Q&A: States Need to Mandate That Infection Preventionists be Certified

Right now, the certification of infection preventionists (IPs) occurs on a state-by-state basis. Meaning, some states require certification, and some don’t. Ann Marie Pettis, RN, BSN, CIC, FAPIC, the president-elect of the Association for Professionals in Infection Control and Epidemiology, thinks that one of the results of the COVID-19 pandemic will be placing more emphasis on the need for IP certification. That’s just one of many things that will change for IPs, says Pettis. She also believes that IPs will get a seat at the table when it comes to running healthcare institutions and she worries that a second wave of COVID-19 might piggyback on the flu season, and IP expertise will have to ride to the rescue again. She recently sat down with Infection Control Today^® to discuss the many challenges IPs face and how their jobs will change. 

Infection Control Today^®:  Do you think the COVID experience will encourage hospital administrators and other healthcare leaders to lean more on the knowledge that infection preventionists have? I mean more of an influence on the day-to-day workings of your typical hospital now?

Ann Marie Pettis:  I think in general it definitely has and will continue to. I do think some of it depends on where you’ve been practicing as an infection preventionist. I talked to some of my colleagues who actually have not been as much in the forefront as they would like to be. But I would say the majority of us have been more in the forefront than perhaps we would like to be because [COVID-19’s] emphasis on infection prevention obviously has been huge, and rightfully so. I do think that we will definitely feel a positive effect in terms of being more at the table, if you will, as we move forward. But some of it does depend on your own facility and whatnot. But I think in general, yes, we’ve been front and center through all of this.

ICT^®:  When you say infection professionals will probably have more of a voice at the table, how do you see that playing out?

Pettis:  Well, I think the ability to influence the C-suite, if you will, as far as what new technology might be out there that should be incorporated into infection prevention. I think it might be a little bit easier to make those arguments moving forward, given the dire consequences of COVID-19 on our patients. And all of the different things that we’re having to look at putting in place that perhaps we didn’t have in place before. I think much more influence and ability to influence decisions as well as purchasing appropriate PPE, personal protective equipment. And as I mentioned, additional types of technologies that perhaps aid in the assistance of healthcare associated infections, as well as COVID.

ICT^®:  If a hospital administrator asked you in your capacity as an infection preventionist: “OK, Ann Marie, what do you want? What do you need right now today?” How would you answer?

Pettis:  Well, you know, we’re still on a day-to-day basis making sure that we have appropriate and adequate PPE. As far as testing goes, in particular for PCR [polymerase chain reaction] testing, making sure that we have all the other things that are necessary to do that testing has been a day-to-day, week-to-week dance I’d say, because we’ve really had to go to a lot of different sources and work with our health departments, both local health departments, as well as the state health departments. And so even though right now, most of us are feeling a little better about our ability to provide the appropriate PPE, I think moving forward, it’s very important that we don’t let our guard down and that we continue to try to ramp up our supplies. What they’re recommending is at least having a 90-day supply of PPE. So that’s one of the main things that we’re working on, on an ongoing basis, as well as all the testing materials and all the other things that are required as far as taking care of COVID patients. And as far as preventing additional cases and providing safety for our patients. We’re looking at bringing back visitors, for instance, in our state. So, we need to keep everybody safe. And that’s going to require more and more personal protective equipment. I think that that is one of our biggest tasks, and that’s one of our biggest challenges is to not let our guard down and continue to think about surge availability for beds and we’re constantly planning. In other words, you hope for the best because our numbers have come down. There are certain hotspots in the country. But where I am, which is New York State, our numbers are the lowest that they’ve been. But again, you don’t want to get complacent. And so we need to plan from an emergency preparedness standpoint for the fall where, unfortunately, we may start to see a surge again. And, and as things open up, which they are, the businesses, and as we’re bringing patients back into the scene for those tests that are so vital for them and for procedures that are vital as well as elective surgeries-all of that requires additional PPE, additional planning for social distancing.

