The COVID-19 pandemic has been a wake-up call for many in the healthcare industry.
News reports were common, particularly early in the pandemic, of a lack of personal protective equipment like N95 masks. At many facilities and nursing homes, gaps in infection control policies and practices surfaced as COVID-19 infections and deaths spread among elderly patients.
Infection control experts hope the tragic lessons learned during the pandemic will result in a greater appreciation of the risks associated with disease pathogens and steps that can be taken to reduce their spread.
“The good news is I think people have a much healthier respect for infection prevention as a result of the pandemic,” said Ann Marie Pettis, BSN, RN, CIC, FAPIC, President of the Association for Professionals in Infection Control and Epidemiology (APIC). “I do think that healthcare workers are taking infection prevention much more seriously.”
As a result of the pandemic, Pettis said nurses and other healthcare workers are paying closer attention to everyday infection prevention measures such as disinfecting surfaces and regularly cleaning equipment like stethoscopes when going from patient to patient.
Practicing proper hand hygiene is another prevention measure healthcare workers are taking more seriously because of the pandemic, according to Elaine Larson, PhD, RN, FAAN, CIC, a nationally renowned infectious disease specialist and retired Professor of Epidemiology at the Columbia University Mailman School of Public Health.
Larson, who has published more than 400 journal articles and four books on infection control and prevention and related issues, has written frequently about the importance of hand hygiene and believes the pandemic has increased staff compliance with recommended hand hygiene practices.
She also said that, combined with the regular use of masks and social distancing, hand hygiene has not only helped reduce the spread of COVID-19 in facilities but also has resulted in record low cases of seasonal flu.
“It’s clear that physical distancing and hand hygiene works,” she said. “I think there’s more data now showing the impact.”
Larson is concerned, however, that after past disease outbreaks hand hygiene and other infection prevention practices were typically not followed as carefully once the immediate crisis was over. “The challenge is how to change the fundamental culture so that hand hygiene is an expectation and habit rather than perceived as an ‘add on’ during crisis,” she said.
The Need for PPE
The pandemic also has highlighted the need for specialized equipment when dealing with infectious patients, such as N95 respirator masks and eye protection, according to Phenelle Segal, RN, CIC, FAPIC, President and Founder of Infection Control Consulting Services, a national consulting firm that offers expert infection control and prevention services to a variety of healthcare facilities and other organizations.
Before the pandemic, Segal said this type of specialized PPE equipment was used sparingly, if at all, by healthcare workers and usually only when dealing with patients with highly infectious diseases such as pulmonary tuberculosis. Segal said because of the pandemic, staff will always be more aware of the need for N95 masks and eye protection when treating infectious patients.
Healthcare facilities also have been forced to make changes in response to COVID-19. Many healthcare facilities were caught off guard by the pandemic and did not have adequate supplies of PPE or other equipment for staff. Pettis believes that most healthcare facilities now realize the “just-in-time” mentality of purchasing supplies and equipment only as needed does not work in emergency situations like a pandemic.
“One of the biggest challenges that nurses and other healthcare workers faced during the pandemic was a lack of supplies,” Pettis said. “Hopefully this is something that will never happen again.”
Segal believes hospitals, nursing homes, and outpatient treatment centers have a greater appreciation of the need to maintain adequate supplies of PPE because of the pandemic.
While COVID-19 is the worst pandemic in more than a century, Segal noted that there have been worldwide outbreaks of other diseases in recent years such as SARS-CoV-1, H1N1, MERS, and Ebola. “Something is going to happen again,” she said. “It’s inevitable. So we need to recognize that keeping up supplies of PPE is incredibly important.”
Segal added that many facilities also have reviewed and updated their policies and procedures on infection control and prevention and implemented new policies regarding hand hygiene and other transmission-based precautions. Other practices were enacted specifically for the pandemic such as screening for illness, temperature checks for staff and visitors, and even limiting visitors. While some of those measures will be relaxed in a post-pandemic world, she said many of the changes will likely become regular practice.
Pettis said the pandemic also highlighted the importance of facilities having trained and experienced infection preventionists on staff. This is becoming increasingly important because of the aging workforce and the fact that some staff left the profession during the pandemic due to burnout and stress.
She said APIC recently put out a request to encourage colleges and universities to help design and pilot a core curriculum for infection prevention. “This is important because there has been an unbelievable increase in demand (for infection preventionists), and it’s only going to continue to increase,” she said.
On the positive side, Larson said there have been encouraging signs in terms of increased enrollment in schools of nursing and medicine, and more people are interested in pursuing careers in the healthcare profession.
However, there are still significant staffing shortages and other challenges such as fighting vaccine hesitancy among patients and staff. “There are many healthcare professionals working in nursing homes that are hesitant about the vaccine,” she said.
Lessons Learned From Pandemic
Larson said she would like to think the lessons learned from COVID-19 will lead to long-term changes in infection control and better preparedness for future pandemics. She believes there must be a worldwide focus on pandemic preparedness since viral pathogens can easily spread from country to country.
“We have to find a way to collaborate across countries better than we do,” she said. “There has to be a global effort if we’re going to do better in the future.”
Segal said she is optimistic that permanent changes will come about in infection prevention and pandemic preparedness because of the devastating impact COVID-19 has had worldwide.
“I can’t see us ever going back to pre-pandemic thinking,” she said. “This has been such a wake-up call that I don’t believe we’ll ever be in this sad of a situation again. I’m confident that the lessons learned will be transferred to everyday situations, and we’ll never be in as dire a situation in terms of not being prepared.”