at them and think , ‘ You ’ re kidding , right ? Do you realize that I haven ’ t even taken a potty break ?’ So , it ’ s a challenge and who knows what the answer is , except that we must continue to be out there and not hide out in our offices behind the computer , and that ’ s easy to fall into . During the pandemic , some colleagues did most of their work virtually from home during most of it , while others were boots on the ground the whole time . Those who worked from home need to break that habit in a hurry , get back out there in the weeds with everybody so that they don ’ t think you ’ re just speaking from an ivory tower . You ’ ve got to be out there mixing it up with the staff , and yes , it ’ s hard , but it must be done .”
The recent escalation in HAIs might be impetus enough for a return to so-called shoe-leather epidemiology .
A recent paper by Weiner-Lastinger , et al . ( 2021 ) reported that significant increases in the national standardized infection ratios ( SIRs ) for central line-associated bloodstream infections ( CLABSI ), catheter-associated urinary tract infections ( CAUTI ), ventilator-associated events ( VAE ), and MRSA bacteremia were observed in 2020 , during the COVID-19 pandemic . The researchers sought to determine the impact of the pandemic on HAI incidence in U . S . hospitals , and national- and state-level SIRs were calculated for each quarter in 2020 and compared to those from 2019 . The largest increase was observed for CLABSI , and significant increases in VAE incidence and ventilator utilization were seen across all four quarters of 2020 .
As the authors note , “ The pandemic response placed burden on acute-care hospitals ( ACHs ), which may have altered staffing practices , increased critical care capacity , and modified use of personal protective equipment ( PPE ). In the early stages of the pandemic , little was known about how COVID-19 hospitalizations would affect the incidence of healthcare-associated infections ( HAIs ). Single-site studies observed early signs of increases in select HAIs during the spring of 2020 . Others have studied the occurrence of secondary infections in COVID-19 patients Additionally , a report from the National Healthcare Safety Network ( NHSN ) found significant increases in central-line – associated bloodstream infections ( CLABSIs ) during the early months of the pandemic .”
The researchers note further , “ The year 2020 marked an unprecedented time for hospitals , many of which were faced with extraordinary circumstances of increased patient caseload , staffing challenges , and other operational changes that limited the implementation and effectiveness of standard infection prevention practices . A regular review of HAI surveillance data is critical for hospitals to identify gaps in prevention and address any observed increases in HAIs . Infection prevention staff should continue to reinforce infection prevention practices in their facilities and consider the importance of building resiliency in their programs to withstand future public health emergencies .”
While IPs grapple with HAIs anew , it ’ s interesting to reflect on an APIC campaign from 2007-2008 called the Targeting Zero Initiative , designed to eradicate infections deemed preventable
A regular review of HAI surveillance data is critical for hospitals to identify gaps in prevention and address any observed increases in HAIs . Infection prevention staff should continue to reinforce infection prevention practices in their facilities and consider the importance of building resiliency in their programs to withstand future public health emergencies .” by the Centers for Medicare & Medicaid Services ( CMS ). The campaigns educational initiatives aimed at eliminating Clostridium difficile-associated disease , as well as CAUTIs , CLABSIs , and mediastinitis . The initiative provided a package of education , research , and guidance for IPs , and at the time sparked an energetic debate over the feasibility of reaching zero infections . The initiative spawned a number of APIC Guides , including one on the elimination of C . difficile , that sought to help IPs address new changes to the CMS regulations at the time , which eliminated or reduced payments for the aforementioned three HAIs .
At the time , then-APIC president Denise Murphy noted , “ We want to prepare infection prevention and control professionals to more effectively educate and influence frontline healthcare teams about process improvements that could ensure safe patient outcomes . Leveraging the new CMS guidelines , we hope to heighten awareness among clinical and administrative leadership about the value of infection prevention . Responding to this challenge requires a blend of research , education , and practice guidance — a combination of activities that APIC is uniquely positioned to undertake . Following our positive experience taking a very comprehensive approach to MRSA in 2007 , we plan to launch an aggressive fight against these deadly infections on multiple fronts in 2008 .”
Today , thinking has evolved , but the topic of zero infections is the high bar for IP & C programs , albeit a difficult one for some institutions .
“ We ’ d all love to see that happen , as it ’ s a laudable endeavor ,” says Dickey , “ but is it realistic to hit zero ? I don ’ t think any of us believe that could ever happen unless we didn ’ t live in a world of germs . Certainly , we want to see long , sustained periods without infection . We ’ ve seen it in high-risk populations , so it is possible to do , but I think having a goal of sustainable zero for as long as you can go is wonderful . To think that it will always be zero , I don ’ t believe is doable , but certainly being able to sustain zero for long periods of time is attainable and that ’ s an exciting goal .”
References :
APIC . 50th Anniversary Timeline . Accessible at : https :// apic . org / 50thanniversary-timeline /
Bartles R , et al . A systematic approach to quantifying infection prevention staffing and coverage needs . Am J Infect Control . 46 ( 2018 ) 487‐91 .
Weiner-Lastinger LM , et al . The impact of coronavirus disease 2019 ( COVID-19 ) on healthcare-associated infections in 2020 : A summary of data reported to the National Healthcare Safety Network . Infect Control Hosp Epidemiol . Sept . 3 , 2021 .
www . healthcarehygienemagazine . com • june 2022
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