if they just do the very minimum that public health is recommending that everything will be OK. And for a large part it will because the CDC [US Centers for Disease Control and Prevention] and the local boards of health, make recommendations and guidelines that protect most of the people most of the time. But as we know, there are people who are in special situations either because they are doing things like standing shoulder to shoulder, such as in the meat packing industry, where they can’t maintain that six feet of social distancing. Or other companies that require very dense involvement of their staff. Or just people who have a difficult time following directions, such as those who live in group homes or who are in some form of congregate living. And really cannot social distance, cannot necessarily choose their face coverings, or who might have a medical condition that makes them more vulnerable to the pandemic virus. We can take the special circumstances into account in talking with organizations, business leaders, organizations like unions or associations, and also individuals who find themselves in unique situations and would really like someone with a lot of expertise to come in and help and work with them on their specific risk reduction.

ICT®: What did people ask you about most often before COVID-19? And what do people ask you about after COVID-19 about infection control and prevention?

Campbell: Well, I think before COVID-19, the standard kinds of things … they want their staff to learn about hand hygiene and about chain of infection and breaking the chain of infection and what a boehmite is and how to disinfect properly, whether it’s a dietary setting or non-dietary one. But when you’re in COVID-19, we’re dealing with not only a pathogen that is airborne, but one that is transmitted both by droplets within the 3- to 6-foot radius of the individual who coughs it out or speaks it out. But also the aerosol that’s much, much finer, and can stay aloft for very long periods of time and move, you know, 30 feet or more from the individual that exhaled it or spoke it or shouted it or saying it. And this is something that’s new to the world and even some healthcare professionals are having difficulty understanding that the protections that worked for them in the past are not necessarily as complete in their coverage today.

ICT®: The metaphor I read about COVID-19 that struck me as really to the point is that imagine that you’re in a closed room and somebody’s smoking a cigarette. Now you can maintain 6 feet of distance from that person. But that smoke is going to hang in the air, it’s going to come to you eventually. Is that an apt metaphor?

Campbell: Yes, indeed. It’s a very good one. In days past, when we infection practitioners in healthcare centers would certify our negative pressure rooms, that they were functioning properly, we used to, sometimes with the engineer that would work with us, do a smoke test, and see which way the smoke was blowing. And of course, in a negative pressure room, it’s supposed to be pulled into the room out of the corridor and then be pulled into a vent that exits to the outside of the building. Of course, it needs to be a long distance away from any entrances or other windows that can be opened. And so that’s really instructive when you think about the problem you just posed, which is a closed room, whether that room be in a clinic, in a nursing home, or in somebody’s own home. If you have dead air, then you’re going to have cumulative aerosol build up over time, even if everybody in the house who has it is asymptomatic. And that’s something that people really don’t think about these days yet enough.

ICT®: Do you think that COVID-19 is spreading the word a little bit that being an infection preventionist might be something that someone would want to choose as a career? And is there a right career path for people to take?

Campbell: It’s a little more difficult than you might expect. Largely because we don’t have a megaphone. We infection preventionists don’t have a megaphone. And although APIC [Association for Professionals in Infection Control and Epidemiology], the organization that supports the infection practitioners, does have an arm that is political, and does lobbying to raise awareness among elected officials of the infection preventionist role, we don’t get a lot of airtime. And I think one of the things you’re seeing, as this pandemic develops, is that epidemiologists are in fairly high demand and infectious disease doctors, because they get the platform. They’re offered the soapbox. They’re called to come on the new shows. And if you’re an infection preventionist, you have a lot harder time reaching your audience. Now, the thing is that we do this all the time. We think practically all the time. And we can certainly in many cases, perhaps not all cases, but in many cases, infection preventionists can adapt what they know in the hospital setting and make it work in other settings. Whereas for physicians who are doing this, even infectious disease specialists or epidemiologists, their role is actually quite different than ours. They’re in a way making it up as they go. I think we do have a lot to learn in terms of how to market our services. And even if we do know how to present ourselves and explain that we have a very practical, real-world approach to solving problems and helping people reduce risk in their own settings, it’s still very hard to get that megaphone to be able to say it.

ICT®: Anything else you want to add to that you think might be pertinent that I didn’t ask you?

Campbell: Well, I think that each situation that presents itself, whether it’s getting together with friends and family during the holidays, or just ordinary life and figuring out whether to shop or to have your groceries delivered requires a lot of thought. There really isn’t a straightforward way to address every single problem. Now, over time, I’m sure we will develop algorithms for each and every typical circumstance. But individuals really have to consider where they are, how many people they’re coming in contact with, and how often that contact is occurring, and how long it’s occurring and how distant they are. And the simple reason for that is that most of the people who are infected do not realize it. At least half of them don’t realize it until they become symptomatic. The other half stay asymptomatic. They can be busy spreading their infection to everyone around them and look and act and feel perfectly normal. And that’s, again, something that’s very unusual for us in the infection prevention world. And I think that simple message, getting out to businesses, getting out to community organizations, can help to spread the word that we can be involved, and we can help whether we’re doing it as volunteers in our community, or whether we’re trying to stand up a business. It first requires people to recognize that there is a problem, and then that we can help them define their specific problem. And we can help them come up with solutions. For instance, in my own family, people said to me, “Well, you know, do we dare come and visit our mom for the holidays? She hasn’t seen anybody in six months. And, you know, her partner died a while back, and she’s really suffering from the loneliness.” And in this situation, if that person has discussed it with her, and she finds it more important that she get a visit, then that she continued to maintain her quarantine, then they need to talk about how they can make that visit the safest possible. And that can be things like getting a couple of tests beforehand at the right period of time, the right period of time really should be discussed with the visitor’s own physician. And they should talk about when their last possible exposure to someone else was. How intensive that exposure was likely to have been. Was it a known exposure, or just the last person they saw outside their own home and they’re away from their own housemates? Do their own housemates go out by the house, or do they also self-quarantine? If you have those conditions met, that there’s been a self-quarantine for two weeks, and the doctor says, “OK, one PCR test we’ll do. Or two antibody tests we’ll do. And stay in your own car and bring your own food along and your own water along on the trip.” Then you can probably have a pretty safe visit, especially if you will wear at least a simple barrier face covering while you’re visiting your mom. But other than that, it could be very dangerous for an elderly person to get visits from their younger family. And so those are the kinds of situations that really should be thought through. Because in the end analysis, would you want to see that parent end up in the ICU or dead? Because they were lonely, and you were lonely, and you wanted to both have a visit? So that’s the nature of the question asking that needs to happen. And it’s not an easy thing to do on your own. It’s even sometimes hard to raise the questions.

This interview has been edited for clarity and length.