Nurses and Infection Preventionists: An Integral Partnership

Infection preventionists and nurses must work together to prevent infectious diseases. (Adobe Stock)

As a perioperative nurse and infection preventionist (IP), I see the struggles that both specialties are facing in practice today. Behind the double doors, perioperative nurses are making do with lean staff and working to advance knowledge on infection prevention practices as they quickly onboard new team members. Operating room (OR) supply shortages are forcing us to consider safe alternatives that still protect patients from infection when critical supplies are running low. On the other side of the double doors, IPs are working across their facilities to balance ongoing COVID-19 vigilance while also responding to the widespread effects of the pandemic, such as a spike in several health care-acquired infections (HAIs) including methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. This HAI uptick is putting the infection prevention community on high alert to control further spread of HAIs that could lead to deadly outcomes, including surgical site infection (SSI). Amid these practice challenges, there is one certainty—we can’t face them alone, especially as postpandemic burnout is a stark reality for all of us.

Tackling Infection Prevention Challenges Together

I frequently remind perioperative nurses that infection prevention colleagues are critical allies when it comes to voicing their concerns about infection safety risks. Historically, IPs have worked closely with perioperative nurses in the fight to prevent the spread of transmissible infections to surgical patients. This close collaboration must continue—not only for the challenges we now face, but also for the future infection risks we need to prepare for. The current outbreak of monkeypox provides a perfect example of how we are constantly learning how new and sometimes known but uncommon viral diseases could be transmitted in the perioperative setting to stay ahead of the curve.

From my shared perspective in both practice specialties, I see how collaboration and camaraderie between perioperative nurses and IPs can build resiliency and knowledge on safe practices to reduce infection transmission in the health care setting. Here are 6 key challenges where I see value in perioperative nurses and IPs working together.

Staffing shortages risk patient safety.

Staffing shortages made the top of Emergency Care Research Institute’s (ECRI’s) 2022 list of patient safety risks, in which they cite data such as hospital registered nurse turnover being at 18.7% in 2020. They also note concerns such as age close to retirement as a factor that will only increase nursing shortages in the near future.¹ We know the impending worsening of staff shortages is not unique to nursing, as IPs, physicians, and other critical health care positions are also expected to be short-staffed. Such shortages can have lasting effects, affecting patient safety, care disparities, and burnout.

Despite reading these bleak data, some recommendations in the report give me hope. ECRI suggests designing the health care system to be nimble in responding to staff needs¹—a perfect opportunity for perioperative nurses and IPs to stand together in voicing such needs, whether those be mental health support or the ability to share patient safety data in a more fluid manner.

Widespread burnout highlights the need for resilience.

Speaking of mental health, the ECRI report also cites startling data on the current state of mental health concerns that spiked during the COVID-19 pandemic response. For example, a 2021 survey of nurses found that 28% demonstrated heightened anxiety during unexpected events.¹ If we are being honest with ourselves and our teams, we know that burnout was a reality before COVID-19. Now that the issue is being discussed widely, perioperative nurses and IPs can take this opportunity to foster new ways to connect and support each other for morale, resiliency, and practice safety.

Supply shortage solutions require shared decision-making.

Supply shortages can pose major risks for infection transmission and other patient safety issues when health care providers are forced to “make-do” with what they have. For example, during the recent shortage of sterile water, which is critical for keeping instruments clean and moist during surgery to facilitate cleaning, OR nurses asked the professionals at Association of periOperative Registered Nurses (AORN) how to sterilize water themselves in the surgical setting. This workaround is not ideal for patients or staff and speaks to the need for ECRI’s recommendation to support “planning, preparation, communication, flexibility, and cooperation with outside collaborators” to safely navigate supply chain disruptions.¹ Perioperative nurses and IPs share a foundational understanding in infection control measures in the OR and need to amplify a united voice and evidence-based rationale for discussing safe alternatives to supply shortages with vendors and other facility collaborators.

Increased infection rates demand data sharing.

