Focus on Preparedness: Infection Prevention Lessons Learned from COVID-19
The global COVID-19 pandemic has put infection prevention teams in the spotlight, showcasing their expertise and decades of preparedness. As the outbreak continues, with the omicron and delta variants driving hospitalizations again, these teams are helping deal with an unprecedented surge in critically ill patients to deal with the additional ongoing challenges of inadequate supplies of personal protective equipment, staff shortages, fear and fatigue . The response to COVID-19 has challenged established procedures in ways previously unimaginable.
This experience highlights the importance of maintaining strong infection prevention teams and involving them fully in emergency preparedness planning. Hospital and health system leadership should make it a top priority to provide people and resources to support strong infection control teams with the ability to predict and respond to pandemics or local outbreaks, while advancing antibiotic stewardship and infection prevention practices. Antibiotic resistance adds nearly $1,400 to the treatment of a single bacterial infection, according to research based on the Federal Agency for Healthcare Research and Quality’s Healthcare Expenditure Group survey. A 2014 AHRQ study found that healthcare-related infections cost hospitals anywhere from $28 billion to $45 billion annually.
Despite enormous efforts, the hard-won progress in health care-related infection rates in the midst of the COVID-19 pandemic has taken a step back. A recent report from the Centers for Disease Control and Prevention’s National Health Safety Network published in Infection Control and Hospital Epidemiology found that four health care-related infections increased from 2019 to 2020. Increased use of ventilators and other equipment in critically ill COVID patients explains some, but not all, increases in centralline-related bloodstream infections, catheter-related urinary tract infections, ventilator-related events, and methicillin-resistant Staphylococcus aureus (MRSA) infections . The increases come after years of steady declines in healthcare-related infections.
The report also had some good news, showing that with proper support, infection prevention efforts are effective. Surgical site infection and C. difficile infection rates remained stable during the first wave of the pandemic—probably because long-established operating room procedures remained in place, and because handwashing, patient isolation, and environmental cleaning increased system-wide .
Beyond the operating room, many tried-and-true infection prevention efforts were disrupted as teams struggled to save lives and treat waves of COVID patients in challenging circumstances. Infection prevention and control teams are fragmented due to staffing pressures, the need for rapid training reassignment, and the need to develop and revise COVID infection prevention protocols in response to changes in virus knowledge. Antibiotic stewardship took a hit, especially early in the pandemic, as health teams with few options tried multiple ways to treat patients, leading to overuse of antibiotics.
This real-life stress test of our system highlights the need to configure infection prevention practices differently so that they become a sustainable part of care delivery. Evidence shows that strengthening infection prevention and control capabilities is effective, but stronger, deeper, and broader resources are needed to improve our ability to protect patients in future pandemics, while also improving patient care and protecting patients from disease every day. infected.
As the pandemic develops and eventually subsides, healthcare leaders must work to get back to basics, training and retraining employees, cross-training and building systems that work even under stress. Infection prevention policies, antibiotic stewardship and training will require ongoing monitoring of rebuilding capacities weakened in the recent crisis. Leaders must ensure infection prevention teams are strong enough to take a leadership role in managing the outbreak, while continuing to play a key role in overall patient safety. Without vigilance, health care-related infection rates, antibiotic overuse and related complications, deaths and costs will continue to rise, and the quality of care will decline.
Health systems must hardwire care processes to ensure healthcare-associated infections are not monitored during a surge in cases. This requires dedicated resources from healthcare leaders, especially adequate staffing, to contain the infection. Leaders must also include hospital epidemiologists and infection prevention staff in all emergency preparedness plans, ensuring they are a core member of the command center.
There is no time to waste. It is never a question of “if” but “when” the limits of the healthcare system will be tested again by another outbreak, epidemic or pandemic. Our preparation depends on healthcare leaders committing to never forget the hard lessons of the COVID-19 pandemic and prioritizing resources for lasting and sustainable change.