And the whole idea of PPE fatigue on the part of the healthcare workers. It’s exhausting to have to wear masks and face shields and all of it-the gowns and gloves and whatnot. Then you start to worry about, again, people letting their guard down. So, it’s an ongoing challenge to continue to remind and audit and educate staff. You asked what my wish list is. It’s that the country continues to ramp up our manufacturing ability. So that if and when we get another surge, or even some of the hotspots right now that are experiencing it, that we don’t end up with the desperate shortages that have required us to do things we would have never dreamt of doing from an infection prevention standpoint. And I do worry some about us being able to take back some of the things that we’ve been doing that might not be safest and might not be things that we would normally condone. But yet because we’ve been sort of desperate, we’ve had to do things that have not been something we would have enforced before. And because if indeed a second wave comes, you know, what will be our steps? So again, I think lessons learned is what we focus on. I think moving forward, we really need to emphasize the importance for things that we can do. We don’t have a vaccine yet. We don’t have very good treatments yet. But we do have flu shots. And I do think that late summer into the fall and well into the winter, it’ll be very important to make a concerted effort to do an even better job than what’s been done in the past. Certainly, infection preventionists have been struggling for years to get the attention that flu vaccination deserved. But I think now our state governments will realize how important it is as well. And for those organizations that can get mandatory vaccine in place for their healthcare providers, healthcare workers, I think that would be great. Some of us have been more successful than others around the country in already being able to do that. Get that enforced. But that’s something to think about. Because if indeed flu comes at the same time a second wave of COVID comes, that’s going to be difficult-unbelievably difficult because the symptoms obviously are somewhat similar. We’ll be trying to rule both of those things out. It will create more of a risk for a surge, and it will put more taxing on our PPE supplies. I think flu vaccine is one thing that we can do. Anybody six months and above should really get a flu vaccine in this coming year. More important than ever. Always important, but even more important.

ICT^®:  Anything else in the works?

Pettis:  Yes. We’re still having weekly meetings throughout our system to continue to look at: Are there additional places we could put surge beds? Are there ways that we could make it safer for our long-term care patients in our community? We’re looking at alternate sites that we could dedicate as, for instance, a COVID center, if you will. But you could do the same thing with influenza. We had a terrible season nationally with influenza last year. During swine flu, we had a pandemic basically. I think we are working right now as we speak. Even though the numbers are coming down for COVID. We’re trying to ramp up our ability to deal with this come next fall and winter Those efforts are continuing locally. They’re continuing in our facilities across the country. And they’re happening at the state levels all throughout the country as well. So, yes, the work goes on.

ICT^®:  I get the feeling infection preventionists-before they became the rock stars they are now-felt a little bit underappreciated and underutilized. Is that a fair assumption? Or was I misreading the mood?

Pettis:  I think it is fair. I have been doing this for more than 30 years. And you always felt a little bit like the Maytag repairman. And as we move through things like HIV and then into the different pandemics, H5N1, swine flu, SARS, and COVID-each time I think infection prevention has gotten more and more attention. I do think that-what do they say-don’t let any crisis go to waste. I do think that things have gotten better and better. The only thing that’s changed is the emphasis. Be careful what you pray for, because now the spotlight is so great on infection prevention. And sometimes it is true, the resources have not kept up with the demand and the needs. But nonetheless, I think that the emphasis has improved the attention placed [on IPs]. I think APIC has done a very good job helping the C-suite understand what infection prevention brings to the table. I also think the efforts to require certification for infection preventionists is very important. There are some states that already require that. Others were also previously focusing on it, but once COVID came…. But once we’re not in such crisis mode, we’ll be able to focus again on requiring certification for IPs, so that there’s a level playing field of what people can expect from their knowledge base. And I think all of those things together will continue to help promote the importance of not just the infection preventionist but epidemiology and infection prevention in general.

This interview has been edited for clarity and length.