Healthcare Hygiene magazine September 2020 September 2020 | Page 10

infection prevention
By Sue Barnes, RN, CIC, FAPIC
Beyond Bundles: Resources to Support IP
Departments During the Pandemic
During the current COVID-19 pandemic, infection prevention
department (IPD) resources have been dramatically impacted
by efforts required for containment of the virus. There is,
consequently, less focus on prevention of healthcare-associated
infections (HAIs). This diversion of focus is creating risk for
patients according to clinicians at the Virginia Commonwealth
University Health System. Their Twitter survey in April revealed
that the majority of more than 200 respondents reported that the
pandemic was consuming 75 percent of IPD time and resources. 1
The report from the authors of a recent clinical paper makes
similar observations, based on the experience of several of the
hospitals in New York and Missouri. 2 They suggest that the
COVID-19 pandemic will significantly impact the rate of central
line-associated bloodstream infections (CLABSIs), which have been
observed to increase more than 300 percent in two hospitals over
the past 15 months. The authors theorize that this may be due
to smaller denominators as a result of fewer elective procedures,
decreases in hospital census, as well as an increase in high-risk
patients. In addition, proning critically ill COVID-19 patients
could potentially cause disruption of central-line dressings. 2 Also
adding to the risk in some locations, intravenous (IV) tubing is
being extended so that IV pumps can be kept outside of patient
rooms. This creates the potential risk of contamination of tubing
when in contact with floors. 3
This is truly concerning, given that even prior to the pandemic,
zero preventable HAI had not been achieved and/or sustained in
many U.S. healthcare facilities. 4 In most hospitals, a bundle of
standard measures (i.e., supported by category 1 level evidence,
defined as at least one properly designed randomized controlled
trial) is the first line approach for prevention of all categories of
HAI. When zero preventable infections are not achieved with
a bundle of standard measures, one or more plus measures
are often added (defined as supported by less than category 1
level evidence such as cohort or case control studies and expert
opinion). For example, a standard bundle measure for prevention
of surgical site infections (SSIs) is controlling serum glucose. An
example of a plus measure for prevention of SSIs is pre-operative
nasal decolonization. The number and type of plus measures
is dynamic and always changing as studies are completed on
emerging technologies and evidence is made available. Keeping
pace with this dynamic body of knowledge is time-consuming.
Consequently, in one large multi-hospital system, the national
infection prevention program leader developed a Beyond Bundles
Plus Measures HAI Prevention Toolkit to help the organization’s
infection prevention staff keep pace with the constantly evolving
infection prevention measures (products and practices) and
associated evidence of efficacy.
Beyond Bundles Plus Measures HAI Prevention Toolkit
This 48-page document includes evidence summaries for all
products and practices included, and is updated every two years.
It is organized in chapters by infection type as follows: CAUTI
(catheter associated urinary tract infection), CDI (Clostridium
difficile infection), CRBSI (catheter related bloodstream infection
which includes prevention of both CLABSI and peripheral
bloodstream infections), HAP (non-ventilator associated hospital
acquired pneumonia), MDRO (multi-drug resistant organism
infections), VAP (ventilator associated pneumonia) and SSI.
Each chapter begins with a list of standard bundle measures.
Following the standard measures in each chapter, a table lists the
plus measures designed to prevent that particular type of HAI.
The plus measures are identified during deep review of clinical
journals, attendance of professional conferences, continuing
education courses, and networking with clinical experts and
industry partners by the author. The collection is not intended to
be exhaustive, as it is limited by the author’s due diligence in the
collection and review of this clinical information. Vendors have
been invited to share evidence, and product names are included
when evidence of efficacy has been made available. So, although
the toolkit includes product names, it does not seek to promote
any product or company.
Following each plus measure there is
an embedded document containing an
evidence summary, which is also updated
every two years. Product order information
View first page of
CRBSI chapter in
Beyond Bundles HAI
Prevention Toolkit
is provided in the form of links and text, as
well as tools supporting implementation of
the product or practice, such as video clips
and embedded checklists and guidelines.
The toolkit is available for download in full,
and also by individual chapter, in open-access format and has
been publicized widely including via social media. https://www.
zeroinfections.org/toolkits.html
Especially today, when faced with the COVID-19 pandemic,
infection preventionists are challenged with competing priorities.
This open-access toolkit offers a no-cost aid for IPDs which
supports the resource-intensive task of reviewing the emerging
evidence of efficacy associated with infection prevention measures.
Unless zero preventable infections have been achieved with
standard bundle measures, this is an essential task in optimizing
infection prevention programs.
References:
1. Stevens M, Doll M, Pryor R, Godbout E, Cooper K and Bearman G. Impact of
COVID-19 on traditional healthcare-associated infection prevention efforts. Infect
Control Hosp Epidemiol. 41(8), 946-947. 2020. doi:10.1017/ice.2020.141
2. McMullen KM, Smith BA, Rebmann T. Impact of SARS-CoV-2 on hospitalacquired
infection rates in the United States: Predictions and early results. July
2, 2020. Am J Infect Control. 2020; S0196-6553(20)30634-9. doi:10.1016/j.
ajic.2020.06.209
3. Institute for Safe Medication Practices: https://ismp.org/resources/clinicalexperiences-keeping-infusion-pumps-outside-room-covid-19-patients
4. CDC HAI Progress Report: https://www.cdc.gov/hai/data/portal/progressreport.html
10 september 2020 • www.healthcarehygienemagazine.com