Infection preventionists (IPs) are often known as subject matter experts in their field. We are asked our thoughts and opinions about what keeps patients safe from germs and infections while keeping their caregivers safe. But what happens when 2 subject matter experts conflict over what is best for the patient?
Case Study: Mr. Smith is a 78-year-old male who has been in the long-term care (LTC) facility for several years. He has a history of mild dementia and goes to dialysis several times weekly. One day, he presents with symptoms of COVID-19 and tests positive. The IP puts Mr. Smith on transmission-based precautions with N95 use inside the room and advises keeping the door closed.1 Mr. Smith’s nurse calls the IP later in the afternoon and states that they are having difficulty keeping the patient in the line of sight at designated frequencies, as is ordered for patient safety, with the door closed. Thus, the dilemma begins.
From Robbie Hilliard, MSN, RN, CIC
Greetings. I’m Robbie Hilliard, and I have a master’s degree in nursing and am a Board-Certified Infection Control nurse. I’ve been in the infection control field for 2 decades in the private sector and the Veteran’s Healthcare Administration. I have been at my organization for 9 years, covering infection prevention for 6 long-term care units.
I frequently search for answers to questions about managing special infection control situations in the long-term care patient population. The Long-Term Care Chronicles will answer often-asked questions and give real-world advice on balancing safety, infection control, and a home-like environment.
In this position, I have found that networking is one of the best ways to solve problems effectively. My hope is to share information through case studies and offer information that I have gathered in my never-ending quest to keep our residents infection-free.
The Department of Patient Safety’s job is to keep the patient free from falls and injury because he gets out of bed without assistance. Patient Safety tracks events such as falls, sentinel events, and other adverse events, much like IPs track catheter-associated infections and other health care-associated infections. The Department of Infection Control’s job is to prevent or decrease the spread of the infection he has from staff and other patients. Which aspect is more important? Sometimes, subject matter experts must collaborate to do what is best in each case.
In this patient’s case, it was not safe to shut the door, so the staff could not see him due to several previous falls with injuries. Because staffing was short, assigning him to 1 staff member was not an option. Sometimes, we must mitigate the spread of germs while considering the patient’s primary needs. We do not often yield in our positions, but it is necessary to concede under some circumstances. Just remember that to yield does not mean to surrender. Interventions can always be done to lessen the risk of transmission. Modifiable risk factors such as strict hand hygiene, masks past the door threshold, and vaccinations for staff and patients alike all contribute to lowering the risk of transmission.
How Can We Safely Mitigate Infection Control Risks in LTC Facilities in Grey Areas?
IPs often use risk assessments to document that they have thoroughly weighed the options before making recommendations and that they have considered the likely outcomes. Asking other IPs in their support network is incredibly helpful and avoids recreating the wheel. Infection prevention is often challenging because every patient is different, but often, if 1 hospital is experiencing an issue, then another has experienced it as well. Sharing ideas gives IPs wisdom, resources, and often much-needed support that can’t be found anywhere else but the infection prevention community. Martin Luther King Jr sums it up in one of my favorite quotes: “We may have all come on different ships, but we’re in the same boat now.”
Persevere. Even in the grey areas, IPs do make a difference.
References:
Infection Control Guidance: SARS-CoV-2. CDC. Accessed August 5, 2024. https://www.cdc.gov/covid/hcp/infection-control/index.html
