patient safety & quality
By J . Hudson Garrett Jr ., PhD , MSN , MPH , MBA , FNP-BC , IP-BC , PLNC , CFER , AS- BC , VA-BC , BC-MSLcert™ , NCEE , NREMT , MSL-BC , DICO-C , TR-C , CPPS , CPHQ , CPXP , FACDONA , FAAPM , FNAP , FSHEA , FIDSA , FACHE
Sniffles , Snorts , Coughs , and Hacks : The Era of Modern Respiratory Infectious Diseases
Currently , the most common respiratory infections include COVID-19 , influenza , pneumococcal disease , and colds . Some pathogens follow a more seasonal distribution pattern , such as influenza and RSV , and can even target the most vulnerable patient populations , such as newborns and the elderly . For respiratory pathogens to infect patients in healthcare settings , only a few things need to happen to result in transmission . Luckily , with basic and consistent infection prevention measures , many of these infections can be mitigated successfully . The chain of infection transmission includes :
• Infectious Agent : the bacteria , fungi , or virus that is pathogenic
• Source : people , equipment , water
• Exit : such as aerosols and splatter
• Means of Transmission : contact , inhalation , airborne , or vector-borne
• Portal of Entry : mucous membranes , respiratory tract , or broken skin
• Susceptible Host : a patient with a compromised immune system .
There are several primary routes for infection transmission , which include :
• Contact : This isolation level requires hand hygiene , gloves , and a gown .
• Droplet : This level of isolation requires a surgical mask and preferably eye protection .
• Airborne : This level of isolation requires the use of a NIOSH-approved respirator .
In addition to the patient-specific issues regarding respiratory infections , healthcare providers must also consider patient exposure , symptoms , the availability of laboratory testing , the availability of efficacious treatment options , and vaccines .
• Patient exposure
• Symptoms
• Availability of laboratory testing
• Availability of efficacious treatment options
• Vaccines
RSV is a common respiratory infection that has historically infected the infant population and has caused many outbreaks in neonatal intensive care settings . RSV can be problematic and deadly to premature infants or those with severely compromised immune systems . Luckily , with good adherence to core infection control measures such as hand hygiene , appropriate use of personal protective equipment , particularly masks , and frequent environmental cleaning and disinfection , healthcare professionals can normally stop outbreaks in their tracks .
While some respiratory pathogens have prophylactic vaccines available , these vaccines have varying levels of efficacy , particularly
that of the annual Influenza vaccine . The development of vaccines , in and of itself , is an extraordinarily complex science that requires tremendous research and development . Vaccines , however , have significantly reduced overall mortality and morbidity in many instances .
Given the ongoing threat posed by the COVID-19 pandemic , healthcare facilities should also be given special consideration to the risks associated with aerosol-generating procedures ( AGPs ). According to the current Centers for Disease Control and Prevention ( CDC ) guidance , AGPs include but are not limited to :
• open suctioning of airways
• sputum induction
• cardiopulmonary resuscitation
• endotracheal intubation and extubation
• non-invasive ventilation ( e . g ., BiPAP , CPAP )
• bronchoscopy
• manual ventilation
Even though AGPs can heighten the risk of transmission to healthcare staff , adherence to proper personal protective equipment practices can effectively eliminate this risk . Other measures such as using antiviral filters in circuits can trap potentially infectious aerosols and prevent them from escaping into the air . There will always be inherent risks of infection transmission in healthcare , but with aggressive infection prevention efforts , many of these can be mitigated .
Respiratory pathogens are here to stay , but by consistently following infection control best practices , healthcare facilities can substantially reduce the risk for infection in both patients and healthcare staff members alike . There are many lessons to be learned from the COVID-19 pandemic and most can be applied to the general prevention of respiratory infections . As we continue to experience respiratory pathogens such as COVID-19 , RSV , and seasonal influenza , now is the time to formalize the infection prevention core measures to decrease risks , improve clinical outcomes , and remove preventable costs from healthcare .
J . Hudson Garrett Jr ., PhD , MSN , MPH , MBA , FNP-BC , IP-BC , PLNC , CFER , AS-BC , VA-BC , BC-MSLcert™ , NCEE , NREMT , MSL- BC , DICO-C , TR-C , CPPS , CPHQ , CPXP , FACDONA , FAAPM , FNAP , FSHEA , FIDSA , FACHE , is president and CEO of Community Health Associates , LLC . He also serves as an adjunct assistant professor of medicine in the Division of Infectious Diseases at the University of Louisville School of Medicine , is a fellow with the Institute for Healthcare Improvement , and has earned designation as a Fellow with both the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America . Garrett is a frequent lecturer globally on patient safety , infectious diseases , and medical device reprocessing and safety . He may be reached at : Hudson . garrett @ chaassociates . com