When COVID Turns 2: Infection Preventionists Take Stock

We’ve always said in global health and health security that it’s not a matter of if, but when. COVID-19 was no exception and yet it turned things upside down—politicization, misinformation, testing issues, supply chain challenges that left us without masks, and a sort of burned-out feeling that most of us had never felt before. Like so many in my field, I’ve spent a lifetime studying and working in pandemic preparedness, but nothing really prepares you for the realities of it.

As we work through this next phase of the pandemic and a novel variant (omicron) that has a subvariant (BA.2) that’s also stressing our systems, what have we learned? Hindsight is often 20/20 but are we at a place where we can look back and clearly discern what we’ve been through? Can we

Saskia v. Popescu, PHD, MPH, MA, CIC

dispassionately examine a pandemic in which we collectively failed and learn from our experience? One could argue that our inability to learn those lessons and be able to pivot into uncertainty has been, perhaps, the most common approach to public health and infectious diseases. To be frank: We seem unable to use lessons from previous outbreaks to steer the response to current and future events. In the field of infection prevention, what does COVID-19 look like 2 years later?

One thing I’ve been grappling with was asking myself how the pandemic has changed our field. What does COVID-19 mean for the field of infection prevention and infection preventionists (IPs)? While my work in biopreparedness has focused on these events, I’m ultimately an epidemiologist and infection preventionist, meaning that I’m acutely aware of how little support there often is for future events and our work in general. What, though, does this global event mean for our field, if anything?

Limited Power

Infection prevention and control (IPC) often works in the shadows. We’re responsible for ensuring patient and staff safety but often with limited power or, if we have authority, it is too commonly tied to hospital administrators whose support for our work can ebb and flow. For the field of IPC, COVID-19 has certainly changed things. I look at 2 main indicators for this change: our administrative support, but also the work that’s part of the program.

First, when COVID-19 started to hit in late 2019, other health care professionals leaned on IPs. Working hand in hand with infectious disease physicians, the IPC program was the go-to source for all the latest guidance and translating it to real-world application. Hospital administrators, for the most part, leaned into the IPC program to help decipher guidance from health agencies such as the Centers for Disease Control and Prevention, liaise with local public health resources, and ensure staff were trained on the latest protocols. In a matter of days, our departments were the resource for it all…and, meanwhile, the work IPs usually do still needed to get done.

Increasing risks for central line–associated bloodstream infections for those COVID-19 patients was very real, as was the risk for other health care–associated infections (HAIs) for those long hospital stays.

While hospital leadership started to lean on IPC more, especially as guidance changed and the nuance of a novel disease became increasingly apparent in a world of misinformation, the inherent nature of the IPC program changed.

Pandemic preparedness has always been a part of IPC work, so much so that there is a chapter in a guide published by the Association for Professionals in Infection Control and Epidemiology (APIC) to help us train for such events. Suddenly, the program of IPC became intrinsically linked to COVID-19 and the pandemic response that was, on far too many days, chaotic.

IPC programs were responsible for preparing hospitals and health care facilities for the existing problems while predicting those coming down the pike, all in addition to the work that many IPs found exhausting even before the pandemic struck.

In this situation, though, IPC programs couldn’t suddenly increase staffing because it was a geographically isolated event, but this global event meant that moving forward, we would have to ensure a strong infusion of pandemic preparedness and response into IPC programs and the role of the IP.

Underappreciated

The IP role is easily one of the most underacknowledged and underappreciated in health care and especially in this pandemic, despite how IPs came through in those first months. First and foremost, health care and ancillary support deserve more attention, support, and acknowledgement and COVID-19 has shed light on that. These are not mutually exclusive concepts, however.

We can be proud of the acknowledgement health care workers and ancillary staff such as respiratory therapists and environmental services personnel have received, while still calling for awareness and appreciation for IPC and IPs. Few articles have discussed our departments and roles, which is breathtaking considering the role we’ve had during this pandemic.

Many countries are ready to go “back to normal” and IPs are still struggling with burnout, fatigue, post-traumatic stress disorder, and a frustration that often comes with departments/roles that are seen as a cost center and not a revenue generator.

My hope, though, is that moving forward, as we saw with the Ebola outbreak in 2014 to 2016, there will be increased attention to IPC and those who are responsible for it. Our roles have changed. We have had to focus more on risk communication and combating misinformation in a time that is increasingly politicized. IPs had to become experts in re-use and extended use of masks and how to manage those programs.

We had to work with clinicians and information technology staff to ensure patients and families could talk when visitors weren’t allowed. We’ve had to navigate complex policy changes with mandated vaccines and shortening isolation periods, while still encouraging people to stay home when they’re sick. In short, I would say that our role has become ever more complex and critical and requires a deep look at the people who are able to manage something that often gets little acknowledgement.

Fun Police

A friend once said IPC was the “fun police” and while that made me chuckle and sad at the same time, I’ve realized that COVID-19 has shown that we’re actually one of the elements of the pandemic response that has helped keep health care afloat. We work in the shadows, the peripheral, and areas that require gray and objective review of things.

We are the future of health care. We have diverse backgrounds with expertise across many fields and the ability to pivot when needed.

That’s always been IPC, but now more than ever our roles have underscored the diversity of our work and those doing it. For the future, I hope we gain more acknowledgement and appreciation for the work we do.

I also hope we continue to see how much more we can do for public health and global health security. I hope our ability to be subject matter experts on things like disinfection, disease transmission, personal protective equipment, donning/doffing, and a million other things becomes recognized for the resource it is rather than the all-too-common focus of HAIs. The world has changed greatly in 2 years and IPC programs have changed as well. As approach year 3, the IP contribution in battling this pandemic should be appreciated more.

Saskia v. Popescu, PHD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in biodefense from George Mason University in Fairfax, Virginia, where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in infection control and has worked in pediatric and adult acute care facilities.