Private Industry May Call on Infection Preventionists for Help

Companies in the process of reopening after the coronavirus disease 2019 (COVID-19) pandemic face unprecedented challenges. They want to make a profit so that they can pay their workers a living wage, but they also want to ensure the safety of those workers on their worksites. Anthony Harris, MD, MBA, MPH, the chief innovation officer at WorkCare, tells Infection Control Today® that the concerns have shifted over the course of the pandemic. Back in February and March, the companies wanted to know just how SARS-CoV-2 is transmitted. Now, a lot of it has to do with proper airflow to reduce the amount of droplets, and how to go about COVID testing. Concerns “will probably continue to shift as we talk about vaccinations and as waves of people become vaccinated,” says Harris. “What’s the strategy there with minimizing and who can come back and when?” Some companies are turning to infection preventionists for answers, says Harris.

Infection Control Today®: We’re hearing more and more about the possibility of infection preventionist moving out of the healthcare system and into private industry or school systems. When I just introduced you, I use terms like automated screening, risk assessment, testing. They sound very much like things that infection preventionists might help out with. Is that a fair assumption?

Anthony Harris, MD, MBA, MPH: Absolutely. Yes. And when we talk about prevention, certainly the epidemiologists, myself included in my training and the infection prevention specialists, spend probably most of their time doing prevention, right? It’s only in these unfortunate rare times that were activated to do the kind of boots-on-the-ground type of activities, but for the most part, it’s primary prevention.

ICT®: You work mostly with private industry?

Harris: We do. We’re a full-service organization that has been around for about 35 years. And my experience has been in being board certified in occupational environmental medicine, primarily with large and small businesses. But, certainly, we work on the public health side, alongside our brothers and sisters on the community and state level public health.

ICT®: What are you hearing from your clients and private industry about their concerns in terms of infection prevention? Everybody’s got concerns these days about COVID-19.

Harris: We’ve seen their concerns raised and kind of shift as we learn more and more about SARS-CoV-2 and how it’s transmitted. Early on, back in February and March, as we were working with industry, it was concern around not just airborne but surface contamination as a means of transmission. Obviously, we’ve seen data to suggest that the surface transmission is not as prominent as we once believed. Now it’s shifted toward: “How do I minimize airborne illness?” And in particular, there’s been a kind of resurgence in the attention to airflow control in a workplace setting, and even guidance from the CDC and the FDA around how do we modulate the airflow in our facilities to reduce the number of airborne droplets that can transmit the virus. We’ve seen these concerns obviously shift as we’ve learned more. It will probably continue to shift as we talk about vaccinations and as waves of people become vaccinated. What’s the strategy there with minimizing and who can come back and when?

ICT®: I know this is just anecdotal, but do you find that the heads of companies are having trouble following the guidelines and figuring out what they should be doing and not doing?

Harris: It all is kind of fragmented in terms of success at following guidelines and those who are doing it well and those who are struggling. And what I mean by that is oftentimes it’s predicated on the resources that they have access to both locally and at the national level. We operate coast to coast. And as we do so, we’ve kind of been able to see the disparities between those who have local resources to partner with and those who have been struggling to find those resources. And it really hit home with regard to testing, right? Testing individuals, to be proactive in regard to who needs to be at work, who can be cleared to come back to work and when, has been across the board a bottleneck nationwide. And we know we’re still struggling with that in terms of access. But, certainly, those preventive methodologies that include the screening, like you mentioned before, those who have taken advantage of digital platforms that are easily scalable at a reasonable cost to the entire workforce. We’ve helped usher in 20,000 to 50,000 workers in a matter of weeks to do those type of processes, and they’re doing it well, and it’s working. But we still see the community acquired transmissions. We’re struggling to prevent those because of lack of access to appropriate measures.

ICT®: Companies over the last couple of decades have been turning more and more to the open floor plan. I guess that’s not going to come back. Is that a fair assumption?

Harris: I would say so, and even if we look at things that are in place, from a legislative standpoint, we look to Oregon and the measure that they passed and approved, we can see that it’s mandated social distancing at six feet, and it’s cumulative. So even if we pass each other in the hallway, and in passing, we only spend less than two minutes in passing, that is summed up at the end of the day over an 8-hour or 10-hour period. And if that sum is more than half an hour, you have to have measures in place to prevent that potential transmission. Whether that’s a physical barrier that’s not permeable or wearing face coverings and things of that nature. So, definitely there are things that are going to preclude us from seeing that European style of office space.

