The novel coronavirus exposes healthcare facilities to several infection risks, including spread of the virus from asymptomatic people.
After months of grappling with the novel coronavirus, infection preventionists have developed several best practices for tackling the germ, the president-elect of the Association for Professionals in Infection Control and Epidemiology (APIC) says.
The coronavirus—which emerged from Wuhan, China, last December—initially posed many infection prevention challenges. How was the virus transmitted to humans? How virulent was the germ? How could healthcare workers be protected from getting coronavirus disease 2019 (COVID-19)?
"Infection preventionists are certainly front-and-center during this pandemic—it is an essential role in facilities trying to deal with all healthcare-associated infections. COVID-19 presents unique risks," says Ann Marie Pettis, RN, APIC president-elect and director of infection prevention at Rochester, New York-based UR Medicine.
The coronavirus presents five primary infection prevention challenges in the healthcare setting, she says.
- People can be asymptomatically infected and infectious. "With the first SARS virus, that was not the case—those patients only became infectious once they became symptomatic. What we are seeing is that we are sometimes having patients admitted who test negative but start to exhibit symptoms a couple of days later. When they are re-tested, they test positive," Pettis says.
- This germ is also more infectious and easier spread than influenza virus. "The experts are still trying to figure out all of the ways the new coronavirus might be transmitted," she says.
- Asymptomatic or pre-symptomatic healthcare workers going to work present a risk.
- Healthcare workers have to be on guard for surface contamination. "With the surge that many facilities have experienced such as in New York, you worry about all of the surfaces getting decontaminated appropriately and whether we are letting the disinfectants sit long enough for them to kill the organism," Pettis says.
- Aerosol-generating procedures such as intubating and extubating pose a high risk to healthcare workers. "All of these things can make patients cough and create more of an infectious environment," she says.
Novel coronavirus infection prevention in healthcare settings
There are seven primary infection prevention best practices for coronavirus in healthcare settings, Pettis says.
1. Telehealth: Using telemedicine capabilities for routine medical care and assessing infectious disease symptoms is going to be "a new normal," she says.
2. Triage: Assessing patients who have respiratory symptoms in tents and other sites outside healthcare facilities protects hospitals from the spread of coronavirus. "After triaging, you can send patients home who do not require hospitalization. We are even talking about creating more permanent structures rather than tents to do rapid triage," Pettis says.
3. Personal protective equipment: At UR Medicine, there is not only universal masking to prevent the spread of coronavirus at healthcare facilities but also universal eye protection for healthcare workers, she says. "For several months, our facilities have been requiring eye protection as well as masking, which has dramatically reduced the amount of exposures for our staff."
4. Patient coronavirus testing: UR Medicine is pre-testing patients who are having elective surgeries as well as procedures that require sedation.
5. Visitation policies: Limiting patient visitors helps keep the coronavirus from entering healthcare facilities. "Even though UR Medicine is loosening some limits, we are limiting the amount of time patients can have a visitor, masking visitors, screening visitors, keeping visitors in the patient's room and not letting them go to the cafeteria, and directing visitors through one entrance," Pettis says.
6. Traffic control: Patients should not spend time in waiting rooms. For example, patients can wait in their cars for appointments.
7. Staff and patient engagement: Healthcare facilities must engage staff and patients to follow infection prevention best practices. For example, staff need to be reminded continually not to come to work if they have COVID-19 symptoms, she says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
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