Q&A: Infection Preventionist Role Will Expand Because of COVID-19

The reopening of the United States thanks to the easing of the COVID-19 pandemic will force a re-evaluation of a lot of elements in our society and none might be as closely scrutinized as the healthcare system. That scrutiny will come from without-investigative committees will be formed at every level of government, to be sure-and within. Healthcare professionals will want to know what they could have done differently and how their jobs should change in light of the lessons that the SARS CoV-2 virus taught. Rebecca Leach, RN, BSN, MPH, CIC, will no be a part of that discussion. Leach, a member of Infection Control Today^®’s Editorial Advisory Board, has been an infection preventionist since 2010. She works at a healthcare system in Phoenix that includes 5 hospitals and more than 100 outpatient treatment centers. Recently Leach sat down with ICT^® to discuss IPs role in the new normal.  

Infection Control Today^®:  How will COVID-19 change the job infection preventionists do? Or will it in any substantial way?

Leach:  I think it will change a lot of what infection preventionists do on a daily basis going forward. It certainly has in the immediate time and probably for the next, I would think, year or so. But going forward, I think one of the biggest changes will be more of a focus on emergency preparedness and bio-preparedness and infection prevention. Right now, that’s not one of the main focuses of our job. It’s more so on preventing hospital acquired infections, and other things like that and hand hygiene. But I think really getting more involved in being prepared for outbreaks and pandemics will be something in the future we’ll be doing a lot more of.

ICT^®:  How do you see this preparedness playing out in an IP’s day-to-day work?

Leach:  I think part of the day-to-day, it will be more of bringing awareness to frontline staff. A lot of our work is a lot of education of staff. Mostly we focus on preventing infections or transmission or keeping staff safe while they’re working in healthcare facilities. But also kind of bringing around the idea of focusing on proper PPE use and thinking about patient isolation and the things that we’ve had to do a little bit differently for this pandemic that might become more of our everyday work environment, like separating out our patients by symptoms. When we don’t have a diagnosis, thinking about visitor restrictions. Just thinking about how we interact with our coworkers and trying to keep our social distancing and those kinds of things at work. 

ICT^®:  How might an infection preventionist’s interaction with coworkers change?

Leach:  I think what we’ve seen here in particular in my facilities has been a lot of not so much transmission from patient care, but more so between employees. So, focusing more on how you’re interacting away from the patient. In our break rooms or in our office spaces or desks, and how we need to be aware of the important infection prevention tactics, even when we’re not taking care of patients because we can expose each other while we’re at work, too.

ICT^®:  Do you think infection preventionists will have a larger say in how hospital systems operated or even how they may be laid out? 

Leach:  I think that’s true because part of our role already is involved in when there’s new construction or redesign of spaces. And we should be involved in that and part of that can be looking at how do we design this space if we were to have an influx of patients or an outbreak. How would we set up our space so that we might have enough negative pressure rooms to take care of patients if it’s a respiratory illness? Those kinds of things. I’m thinking that that will become more of an important topic when we look at new building designs or how we redesign current spaces in the future as well.

ICT^®:  When we talk about infection preventionists interacting with other healthcare professionals in the hospital system, who in particular will you work closer with?

Leach:  I think one of the areas that infection preventionists are going to have to work more closely with our supply chain and logistics area. And that was something that we found were when it came to PPE supplies, disinfecting wipes, all these other supplies for patient care. Infection preventionists had to work very closely with our supply chain and look at all of our options and really keep track of it. I also think working with lab more closely will be important in the future, to understand testing modalities, understanding our abilities to test and interpreting those tests. So those are two areas where we’ve had some interactions with them. But I think it’ll be more important in the future to really keep consistent relationships with those groups.

ICT^®:  Have any of these changes already been set in motion? 

Leach:  We haven’t made any permanent changes in our team. We’ve talked about how going forward, we’ll be trying to integrate the work that we’re still doing for COVID response with the work that we were doing before for infection prevention, hospital acquired infections, our surveillance, all of those things that we were doing on a daily basis before. How do we integrate these two things and what kinds of things do we need to leave aside for the moment and focus on instead? But we haven’t really made any permanent changes. We had a very strong group that was working on bio-preparedness before coronavirus. And all of this happened. I think that was beneficial for us. And so we already have that group established. So that will continue to go forward. I think that group will become more prominent in the network as a committee that probably more people will want to be a part of. And the information will probably be shared more broadly. There will be more recognition for that group, as far as importance and the work that they do.

