Despite the challenge of too much work , some IPs described the frustration of not being involved in
COVID-19 planning or response decisions .” among the staff , and staff distrusted new protocols , such as when and how to isolate infected patients or implementing respirator decontamination procedures .”
IPs also addressed how the pandemic presented them with too much work , resulting in the need to drop some routine duties : “ The relentless workload has also caused a loss of work life balance for many IPs . As one explained , ‘ There is no Monday through Friday . It is literally 24 hours a day , seven days a week .’ Despite the challenge of too much work , some IPs described the frustration of not being involved in COVID-19 planning or response decisions . As one IP said , ‘ Decisions were being made in organizations without their infection preventionists , which were resulting in extreme difficulties in coordinating throughout the county .’ Another discussed how their system-wide incident command center did not involve an IP nor ask for IP input on policy decisions ,” according to Rebmann , et al . ( 2021 ).
Rebmann , et al . ( 2021 ) said the identified gaps in pandemic response “ need to be addressed to minimize healthcare-associated infections and occupational illness . In addition , the educational topics identified by the participating IPs should be developed into new educational programs and resources .”
Impacts of the Pandemic on Infection Prevention and Healthcare Epidemiology
In her 2021 IDWeek presentation , “ Impact of COVID-19 on Infection Prevention ,” Catherine Passaretti , MD , explained that “ COVID-19 has had a tremendous impact on healthcare epidemiology , infection prevention and healthcare-associated infections ,” specifically relating to diversion of surveillance resources , process measure data collection , mitigation resources , as well as PPE inventory . She added , “ Antibiotic stewardship personnel efforts were diverted , the influx of critically ill patients may have driven suboptimal antibiotic use , and increased antibiotic use was seen due to secondary bacterial infections .”
Passaretti continued , “ Hospitals also struggled with higher nurse-to-patient ratios , and experienced swings in patient acuity levels . Then there was turnover and burnout among nursing and medical staff , as well as for our infection preventionists . Facilities may have had traveling nursing staff who are unfamiliar with protocols , so it was almost like starting anew with a big group of staff members . In many instances we redeployed personnel to work in areas that have protocols they aren ’ t used to . And many times during the pandemic , people literally could not do anything other than take care of COVID-related issues . Process-improvement resources had to be shifted . These kinds of impacts continue to create a domino effect , and touch upon our hospital-acquired infection rates as well as on some of our preventive measures .”
One of those measures included hand hygiene . “ When COVID first hit in 2020 , our hand hygiene improved significantly , as did good attention to PPE use ,” she explained . “ Then as the pandemic wore on , fatigue set in , and we saw a gradual diminishment of that attention to some infection prevention protocols .”
Passaretti pointed to the recent findings of Weiner-Lastinger , et al . ( 2021 ) comparing HAI rates in 2019 and 2020 , indicating that in the first quarter of 2020 , HAI rates were mostly declining , but by the second quarter of 2020 , several HAIs , like CLABSI and VAE , were beginning to increase . By the third and fourth quarters of 2020 , the decline in HAI prevention continued .
“ Before the pandemic we were seeing a nice downward trend in HAIs . Then COVID hit , and you see a very different picture , especially for device-associated infections ,” she said . “ Other studies indicated the same kind of trend among HAIs , especially CLABSIs and CAUTIs , during the pandemic .”
She emphasized that HAIs are impacting COVID patients . “ COVID has been associated with increased HAIs , and in smaller facilities where infectious disease physicians are wearing multiple hats , you are seeing very few areas of the hospital that have not been impacted , and COVID has touched all infection prevention departments in some way . Obviously , the biggest issue was the evolution of the personal protective equipment recommendations for COVID to recognize the science and address the shortage of different types of PPE .”
Passaretti said the evolution of COVID PPE strategy involved juggling PPE supply limitations , adjusting strategy to the evolving knowledge about SARS-CoV-2 transmission , dealing with the impact of healthcare worker fear on PPE requests , engaging in constant PPE education , and becoming best friends with the healthcare institution ’ s materials management department .
“ The impact of healthcare worker fear on PPE-related requests was significant ,” she said . “ I had some heated and lengthy discussions about things like shoe covers and Tyvek suits in the early days of the pandemic and was probably not reflecting on the impact that human behavior has had on COVID-related care that put us at a bit of a disadvantage . Obviously , with all these changes in PPE protocols , we were constantly educating personnel .”
She continued , “ We were also implementing COVID care protocols invented from scratch . This was happening not just in inpatient-care settings or just in large hospitals , but also in small hospitals and in all types of settings . We were engaging in new kinds of thinking around how to keep patients free from infection , both from COVID and from healthcare-acquired infections .”
She acknowledged that healthcare epidemiologists and infection preventionists were constantly battling misinformation and striving to provide the latest information with healthcare personnel .
“ We who work in infection prevention and healthcare epidemiology are educators at heart , and never more so than during COVID ,” Passaretti emphasized . “ We were also trying to keep up with the evolution of information and making sure that we were constantly explaining that to our caregivers and patients . Throughout the pandemic , infection preventionists and healthcare epidemiologists played different roles in both the background and the forefront and were a trusted resource in and out of the healthcare setting , especially in the community . We tried hard to take the lead to battle misinformation as the pandemic evolved and as information was updated .”
She continued , “ Infection prevention and healthcare epidemiology also became deeply embedded in everything from screening protocols to testing protocols , post-exposure quarantine and isolation guidance , guidance on return-to-work timing and strategies , as well as patient and healthcare worker hospital-acquired COVID cluster management .”
The infection prevention and control department played a significant role in leading occupational health-related issues when it came to COVID-19 vaccine rollouts . “ This is another key