Infection Preventionist Guide for Dealing With Flu and COVID-19

Even today, as of this writing and very likely as of your reading, many healthcare facilities in the United States—whether acute care, assisted living, or long-term care—are not equipped to handle a surge in coronavirus disease 2019 (COVID-19) cases, even though the world has wrestled with this history-altering pandemic since last year, and even though systemic problems should be fixed by now, but are not.

Some facilities continue to refine policies, procedures, and protocols for COVID-19. In some instances, healthcare is not succeeding with staff social distancing and proper use of personal protective equipment (PPE) (note: fabric and cloth masks ARE NOT considered PPE and should not be used within a healthcare setting) and proper cleaning of high-touch areas. There is still a lack of testing for COVID-19 as well as a lack of PPE and hand sanitizer—the basic items needed to protect healthcare workers and patients.

And just when many healthcare facilities thought it couldn’t get any worse, here comes influenza. Flu season on top of COVID-19 will make many hospitals and other healthcare facilities feel as if they’ve been caught in a whirlwind.

No one can really predict what is going to happen, but take heart, because seasoned infection preventionists (IPs) will be ready to accept and take on the challenge of the flu/COVID season. Novice IPs should use all the resources available to them to help them develop strong infection prevention and control programs within their facilities. Seasoned and novice IPs should reach out to websites such as:

• https://www.cdc.gov/coronavirus/2019-nCoV/index.html,
• https://www.cdc.gov/flu
• https://www.who.int
• www.apic.org
• Websites for local health departments.

These organizations will keep IPs up to date on what is happening across the United States and the world so IPs can adjust practices as needed in their facilities.

The wearing of masks and face shields or goggles have become part of healthcare workers’ uniforms. The responsibility of IPs and management continues to be reminding all disciplines within the healthcare facility to wear their PPE appropriately and to social distance. All disciplines must work as a cohesive group to remind and protect each other. If you see something, say something. Let coworkers know when they may have breached infection control practices such as forgetting to wash their hands, not wearing PPE properly, or missed opportunities to clean high-touch surfaces. Whether dealing with influenza or COVID-19, practices are the same. The only difference is that COVID-19 is more infectious and transmittable and more deadly than influenza.

As of August 15, the United States has seen a total of 5,285,546 cases of COVID-19, with 167,546 deaths. Data have been collected for 3,924,574 people, but healthcare personnel status was only available for 879,436 (22.4%) individuals. For the 134,397 cases of COVID-19 among healthcare personnel, death status was only available for 93,236 (69.4%). Among the data available for healthcare workers, there have been 628 deaths.

The 2019-2020 US flu season data reported on April 17, 2020, showed that the number of flu illnesses reported were between 39,000,000 and 56,000,000, with between 24,000 and 62,000 flu deaths occurring from October 1, 2019, to April 4, 2020. This was a total of 7 months. When deaths from influenza are compared with deaths from COVID-19, there have been fewer cases of COVID-19 than influenza, but there have been more than double the number of deaths from COVID-19 than from influenza.

So, what do we know for sure about influenza and COVID-19?

Key to balancing safety and success during influenza season in the middle of a global pandemic:

• Educate staff and management about new information that is published by professional organizations and associations. We cannot anticipate what will happen if patients are co-infected with influenza and COVID-19. Monitor reputable sites for guidance.
• Utilize other IPs in other facilities for advice if an unusual situation arises.
• Utilize local department of health epidemiology branch.
• Rounding in all patient care areas and monitor use of PPE/hand hygiene and surface cleaning and disinfecting.
• Encourage the buddy system for donning and doffing of PPE.
• Hold listening sessions with staff and management to let them express what they see as needs or problems.
• Monitoring staff and visitors for symptoms of influenza/COVID-19.
• Contract tracing once COVID-19 is identified is a must for COVID-19. US Centers for Disease Control and Prevention (CDC) has good online contact tracing education.

Vaccination to protect against influenza is extremely important. And when the flu is here, there are also a lot of other respiratory viruses circulating. It’s not just influenza A and influenza B that’re seen during flu season. Healthcare professionals only test for the virus that they suspect is going to cause the most deaths for that year. That’s how the government decides what the flu vaccine is going to be. There is still respiratory syncytial virus (RSV) among young kids, and even the elderly.

Infection control personnel really have to monitor closely all respiratory viruses that are out there and be sure to work with management to put in place whatever needs to be put in place. Communicate well with the nursing staff and communicate well with all departments because if environmental services teams see nurses wearing a particular PPE, but they’re not being given it to wear, they’re going to be scared and wondering “why do they get better protection than me?”

IPs need to have all lines of communication open and really work hard at it. This can get very complicated.

LINDA SPAULDING, RN, CIC, BC, CHEC, CHOP, is an infection prevention consultant and founder of InCo and Associates International.