Infection Control: Maintaining the Momentum

The sudden and significant impact of the pandemic put infection preventionists at the forefront of efforts to keep staff and patients safe. Their knowledge and guidance have always been crucial, but responding to COVID-19 required them to act swiftly. Guidelines were constantly evolving, and many facilities struggled to digest the influx of new information while trying to figure out what new guidance was necessary and what might be overkill. 

At the onset of the pandemic, staff at Memorial Hermann-Texas Medical Center (TMC) in Houston felt extremely anxious. “Frontline nurses who hadn’t previously cared for patients with an infectious disease were now tasked with becoming intimately familiar with proper PPE procedures and attire,” says Rosemary Pine, PhD, RN, the medical center’s director of hospital education and professional development. “It became critically important to ensure that we educated staff about proper donning and doffing techniques.”

To quell her staff’s nerves, Dr. Pine went looking for guidance and was surprised at the limited research on best training practices for wearing PPE. “I ended up reviewing Ebola literature,” she says. “We didn’t know what COVID-19 was all about in the beginning, but we wanted to make sure our staff felt safe taking care of patients.”

At the height of the pandemic, when elective surgeries were put on hold, around 60 members of the perioperative staff were furloughed. But instead of waiting by the phone to be called back to work, the hospital asked them to form a PPE Surgical Task Force, which served as a highly reliable source of educational and coaching support for staff members assigned to care for COVID-19 patients. “It was the ideal opportunity to have members of the perioperative team educate other members of frontline staff,” says Dr. Pine.

The members of the task force attended a two-hour education class led by a CDC-trained observer. Donning and doffing guidelines were reviewed, and competency was verified. Although the PPE Surgical Task Force is no longer active, its formation during the initial phase of the pandemic helped the staff form concrete protocols for the future and define which strategies are most effective in making sure they follow infection control’s best practices.

• Positive reinforcement. The task force identified that simple communication and clear direction worked best during stressful situations. “The education class taught members of the task force how to effectively inform staff who were not donning and doffing their PPE properly,” says Valerie Ausborn, MPH, CIC, regional manager of infection prevention at Memorial Hermann-TMC. “It’s crucial to be honest and supportive. Saying things like. ‘I am here to help you,’ are very successful. This has helped our staff feel a lot more confident and comfortable.”

The task force also learned staff appreciate face-to-face instruction instead of just being handed literature on topics. Even as the numbers of COVID-19 infections continue to decline, Dr. Pine says communication among and with the staff is stronger than ever. “Every month our health system’s president and CEO hosts a virtual town hall to share the latest policy updates and answer any questions our employees have,” she explains.

• Clear policies. Like most healthcare facilities, Memorial Hermann-TMC instituted health screenings and visitor limitations during COVID-19. The facility’s staff has been constantly informed about updates to the polices through the various phases of the pandemic. As of mid-April, health screenings are not required for members of the workforce, patients or visitors before they enter the facility. COVID-19 testing is now required only for specific procedures and patients who are asymptomatic and can provide proof of current COVID-19 vaccination are exempt from testing. Masks are still required in all patient care areas, but are optional in non-patient care spaces.

Pam Falk, MPH, CIC, FSHEA, FAPIC, who has worked in the infection control field for more than 40 years and is the president of Pamela S Falk Consulting in Atlanta, believes it’s still critically important for facilities to update policies based on infection rates in their communities and keep staff informed of the changes. She says with new variants of COVID-19 popping up it’s best for facilities to not let their guard down. “Visitation has not completely opened up, primarily because COVID is not gone,” she comments. “We’re still watching variants to determine what kind of impact they might have.”

• Consistent rounding. Ms. Falk says certain basic protocols were put on hold during the height of the pandemic, and now those practices need to be reinstated. “Everyone was doing more than they usually do to keep up with new polices and procedures, so regular responsibilities such as monthly reports, team meetings and rounds were deferred,” she says.

Ms. Falk believes reemphasizing back-to-basic practices will be the focus for many facilities moving forward. “There will be more rounds by multidisciplinary groups to make sure staff is following infection control protocols,” she says. “Multidisciplinary rounds allow leaders with various areas of expertise to share their challenges and ideas about patient care. It also allows for better buy-in, communication and coordination among teams of different providers.”

Infection preventionists now make regular rounds at Memorial Hermann-TMC to continue supporting staff. “These rounds are paramount, because they help to improve patient outcomes and increase staff compliance with current protocols,” says Ms. Ausborn. Many hospitals have reported that multidisciplinary rounds improve communication and collaboration among members of the care team, and contribute to more reliable adherence to process measures.

The impact of COVID-19 has helped facilities prepare for future pandemics. It’s also helped to refocus efforts on basic best practices. Simple measures such as mask-wearing and handwashing have proven to be effective in preventing the spread of disease. In a global crisis when action plans are created and standardized with frontline stakeholders’ participation and leader support, a strong, sustainable safety culture is established that can empower the entire care team. OSM