infection prevention
By Sylvia Garcia , MBA , RN , CIC
Leading the Way to Zero : Integrating What We ’ ve Learned to Create the “ New Normal ”
On
Sept . 14 , 2020 , the Institute for Healthcare
Improvement ’ s National Steering Committee for Patient Safety released “ Safer Together : A National Action Plan to Advance Patient Safety .” This plan emphasizes that “… safety requires a shift from reactive , piecemeal interventions to a proactive strategy in which risks are anticipated and system-wide safety processes are established and applied …”
Anticipating risks and implementing safety processes are an infection preventionist ’ s “ bread and butter .” We are trained to systematically apply models to explain and prevent transmission of infections within our organizations . The chain of infection is one model and another is the Hierarchy of Controls . The chain of infection identifies the route of transmission as the weakest link in the chain . If we can break that link , we can prevent transmission . In the Hierarchy of Controls , the most effective methods are at the top : elimination and substitution , and the least effective methods are at the bottom : administrative controls and personal protective equipment . Using what was known about COVID-19 transmission , initial reaction to COVID-19 focused on an integrated response to prevent transmission of COVID-19 which strived to :
● Eliminate the hazard and conserve resources by stopping elective procedures and limiting or barring visitors
● Substitute processes such as telehealth to provide care
● Install engineering control such as physical barriers at reception points
● Implement administrative controls such as screening everyone entering the facility for symptoms
● Provide personal protective equipment ( PPE ) to our frontline workers .
As cases increased around the world and transmission from asymptomatic cases was identified , organizations adjusted their approaches . Many people started to wear face masks and respirators out in public and in healthcare settings causing confusion and controversy . With dire PPE shortages in some parts of the United States , public officials emphasized that medical face masks and respirators should be reserved as PPE for those providing care to patients . In an effort
to conserve scarce resources , some organizations restricted use of medical and surgical masks and respirators to those providing direct care to patients with known or suspected COVID-19 .
Face coverings ( masks made of cloth ) were suggested as an alternative that would conserve resources for frontline workers . Initial information indicated that face coverings would not protect the wearer but could protect others . Now , increasing evidence concludes that universal masking and use of face coverings can protect the wearer and others from COVID-19 .
The effect of COVID-19 prevention methods on influenza in the southern hemisphere countries offers hope for a controlled influenza season . Data on influenza from Australia , Chile , and South Africa shows very low influenza activity during June thru August 2020 , the months that reflect typical Southern Hemisphere influenza season . Summer circulation of influenza in the United States is at a historical low .
There is no “ magic bullet ” that , by itself , will prevent transmission of respiratory viruses , including COVID-19 and influenza . Historically , we have focused on respiratory etiquette -- encouraging patients to cover their cough and when possible wear a mask if they have respiratory symptoms . Despite improving influenza vaccination rates and implementation of respiratory etiquette , health care organizations have continued to identify health care associated transmission to patients and staff . As we move into the “ new normal ” of COVID-19 and face the start of influenza season , we need to use information we have learned from our experiences with COVID-19 to protect our patients , visitors , and staff . The CDC estimates that 3 percent to 8 percent of the U . S . population contracts influenza each year . Like COVID-19 , influenza is transmissible before symptoms develop .
With information evolving on the role of microdroplets and ventilation , specifically air exchanges , in transmission of COVID-19 , healthcare organizations need to plan for the coming winter . Rigorous implementation of COVID-19 prevention strategies including universal masking , social distancing , hand hygiene and surface disinfection can control COVID-19 . When paired with influenza vaccination , these strategies
As we move into the “ new normal ” of COVID-19 and face the start of influenza season , we need to use information we have learned from our experiences with COVID-19 to protect our patients , visitors , and staff .”