Healthcare Hygiene magazine August 2020 | Page 6

from the editor UPPs Require a Paradigm Shift In a recent commentary, Weber, et al. (2020) suggested the adoption of what they call Universal Pandemic Precautions, likened to the creation of Universal Precautions (now called Standard Precautions) which was a response to the HIV epidemic-driven threat of bloodborne pathogens. Standard Precautions recommend that healthcare personnel (HCP) wear gloves for anticipated contact with all body fluids. The researchers remind us that, “Although there was some initial pushback with the implementation of Standard Precautions due to concern that routine wearing of gloves would be poorly received by patients and impair the ability to perform procedures such as placing intravenous catheters, they are routinely practiced and accepted today.” They add, “Similarly, the threat proffered by the sudden appearance of COVID-19 in the healthcare workplace resulted in the implementation of risk mitigation strategies that may also produce permanent behavioral modification in the healthcare setting. As happened during the 1980’s with the HIV/ AIDS epidemic, the introduction of a new disease and new risks into the healthcare setting should result in long-lasting changes in patient care that at least offer potential for increased patient and staff safety.” There’s no doubt that measures need to be taken to prevent SARS-CoV-2 transmission, just like any infectious pathogen; hospitals know the drill, including: screening patients, visitors and HCP for COVID-19 symptoms prior to entry; routine use of source control masks by patients, visitors and HCP; frequent hand hygiene and surface disinfection of shared equipment and devices; enhanced PPE for HCP performing aerosol-generating procedures and during care of known or suspected patients with COVID-19; and prompt testing of persons with signs/symptoms of COVID-19 and appropriate isolation precautions. However, are we ready for a shift to implementation of Universal Pandemic Precautions (UPPs) – use of a mask and eye protection for all direct patient contacts or at a minimum, use of a mask and eye protection for direct patient contact when the patient is unable or unwilling to wear a mask. The researchers say this is necessary due to several factors: transmission from pre-symptomatic an/or asymptomatic COVID-19 patients; use of masks and eye protection by HCP protects against acquisition of SARS and SARS-CoV-2; and use of UPPs would prevent HCP from having an exposure that per the CDC would lead to exclusion from work for 14 days. They add that UPPS will “likely also offer a potential beneficial effect on the prevention of transmission of other droplet-spread respiratory pathogens in the healthcare setting (e.g., influenza A and B, respiratory syncytial virus, seasonal coronaviruses, etc.), especially during seasons in which these and other respiratory viruses are circulating.” In their pitch, Weber, et al. (2020) acknowledge, “We understand that implementation of UPPs will require careful messaging for our colleagues and patients. We expect that the rationale … will be persuasive for our colleagues to accept UPPs. Messaging to patients should focus on describing the rationale for UPPs including noting that use of UPPs is one of several precautions that protect patients. In addition, patients should be informed that this is routine practice not specifically focused on them individually. Finally, we realize that institution and discontinuation of UPPs should be based on current local case numbers (or rates or burden) and local prevalence of infection in asymptomatic populations (e.g., pre-procedural test positivity rates, as symptom screening cannot detect these potentially infectious patients. We realize that paradigm shifts are difficult and as demonstrated by Semmelweis may not be accepted. However, ultimately the use of hand hygiene as advocated by Semmelweis became a keystone of infection prevention. We believe that UPPs will be accepted by patients and staff and that it will ultimately result in a safer healthcare environment for all.” What do you think? Until next month, bust those bugs! Kelly M. Pyrek Editor & Publisher [email protected] healthcarehygienemagazine Kelly M. Pyrek editor & publisher [email protected] A.G. Hettinger, CPA president & CFO Patti Valdez art director Linda Lybert business development consultant J. Christine Phillips customer service manager Send inquiries to: [email protected] Healthcare Hygiene magazine is published monthly by Keystone Media Inc. 8925 Ridgeline Boulevard, suite 106, Highlands Ranch, CO 80129. Free digital subscriptions available at www.healthcarehygienemagazine.com for U.S., Canada and other foreign subscribers. Copyright © 2019 Keystone Media Inc. All rights reserved. The publisher reserves the right to accept or reject any advertising or editorial material. Advertisers, and/or their agents, assume the responsibility for all content of published advertisements and assume responsibility for any claims against the publisher based on the advertisement. Editorial contributors assume responsibility for their published works and assume responsibility for any claims against the publisher based on the published work. All items submitted to Healthcare Hygiene magazine become the sole property of Keystone Media Inc. Editorial content may not necessarily reflect the views of the publisher. No part of this publication may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher. Reference: Weber DJ, Hayden MK, Wright SB, et al. State of the Pandemic Commentary: Universal Pandemic Precautions – an Idea Ripe for the Times. Infect Control Hosp Epidemiol. DOI: 10.1017/ice.2020.327 6 august 2020 • www.healthcarehygienemagazine.com