We must attract more people to our fields . Maybe it means doing a better job of helping people , even at the undergraduate level , recognize that there are careers in healthcare epidemiology , infection prevention , and antibiotic stewardship that are meaningful and important , and are careers that they may want to pursue .”
as impactful if you don ’ t have the staff or the time to complete them . So , even before COVID , that was part of our normal reality . Do we want to go back to normal ? I ’ m not so sure .”
He continued , “ What we must do is think about moving toward a new normal , but , of course , there ’ s a lot implied in the air quotes that I ’ m using to define the ‘ normal ’ that we want to get back to . We can strive for uniformity in our prevention success . We don ’ t want to see any healthcare facility left behind . There is quite a focus on understanding and addressing health disparities and that is fantastic . It ’ s also important to understand facility-level disparities in healthcare epidemiology and stewardship . And what are the patient-level disparities that create challenges for healthcare ? We must acknowledge that in our hospitals and in our nursing homes there are disparities in the quality of our infection control and stewardship programs that can drive adverse outcomes . We have seen success when we seek to understand and address the drivers of disparities .”
As an example , Srinivasan pointed to data indicating that small facilities and critical-access hospitals were struggling to implement stewardship programs that met all the CDC ’ s core elements . “ We partnered with them to learn what their unique challenges were and how we could address them . We said , let ’ s get together with those who have found ways to implement these core elements , let ’ s understand how they overcame some of their challenges and let ’ s try to share those experiences . What came of that was a core element implementation guide that was specifically directed at critical-access hospitals . The concept was ‘ nothing about us without us .’ Over the past several years critical-access hospitals have been closing those disparities gaps and implementation of core elements for hospital stewardship programs in those facilities has gone from 23 percent to 83 percent .”
For a better ‘ normal ,’ Srinivasan emphasized the need for more personnel . “ Any time a crisis comes , infection prevention and stewardship activities stop , so we need more staff . We saw this during the last influenza pandemic , and we saw it during Ebola . We see it anytime there ’ s a natural disaster , and we ’ ve seen it so dramatically during COVID . Stewardship stops because staff get deployed to focus on whatever the crisis is , and that has devastating consequences .”
Srinivasan advocates attracting more professionals to the fields of infection prevention and healthcare epidemiology , starting with undergraduate training programs . “ We must attract more people to our fields . Maybe it means doing a better job of helping people , even at the undergraduate level , recognize that there are careers in healthcare epidemiology , infection prevention , and antibiotic stewardship that are meaningful and important , and are careers that they may want to pursue . The other way I think that we can address this crisis is making sure that all healthcare personnel are better trained in infection prevention and in in efforts to improve antibiotic use .
Much of what we do when there ’ s a crisis is just-in-time training , but we must reinforce infection prevention and control training for personnel who are not familiar with best practices in infection control . We won ’ t need as much just-in-time training if everyone is already well versed in infection prevention , and that is the focus of our Project Firstline effort , a first-ever CDC attempt to provide tailored infection control training to every frontline healthcare worker in the U . S . – that ’ s 6 million-plus healthcare personnel across all segments of the healthcare continuum . These personnel will be trained and ready to respond when that next crisis comes , so that our infection prevention or stewardship staff don ’ t have to be pulled offline as much .”
Srinivasan emphasized several COVID-19 interventions he said that “ we might want to become part of a new normal .” One of those is data from long-term care facilities . “ During the pandemic , all CMS-certified skilled nursing facilities started reporting COVID data to NHSN . We also would like to know more about healthcare-associated infections in nursing homes , as this has long been a blind spot for us . We haven ’ t had the information that we want , so the question becomes , can we transition from COVID reporting in skilled nursing facilities to more robust HAI reporting as a new normal in nursing homes . Obviously , there ’ s a lot that goes into that , including how do we do this without creating an unacceptable burden for these facilities and personnel . How can we best collect and report this information ? It ’ s not to say that this is a done deal , but this is definitely something that we should be talking about as part of a new normal .”
He acknowledged the federal vaccine mandate starting with nursing homes , but which has been extended to all facilities that are covered by CMS . “ All facilities that receive funds from the federal government are now part of the federal vaccine mandate ,” Srinivasan said . “ This is a first-of-its-kind vaccine mandate , so it begs the question , should this be something that we consider as part of our new normal ? I think again there are pros and cons . It does ensure rapid uptake , which could help protect staff and residents . It also will help level the playing field on one of the major pushbacks that we ’ ve heard from many nursing homes , in that if they are the only setting that has a mandate , then they are going to lose their personnel who don ’ t want to get vaccinated . If there ’ s a uniform federal mandate , those issues of variability in application of vaccine requirements won ’ t be at play .”
Srinivasan continued , “ On the downside , will it undermine healthcare personnel ’ s confidence in the vaccines , with them asking , ‘ Why are you requiring it if it ’ s such a good thing ; then the vaccine is probably not as effective .’ After the pandemic our focus should not be on getting things back to the way they were , but instead , it should be on keeping the best of what we had before and exploring where things could have been better . We all long to go back to normal , but we should remind ourselves that normal was not ideal .