Healthcare Hygiene magazine September 2020 September 2020 | Page 26

Risk Assessment and
Management in the
Era of COVID-19: It’s
Everyone’s Responsibility
By Kelly M. Pyrek
As
SARS-CoV-2/COVID-19) continues to reframe how
healthcare is received by patients and delivered by
personnel, risk assessment and management is evolving to meet
the clinical- and asset-related challenges.
It is safe to say that just like with infection prevention, risk
management is everyone’s responsibility, now more
than ever before.
Brigitta Mueller, MD, MHCM, MSJ, FAAP, executive
director of patient safety, risk and quality at ECRI,
emphasizes that all healthcare personnel are patient
safety advocates, especially as the world continues to
battle a once-in-a-century kind of pandemic.
With the full impact of COVID-19 still not clearly understood,
Mueller says, “I don’t think we have all the answers yet, as there
are so many pieces of the puzzle that have yet to fall into place.
We were confronted with new and unknown situations with
which healthcare professionals had to contend, such as the
personal protective equipment (PPE) and ventilator shortages.
That is not something that healthcare providers usually have to
deal with, and we were caught off guard. That scenario increased
the risk both to patients as well as to healthcare providers. Then
there were the resulting financial issues that many healthcare
organizations experienced, with some entities being forced to
furlough or let go of people who didn’t have direct patient care
obligations, because it was felt that they would be safer at home.
But, of course, that means there are fewer people on the front
line, so it’s a double-edged sword.”
In the following Q&A, Mueller discusses how COVID-10 is
impacting patient safety and risk management.
HHM How well were healthcare facilities prepared before
the COVID-19 pandemic hit?
Brigitta Mueller (BM): We all know that many long-term
care facilities were woefully unprepared. Part of the reason is that
they never received all the financial support they needed, while
some of it is due to regulatory issues. And some of it is due to
infrastructure limitations. We also have had very well-known and
well-equipped healthcare systems that were stretched to their
limits. For example, as we know, facilities ran out of certain
equipment, PPE most commonly, but other supplies as well.
Suddenly, institutions had to purchase supplies and materials from
unknown sources, so no one knew how good the masks or the
gowns were, for example. ECRI conducted a great deal of work
in this arena, helping to assure clinicians that their institutions
purchased something on which they can rely. Unfortunately,
we found quite a few that did not meet our standards. I lived
for almost 20 years in the South, and I was part of the hospital
leadership for several hurricanes; after Katrina, every hospital made
multiple improvements, and nowadays I think these hospitals are
much better prepared. However, with regard to the pandemic,
we really haven’t had to deal with something that is not only a
threat to our patients, but is bringing in a significant influx of
patients, and making staff sick and some of them are dying from
it. That is not something we have dealt with in the past, so there
are limits to how well you can prepare for every eventuality. You
can be sure that the pandemic response will be stronger than it
used to be going forward.
HHM How is COVID-19 impacting HAI risk-related management?
How challenging is it to manage both SARS-CoV-2
and the regular pathogens of concern in the hospital?
BM: It comes down the using common sense about managing
pathogens in healthcare facilities; the key pathogens and sources
of infection transmission are still an issue whether you have a
pandemic or not. The pandemic does pose specific challenges to
manage; for example, Now, we may see new pressure injuries in
new areas of the body because patients are being positioned on
their bellies to be ventilated, but the principles of pressure-injury
prevention remain the same. There are more unusual scenarios,
with some facilities that may have been shut down and not used
for weeks or even month, and now we must think about the
potential for Legionella to be present in any stagnant water in
pipes, for example. So, it is important to not lose sight of the
normal pathogens that pose a threat before the pandemic began,
as well as to constantly consider how SARS-CoV-2-related risk
must be managed.
HHM Does the pandemic present an opportunity for a
healthcare institution to re-evaluate its risk tolerance as
well as its overall response to risk-related scenarios? How is
COVID-19 changing healthcare institutions’ safety cultures?
BM: We realized that when clinicians are so busy dealing with
a situation like an outbreak or a pandemic, they don’t have the
time or the inclination to necessarily think like risk managers,
and properly report the kinds of issues they’re finding, or what
kind of errors have occurred in the midst of saving lives. We all
need to hear about them, learn from them, and prevent them
form happening again. From a patient safety perspective, I started
hearing that, in some healthcare organizations, there has been a
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