For all its application and importance during the COVID-19 pandemic, infection prevention and control remains a widely misunderstood endeavor, with physicians and health system administrators often focused on written standards—rather than the actions, systems and culture that bring them to life.
A webinar, “Infection Control: Transmission and Prevention Standards,” produced by the AMA and Project Firstline—the Centers for Disease Control and Prevention's national training collaborative for infection prevention and control—provided a refresher on the basics of infection prevention and control. Among them: knowing how to translate policies, guidelines and regulations into concrete clinical processes.
Infection prevention sounds like a straightforward concept—to prevent the spread of disease. But all too often, health professionals think it is driven by policies, guidelines and regulations, said Abigail L. Carlson, MD, MPH, assistant professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis.
“I want to emphasize that these are all paper. None of this actually prevents a person from getting sick,” Dr. Carlson said. The existence of a policy does not prevent a person from getting sick. The existence of a guideline does not prevent a person from getting sick. It’s how these things are translated into the clinical workspace that matters.”
For starters, there are specific actions. Compare, for example, the code blue for cardiac arrest.
“There are things you do to stop a patient from dying,” Dr. Carlson said. “You do CPR. You give meds. You take blood. You put on a defibrillator pad and defibrillate the risk.”
Those actions are, in turn, supported by a system.
“If there's no emergency number to call, if there's no code team, if that code team doesn't have pagers, if there is no crash cart, if that crash cart doesn't have a routine of getting refilled … All of those are systems,” Dr. Carlson said. “Those are not CPR-type actions, but all of those things make the actual code possible. And without them, the code is chaos, right?”
Undergirding it all is a culture of infection prevention.
“In the hospitals, we often tell new employees, ‘If in doubt, call a code.’ Yes, you might be wrong, but the culture is, ‘If you're uncertain—if you need help—call a code.’ And so that same culture can apply to infection prevention,” Dr. Carlson said.
Dr. Carlson also reviewed the microbiology basics of infectious diseases and explained why SARS-CoV-2 doesn’t fit neatly into any of the three routes of infectious disease transmission in health care—contact, droplet and airborne. In fact, it has even challenged infection prevention experts to reevaluate their terminology.
“If this sounds confusing, it is,” Dr. Carlson said. “It was for me as I started breaking it down and learning it in order to teach it at the beginning of the pandemic.”
In addition, the webinar featured a case study by Laura Richio, MD, a generalist ob-gyn at Beverly Hospital, in Beverly, Massachusetts. Using a case study of a nurse infected with SARS-CoV-2 by a symptomatic, unvaccinated person while providing antepartum care, the situation led to a discussion exploring the infection control strategies that could help prevent future spread of COVID-19 in labor and delivery as well as how the application of infection control principles can vary between patients and staff.
Project Firstline is a collaborative of health care and public health organizations—including the AMA—that have come together to provide infection control training for millions of front-line U.S. health care workers and members of the public health workforce.
This collaborative offers a myriad of resources and training opportunities.