ICT^®:  Is COVID over? Will we ever get to a point where we can say it’s over?

Leach:  I don’t think it’s over. I don’t think it’s going to go away. I think over time, as we see treatments or vaccines come through, then it’ll change how we respond to it or think about it, probably. But I think it’s going to be here with us for a long time, if not forever. I don’t think it’s going away.

ICT^®:  The balancing act that infection preventionists had to do between protecting patients and protecting coworkers from COVID-19. Is that going to continue?

Leach:  Oh, for sure. I think so. And I think part of it too, for infection preventionists, will be understanding what’s happening in our communities. If you’re an infection preventionist and if you work in a hospital or nursing home, what you’ve been trained in is kind of public health and basic epidemiology. And so you’re probably one of the only people in your area that might understand when we see public health data being reported and that kind of thing, how it impacts your specific community and how to translate that data back to what you’re doing in your facility or doing for patient care or how it translates to your staff. I think it’s just going to increase that.

ICT^®:  Do you foresee more cooperation between hospitals and local governments or state governments?

Leach:  Yes, for sure. I think that’s part of it. And also just that a lot of infection preventionists’ background is based on epidemiology and understanding the data that's recorded. But also cooperation with our local health departments and public health authorities to really have unified responses. And so that we can all rely on each other and work together and be able to provide the information that we all need to make the right decisions and support each other.

ICT^®:  You’re in Phoenix, Arizona. Is it basically back to normal there? 

Leach:  Well, somewhat. We’ve reopened for elective procedures at the beginning of May when the governor allowed that to happen. And so we are seeing more of our kind of normal patients, I guess you would say. Elective surgeries were very important in the facility I work in. But we still have a lot of COVID patients too, especially in our network. So, it’s kind of a mix of both. We’re still very much living COVID. We haven’t lifted visitor restrictions. We’re still doing a lot of testing and screening of patients. But you know, we’re trying to bring in some of that more normalcy as well to sort of balance it out.

ICT^®:  What was your best day during the pandemic?

Leach:  I think the best day was the day that our first patient with COVID 19 was discharged to home. He had tested negative and was discharged and was able to go home. And that was one of our best days because it kind of felt like a triumph. The patient had been here for a very long time, several weeks and it was just a good thing to see it and I think it was good for all of us who had been preparing and working on it to see a success story like that. That was a good day.

ICT^®:  Was it touch-and-go for that particular patient?

Leach:  It was. He was on a ventilator. He was in the ICU for a very long time. It was touch-go-and but then he was finally well enough to get off the ventilator and move down to our medical surgery floor. He was there for a long time as well. Just getting basically rehabilitated and getting his strength up. We couldn’t get him discharged to a long-term care facility at the time. So, we kind of just had to do all of his almost post-acute rehab in the hospital and so then he was finally able to go home.

ICT^®:  Did you and the hospital staff give him a nice sendoff?

Leach:  I think everybody was sort of cheering and sort of happy to walk him out. We didn’t do a big parade or anything but there was a lot of good positive sentiment around it. I think it really helped the staff that were working on our COVID cohort unit to see a kind of a happy ending and outcome for this patient. We have our share of the sad stories too. But you try to focus on the positive ones that come out and there’s more positive than bad. So that’s a good thing.

ICT^®:  Any final advice for your fellow infection professionals about how to face the future?

Leach:  I think this is a really interesting time to be in our field. We are definitely being pushed to our limits of our jobs and what we do and what we’re passionate about. I think if we have a chance to sit back and really take it in and absorb what we’re doing right now, we are kind of living in a historical moment. And our jobs are very important and very pivotal right now. And so I think if you have a chance to stop and just think about that, it makes you feel very proud for what we do. And this is why we’ve been doing what we do forever. I think we all just need to be proud of what we do and support each other. And try not to lose faith and just keep going and be strong.

This interview was edited for clarity and length.