stewardship being performed , etc . We must re-emphasize the interventions we were working on prior to the pandemic . One of the things I hope comes out of this crisis is a re-emphasis on the importance of the nurse ’ s role when it comes to antibiotic stewardship ; I think we will pick up that ball again and run with it because that is a very important initiative . We know what to do — we were having great success before , and we will again — but we are going to have to reclaim some lost ground .”
Regarding balancing COVID-19 transmission prevention with HAI prevention so that nothing gets ignored , Boston-Leary notes , “ We must focus on the overall risk of HAI , which includes viruses actively spreading within the community that can pose a threat within a health care setting . It ’ s a matter of on-going assessment of overall risk of HAI , versus focus on mitigation of a single or select few viruses or organisms .”
Rebuilding a Safety Culture
A safety culture is the bedrock of infection prevention and control and healthcare facilities are encouraged to lay and maintain this foundation above all else . As a whitepaper , “ COVID-19 Lessons Learned : A Resource for Recovery ,” issued by Deloitte and Joint Commission Resources , noted , “ During the COVID-19 response , healthcare organizations mounting the most effective response to surges in demand for complex care have demonstrated strong safety cultures featuring high-performing , collaborative , and resilient teams . These organizations have also demonstrated forethought in preparation and organizational agility . Such organizational characteristics hinge on cascading leadership engagement that builds strong , empowered teams in a patient-centered culture of safety with preparedness as a priority .”
The Deloitte / JCR whitepaper says that an organization may strengthen its culture , resilience and preparedness by engaging in the following activities :
• Develop and sustain organizational values
• Drive leadership engagement with front-line teams
• Develop the organization ’ s teams to be collaborative problem-solvers
• Adapt to become a learning organization by setting measures , targeting change , assessing progress , and remeasuring as needed
• Maintain preparedness and planning for contingencies as a strategic priority
• Establish mature community and governmental partnerships for contingency response
• Monitor indicators of potential public health threat ●Apply executive intent , presence , encouragement , support , and communication regularly :
• Employ leadership engagement techniques through all levels of the organization with practices such as leadership rounding for shared problem solving
• Schedule regular meetings or huddles to maintain frequent discussion and information sharing ; apply and promote active listening practices during leadership rounding to demonstrate deep understanding of and empathy to staff concerns
• Follow-up with updates on issues raised during interaction with staff
• Communicate frequently through multiple modalities including direct interaction , short videos , social media , virtual town halls , emails , newsletters , websites , and formal correspondence
Continued from Page 20 ●Use predictive analytics to anticipate the needs for surges . ●Use full-face respirators vs . N95 masks when safely applicable .
●Develop and implement long-term processes for continuously assessing PPE needs , including establishing clear communication channels and relationships with reliable vendors / suppliers for both short-term and longterm needs .
●Work with subject matter experts and conduct trainings to ensure clear , evidence-based guidance for the proper use of PPE and proper types needed for various settings to minimize unnecessary use of critical supplies .
●Develop and implement a process for reviewing PPE manufacturers ’ length of use , extended use , reuse and decontamination protocols . Follow the CDC ’ s National Institute for Occupational Safety and Health ( NIOSH ) guidance , including :
4
●Minimize the number of individuals who need to use respiratory protection through the preferential use of engineering and administrative controls . ●Use alternatives to N95 respirators where feasible . ●Implement practices allowing extended use and / or limited reuse of N95 respirators .
●Prioritize the use of N95 respirators for personnel at the highest risk of contracting or experiencing complications of infection .
●Develop and implement crisis standards of care for decontamination , referring to NIOSH guidance Follow rigorous disinfection and cleaning protocols
5 within the organization . ●Reassure and train staff in cleaning protocols and products continually .
●Provide approved cleaning agents for the pathogen , adequate PPE , and instructions in a language understood by the environmental services staff implementing the protocol . Post instructions in easily accessible environmental services staff locations .
●Consider decontamination and sanitization methods that anticipate a broad range of pathogen transmission and longevity .
●Monitor room turnover times actively . Those recommended by the CDC will impact the availability of beds and create delays due to cleaning .
●Follow new methods for decontamination , as they are rapidly evolving . The efficacy of alternative non-touch methods varies widely , so current recommendations by the Environmental Protection Agency ( EPA ) are limited to identified surface disinfectants and manual cleaning in healthcare settings . Acknowledge that response requires a marathon
6 mentality . It involves long-term diligence using preventive strategies . Build and support the ongoing growth of
7 internal infection prevention and control experts within your organization . This is necessary to facilitate preparedness well before an emergency situation arises .
Source : Reprinted with permission from Joint Commission Resources