Q&A: Infection Preventionists Keep Hospitals on Track

The lessons the entire world learned this year about how best to protect against dangerous pathogens will probably need to be reinforced even after coronavirus disease 2019 (COVID-19) recedes (we keep hoping) like some bad dream. Infection preventionists (IPs) have been at the forefront in the battle against COVID-19 serving two vital constituencies: patients and their fellow healthcare workers. Caitlin Stowe, CIC, MPH, CPHQ, VA-BC, an infection preventionist by training, is the clinical affairs research manager at PDI, a company that makes disinfection, skin antisepsis and nasal decolonization products for healthcare, foodservice, and other industries. Recently, Stowe sat down with Infection Control Today® to discuss the many challenges IPs face in trying to keep their hospitals and other healthcare facilities as free from infection as possible. Pathogens lurk everywhere. Get rid of the water fountains and tear up the carpet, Stowe suggests. And keep your guard up. Stowe realizes that “nine months into a pandemic, everybody’s tired. And it can be hard to maintain that diligence, but they have to remember that this winter is going to be pretty bad for both flu and COVID. And I think the more that they can do to help make sure that their staff is supported, they feel protected and safe at work, both physically and mentally, will only help hospitals in the future.”

Infection Control Today®: If you were asked to redesign a hospital or health care system and had free reign, what key things would you do first to improve infection control at the patient and ward level, and also at the system’s level?

Caitlin Stowe, CIC, MPH, CPHQ, VA-VC: The first thing I would do is I would remove all of the water features such as the decorative water fountains or the waterfalls that you see in a hospital that make it very inviting. But those water features can actually harbor pathogens that love to live in the water and can actually cause infection in patients, especially if they’re

Caitlin Stowe, CIC, MPH, CPHQ, VA-BC

immunocompromised. That’s the first thing that I would do. The second thing that I would do is to remove all of the carpet, in a hospital as well. And any cloth chairs because a lot of that is not easily cleanable. Even, you know with the best vacuuming or the best spraying, it’s the cloth that allows pathogens to harbor and hang out within the fabric and can also potentially transmit infection. So those are the first things that I would do. Plus, those surfaces really aren’t easy to clean. And that’s really important.

ICT®: Do hospitals have a lot of water features in your experience?

Stowe: The newer ones, if they’ve done any renovation or construction… A few years ago, the FGI [Facilities Guidelines Institute] actually discouraged the use of these water features and fountains because there was so much evidence showing that they could potentially transmit infection. So, you won’t see them in a lot of the newer hospitals, but some of the older hospitals, or some remodeling that was done maybe greater than five years ago, you will still see them.

ICT®: What are some of the high-touch surfaces that are commonly overlooked in hospitals?

Stowe: I think there are a few things. The first thing I would think is the medication dispensing machine that the nurses use to get medication for their patients out. Those are touched hundreds of times a day, but they may only be disinfected once a day. There is a lot of opportunity for those pathogens that are spread by touch to be transmitted from one healthcare worker to another and potentially to their patients, especially if they don’t do good hand hygiene. The second thing I would do is the pneumatic tube system. It’s really great for transporting medications and maybe even lab samples. But it’s honestly not cleaned very often. We often had spills in those pneumatic tube systems where we’d have to shut it down. So those are definitely not cleaned as much as they should be.

ICT®: As we approach flu season, will infection prevention protocols have to change or is what we’re doing to disinfect hospitals from SARS-CoV-2 enough to handle influenza, as well?

Stowe: We actually are already in flu season. That started October 1 and runs through March 30. While it is early, we are in it. I highly encourage the best method of preventing influenza infection, especially during a pandemic is to get your vaccine. Get it now. Now’s the perfect time to get it. It takes anywhere from two to six weeks to build immunity to the strains that are in that vaccine. It’s really important to get that now. I think our approach doesn’t need to change necessarily. I just think we need to ensure continued diligence to protect our patients and our healthcare workers from flu just as much as COVID. We know that flu kills hundreds of thousands of Americans every year. Infects millions of people. Can be very serious. There’s a lot of serious secondary complications that can occur when a patient has influenza. And really honestly, there’s not clinically a huge differentiation between SARS-CoV-2 infection and influenza. And so, it’s really important that we do everything we can for SARS-CoV-2 to help us also prevent any kind of influenza illnesses.

ICT®: That last thing you mentioned, how similar the two are, that can be a huge headache for healthcare providers, right? Especially in emergency rooms?