ICT®: Do you also work with some public health departments?

Harris: We don’t work with them often directly. We work with them in tangent in terms of best practices or recommendations. Oftentimes, we’re collaborating with our cohort of occupational health doctors. There are kind of two delegations of docs, if you would, those who work in the corporate realm and those who work in the public sector. And those are the individuals we work alongside of in terms of making sure across the board, we’re recommending the best practice, the best science, applying the best knowledge. Whether it’s been published and peer-reviewed or whether it’s, “Hey, look. This is what we’re seeing locally in this area, and let’s respond appropriately and proactively to help mitigate risk.” And so that’s how we’ve been prominently working with the community health departments.

ICT®: Have you and your company personally reached out to infection preventionists to seek some guidance in what you’re doing?

Harris: Absolutely. In various universities…. I went to med school with the current Surgeon General [Jerome M. Adams, MD, MPH]. Now, I’m not saying I’m calling them up and giving advice day after day, right. But I say that yes, indeed, our colleagues that we work with and have been working with for years, decades in some cases, are those who we’re calling up on the public side to help collaborate on what’s the best practice for infection control.

ICT®: Infection preventionists now are currently in the hospital setting. Have you actually seen them moving into private industry? Is private industry hiring them?

Harris: Yes. Anecdotally, I have. Right. Do I have a colleague that has done so directly? No. But certainly talking to the professionals at the different businesses that we counsel, they are reaching out to university hospital-based experts—infection control experts—to get counsel. And in I believe one case I know of anecdotally, an individual has moved from that sector into the corporate sector successfully.

ICT®: What are the main questions that you’re getting from corporations lately?

Harris: Really now it’s all about testing. How do we test? What scale do we test with? And, you know, what are the steps toward getting that access to the testing levels that we need necessary to mitigate risk? And it really is a local recommendation based upon local incidents transmission. And those questions and answers are varied. If you have access locally, that’s one scenario. Even if you have access, right, meaning that you have 10 facilities around you, the queue to get people in the door still may be days. We’re seeing that down in Miami, for instance, in the Fort Lauderdale area. We’re seeing that also in the Midwest in Chicago. And then we’re also seeing new solutions come out and some of the questions around, “What are these saliva tests that can be done at home? How do we access them? What do we do to practice that?” And we’ve been doing thousands of those type of tests with our employers because they provide a greater access in a greater swath of the nation. It really is still the how and when of testing that predominated the questions from our employers.

ICT®: Do you think working at home will become the new thing?

Harris: Absolutely. You know, if I take off my epidemiologist hat, my MPH hat, and put on my MBA hat. When we look at the economics of working from home, we’ve seen some companies announced that a significant proportion of their workforce will never come back to the workplace because it decreases the overhead for these operations. And incidentally, companies have seen an increase in productivity in certain sectors when people are working remotely from home. And we know when we study workplace productivity, one of the main factors that drives productivity is being able to control your schedule a little bit more. And what we know to be true in terms of—and this may be geeking out a little bit too much on productivity—but individuals work best in blocks of time. And if you’re working from home, there are less distractions for your block of time. Versus walking down the hall or going to get coffee and having a conversation. And those small changes in the day-to-day rigor allow for increased productivity in some scenarios. And we’re going to see that play out in, again, a significant proportion of the workforce never coming back to work.

ICT®: What do companies need to do to their buildings to make them as COVID-free as possible?

Harris: If you have the opportunity to retrofit your building facilities with HEPA [high-efficiency particulate air] filters, then we see companies doing so. If you have an opportunity to update the exhaust system so that you’re turning over the air six times an hour. That’s been shown to reduce particles. Actually, that’s the cut off for the healthcare setting for isolation, six times an hour at a minimum. We know that companies are looking to do these things, retrofit facilities, so that it may decrease the opportunity for workplace transmission by minimizing those droplets that hang out in the air that are about five microns in size. It’s probably less the abandoning of the facilities versus just investing the capital to retrofit because the ROI of a more productive workforce and reducing the anxiety of the workforce about coming back to work when they need to, is worth it.

This interview has been edited for clarity and length.