Preventing Increases in HAIs and Burnout During the COVID-19 Pandemic

Health care-acquired infections (HAIs)

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A severe infectious threat response initiative (SITRI) was implemented by the Infection Prevention and Control (IPC) team at Veterans Affairs North Texas Health Care System (VANTHCS) and positively affected IPC staff burnout. Further, the initiative helped prevent an increase in health care-associated infections (HAIs) during the COVID-19 pandemic.

The study’s findings were published in the American Journal of Infection Control. They suggest that investment preemptively in preparedness initiatives can assist health care facilities in retaining systematic prevention efforts and improving patient safety during infectious disease outbreaks.

“Like all other hospitals, personal protective equipment (PPE) had to be redirected to COVID-19 care. We had to reassess how we cohort patients with multidrug-resistant organisms,” Madhuri Sopirala, MD, MPH, Director of Infection, Prevention, and Control, VA North Texas Health Care System at the time of implementation of the program, Associate Professor of Infectious Diseases and Geographic Medicine at UT Southwestern Medical Center, and the lead author on the published study stated to Infection Control Today^® (ICT^®)in an exclusive interview.

“We had to stop isolating patients with methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization. Because of these kinds of changes, we were concerned about potential outbreaks. Having the SITRI program in place with a rotating schedule to address COVID-19 issues allowed infection preventionists to focus their efforts on other high-impact infections that could still place patients at risk for morbidity and mortality. We had increased oversight on infection prevention practices such as hand hygiene, isolation compliance, disinfection of reusable medical equipment, and environmental disinfection. We believe these efforts helped prevent health care-acquired infections (HAI) outbreaks.”

Rates of HAIs– Central line-associated bloodstream infections, Catheter-associated urinary tract infections, MRSA, Clostridioides difficile, hip and knee prosthesis surgical site infections (SSI), colon SSI, coronary artery bypass graft SSI with both chest and donor site Incisions either decreased or stayed the same in acute care and long-term care.

ICT: A summary of the key findings and why they are important.

Madhuri Sopirala, MD, MPH: The most significant peak in phone calls SITRI received occurred before any COVID-19 patients were admitted to the hospital. This signifies staff anxiety about COVID-19. SITRI aimed to support staff and operations during this difficult time with around-the-clock service.

Evaluation of burnout of the IPC program using an all-employee survey revealed lower levels of exhaustion and reduced achievement in 2020 and 2021 compared to 2019. We believe this was due to some safeguards that the SITRI program had in place, such as compensating overtime, organizing around-the-clock call schedule while providing time-off after working overnight, prioritizing workload and strategically allowing them to work from home on certain days, having protocols for COVID-19 management very early during the pandemic, daily huddles to provide support to infection preventionists and having around the clock access to the hospital epidemiologist who is also an infectious diseases physician. Such organizational support is necessary for the success of programs like SITRI.

Rates of HAIs– Central line-associated bloodstream infections, Catheter-associated urinary tract infections, MRSA, Clostridioides difficile, hip and knee prosthesis surgical site infections (SSI), colon SSI, coronary artery bypass graft SSI with both chest and donor site Incisions either decreased or stayed the same in acute care and long-term care. COVID-19 literature is scarce in HAI data for long-term care and lacks SSI incidence data. This contrasts with what was nationally reported and reflects the organization’s efforts not to lose focus on these high-impact infections.

The organization paid overtime for infection preventionists to support the SITRI program, which was not insignificant. The potential savings from prevented HAI could easily offset this cost.

ICT: What is the practical application of the key findings for infection preventionists from this study?

MS: Having an organized program to keep the focus on other high-impact infections is important during a pandemic to avoid untoward outcomes. Organizations need to support these types of programs.

ICT: What results surprised you, if any?

MS: We were surprised that our HAI outcomes contrasted with what was reported in the literature. We were also surprised to see the results of the all-employee survey indicating improvement in infection preventionist exhaustion and reduced achievement scores during the pandemic.

ICT: What, if any, future research will there be related to this one?

MS: Potential future research areas include future planning for infectious disease disasters accounting for efforts to avoid collateral damage due to high-impact infections.

ICT: Is there anything else that you would like to add?

MS: Our long-term care areas had the same level of support as our acute care areas, with IPs dedicated full-time to infection prevention. This key element helped prevent adverse outcomes with high-impact HAIs as much as possible in this vulnerable population during SITRI implementation.