Infection Control Experts Share Learnings from Pandemic Response

When infection control experts at healthcare facilities in Northeast Ohio were asked about lessons learned from those first whirlwind months of pandemic response, an overwhelming theme that emerged was the need to be nimble, flexible and creative as they adjusted to almost constantly changing circumstances. The COVID-19 pandemic put to the test nearly two decades of emergency preparedness training and planning by hospitals, public health agencies and their partners. For the first time since this collaborative work began with the support of federal funding shortly after Sept. 11, 2001, partners were called upon to meet a rapidly developing public health crisis unlike any they had previously experienced.  Seeking to learn from it, in late 2020 The Center for Health Affairs distributed an infection control survey to 27 hospitals as well as to long-term care facilities. The purpose of the survey was to glean information about the strategies they implemented and barriers they faced during the first eight months of their pandemic response. Survey responses were received from 48 organizations – 27 hospitals plus 21 additional facilities – in which participants reflected on their experiences with infection control. When asked about their top lessons learned, facilities said:

• Communication and collaboration with partners proved critical.
• The specific needs of children during a pandemic are crucial and need to be addressed.
• Consistent messaging and education – from top national leaders on down – is needed to ensure compliance with policies and to manage fear among both the public and healthcare workers.
• Data is the key to guiding and gauging the effectiveness of response strategies.

Effective Strategies The most commonly cited infection control strategies or policies that positively impacted their facilities during those initial months were enhanced conservation strategies for personal protective equipment (PPE) and visitor and staff screening. Staff education on PPE and handwashing as well as testing patients during admissions and prior to procedures were the next most commonly cited.  Of those completing the survey, 100% reported implementing training on the proper use of PPE, including donning and doffing, and nearly all reported extending infection control training to include those not providing direct patient care. Facilities used a variety of additional communication tools to share information, such as posters and signage as well as social media campaigns. Other top strategies included:

• Universal masking. 
• Designated COVID-19 units with designated staff. 
• Isolation precautions including specialized patient types. 
• Visitor restrictions, social distancing and limiting movement in and out and around the buildings.

Not surprisingly, the use of telehealth was also a top strategy, with 81% of facilities reporting they optimized telehealth services as an alternative approach for providing care.  Barriers and Challenges By far, the top challenges faced by these facilities were related to PPE, including shortages, utilization, education and communication. This was followed closely by staff fatigue and maintaining infection control compliance. Additional challenges included:

• Rapidly changing federal and state guidance, leading to constant staff education and conflicting messages.
• Lack of testing supplies and other testing issues.
• Non-compliance with policies by visitors, residents or patients.   
• Changes in visitation policies and staffing shortages.

In the intervening months, some of these challenges have subsided and many of the changes in routine that came about under the pandemic have become a “new normal” for facilities and their staff. Yet, survey respondents report that a few challenges remain. Most noted and impactful include: 

• Ongoing supply chain shortages affecting PPE, testing and sanitizing supplies.
• Unclear or conflicting information from state and federal agencies.
• Data reporting changes and redundancies.
• The lack of a solid plan for vaccine distribution.

Looking Ahead When asked about their needs as they look toward the future evolution of this pandemic, facilities overwhelmingly cited communication. Maintaining the flow of information, which was so critical during those early days, remains important. And this only serves to reinforce the critical importance of planning and preparedness work, through which relationships were built and networks were developed, enabling these facilities – and the people who work for them – to collaborate effectively with one another, all for the good of the community. For more on the regional hospital pandemic response, contact us.