Turning Crisis Into Catalyst: An IP’s Perspective on Leveraging Insights From the COVID-19 Pandemic to Enhance IPC Program Operations

COVID-19: A tired health care worker

(AdobeStock_614660257 by RomanR)

On Monday, January 20, 2020, the CDC confirmed that a new emerging pathogen had been introduced into the US. I was a hospital infection preventionist (IP) then, and for several months, my colleagues and I had been reading scientific and news articles to learn about this mysterious respiratory virus that was decimating the population of Wuhan, China.

I remember feeling both the excitement of learning about the SARS-CoV-2 virus and the apprehension at the prospect of seeing a surge in cases within our already strained health care system. I knew somehow that, from that day forward, my career and our lives as IPs would change.

Cross-Departmental Collaboration in Infection Prevention and Control Response

Over the next few months, my team was inundated with calls from frontline staff and community members who needed expert guidance on COVID-19 prevention methods and answers regarding what to expect next. The increased number of calls contributed to hundreds of weekly hours dedicated to COVID-19-related work to meet the new demands of the role. Then, I realized the importance of having a diverse infection prevention and control (IPC) team and an effective program with well-established processes. Our diverse expertise in nursing, microbiology, and public health led to a quick shift in operations within the team. Our 4 masters of public health (MPH)-trained IPs were dispatched to different operations based on their diverse backgrounds, interests, and expertise.

Since our organization had a culture that emphasized quality, had a well-educated workforce on IPC principles, and established partnerships between the IPC program and department leaders, an incident command system was quickly established, and the IPC team received support from several departments to ensure that infection prevention remained at the core of all operations.

With the increased support throughout the system, the IPs could be safely assigned to consultative roles to support frontline staff and were able to focus on immediate COVID-19-related IPC interventions such as staff education, training on PPE donning and doffing techniques, and respirator fit testing.

Building a Strong Infection Prevention and Control Foundation

The COVID-19 pandemic revealed the importance of establishing efficient processes and a strong IPC foundation within health care systems worldwide. My experience within my organization highlighted the importance of having this foundation before the crisis, as it helped ensure a smoother shift in operations. When IPC programs have a strong foundation, the workforce can easily look up to the IPs as experts and readily participate in IPC initiatives to ensure personnel and patient safety.

Health care facilities must proactively incorporate IPC within normal operations and their emergency preparedness plan before an emergency occurs. In the example highlighted here, several years of building a positive relationship between department heads and the IPC department contributed to the success of operational changes during the crisis. It quickly became obvious that staff knew who the IPs were, and they treated the IPC department as an ally in the fight against COVID-19. That is not to say those processes were perfect; however, they appeared to provide a great starting point for moving forward as an organization.

Where should health care organizations start to establish such a foundation?

Organizations that still need to establish a trusting, mutually beneficial relationship between the IPC department and their stakeholders should start with the basics. The CDC lists core infection prevention and control practicesthat can be implemented in various settings. As the pandemic has stressed the importance of infection prevention, IPC departments have a golden opportunity to establish meaningful partnerships within their organizations. To minimize disruptions within normal operations, I propose that organizational leaders start by focusing on the overall structure of their IPC programs and prioritize the following 3 core principles: Leadership support, Training and education, and Routine Monitoring, with a continuous improvement mindset. They should collaborate with their workforce to incorporate these within their normal workflows to maximize adherence to best practices.

• Leadership support

IPs should seek the support of their leadership teams to assist them in developing strong connections with the workforce within their organizations. This will ensure they receive buy-in when various IPC initiatives are implemented and during emergencies where the IPC team’s expertise and leadership prove crucial to advancing normal operations.

• Training and Education

“Infection prevention is everyone’s job” is a commonly repeated slogan in the IPC field. IPC departments and frontline staff should collaborate to promote patient safety. IPs should engage the workforce and get involved with patient advocates, such as patient advisory councils, to ensure that everyone is educated on infection prevention and control policies established by the organization. This will help ensure that safety remains at the forefront of organizational culture and operations.

IPC departments should work with departmental leaders at different levels (eg unit managers, dietary managers) to ensure that policies and procedures are reviewed and updated regularly, at least annually, and reflect infection prevention best practices. They should also educate staff on infection prevention to improve knowledge competency and adherence to established policies. Patients and families should also be educated to ensure that they remain active participants in their care and understand all the infection prevention guidelines established by the organization.

• Routine Monitoring and Continuous Improvement

IPC departments should establish routine auditing systems to observe adherence and deviations in normal processes among staff. Without baseline data, IPC departments cannot measure the effectiveness of their interventions, nor can they help improve what they have not measured. Routine monitoring also allows for the prompt detection of changes in disease burdens and infection transmission rates and helps manage outbreaks promptly. Additionally, by establishing routine auditing processes and maintaining a continuous improvement mindset, healthcare organizations can work towards building a culture of quality as infection prevention and control becomes an integral part of health care delivery.

Conclusion

Although these concepts sound practical and straightforward, getting back to the basics to ensure the success of IPC programs requires strong collaboration between multiple departments and mutual respect and understanding of each department’s scope of expertise. This helps establish a robust framework within the organization, eliminates silos, and encourages the entire workforce to work towards a common goal.