Stowe: Yes, it totally is. The research out there currently states that really the only differential symptom between SARS-CoV-2 and flu is the loss of the sense of taste or smell. And so really, the only way to be sure that it’s SARS or influenza is to do the testing, which unfortunately can take from a couple of hours to a couple of days. It’s really, really important that we protect ourselves from both. And thankfully, both are spread mainly by droplet; can be aerosolized and become airborne. So, wearing your mask, washing your hands, doing good respiratory etiquette, coughing and sneezing into your sleeve, doing really good and frequent environmental disinfection will only help protect you from both.

ICT®: Do you have any words of advice for healthcare facilities on how to protect staff and patients from SARS-CoV-2 that you didn’t already cover in your previous answers?

Stowe: I think really it’s making sure you have enough PPE in stock. Making sure that your nursing staff is being diligent about their hand hygiene. Making sure that the surfaces are being cleaned on a very frequent basis. It’s not so much different things, it’s making sure that they remain diligent. Which I know nine months into a pandemic, everybody’s tired. And it can be hard to maintain that diligence, but they have to remember that this winter is going to be pretty bad for both flu and COVID. And I think the more that they can do to help make sure that their staff is supported, they feel protected and safe at work, both physically and mentally, will only help hospitals in the future.

ICT®: As I mentioned in the introduction, you are an infection preventionist. And I think you have a background working in hospitals. What lessons did you take from your time working in a hospital that you might want to impart to others that are actually there now?

Stowe: I was in the hospital setting almost 10 years before I switched over to PDI. And I love the hospital, I actually miss it at times, but you definitely learn to be very flexible. The cool thing about being an infection preventionists is that I call myself the jack of all trades, but the master of really none. Because you really have to know a little bit about everything. Construction to epi to medication to antibiotic stewardship. And the really nice thing about infection prevention is that you walk in and you’re going to do something different every day. It’s really a kind of fun. I learned very early in my career that I need to be flexible, I need to keep an open mind, because there are always multiple sides to every story in every case. That I need to remain compassionate. And that hindsight is always 2020. I can make the best decision that I can with the information that I had at the time. And I can’t always go back and look and wish I made a different decision. Because I’m doing the best for my patients and my staff with the information that I have at that time. So just giving yourself that flexibility and grace, I think is a really big thing.

ICT®: When you were an IP at a hospital, what department did you interact with the most? I’m assuming that IPs interact a lot with the nursing department. Even help the hospital administrators. But does it depend on what’s going on?

Stowe: You know, I was very fortunate. I’ve always had great leadership, whether it was the chief nursing officer or the vice president of quality. Whoever I reported to, I always felt very supported and enabled to do the best job that I could. I’m very lucky in that respect. I interacted a lot with biomedical engineering, making sure that we weren’t having issues with our equipment or breakage due to the wrong surface disinfectant. I also interacted a lot with our ambulatory care services to make sure that they didn’t feel like they were being left out and that they felt supported. Nursing, obviously, is a big one. Physicians, I went to a lot of the OR committees and maybe radiology committees. I really liked interacting with everybody. EVS [environmental services] was my favorite to interact with because those are the frontline people protecting us every day and keeping our patients safe. And I just loved working with my EVS director especially. And honestly everybody that I interacted with, I always felt like I had really positive interactions even if it was a hard conversation because they knew I was there to support them and make their job easier.

ICT®: As the pandemic eventually subsides, what should infection preventionists think about as they adjust to the new normal?

Stowe: Well, at first, I think they should take a very well-deserved vacation for at least two weeks, and really just relax and recover. And, you know, it’s been a very long pandemic thus far. And it’s not going anywhere, anytime soon. I think when it ends finally vacations are very much needed. I think making sure to keep monitoring cleaning and disinfection. Just because the pandemic has gone away, does not negate the need for cleaning and disinfection. So, making sure that they maintain that routine monitoring, and ensuring that the practices are still being carried out the way they should be. And then finally, I think the biggest thing that I’ve talked to my colleagues about is some of those patient care basics that may have fallen to the wayside because the healthcare staff was ground up and they couldn’t go into the room as much as they wanted to. Or maybe they just got so busy and so overwhelmed that they forgot to do some of those basics. I think having a really nice reminder of scrubbing the hub, making sure you scrub the skin before you insert an IV. Make sure you do hand hygiene when you’re supposed to. All of those things that people know how to do but tend to fall to the wayside when they get busy or stressed. I think those things just really need to be reinforced.

This interview has been edited for clarity and length.