Infection Preventionist Methods Must Evolve to Face Evolving COVID-19 Threat

These are not easy times for infection preventionists in hospitals, especially with the rapidly evolving criteria for patients under investigation (PUI) for COVID-19. Infection prevention and control (IPC) efforts will have to change as well, as all signs point to a situation that’s worsening.

COVID-19 has sickened more than 89,700 people worldwide, according to official counts. As of Monday morning, at least 3056 people have died, all but 144 in mainland China.

Two of those deaths occurred in the United States, where there have been 88 confirmed COVID-19 cases. One casualty was a man in his 70s with underlying health conditions in Washington state. He was a resident of the Life Care Center of Kirkland. Four other nursing home residents have been hospitalized, 3 in critical condition. A healthcare worker there in her 40s remains in satisfactory condition. Another man in his 50s from Washington State also died from COVID-19. He was not associated with the nursing home and he, too, had underlying health conditions, the New York Times reports.

These cases should serve as a reminder to hospital administrators and infection preventionists to evaluate hospital practices to ensure rapid identification, isolation, and communication occur. 

First, the screening of patients coming into the healthcare facility. Last Thursday, the US Centers for Disease Control and Prevention (CDC) updated and expanded the criteria to guide evaluation of PUI (PUI) for COVID-19. Now, the recommendations include:

• Fever or sign/symptoms of lower respiratory illness and any person who has had close contact with a confirmed COVID-19 patient within 14 days of symptom onset.

• Fever and signs/symptoms of a lower respiratory illness requiring hospitalization and a history of travel from an affected area within 14 days of symptom onset.

• Fever with severe acute lower respiratory illness requiring hospitalization without alternative explanatory diagnosis and no known source of exposure.

These changes mean that screening and triage processes must now shift to capture a wide net of people. Identifying those with known exposures can be a challenge though, as most hospitals have travel screening questions built into the triage process, but not necessarily a question regarding exposure history. Moreover, these updates mean additional education is needed and expanded beyond just emergency departments, but also to hospital units where patients might be admitted for severe illness like pneumonia. 

For infection preventionists, this means that much more time is spent with providers and healthcare workers to ensure they understand the new changes and what they mean for workflow or processes. 

In addition to ensuring airborne infection isolation rooms (AIIR) are functioning effectively, it is important to keep daily tabs on supply of personal protective equipment (PPE). Mask supplies are becoming increasingly strained and now is the time for 2 steps: First, reiterate the use of masks only when clinically indicated. It’s important that masks are only used when necessary and the appropriate usage is occurring, meaning that people don’t use N95 masks for patients only requiring droplet precautions. 

Second, establish plans for re-use and/or extended use per CDC guidelines. Communicate these to staff and ensure they are added to existing policies. 

During this time, it’s also important to establish plans for employees returning from foreign travel. Some ask employees traveling to the affected areas to self-quarantine for 14 days prior to returning to work, but ultimately this should be discussed. 

For the general public, the CDC has advised against all non-essential travel to international hotspots such as China, Iran, South Korea, and Italy. 

That might just be the beginning. Last week, the CDC advised US businesses to consider offering employees telecommuting options, schools might need to teach online, and hospitals should reinforce their telehealth abilities. 

The CDC appears to be taking its own advice, too. Koo-Whang Chung, MPH, a health scientist with the CDC’s Division of Healthcare Quality Promotion, said that a 2-day meeting of the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) scheduled for Wednesday and Thursday of this week at CDC headquarters in Atlanta has been changed to a 1-day only (Thursday, March 5) teleconference, according to an email obtained by Infection Control Today^®.

“If you’ve made travel plans, please adjust them accordingly,” wrote Chung in the email to participants. HICPAC provides guidance to the CDC on how best to prevent infections. These recommendations focus largely on health care delivery practices and occasionally on general categories of products, but last year HICPAC expanded its reach by creating an algorithm that’s meant to grade the viability and effectiveness of the onslaught of infection control devices flooding the market.

Chung wrote that, “Due to the rapidly evolving novel coronavirus disease outbreak (COVID-19), the March 5-6, 2020 in-person meeting will now be a teleconference only meeting on Thursday, March 5, 2020…. All in-person registrants will be sent the details for the teleconference in a separate email.”

But when it comes to the day-to-day workings of hospitals and other healthcare facilities, remind people that the prevention strategies for COVID-19 are similar to flu-hand hygiene, covering coughs/sneezes, staying home when sick, environmental disinfection, and avoiding touching one’s face. 

Infection preventionists are the subject matter experts in these times for healthcare facilities and it’s important that they are supported so that they can in turn, support their staff. Since it is likely more cases will be identified in the United States, ensuring infection prevention practices are being followed, staff feel supported and well-resourced, and supplies are being monitored, is critical.