Preparing to Improve Infection Prevention After COVID-19
By Matt Phillion
We aren’t out of the COVID-19 woods yet, but the healthcare community is already looking at what steps everyone can take for a safer environment. From infection prevention and control, to cleaning and disinfecting practices, to new and improved cleaning products, there’s a myriad of ways organizations will look to advance patient safety in a post-pandemic world.
Patients are noticing, too, notes Larinda Becker, executive director of marketing in infection prevention with Diversey.
“In a HIDA survey conducted a few years ago, when asked what was most important to patients when entering the hospital, 48% said visible commitment to infection prevention,” says Becker. “After a year-plus-long pandemic, awareness of infection control practices has grown significantly for patients and their families. They want to ‘feel the clean’ when they walk in.”
Today, that means patients should have easy access to hand sanitizers and be able to see staff thoroughly cleaning areas. “That visible commitment has really expanded,” she says. “Now we want to see validation systems and make sure it happens.”
“The public’s perception of surfaces and the role of transmission has evolved,” says Jim Gauthier, MLT, CIC, senior clinical advisor for infection prevention with Diversey. At the outset of COVID-19, we saw the public wiping down groceries when they arrived home and leaving packages outside to prevent transmission. But surfaces aren’t a major source of microorganism transmission, Gauthier says.
All the same, “we’re trying to get folks to focus on hand hygiene,” he adds. “If they encounter it on a surface, they need to be sure to not let it touch their eyes, nose, or mouth, as well as clean and disinfect commonly touched surfaces.”
The focus on surface cleaning has also elevated the overall conversation about disinfecting and hygiene. Many best practices we didn’t worry about in public before COVID-19 are under greater scrutiny today.
“In a restaurant, we have seen the staff spray and immediately wipe the table down. Now, they’re hopefully looking at the label to see that the surface must remain wet for a specific amount of time to ensure it will work against the germs before it is wiped,” notes Gauthier. “It’s a heightened awareness of how to clean and disinfect properly.”
For many infection prevention professionals, this has meant checklists, pictograms, and other educational offerings to teach how to disinfect properly and consistently. It’s reached beyond healthcare too, with schools, businesses, and even film sets taking a harder look at how they clean.
Yet there is still a struggle with a core preventive measure for COVID-19 and other viruses: improving hand hygiene compliance. “I’ve been doing this for 33 years, and we’re still fighting the hand hygiene battle,” says Gauthier. “There’s a lot that ties into it, changing adult behaviors.”
COVID-19 did result in an uptick in hand washing, at least at first. “Right after COVID began, hand hygiene compliance went up by over 70%, but then a survey this year showed it had dropped significantly,” says Becker. “Our behaviors change, but our habits don’t.”
Of particular interest with that spike in compliance, Becker notes, is that the healthcare industry saw much lower incidence of influenza and the common cold. Clearly, better hand hygiene and other improvements to disinfection lead to better outcomes beyond COVID-19. Whether the public can sustain these improvements remains to be seen.
Preventing future outbreaks
In our struggle with the pandemic, we developed quite a few good practices for infection prevention. But which ones will stick around long enough to help with the next crisis?
COVID-19 has helped usher in “the acceptability of wearing a mask when you’re unwell,” says Gauthier. “It’s been acceptable traditionally in Asian countries, to protect other people. It also stops you from touching two portals of entry, your nose and mouth. What I’m hoping we see going forward is, if [we] have to travel or go out, we put on masks when we’re sick to contain the virus.” This doesn’t have to be a sealed filtration mask, Gauthier says—just a mask to contain particles from the mouth and nose.
“This fear of things being in the air all the time; I think we need to focus down on specific risks,” he says. “I don’t think we need to live the rest of our lives afraid of that roaming virus. But if we’re sick, we don’t go visit a loved one in a long-term care facility. We keep sick children home. If I’ve been up all night sick with vomiting, I shouldn’t go out in public for 48 hours.”
Commonsense practices adopted during the pandemic are widely applicable for a generally healthier society, Gauthier says. “Part of my fear is we got so focused on COVID that we forget there are all kinds of things out there,” he says.
“We’re very focused on COVID, and we get questions all the time about it,” adds Becker. “Yes, this disinfectant kills COVID in 15 seconds, but it doesn’t have the same impact on rhinovirus, or the cause of the common cold. At the end of the day, we need to think beyond COVID. As habits change, as the COVID scare goes down, we are going to adjust and adapt. There are things looming out there, and we need to continue to be on guard and cautious and deploy the best practices we’ve learned.”
