Infection Preventionist: ‘We On the Frontlines Have to be Strong’

No, there is no rest for the weary infection preventionist (IP). Not while the second wave of the coronavirus disease 2019 (COVID-19) rages. The United States recorded 3157 COVID-19 deaths yesterday (December 3), the highest number in a single day and more than 20% higher than the previous record of 2603 deaths set back on April 15, according to Johns Hopkins University. Meanwhile, according to the COVID Tracking Project, more than 100,000 people have been hospitalized for COVID-19, another new record. That’s an 11% increase in hospitalizations in a week; a 26% jump in the past two weeks. Rebecca Leach, RN, BSN, MPH, CIC, is an infection prevention coordinator and a member of Infection Control Today®’s Editorial Advisory Board. She’s also in the thick of the COVID-19 battle, routinely working 10-hour days but, as she says, thinking about the novel coronavirus every waking moment. She has some suggestions for how IPs can cope. Give “yourself permission, when you have those down times, to really let out those emotions and let it happen. It’ll help.” Leach adds, however, that “I honestly think there are going to be a lot of people who have really been working more on the frontlines than I am who are going to have long-term psychological effects from this.” Yesterday, Leach took time out of her busy schedule to file a dispatch from those frontlines via a conversation with ICT®.

Infection Control Today®: So, what’s it like on the frontlines?

Rebecca Leach, RN, BSN, MPH, CIC: It’s very busy. It’s very hard, I think, for a lot of us who have been working in this for almost the whole year now. And we all sort of anticipated this would happen over the holidays. And as states started lightening up on their restrictions, but it’s really hard to see it actually happening and to be resilient and to keep moving forward. It is a long journey, for sure.

ICT®: Another one of our Editorial Advisory Board members, Doctor Kevin Kavanagh, is downright impatient with the public. He says the public isn’t taking this seriously enough. Not to put you on the spot, but are you also a little bit impatient with the public?

Leach: I definitely feel impatient in general with the public. I think the hard part is that we all are exhausted from this. Everybody’s tired of having to change their way of life for this and I can understand the fatigue factor in the public. I think my biggest impatience is probably more with leadership and government. Some states are doing more to be more proactive, and some states are not. And that’s where my biggest concern is. That we have leadership that really should be setting the standards and the expectations. And this is the time when public health authorities really need to be the ones to make those statements and be listened to. And I think if that happened, as we saw before, in the summer, when states really locked down or mandated masking and that kind of thing, we saw a decrease. If we did that, again, I think it would work. I just think that there are a lot of people who just don’t want to do that for various reasons; a lot of economic reasons, political reasons. But it just is very frustrating.

ICT®:How much hope are you placing in a vaccine maybe controlling this thing?

Leach: Well, I’m trying to be very hopeful about the vaccine, but also very realistic. We know there are not going to be enough doses until probably well into next year to really cover a lot of people that we would have to change a lot of these behavior modifications we need to do. You know, they say in the next few weeks, potentially, that we would start seeing a vaccine being disseminated here in Arizona, which is exciting news. But it’s going to be limited to however many doses we get. And then of course, that tier of who’s going to get it first, which will be most likely healthcare workers and long-term care residents. And the whole process of how they’re going to distribute it and all of that is a little bit up in the air. There are plans, but do they have the people to actually give the vaccines and track it and how is that going to work? So, you know, it is hopeful. But it’s not the end by any means, especially not in the next few months. I think we’re going to keep seeing cases go up in the next few months until the vaccine is more distributed or we make other changes like we did before with masking and the closing down of gathering places.

ICT®: Forgive me for forgetting this. You’re in Arizona. You’re an infection prevention expert. How many facilities do you actually oversee the infection prevention for?

Leach: Well, right now I’m actually in a different position. I’m in one main facility, but it’s a large facility 570 beds, and then we also have some satellite clinics and a smaller facility that we oversee. It is part of a large healthcare system.

ICT®: How many hours a day do you work?

Leach: I’m actually here at least 10. But thinking about it and working on it constantly, pretty much. Always thinking about COVID-19 for sure.

ICT®: Have you discovered tricks regarding how to take the pressure off that you can share with your fellow infection preventionists or fellow healthcare workers who also on the frontlines?

Leach: I would say that most of us who have been dealing with this for so long have had our highs and lows, where you have your days where you feel like you’re energized, and you can really do this, and then you have those really hard days. And I think the biggest thing is just having support, whoever it is. If it’s a fellow infection preventionist that you can talk to, people at

Rebecca Leach, RN, BSN, MPH, CIC

home that you can talk to. It really is that emotional support of being able to talk to each other about your experiences and really process your feelings. And I think a lot of it too is we on the frontlines have to be strong. We’re the ones that have to do the work. And so giving yourself permission, when you have those down times, to really let out those emotions and let it happen. It’ll help. But I honestly think there are going to be a lot of people who have really been working more on the frontlines than I am who are going to have long-term psychological effects from this.

