Hospitals and Infection Prevention Concerns Around COVID-19: One Expert’s Perspective

March 20, 2020
Robin Carver of Premier Inc. shares her perspectives on the infection prevention and control issues facing U.S. hospitals right now as the COVID-19 pandemic surges

Infection prevention couldn’t possibly be a timelier topic these days, with the COVID-19 virus surging nationwide and globally right now. One healthcare leader who’s in the thick of things around this issue is Robin Carver, R.N., vice president of member engagement at the Charlotte-based Premier Inc. Carver practiced for years as an infectious disease specialist, with training in infection control. She spoke this week with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the current situation in U.S. hospitals around infection prevention and control, and what senior hospital leaders should be thinking about right now. Below are excerpts from that interview.

How would you describe the state of preparedness around infection prevention and control issues right now in hospitals?

Honestly, infection prevention and control professionals in hospitals and health systems have been planning for situations like this for years. I was running the infection prevention department in a hospital, and the Joint Commission requires that you have these plans in place as part of their model standard. And you always want to prepare as much as possible. The reality is that you can only stock so much PPE [personal protective equipment] as possible and you can only acquire so many ventilators. So you need plans to ramp up. And yes, it’s disturbing for organizations because they’re responding on the fly and trying to keep up with changing rules and regulations, but from an infection prevention standpoint, we’ve been through this a few times already, with H1N1, MERS, and SARS.

What are the key areas you’re concerned about right now as potential gap areas?

There are a few areas I would focus on. The first is the potential for this to overwhelming the staff. Also, you worry about some of your staff getting sick. You worry about overwhelming the system with worried well patients and also patients who are symptomatic and need to be tested. Also, flu is so widespread. And other viruses. Here in North Carolina, it’s all yellow right now, so respiratory symptoms could be pollen-related. And in terms of the PPE situation, where we know hospitals are running through supplies very rapidly—you worry about people taking supplies with them from the hospital. And then our radiology techs, infection preventionists and the environment services and food services workers. We think first about doctors and nurses, but all these other people we should be concerned about, too.

What should senior hospital and health system leaders be doing right now?

One thing that senior leadership could do is to support the staff—emergency preparedness folks, infection preventionists, they are the experts. The support that a senior leader can offer them is invaluable. Help with dispelling myths. Ensure that we can have a consistent message from the top down. Presence. That’s very important as everyone is going through the stress and anxiety. As a nurse, you’re worried about bringing this home to your family. So presence to say, we understand you’re worried about your families, too. The other thing is giving them the tools. You need a customizable, flexible, adaptable system. We created a package of alerts around patients with symptoms, patients with pending lab tests, and patients with positive lab tests. You want to follow them and make sure their observed. So the infectionist needs to follow that.

What is your sense of the level of preparedness in hospitals nationwide right now?

I’ve been in infection prevention for nearly 20 years. This has always been a very important topic. We’ve had plans in place. We take what we learned from previous outbreaks, adjust our plans, and then adjust in the moment. Do I think that hospitals have an overwhelming abundance of PPE? No. that’s where our supply chain partners come into play. And with turnover of nurses—a lot of nurses infected themselves during SARS—gowns, gloves, masks—there’s a proper order in which to put on and take off the PPE. You have to not infect yourself. After you take your mask off, you can’t touch your face, because you could infect yourself. And infection prevention specialists are on the wards and in units and are doing reeducation as necessary. They’re listening to the updates from the CDC and WHO, and also have to monitor to make sure patients coming in are being monitored and isolated correctly. And they’re running at 100-percent capacity right now.

Could you address the conflict between the WHO [World Health Organization] and CDC [Centers for Disease Control and Prevention] guidance, around the use of PPE, with the CDC guidelines far more rigorous, thus potentially making it harder for hospitals to retain PPE supplies?

In the U.S., we use CDC as the gold standard for guidelines. And so yes, there seems to be a disconnect where CDC is still recommending airborne isolation rooms and 95 masks, when we know that coronavirus involves droplet transmission. I don’t want to speak to that rationale specifically. But at a hospital level, what we have to think about is that N95s are a bit more difficult, because we have to fit-test people for those. And airborne isolation rooms are not plentiful; they involve a special type of ventilation. I came from a hospital with a high rate of TB, and so we built more airborne isolation rooms. And you can put some engineering controls in place to do that, but it slows down your throughput and how many patients you can take. And a lot of clinicians are anxiously waiting to see whether CDC will alter its recommendations.

Can you speak to the COVID-19’s exponential growth curve, and the impact it will soon have?

If you think about this from a public health perspective, we want people to abide by the social distancing guidelines. And does that allow the curve to flatten a bit? We want to flatten the curve, and we want to see whether there’s any seasonality to this; we don’t know. But flattening the curve could also allow our health systems to get a handle on this. I know it’s bothersome; it was an adjustment for me, because I work from home. And it’s a big adjustment. But we’re in a unique situation. We had SARS, but it wasn’t like this. So I think that the biggest thing that the American people can do for healthcare is to abide by these recommendations and guidelines to see whether it helps to decrease the spread and relieve some pressure on hospitals and health systems. We’ll still have people with CHF and bacterial infections and everything else. And we need our healthcare providers to be able to function effectively.

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