Recent findings on the state of HAIs flag several key trends that perioperative nurses and IPs should review and track together. For example, Lastinger et al² analyzed data from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network and found that standardized infection ratios were significantly higher than those of the prepandemic period and showed increases that spiked in quarters 1 and 3 of 2021, when there was a high number of COVID-19 hospitalizations. Specifically, rates of central line–associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated events (VAEs), and MRSA bacteremia increased. On a positive note, standardized infection rates for Clostridioides difficile infection went down, which was attributed to enhanced surface cleaning during the pandemic. Also, SSI rates did not increase; however, with MRSA bacteremia rates being high in 2021, this common contributor to surgical infection could lead to an increase in SSI that we will see in forthcoming 2022 infection rate data.

The bigger trend I see in these infection rate increases in CLABSI, CAUTI, VAE, and MRSA bacteremia is a clear indication that we have a heavy burden of sick patients who require the central lines, catheters, and ventilators that are associated with these infections. Additionally, consider how staffing challenges are bringing an influx of new nurses into practice who are just learning critical infection prevention practices. Increasing HAI rates also remind us how important it is to be mindful of antimicrobial resistance patterns. The COVID-19 pandemic set us back in many ways, but these setbacks must be temporary, as the CDC reminds us, noting that, “if properly resourced, the US can continue to build resilient public health and health care systems to keep our nation safe from antimicrobial resistance.”³ Collecting and sharing HAI data can help us better understand the HAI realities we face, so we can address them directly for all patients and for overall safety in the health care setting.

Teams must get back to basics with infection prevention knowledge. Luckily, we have a wealth of evidence-based knowledge and practice guidance available to show all health care providers how their actions can directly impact HAI rates. For new health care professionals, traveling professionals, and even seasoned veterans, getting back to basics will arm them with the knowledge to make smart practice decisions. In surgical care, perioperative nurse leaders and IPs can present a collaborative review of the basics, such as hand hygiene, sterile technique, and skin preparation to protect surgical patients from HAIs. These recommended best practices and the evidence supporting them are discussed in AORN’s Guidelines for Perioperative Practice and in supplementary guideline implementation resources through the association’s eGuidelines+ and Guideline Essentials (a member benefit). One important tool in these implementation resources is a gap analysis survey for each guideline to evaluate and shore-up staff knowledge gaps. For example, AORN has been receiving a high number of member questions about sterile technique practices, such as how long a sterile field can be covered. A gap analysis would identify such areas for perioperative nurses and IPs to reteach best practices and share the infection rate data directly linked to those best practices.

Staff instability indicates a need for better team communication.

Beyond infection issues, we know that simply getting staff talking and collaborating within a culture that supports speaking up can significantly reduce risks for patient safety events. As new and traveling team members become acclimated to their current roles, we need to make sure we are fostering healthy communications within a safe environment where all staff feel comfortable raising issues. IPs and perioperative nurses can model team communication by collaborating on any number of critical safety issues that need to be tackled, whether sharing surveillance data on infection rates or partnering to address supply chain concerns. Even common daily pressures to be more efficient in the OR can create patient safety risks that perioperative nurses and IPs can address together.

As perioperative nurses and IPs face the challenges and uncertainties of postpandemic practice, they may feel there is little time to step out of their individual practice bubbles to collaborate. However, taking a moment to chat and recognize shared challenges can fuel fruitful dialogue and lead to new solutions they can implement together. Camaraderie, collaboration, and data sharing are essential to optimize infection prevention as well as morale, and we have a better chance of success if we can work together.

References

1. ECRI Institute. Top Ten 10 patient safety concerns 2022. Plymouth Meeting, Pennsylvania. ECRI. Accessed September 30, 2022. https://www.ecri.org/top-10-patient-safety-concerns-2022

2. Lastinger LM, Alvarez CR, Kofman A, et al. Continued increases in the incidence of healthcare-associated infection (HAI) during the second year of the coronavirus disease 2019 (COVID-19) pandemic. Infect. Control Hosp. Epidemiol. Published online May 20, 2022. :1-5. DOI doi:10.1017/ice.2022.116.

3. US Centers for Disease Control & Prevention. COVID-19 & aAntimicrobial rResistance. CDC. Updated February 25, 2022. Accessed September 30, 2022. https://www.cdc.gov/drugresistance/covid19.html