The Metric Every IP Should Have on Their Work Plan in 2023

Infection preventionists’ (IPs’) duties remain mostly consistent throughout the year. Still, with the COVID-19 pandemic stirring up the infection prevention and control field, some tasks in their work plans need to be improved. Infection Control Today^® (ICT^®) spoke with Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST, principal infection preventionist for The Clorox Company, about her suggestions for the IPs’ road map of priority activities.

ICT: What should IPs be doing right now?

Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST: If they still need to, IPs need to be conducting the annual risk assessment and IPC [infection prevention and control] program evaluation. They should use the data from these 2 activities to draft their work plan, which serves as the IPs’ road map of priority activities for the year. The work plan should include the top 3 to 5 things that need improvement. [They] can add other priority issues as [they] complete items on the work plan. These are meant to be living documents.

ICT: What topic or issue should every IP include in their work plan this year?

DK: We are entering the 4th year of the pandemic, and for the past 3 years, our attention and resources have been singularly focused on all things COVID-19. That said, it's apparent that COVID-19 is here to stay, so we must accept our new normal–whatever normal is.

So, the one thing that every IP should have on the work plan this year is a thorough environmental cleaning and disinfection program assessment.

ICT: Why is now the time for IPs to do this deep dive into their cleaning and disinfection program?

DK: Since the onset of the pandemic, we have seen increases in the prevalence of some challenging pathogens. For example, there were fewer than 500 clinical cases of Candida auris in this country back in 2019. But fast forward to 2022, and the preliminary data shows we had almost 2,000 cases. That’s more than a 300% increase! We have allowed this emerging pathogen to become endemic while our attention was focused elsewhere.

ICT: Was Candida auris the only pathogen to increase in prevalence during the pandemic?

DK: Sadly, it was not. According to a new report from the World Health Organization, bacterial superbugs became more resistant during the pandemic. This report shows that hospitals with lower infection control compliance reported a higher prevalence of antimicrobial-resistant pathogens. This includes compliance with environmental cleaning and disinfection. In recent years, we have seen increased outbreaks of resistant pathogens like carbapenem-resistant Acinetobacter baumanii (CRAB). We have also seen a significant rise in healthcare-associated MRSA bloodstream infections. And we are in the midst of the worst respiratory season of the decade. We have seen a resurgence of influenza, RSV, and other serious respiratory pathogens. Pediatric [intensive care units (ICUs)] ran out of beds, and influenza hospitalizations achieved a 13-year-high level not seen since the 2009 flu pandemic.

ICT: Why do you think we see these increases?

DK: While contaminated environmental surfaces are not the primary route of transmission for COVID-19, these surfaces are a direct route of transmission for these other pathogens I just mentioned. Patients continuously shed these pathogens to survive in the health care environment for prolonged periods, just waiting to hitch a ride on the hands of an unsuspecting [health care worker], patient, or visitor. This is why a robust cleaning and disinfection program is non-negotiable.

ICT: What about the role of hand hygiene?

DK: The CDC tells us that hand hygiene is the most critical [act] we can do to prevent infections, but I challenge that environmental hygiene (or cleaning and disinfection) is the second most important thing we can do to prevent infections. Because when you think about it, how do HCW hands become contaminated in the first place? From direct contact with patients and indirect contact with unclean environmental surfaces and medical equipment, especially shared portable medical equipment. So essentially, there are only 2 ways in which hands become contaminated.

ICT: I hear that [adherence] with portable shared medical equipment cleaning is a big pain point for IPs. Do you have any recommendations?

DK: I have a few. First and foremost, I would take the time to work with the multidisciplinary team to develop cleaning responsibility grids. This tool documents who tends what, when they are to clean it, and how it should be cleaned (for example, with what product and at what contact time). I recommend bringing key stakeholders to a specific area, such as an ICU patient room. Go item by item around the room and among the team, and identify and document who will clean each and how often or when.

Cleaning Responsibility Grid

(Photo courtesy of Doe Kley, MPH, RN, CIC, LTC-CIP, T-CHEST)

Another tip for compliance with portable medical equipment cleaning I have heard of is facilities using is color-coded tags on the equipment, which identify which disinfectant to use for that piece of equipment. For example, a blue tag with a “3” means use the blue top disinfectant at a 3 minute contact time. Some facilities have even added QR codes to the labels that take you to the cleaning and disinfecting instructions for that piece of equipment.

Last, just like we monitor hand hygiene [adherence], be sure to monitor what is happening with this equipment as it goes from room to room and patient to patient. Document what you are seeing so you can identify trends. Are certain items more commonly missed than others? Try to determine why this is so. For example, at one of my facilities, nurses' aides needed to clean the vital signs machine between patients. A simple fix was to attach an accessory basket to the machine to hold a canister of wipes. This way, the aides always had the disinfectant available at the point of use. As much as possible, you want to make the right thing to do the easy thing to do. Try to eliminate hunting-gathering behavior.