Regardless of the size of the healthcare facility , teamwork has been tremendously important , with nursing partners , infectious disease clinicians , administration , materials management , and local and state health departments . We needed to work together to manage resources , exchange information , and work as much as possible in lockstep with each other as we navigated the complexities of COVID .”
area where healthcare epidemiology and infection prevention played a very significant role . We ensured vaccine site safety protocols but also educated around breaking through vaccine hesitancy . We also brought weight to bear on discussions around COVID-19 vaccine requirements as conditions of employment , once again weighing in on that process and discussing medical and religious exemptions .”
Passaretti added , “ I would be remiss if I didn ’ t acknowledge that public communication and media efforts have taken up a significant amount of time of the part of healthcare epidemiology and infection prevention . That became a very significant part of our job over the past year , ensuring that we interact with the media and that we ’ re communicating effectively to our communities as representatives of healthcare epidemiology and infection prevention .”
Passaretti addressed the pandemic ’ s impact on resources and the numerous competing priorities .
“ Regardless of the size of the healthcare facility , teamwork has been tremendously important , with nursing partners , infectious disease clinicians , administration , materials management , and local and state health departments . We needed to work together to manage resources , exchange information , and work as much as possible in lockstep with each other as we navigated the complexities of COVID .”
In her 2021 IDWeek presentation , “ Competing Priorities Between Antimicrobial Stewardship and Other Hospital Needs ,” Kelly Cawcutt , MD , emphasized that antimicrobial stewardship ( AS ) and infection prevention and control ( IP & C ) are “ two sides of the same coin ,” noting that AS helps prevent multidrug-resistant organisms ( MDROs ), and that infection prevention practices such as handwashing can help prevent infections requiring antibiotics . She said that the two disciplines are better together and are more effective than AS alone , even though competing priorities exist and that “ optimized engagement between these two programs and with your frontline healthcare workforce has a synergistic impact on programming .”
Cawcutt alluded to some in the field seeing AS and IP & C as engaging in “ turf wars ” as individuals practice from their individual spheres of influence . “ As clinicians , we want to make sure that we don ’ t come across as presenting these spheres and priorities as a turf war between two different entities ,” she said . “ I think it ’ s important to understand the idea of having a ‘ battle buddy ’ meaning being assigned to mutually help each other under a structured system . Think of it as comrades working together for success and to keep everyone moving in the same direction . That lends itself to discussing the desired impact of our stewardship and infection control programs . We would love to see synergy where the interactions between stewardship and infection control provide a greater impact than the sum of either program independently . If we cannot achieve synergy all the time , which we probably can ’ t , then it is important to consider being additive – meaning , can we add things to each other ’ s programs to improve outcomes ?”
Cawcutt pointed to data showing that adding superior infection prevention strategies to a stewardship program can improve outcomes as compared to stewardship alone . She emphasized that keeping these programs in sync can be aided by healthcare institution leadership viewing the two programs as a combined force and providing appropriate support and resources .
“ We need appropriate staffing , funding and resources to execute these programs in the most effective way ,” Cawcutt said . “ Striving for synergy instead of engaging in competing turf wars requires adequate resourcing for all .”
Cawcutt said she conducted some informal research on social media to find out just how competitive the two programs are in the minds of practitioners . In a Twitter poll , Cawcutt found that 87.8 percent of poll respondents thought the AS and IP & C programs were synergistic , while 12.2 percent said “ it depends ” without further elaboration , and no one thought the programs were antagonistic toward each other .
“ The poll results heightened my curiosity , so anecdotally , I asked my colleagues ,” Cawcutt said . “ Some found it hard to find ways in which these groups might be antagonistic . When I asked other frontline staff , they immediately said they saw agonism when clinical teams were not synergistic , based on what they were being asked to do . So , I think a better understanding of what frontline workers are perceiving is important .”
Cawcutt acknowledged that these experiences are occurring within the context of the COVID-19 pandemic , further impacting performance “ in ways we don ’ t yet fully understand .” She continued , “ During the pandemic we had to divert resources away from our normal practices to support COVID-related care . We may have lost the capacity to maintain our data collection and report that data back to our stakeholders and to frontline personnel . We ’ ve experienced resource shortfalls and supply chain problems with PPE , impacting our ability to provide the level of care that we would normally have . We ’ ve seen potentially suboptimal antibiotic use and increasing resistance in COVID-19 patients , and that continues to increase those risks of other infections , including C difficile . This is where the competing priorities really hit home for me . A great example in this pandemic has been sepsis and pneumonia in the ICU . The perception of stewardship is that we need to use fewer antibiotics to decrease risk of CDI . We need to make those changes for the good of our patients . When we ’ re dealing with sepsis , we tend to want to use more antibiotics to decrease mortality . When you think about pneumonia in a COVID-19 patient in the ICU , data has shown that these infections are hard to diagnose ; does the patient just have COVID-19 or are they developing a secondary infection ?”
Cawcutt continued , “ Then we have patients telling us over and over , ‘ please don ’ t let me die , please save my life .’ That carries a toll and brings a bias to how we treat our patients and how aggressive we are in therapy .”
She circled back to the pressure of competing priorities . “ We are trying to take the best care of our patients we can in very busy ICU settings . In my infection control role , I think that if everything