cover story
2021
Year in Review
While COVID Continued to Dominate , Other Challenges and Opportunities Surfaced
By Kelly M . Pyrek
As we look back at the major events of the past year , COVID continued its grip on the world and dominated the infection prevention , healthcare epidemiology and public health agendas . Also continuing their stance against the pandemic were infection preventionists ( IPs ), and Rebmann , et al . ( 2021 ) provided a peek into focus groups held to elicit IPs ’ experiences early during the COVID-19 pandemic . These IPs described multiple challenges , including rapidly changing and conflicting guidance , a lack of infection prevention recommendations for nonacute-care settings , insufficient personal protective equipment ( PPE ), healthcare personnel complacency with PPE and infection prevention protocols , and increases in healthcare-associated infections ( HAIs ) and workload .
“ Some of the most frequently mentioned challenges to pandemic response included issues related to PPE , such as a lack of PPE access ,” confirm Rebmann , et al . ( 2021 ). “ Some described placing an order , but only receiving a fraction of what had been promised by the vendor . Others described the logistical challenges of getting PPE to different facilities when their traditional distribution center lacked the supplies to accommodate all sites . A little more than half reported having run out of at least one type of PPE during the pandemic , despite the fact that 89 percent had implemented PPE crisis standards of care . N95 respirators were the most frequently reported PPE shortage ; 28.8 percent ran out of N95s at some point . IPs who work only in LTC were significantly more likely than IPs in all other settings to report having run out of N95s at some point during the pandemic ( 53.8 percent versus 46.2 percent ). Many IPs described needing to order PPE from different vendors due to a lack of availability . Some reported receiving faulty or questionable PPE and discussed the need to verify the quality of PPE before it could be given to staff . Others described challenges in needing to train healthcare personnel on the new PPE .”
Many IPs discussed experiencing a lack of staff trust and / or fear throughout the pandemic due to the frequent protocol changes and conflicting guidance .”
The researchers reported that challenges relating to disinfectant products and hand sanitizers were common : “ Some IPs reported not being able to access sufficient supplies , while others described obstacles to using available products . As one IP explained , ‘ At one point we had to use pool shock , which our pharmacists diluted into bleach to make a bleach spray when we didn ’ t have wipes .’ Others had access to supplies , but the product had an extended dwell time ( 10 minutes ). Many IPs described difficulty in obtaining sufficient hand sanitizer . One IP explained , ‘ We had to rely on alcohol from our local distilleries to use as hand sanitizer .’
A lack of setting-specific guidance created chaos , IPs reported , according to Rebmann , et al . ( 2021 ): “ A major and consistent challenge identified was the lack of guidance available for various topics or that was targeted to specific sites . This lack of guidance left many IPs struggling to answer staff questions , train personnel , or develop evidence-based policies . As IPs explained : ‘ I feel like I ’ m kind of making it up as I go . You ’ re really coming up with answers right there on the spot because nobody else has the answers .’ And ‘ I think the scariest thing is just people trusting what I say when I ’ m not 100 percent sure that what I ’ m saying is correct .’ One of the most commonly mentioned areas of need was site-specific guidance , such as COVID-19 guidelines for specific outpatient procedures or sub-specialties . As one IP stated , ‘ The CDC or the state didn ’ t always have recommendations that were tailored to all the different specific care settings , particularly in the outpatient setting . And so , you kind of had to make an educated logical guess in terms of what the best course of action was going to be .’”
Frequent changes and conflicting guidance posed many challenges to IPs . As the researchers reported , “ Many IPs discussed experiencing a lack of staff trust and / or staff fear throughout the pandemic due to the frequent protocol changes and conflicting guidance . IPs felt as though they lost or could not gain credibility