Finding the right tools, and the right people to use them, will be a challenge as we move forward. In his customer interviews, Becker often hears that organizations are struggling to find staff to disinfect surfaces. They are looking for tools to help with standardization and efficiency, using tools that anyone can pick up and use correctly and safely.
“People have started to open themselves up to new ways to do this,” says Becker. “We’ve seen several hospitals that would use UV light on a room so the staff felt more confident. There’s a lot more creative ways to make staff and visitors feel safer in the environment.”
“It gets back to that visible commitment,” says Gauthier. “We talk about it all the time. If you go to a restroom in a restaurant and it’s dirty, your impression of the entire restaurant changes. It sets the tone. If you don’t have a commitment to my safety in how you clean the restroom, how can I feel safe eating there?”
This attitude carries over into healthcare facilities as well. “If I walk into a hospital, my eyes are taking in everything as a trained practitioner,” says Gauthier. “Shiny floors aren’t necessary, but is there debris? Fingerprints on glass aren’t a big concern, but full trash bins, or no wipes available to do your own cleaning, those are the things I look for. It was what I did as a frontline provider to keep my patients and coworkers safe.”
Where to find buy-in
When considering how the healthcare industry will ensure it continues the practices learned over the past year, Becker points to one group that must buy in to the effort: “the loved ones of the patients,” she says.
Her organization works with long-term care facilities often, and “I’ve watched what nursing homes have been through—their resident stay rates are up significantly, and I think the residents and their loved ones will be very concerned about a safe environment. Getting trained staff will also be harder for organizations too, and providing them the resources to do the job.”
Gauthier says that giving people space in places like lunchrooms or gathering areas will make a difference going forward. “One thing I’ve seen helping a lot is better space between people. Everyone washes their hands coming off the unit before going into the lunchroom, but that concept of having a bit of elbow room, I’m hoping to see that keep going,” he says.
That shared responsibility—staying home when sick, giving space, cleaning up, and a commitment to better practices—will be important.
“Awareness has gone up among all the stakeholders,” Becker says. “We see this across all sectors. In the past, we might see environmental services come in once a day to clean, and they may take steps to avoid disrupting the patient. But what we’ve seen is an influx of situations where, for example, if a nurse comes in and touches five surfaces, they get cleaned.”
That awareness extends to how healthcare professionals act with each other, also. “I’ve had staff tell me they might have missed cleaning a part of a room because the physician came in, asked them to leave, and they forgot to come back afterward,” says Gauthier. “They’ve said it was an opportunity to correct themselves, and next time if they’re interrupted they know they can come back to finish cleaning. It’s a good teaching tool for me as an infection prevention practitioner—staff keeping patients safe can get interrupted, and in an ideal world, the physician can also ask how much time they need to finish and come back afterward.”
Validation tools are growing in use for identifying areas of improvement. “A lot of our customers are using validation as a training tool. It’s the Hawthorne effect: If you know someone’s checking your work, it may be more likely you will do it,” says Becker. “It also helps identify if there’s a training opportunity or a place to improve. This has challenged us to handle infection prevention in the most effective way possible.”
Awareness outside the industry can help healthcare
As other sectors began to retain infection prevention professionals during COVID-19, what used to be an add-on role in many industries has become a standard. “I hope it stays,” says Gauthier. “If we get the messaging right about what was learned in healthcare—that we didn’t have a flu season, that we had minimal amounts of norovirus—maybe it will.”
Industries in general did the best they could with a novel virus, Gauthier says, finding protective equipment and getting disinfection materials out. However, “there were a lot of lessons learned [that] I hope we keep discussing outside of healthcare, too. If we keep people healthy in the community, we keep them out of the hospital.”
In conversations with educational institutions, Becker has noticed a newfound level of awareness of what needs to be done. “I ask them: ‘What do you feel is different?’ They say, ‘These students travel all the time, and we have no idea what they’re bringing back.’ The awareness and diligence will stay on. The ability to prevent and react as needed has improved vastly.”
Things will inevitably backslide a bit, but the hope is that the lessons learned will not be forgotten. “When the next novel virus hits, there’s a fear factor that will make us better,” says Becker. “If we were at zero and now we’re at 90, I’d settle for something higher—as long as we’re at a level higher than our norm in 2019.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.