Written by Carole W. Kamangu
Patient Overflow Situation in a Hospital (AI-generated)
“We just got a new patient who came from [a COVID-affected country]. We’re sending out a COVID test request to the lab right now! We’ve isolated him in [private room number]. We’re all wearing full PPE with N-95s or PAPRs. Are we good to go?”
“Yes, that’s awesome! We’ll monitor those lab results and go from there. Has he had any roommates since he got here? Was he masked while sitting in the waiting room?”
“No, thankfully no roommates! He presented with respiratory distress and didn’t get a chance to sit in the waiting room. The triage nurse sent him directly to a private room that was available in the back.”
“Wonderful!”
This sounds like a movie scene, doesn't it? But this isn't part of my creative writing skills, this is a paraphrased version of a real conversation that happened between an infection preventionist (IP) and a bedside nurse in a facility that I worked with during the pandemic. Although there was still some panic in the nurse’s voice, she remained calm and implemented proper infection prevention and control (IPC) practices that the IPC department had recently added to its Special Pathogen Management and new COVID-19 policies. Additionally, the IPC department had just conducted a facility-wide emergency preparedness drill for Special Pathogens a few months before this situation occurred. The department had also been monitoring the progression of the epidemic in China and started reviewing and updating its policies and procedures since SARS-CoV-2 was described as an unknown respiratory virus. In the scenario, it was evident that the nurse and IP had learned preparedness skills from their experience through the emergency drill and were able to calmly take initial steps to prevent potential exposure within the facility once an infected patient arrived at their facility.
You may have already guessed: the patient had recently traveled from China and tested positive for COVID-19. Thankfully, exposures were prevented due to prompt isolation by the nurse. This was only the facility’s first encounter with one of the first COVID-19 cases in the U.S. before many more similar cases were admitted. The IPC department’s proactive interventions in this case, although on a small scale, are a demonstration of emergency preparedness at its best.
Expanding Perspective Beyond the Bedside
The primary focus of infection prevention and control (IPC) programs is on preventing and controlling the spread of infections within healthcare facilities. The main responsibilities for IPC practice focus on the education of healthcare personnel, patients and their families, transmission precautions (i.e. isolation), cleaning and disinfection, employee health and management of medical equipment, emphasizing a strong focus on daily routine activities.
The topic of emergency preparedness has traditionally been associated with public health and large-scale response activities. The COVID-19 pandemic, however, has given infection preventionists (IPs) an opportunity to rethink how they structure their operations. With increased international travel and reduced adherence to previously established public health guidelines, infectious pathogens, such as measles, that were once eradicated from certain countries have now resurfaced, becoming public health threats once again. The threat of emerging pathogens such Candida auris, rapidly spreading outside of its originally known geographical zone and being reported worldwide by at least 30 countries, its increased resistance to a variety of antifungals and ability to perdure in the healthcare environment despite the implementation of standard infection control practices through environmental cleaning and disinfection, is a major cause of concern. These emphasize the importance of preparedness in IPC programs.
IPs are impacting lives and working in various settings nowadays, including outside of healthcare. Given their roles in ensuring that infectious pathogens remain contained and mitigating transmission risks, now more than ever, IPs need to stay informed and alert about emerging trends of disease transmission outside of their work environment, within their regional communities and also from around the world.
Emergency Preparedness Tips for Infection Prevention and Control
In our previous COVID-case scenario, without the IPC department’s proactive actions, here’s how the conversation between the nurse and IP could have turned out:
“We got a new patient who, we just found out, came from [a COVID-affected country]. What do we do? I spoke with the charge nurse and she told me to call you because she doesn’t know what we should do!!! I can’t get COVID, I have a little one at home! Do we have a protocol for this? The patient is sitting in the waiting room and we’re getting a mask for him right now! He’s been sitting there for an hour! What do we do???!!”
“Thanks for calling us. Is there a private room available? We need to place him in...”
“Not yet! The charge nurse is on the phone with the nursing supervisor. What can I do right now?!!”
This type of conversation could go on for a few minutes, emotions could escalate and miscommunication could occur, making the situation more difficult to handle. Although it’s impossible to prepare for every real-life scenario, having a protocol in place is an effective way for IPC departments to be prepared and for IPs to build confidence in emergencies.
Here's how IPC leaders can encourage their IPs to become more skilled at emergency preparedness:
1. Conduct A Risk Assessment
As demanding as the daily job of IPC leaders can be, juggling multiple priorities often feels like a nightmare, that could easily turn the daily focus to putting out fires instead of preparing for and mitigating them. By changing their mindset from purely reactive consultants who answer calls and questions throughout the day, they can shift their mode of operation to looking at what's happening in the world and thinking of how it would affect them if they have no mitigation plans in place. That's where a comprehensive risk assessment needs to be conducted.
2. Establish A Surveillance and Response Protocol
More important than the IPC risk assessment is having a robust emergency preparedness plan that incorporates critical infection control activities in the event of an emergency. One small step that the IPC team can take is empowering its IPs by guiding them towards the resources they need to be prepared.
Because the pathogen of concern may not always be known, an effective way to remain alert and prompt with IPC interventions should involve:
Syndromic surveillance to identify the need for isolation at the time of arrival by monitoring each patient’s clinical picture via an electronic system that displays a trend of a specific disease
Travel history intake during the triage stage to identify the patient’s potential exposure to a known infectious pathogen circulating in a specific geographical area
Use of the 3 I’s framework for prompt isolation of persons under investigation (PUI) for a communicable disease
3. Subscribe to Emergency Alert Systems
Subscribing to national, local, and international alert notification systems is important for IPs to remain aware of what's going on outside their work environment. This provides ongoing situational awareness and allows them to review their policies and procedures, and plan in advance to address any needs for emergency activation when situations arise. For example, subscribing to the ProMED mailing lists from the International Society for Infectious Diseases (ISID) allows IPs to remain aware of the transmission of diseases and reported outbreaks from around the world. Signing up to email updates from the Health Alert Network (HAN) by the Centers for Disease Control and Prevention allows U.S. IPs to get notified regarding health emergencies at the national level.
4. Educate Yourself and Others
Ongoing education and training are important for IPC programs to remain effective. IPC teams should continue to educate themselves on pathogenic transmission outside their primary setting by participating in in-person and virtual educational sessions through industry-related webinars and workshops, and readily available courses on emergency preparedness. They should also actively participate or initiate emergency preparedness training exercises that engage frontline workers to test out their procedures in the real world and make the necessary improvements before a real emergency arises.
Remaining aware of global developments helps IPs develop a great sense of preparedness, enhancing their skills and allowing them to become proactive practitioners. By staying proactive, IPs and infection prevention and control (IPC) leaders can ensure that their emergency preparedness plans cover the necessary activities that must be quickly activated in the event of an outbreak, ensuring a smooth transition of operations.
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