Course content At the time of this writing December of 2022, the latest CDC published guidance is being referenced.
time” infection control training, the pandemic caused certain healthcare-associated infections to increase. Therefore, we must strive to protect healthcare workers and patients from avoidable infections. Sustaining improvement in infection prevention and control is always a significant challenge.
WHAT WE LEARNED FROM THE PANDEMIC
While the U.S. and essentially the entire world are still dealing with COVID-19, public health planning for the next pandemic should be occurring. The COVID-19 pandemic highlighted many opportunities for improvement when it comes to the public health response to pandemics. The lessons learned from the pandemic are first to strengthen core public health functions: Surveillance and contact tracing (to identify individuals), testing, and quarantine (to minimize transmission and spread of an unusual pathogen in communities (Haldane et al., 2021; Piret & Goivin, 2021). Second, engage the community and develop partnerships to build the local capacity to respond to future outbreaks (e.g., understanding local needs, expanding community health worker programs, listening to public opinion and feedback (Haldane et al., 2021). Third, support the public health workforce as well as front-line healthcare workers. Engaging with these populations along with ongoing training is key before, during, and after any emergency. Surveillance technology and the ability to integrate systems (e.g., lab results sent directly to public health) will be important to detect outbreaks and analyze emerging patterns and trends to determine the proper response. For the public health response to be effective, systems of delivery and equitable supply chains must be functioning. In reviewing pandemics throughout history, the public health response to the COVID-19 pandemic was not too different from that seen in the 1918 influenza pandemic. The containment measures undertaken to prevent the spread of influenza in 1918 were to close schools, churches, and theaters; suspend public gatherings; and practice respiratory hygiene and social distancing (Piret & Goivin, 2021). The public health response was not perfect back then—these measures were too late because of World War I, and the response was not well coordinated. While there were lessons learned after this influenza pandemic, public health unfortunately tends to be underfunded by government leaders. Epidemics and pandemics are unpredictable; however, they occur because of human activities and our interactions with animals and the environment (Piret & Goivin, 2021). Public health will always have challenges—therefore, a level of individual preparedness to respond to the next pandemic is essential.
While vaccines have been effective in slowing the spread of COVID-19 and severe disease, individuals should prepare as if there were no vaccines and medicines to treat the disease. As much as the U.S. can prepare for the next pandemic, the response must be global to be effective in minimizing spread (Piret & Goivin, 2021; To et al., 2021). The Healthcare Infection Control Practices Advisory Committee (HICPAC) is an advisory committee established in 1991 by the federal government to provide advice and guidance to the CDC and the Department of Health and Human Services. Their recommendations evolve as new evidence emerges. While pandemics, epidemics, and healthcare-associated infections will occur, there are core infection prevention and control practices (standards of care) for safe healthcare delivery in all settings (CDC, 2022). The core infection prevention and control practices are: ● Leadership support —To be successful, support is needed from all levels of the healthcare leadership team. ● Education and training of healthcare personnel —Training on infection prevention should be tailored to the facility type and healthcare personnel being trained. ● Patient, family, and caregiver education —Explain how infections are spread and how to prevent them. Materials should be tailored to meet the audience’s educational level, language, and cultural diversity. ● Performance monitoring and feedback —Monitor adherence to practices and provide prompt and regular feedback. ● Standard precautions —Use for all patients in all settings. These precautions will be described further in this course. ● Transmission-based precautions —Implement additional precautions for patients with uncontained body fluids and those with a multidrug-resistant organism. ● Temporary invasive medical devices for clinical management —Early and prompt removal of invasive devices should be part of the plan of care. ● Occupational health —Adhere to federal, state, and local requirements regarding immunizations, work policies, timely reporting of illness, and notifying public health entities, if required.
GUIDELINES AND RECOMMENDATIONS
The Centers for Disease Control and Prevention (CDC) reviews the science and provides the best evidence-based guidance for healthcare settings regarding infection prevention and control practices. The CDC issued its first document related to isolation techniques for hospitals in 1970. They updated it in 1975, and again in 1983 (CDC, 2015). In response to the human immunodeficiency virus (HIV) pandemic, the 1983 guidance included precautions to prevent exposure to body fluids. The Occupational Safety and Health Administration (OSHA) introduced universal precautions in 1987 (Broussard & Kahwaji, 2022; CDC, 1987; OSHA, n.d.b). Universal precautions provide guidelines to protect workers exposed to blood and other potentially infectious materials (OPIM). Universal precautions originally did not consider OPIM to include sputum, feces, sweat, vomit, tears, urine, or nasal secretions unless the body fluid was visibly contaminated with blood (CDC, 1988). Universal precautions apply to all patients regardless of their medical condition. The CDC then published body substance isolation guidelines in 1987, which recommended avoiding direct contact with “all moist and potentially infectious body substances,” even if blood was not visible.
The Occupational Safety and Health Administration (1991) published the Bloodborne Pathogen standard (1910.1030), which requires employers to have an exposure control plan. This plan applies to all employees with the potential for exposure. It describes how employers and employees should work together to reduce occupational exposure to bloodborne pathogens (HIV as well as hepatitis B and C). The employer’s responsibility is to provide personal protective equipment (PPE) for staff to access. The employee’s responsibility is to assess the risk of exposure depending on their task to determine what PPE to wear. The standard was modified in 2001 to include the Needlestick Safety and Prevention Act, which requires safer medical devices and implementation of prevention strategies (OSHA, n.d.a; OSHA, 2001). If respirators (i.e., N95, powered air purifying respirators [PAPRs]) are used, employers are responsible for implementing a respiratory protection program (OSHA 1910.134). This program plan assesses the risk of exposure to airborne contaminants in the workplace. Depending on the risk, employers implement measures such as annual staff training and annual respirator (i.e., N95) fit testing, and they must maintain proper documentation.
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Book Code: RPTTX2024
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