ICT®: Has spreading the message of infection prevention gotten easier? How do you feel about deputizing other people to be part of an infection prevention team—not officially a part of the team—but part of the infection prevention effort?

Leach: I think that actually has improved quite a bit. In the beginning, when we were first doing this, it was infection prevention who was sharing the knowledge and explaining the concepts behind the preventive isolation and transmission and all that sort of thing. And now, since they talked about it so much, there are so many people who are knowledgeable. For example, here on our nursing unit [there are] educators, clinical leaders, who are very well versed in the basic infection prevention concepts and can really be that extra line of defense that we need and can offer that information. Which is really nice in this second wave. That’s a little bit of a different thing for us. We’re not the only ones who have the knowledge, right? Or are seen as the ones who need to answer all the questions. There are other people who they can turn to now. So that kind of takes a little bit of the pressure off of the infection preventionist and we can focus in on maybe other areas like the vaccine development and other things that we’re going to be involved in going forward.

ICT®: Are there things that only an infection preventionist can deal with?

Leach: Well, for example, what we saw with the first wave, the big way here over the summer in Arizona, was a lot of our patients who had COVID also developed other hospital-acquired infections such as CAUTIs [catheter-associated urinary tract infections] or CLABSIs [central line-associated bloodstream infections]. We saw a huge increase in those. And I think that’s been shown pretty consistently across the country and in journals and articles. And so that’s some of the work that we’re trying to focus on here. We know we have these patients who are incredibly challenging treatment-wise. How are we going to prevent this this time around? How are we going to not have CAUTI-CLABSI increases for our patients with COVID? How do we maintain that standard work of the preventive bundles that we know we need to do with such a challenging population and other things we need to do on top of what we’re already doing for these patients? So that’s some of the work that we can focus on as well.

ICT®: Another expert I spoke to said that within the next 10 years she expects that about 40% of infection preventionists currently working will retire. Do you see COVID, ironically, as maybe holding up infection prevention as a possible career path for younger healthcare providers?

Leach: I think so. But I’m also thinking maybe this pandemic will inspire more young providers to become infection preventionists because it’s more exposure to different areas where people didn’t always know what we did or what our jobs involved. And maybe this will inspire people to become involved in infection prevention and public health in different ways. I’m hopeful that that might come out of this; is a little bit more exposure to what our jobs are, as well as a little bit of an evolution in what we do and we’re seeing more of this in the emergency response area as pandemic planning. And other things that we in infection prevention always knew we’re an important part of, but now I think everybody kind of sees how important we are.

ICT®: Are you at your facility? Are you speaking at home?

Leach: I’m at my hospital.

ICT®: So, you’re in an empty room with the proper airflow. When this interview is over, will you be doing all the donning and doffing of personal protective equipment? Putting on the goggles and all that stuff?

Leach: Yes. Right now I’m in here by myself. But we have universal masking and eye protection required for all staff who come in the hospital. And then of course, if I were to go in a patient’s room that was in isolation, then I would have the gown and the gloves as well. Or if it was an N95 necessary, then I would put that on. I don’t see myself without goggles and masks very often.

ICT®: Do you feel a little bit of pressure because you’re the infection preventionist and you have to set the best example?

Leach: I’ve always felt that pressure even before all of this. People watch us. If we’re going in and doing rounds on patients, we better be doing our hand hygiene before and after. And we better be making sure we’re following those guidelines. I’ve always felt that. People are always kind of watching you. You set the example. So especially with this, there have been times where I’ve walked out and forgotten my mask, and I’m like, I’ve got to run back and grab it. You just forget, sometimes. That’s normal.

ICT®: Hospitals can be hierarchical institutions. Have you ever had to flag a surgeon or hospital administrator and say, “Hey, you’re not doing this right?”

Leach: We try to really empower everybody to be able to do that, as well as have people understand, if somebody says something, don’t take it personally. We’re all just trying to watch out for each other. It is very hard. And even before COVID, that’s kind of that culture of safety that you always talked about with infection prevention for a long time. Just having anybody from any position in the hospital be able to speak out if they see something that may be a safety issue. With COVID, for sure, that’s important. But it’s been important for a long time, and some facilities are really great at it and have that culture of safety, and others are still on the journey. This definitely is something where because of that sense of personal safety, maybe people feel a little bit more empowered to speak out. But I think there still is that hierarchical concern for certain groups. And that’s something that an organization would need to work on for sure.

ICT®: Is there a anything that I neglected to ask you about what it’s like on the frontlines that you think might be pertinent and that your fellow infection preventionists or any other healthcare professional should know?

Leach: I think the biggest thing that we need to keep in mind is we’re all on the same team. And so there will be times when people are just tired, and we need to be empathetic to that and understand that if people challenge the recommendations or some of the processes that we put in place, to approach it not from a position of defensiveness, but to really understand where they’re coming from. Because their experience may be different than mine. And I need to understand what they’re going through and how it’ll impact them and as well as what they have learned because everybody has learned different things doing different parts of this pandemic response.

This interview has been edited for clarity and length.