The Challenges of Infection Control in the Age of COVID-19
Infection prevention likely will be a higher priority activity and quality improvement project for surgery centers as the COVID-19 pandemic continues to flare over the next year. One place to start is the interim infection prevention and control recommendations from the Centers for Disease Control and Prevention (CDC), which address COVID-19 in healthcare settings.
“The CDC regularly updates their infection control guidelines for the management of COVID-19 patients,” says Therese Poland, RN, senior vice president of accreditation services at the Accreditation Association for Ambulatory Health Care (AAAHC). “All organizations should visit the CDC website, and update their policies and procedures to reflect essential practice."
For instance, surgery centers could start with reducing risk through early identification, which they can achieve through implementation of a rigorous prescreening process, Poland offers.
“Consider calling patients ahead of time and conducting phone screens and, then, screening again at check-in,” she suggests. “This could lead to immediate isolation of symptomatic patients with separate waiting areas or rooms with dedicated trained staff and equipment.”
Surgery centers also should inform authorities of any identified infections. “Organizations should review their standard and transmission-based precautions, and actively monitor provider and staff adherence,” Poland says. “This includes heightening focus on hand hygiene and use of personal protective equipment [PPE].”
Infectious disease physicians and scientists have addressed some of the challenges related to infection prevention in the era of COVID-19 in twice-weekly virtual media conferences about the pandemic.
One challenge is the complete novelty of the virus. When the first cases were reported, clinicians did not know COVID-19 was infectious during a presymptomatic period that could last up to four days, noted Jeanne Marrazzo, MD, MPH, FIDSA, director of the division of infectious diseases at the University of Alabama at Birmingham. Marrazzo spoke during an April 10 virtual media briefing hosted by the Infectious Diseases Society of America. There also are many more symptoms associated with COVID-19 than initially believed. “We were treating it like a classic respiratory infection. A lot of people refused testing because they didn’t fit the classic symptoms of the syndrome,” Marrazzo said. “Now, we know the range of symptoms is quite expanded, like a loss of smell ... which is specific to this infection.”
This means surgery centers and other healthcare facilities will need to protect against the spread of COVID-19, even among nonsymptomatic patients. Even a negative COVID-19 test is not a guarantee the patient is free from infection. Researchers recently discovered one company’s COVID-19 test produced about a 15% false-negative rate. (Editor’s Note: This research has not yet undergone the peer review process, nor has it been published in a peer-reviewed journal. The company that developed the test stands by the reliability of its device. Read much more here.)
Scientists also have found that the virus is detectable in aerosols for up to three hours and can live up to 24 hours on cardboard and two to three days on plastic and stainless steel.
For these reasons, some surgery centers might choose to direct all staff, patients, and visitors to wear masks or PPE while on site. Even when there are reliable antibody tests, clinics might choose to stick with masks until COVID-19 is gone.
“There has been talk of testing healthcare workers to see who has been exposed or not exposed, but we still do not have enough trust in what exposure means,” says Kimberly E. Hanson, MD, MHS, an associate professor of internal medicine at the University of Utah. “We will all still have to wear our PPE, and that won’t change.”
When organizations experience PPE shortages, they may need to consider crisis capacity techniques. “A carefully planned crisis strategy prioritizes the use of PPE for selected patient care activities, such as sterile gloves and gowns for urgent sterile surgical procedures, or procedures where splashes and sprays are anticipated,” Hanson explains. “Expired PPE may be considered for other types of patient care activities.”
If a surgery center needs more options for PPE access, leaders could consider implementing a limited-use face mask policy, using the CDC’s burn rate calculator as a guide to preserve supplies.
“These are challenging times. We may have to learn new behaviors and use new tools to ensure employee and patient safety is maintained throughout the emergency,” Poland says. “AAAHC will continue to provide updated information relating to COVID-19.”
Infection prevention likely will be a higher priority activity and quality improvement project for surgery centers as the COVID-19 pandemic continues to flare over the next year. There are various resources leaders should consider to help in these endeavors.
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