Q&A: What Infection Preventionists Learned from COVID

The coronavirus disease 2019 (COVID-19) highlighted just how important infection preventionists (IPs) are in the healthcare scheme of things, says Sharon Ward-Fore, MS, MT(ASCP), CIC. “[Infection preventionists are] involved in construction, renovation, linen handling, food service, PPE donning and doffing practices,” Ward-Fore tells Infection Control Today®. “They audit hand hygiene. They help pick disinfectants and cleaners. And again, a lot of people just think IPs are involved in simply being the hand hygiene police. But it’s way more than that.” IPs also learned how to do more with less ,and kept communicating with their fellow healthcare workers about the changing guidelines for dealing with COVID-19. “Most infection preventionists don’t spend their entire day sitting at their desk,” says Ward-Fore. “They’re actually out on the floor rounding or auditing. And it’s really valuable to have a resource like a trained IP to be there to answer questions.”

Infection Control Today®: What have infection preventionists learned in the last year? And how can they use that knowledge going forward? I guess they learned how hard they can work and they’re still working hard, right?

Sharon Ward-Fore, MS, MT(ASCP), CIC: They are. They are working very, very hard, as is probably every healthcare worker and support staff member out there. One of the main lessons infection preventionists learned is how resilient they are. And that they have the ability to bounce back when needed. Communication became really, really important during the beginning of the COVID pandemic and continues to be important. IPs learned that there was a great deal of information being disseminated in the very beginning. But it was also limited and that we knew so little about this virus that there were just little dribs and drabs coming out at the time. And when they would speak to it to staff on the floor, maybe the next day, things would change again. In the beginning, they said for people in the public to not wear masks. Then later on that changed. Then they said healthcare workers should wear N95s. And then that changed as we noticed that our PPE stockpiles were beginning to dwindle. There were a lot of moving parts to this in the beginning. And I think resilience and flexibility is one of the main lessons IPs learned. And they continue to keep those lessons at hand, because we’re in the thick of it. If you look at the graphs of COVID, we’re pretty much back where we were in the very beginning as far as infectivity, although the number of deaths have decreased. But still, this is still an ongoing pandemic. And there’s a lot of hard work to continue to be done as we move into the fall, because of the fact that we’re going to be experiencing flu along with COVID-19.

ICT®: The number of deaths have dropped. In fact, they’ve really gone down considerably. Is that correct?

Ward-Fore: Right? Yes, it is.

ICT®: Does that give you any optimism about how this could be handled in the future? Or optimism in terms of getting our old lives back?

Ward-Fore: I think what we’ve learned from this is that we’ve developed treatment methods now that we didn’t have in the beginning. Although they’re not perfect. They know that early intervention can save lives. They’ve learned the importance of ventilation, keeping patients on their sides when they’re in bed. They’ve learned about remdesivir, and all kinds of other potential antibiotics to take care of patients. Moving forward, as I read yesterday, from Doctor [Anthony] Fauci, we will probably always have COVID-19 in the future, but we’ll just be better prepared for it. And it will be like SARS, and MERS, something that hopefully we’ll have a vaccine for, and we’ll be able to handle it better. But lessons learned from this should be there will be another next big thing. There always is. We need to take the lessons that we’ve learned from this, which is globally, how poorly prepared we were for this pandemic, and figure out what we need to do and plan for the next big thing.

ICT®: Do you think hospitals will start bolstering their infection control and prevention departments?

Ward-Fore: I would hope so. Although these days it seems everyone wears an infection prevention hat. And I guess it’s better to have many people with some skills instead of just a few that are very, very skilled because in a pandemic, we need all-hands-on-deck. I’m hoping that healthcare facilities will find the value in their infection preventionists and understand how important a role they play as far as training on PPE and disinfectants, and in hand hygiene, being kind of a boots on the ground people on the floor to see things firsthand. Most infection preventionists don’t spend their entire day sitting at their desk. They’re actually out on the floor rounding or auditing. And it’s really valuable to have a resource like a trained IP to be there to answer questions.

ICT®: They’ll be there on the floor and also in the department to answer questions?

Ward-Fore: Yes, especially out on the unit and the patient care units answering questions for the staff. Sometimes you’ll answer questions for family members. It’s just a really good way for IPs to get the message out about what it is they actually do. Most people think IPs just are hygiene police, but we’re way more than that.

ICT®: What do you think IPs will need to learn more about as we proceed? I’m thinking specifically about airflow and waterflow in hospitals. And I don’t know if they’ve been stressed in IP training in the past. Is that a fair assumption?

