Special Edition on Infection Prevention & Control | Page 8

perspectives
By Sylvia Garcia, MBA, RN, CIC
Navigating Infection Prevention and Control
During a Pandemic
As we face
a prolonged
pandemic and
move to resume
regular care
delivery, with
additional waves
of the pandemic
anticipated, it
is necessary
to implement
prevention and
control measures
based the best
information
available about
COVID-19 to
protect health care
staff – who in turn
will protect health
care patients.
About a year ago, I was invited to speak at
the annual Joint Commission and Joint
Commission Resources Emergency Preparedness
Conference in Washington, D.C. I began my
presentation by listing unusual pathogens and
emerging infection diseases that I have personally
experienced during my 30-plus years of working
as an infection preventionist. These include human
immunodeficiency virus in the 1980s and 1990s,
anthrax in 2001, suspected severe acute respiratory
syndrome in 2003, disseminated vaccinia in 2007,
H1N1 in 2009, suspected middle east respiratory
syndrome in 2012, and suspected Ebola in 2014.
Based on my experiences, I reviewed key components
of preparing for an infectious emergency and
described possible strategies to maintain constant
readiness. These include:
•
●Providing a means to proactively identify
hazards and how they apply to various types of
healthcare personnel and locations within healthcare
●Creating clear employee health policies that
spell out processes for screening, testing and
management of ill employees
●Ensuring staff are knowledgeable, trained and
competent and are provided supplies necessary
to implement routine prevention methods (e.g.,
hand hygiene, selection and use of personal
protective equipment) that focuses on potential
routes of transmission
●Identifying the strengths and weaknesses of
facility design related to containment of infection
●Communicating effectively and using communication
strategies that both inform staff and
collect feedback.
Cut to 10 months later, and here we are in the
midst of a worldwide pandemic -- how could anyone
have anticipated the challenges that healthcare
providers and organizations would face during the
last five months?
The traditional approach of identifying symptomatic
COVID-19 infection and isolating patients or
sending home employees does not work because
people with COVID-19 are infectious for days
before they show symptoms and a large number of
people do not exhibit symptoms at all. 1 Employees
with symptoms are sent home but others without
symptoms could be exposing the rest of the health
care organizations’ staff.
Many factors affect how healthcare workers and
organizations navigate the COVID-19 pandemic,
including: rapidly evolving guidance, shortages
of PPE and supplies, social media’s influence,
information overload, the psychological impact of
caring for COVID-19 patients…the list just goes on.
As we face a prolonged pandemic and move to
resume regular care delivery, with additional waves
of the pandemic anticipated, it is necessary to
implement prevention and control measures based
the best information available about COVID-19 to
protect healthcare staff – who in turn will protect
health care patients. These preventative measures
include understanding what is currently known
about COVID-19 transmission:
●Transmission is primarily via respiratory
droplets. 2
●Risk of transmission is increased during
aerosol generating procedures (e.g., nebulizer
treatments, BiPAP). 3
●Coronavirus can survive on some surfaces for
hours to days. 4
●Coronavirus can be spread from infected
asymptomatic, presymptomatic, and symptomatic
individuals. 5,6.7
●A negative COVID-19 test does not rule
out infection. 8
As an accrediting organization, the Joint
Commission has used the preceding information to
create a Position Statement: Preventing Nosocomial
COVID-19 Infections as Organizations Resume
Regular Care Delivery. The statement was published
on May 27, 2020. and key measures to prevent
transmission of COVID-19 include:
●Healthcare organizations should continue
to follow Centers for Disease Control (CDC)
recommendations for universal masking of staff,
patients, and visitors. This proactive measure decreases
the risk of transmission from asymptomatic
patients and visitors to facility staff as well as the
risk to patients, visitors and other staff from an
infected health care worker. Wearing masks lets
patients know that an organization is up to date
with current public health recommendations and
encourages trust in the medical delivery system.
Masking should be practiced in addition to (not
instead of) social distancing. 2
8 IP&C Special Edition June 2020 • www.healthcarehygienemagazine.com