Ward-Fore: I think it depends on the institution. A lot of IPs are involved in construction and renovation, where knowledge of airflow is really, really important. But I think you’re right. This should be an opportunity for IPs to not only get up to speed, but to continue to learn more and more about the importance of airflow and ventilation, and also different kinds of barrier precautions. You know, we don’t use these things routinely. We use them for, as I said, construction and renovation. But now we see how important they are for day-to-day patient care. So, IPs, they touch all areas of the hospital. They’re involved in construction, renovation, linen handling, food service, PPE donning and doffing practices. They audit hand hygiene. They help pick disinfectants and cleaners. And again, a lot of people just think IPs are involved in simply being the hand hygiene police. But it’s way more than that. We’re involved in surgical services and the laboratory. We touch a lot of areas. And I think people in general are sort of amazed to hear all the things we’re involved in.

ICT®: Will IPs be migrating into the communities? I guess the backup question to that is are there enough IPs to go around even in hospitals these days, let alone communities?

Ward-Fore: You know, it doesn’t seem to be that there are enough IPs. But I think there are more and more opportunities for IPs to be in healthcare and also outside of healthcare. Maybe the field will see an increase in interest. At a lot of places, once you’ve been an IP in a facility, there really is not a ladder of advancement, so to speak. I mean, you could be the lead IP, but you’re still just an IP in with a group of other IPs. I think the field will see advancement, maybe not necessarily in healthcare, but in other areas. And we talked before about how important it is to maybe have an IP involved in bringing corporations up to speed on what they need to do to safely get their employees back into the workplace, or restaurants and hair salons. We talked before about how people are interpreting the sort of vague CDC guidelines. And they’re not necessarily getting it correctly. Like I mentioned, I saw a worker in a big box store wearing a face shield, but no mask. I think there are opportunities maybe to work closely with industry and provide our level of expertise in those areas.

ICT®: I know you have expressed concern in the past about re-educating healthcare workers about proper infection prevention and control techniques. Because a lot of that had to be kind of thrown out the window because of where we were in terms of supplies of masks and other personal protective equipment in the beginning. Also, people were just scrambling. Are you still as concerned about that? Or do you see that not being such a big problem going forward?

Ward-Fore: You know, the healthcare staff is amazing how they’re able to flex. In the beginning when there was no pandemic, IPs were pretty stringent about “wear this, wear that.” Then as the pandemic ravaged PPE supplies, people were able to say, “Well, do this without this level of PPE and we know you’ll still be safe as long as you do X, Y and Z.” And then we’ve had a little bit of a break where things have leveled off and practices have gone back to normal. Now staff are prepared if there is a shortage. They’ll know what to do. And based on their past experience over these last 300 days, they know that they can safely do their jobs. But they have to be vigilant. And that’s the really important part.

ICT®: Is there a similarity between what has been learned in terms of treating COVID-19 patients—and as you mentioned before the treatments have improved, even though there’s no cure. Has anything like that happened on the IP front as far as advancement in how they do their jobs?

Ward-Fore: Well, IPs have always been prepared for infectious disease outbreaks. This is the same kind of thing, but on a larger scale. I think IPs have been prepared for this, just not for the volume that we’ve seen with this particular pandemic. They have their lessons learned from what happened in the beginning. Right now, everyone should be evaluating their stockpile of PPE, making sure they have enough disinfectants and cleaners on hand. And if they don’t, they should be bringing in alternative cleaners and validating those and training on those.

ICT®: Finally, are you comfortable with the deputizing of IPs that has to go on. It seems like non-IPs are being asked to go further than just keeping an eye out and washing their hands.

Ward-Fore: I am a bit uncomfortable with that. It all depends on the level of training that these deputized people receive. Credentialing is really important in infection prevention, and that’s why the CIC is held in such high esteem. I think desperate times call for desperate measures, and they need more people to help provide oversight, so I can understand that. I hope that doesn’t become the norm. I think it may dilute the profession. And not everyone has the same skillset. I think a clinical background helps. And if you don’t have that, it’s harder to get up to speed. And there’s more that IPs do than just pandemics. It’s healthcare-associated infections. It’s surgical site infections. Being able to interpret clinical data and review charts is really important. If they’re deputized to round down the units and help people with PPE and hand hygiene, I think that’s a great use. Anything beyond that without sufficient training, I’m a little nervous about.

This interview has been edited for clarity and length.