Nurse taking notes, listening to remote doctor during video call
HealthAugust 05, 2021

Navigating COVID-19: Infection prevention implications and the path forward

The Association of Professionals in Infection Control and Epidemiology (APIC) hosted its annual conference virtually in June 2021. Spanning from topics like antimicrobial and diagnostics stewardship, disinfection and sterilization, emergency preparedness, information technology and surveillance, quality assurance and performance improvement, and more, this event was packed with informative and engaging sessions. Our infection prevention team attended APIC 2021 and have shared their key takeaways:

Matt Wissenbach, DrPh, CPH, CIC, FAPICMatt Weissenbach, DrPH, CPH, CIC, FAPIC, Sr. Director of Clinical Affairs

As anticipated, much of the APIC 2021 conference focused on IP experiences from navigating the COVID-19 pandemic and its implications on infection prevention moving forward. There were many tales of IP creativity, persistence, and execution which offered inspiration and hope for a brighter post-pandemic world. 

Many top scientific publications of 2020 were highlighted and one that stood out was a study selected by APIC as a top 10 publication of the year from Ascension’s Dr. Mohamad Fakih et. al. They found that Gram-positive–associated CLABSIs increased by >80% during the pandemic period, and coagulase-negative Staphylococcus–associated CLABSIs more than doubled. This change may indicate the increased risk for line infection and contamination due to suboptimal aseptic practices while obtaining blood cultures in a stressful environment.

The study team concluded that this circumstance may overestimate CLABSI in the setting of a high contamination rate in a severely ill population and that a higher incidence of blood culture contamination with commensal organisms, particularly coagulase negative staphylococci, has been reported in hospitalized patients with COVID-19 infection.

I was also intrigued with the introduction of technologies such as whole genome sequencing and the role they could play in advancing infection prevention practice. Detecting outbreaks and infection clusters in an accurate, timely, and thorough manner continues to challenge many infection preventionists. Alex Sundermann, MPH, CIC, FAPIC outlined fascinating work he and his team are doing in applying whole genome sequencing to outbreak detection efforts. He asserts that these technologies are capable of detecting outbreaks that often go undetected with traditional methods. However, to-date it has been difficult to foster widespread adoption beyond research settings. I look forward to seeing how this evolves in the near future and believe this area of infection prevention is ripe for disruptive innovation.

Mackenzie Weise, MPH, CICMackenzie Weise, MPH, CIC, Infection Prevention Clinical Program Manager

Reviewing findings from the 2020 APIC MegaSurvey helped to frame the current the state of our profession and was fitting as a conference introductory learning opportunity. It's been over five years and an entire pandemic since the first (baseline) MegaSurvey was conducted in 2015; however, many results remained stable over time. Based on 2020 findings:  

  • most respondents continue to practice in acute care settings
  • the primary background for IPs is still nursing
  • CIC certification remains low across practice settings
  • the majority of IPs hold ≤5 years of IP experience
  • most respondents report a desire to continue working in IP in the next five years.

It's my hope the latter finding of commitment to the field remains true even after the introduction of COVID-19. One difference that stood out was that a much larger proportion of respondents reported utilizing an electronic medical record (EMR) system in 2020 (70%) as compared to 2015 (32%). This is great news and hopefully points to an increasing appreciation for meaningful use and the informatics needed specifically for IPC. On the other hand, only 12% of overall IP respondents reported having access to surveillance software solution in 2020. This highlights a continued need to enhance IPC programs with the surveillance technologies that they need in order to identify and analyze HAIs and other reportable data faster, more accurately, and easier.

Access this guide: Five attributes of a high-performing infection prevention & control program

Tom Jordan, RN, BS, CICTom Jordan, RN, BS, CIC, Infection Prevention Clinical Program Manager

I continue to be amazed at the resilience of our health care system and our health care providers. It was not long ago that outpatient surgeries, as well as elective surgeries were cancelled due to the burden of COVID-19. While COVID-19 was certainly a widely discussed topic of concern at the APIC 2021 conference, it was heartening to see the ongoing improvements in patient outcomes through access to COVID-19 tools and information, including the efforts of clinical experts and data driving the steady growth of evidence-based guidelines.

In his presentation, Reducing the Risk of Surgical Site Infections Through Evidence-Based Pathways – 2021, Charles E. Edmiston, MD provided an in-depth review of surgical site infection reduction bundles. Dr. Edmiston’s advocacy for ever-improving surgical bundles is supported by many peer-reviewed studies. Patients who undergo a total joint revision face a risk of infection seven times greater than those undergoing a primary total joint arthroplasty. Additionally, while there are presently about 1.8 million total joint implants nationally, that number is expected to reach 4.5 million in just five years.

More recently, additional co-morbidities have been demonstrated as additional risk factors in the development of SSIs. The identification of these newly identified risks and evidence-based efforts to mitigate these co-morbidities are highly data-driven.

Sometimes long-held practices need to be adjusted based on continued and repeated studies. For example, for several years now, 30 days has been the time frame used, in part, to define a colon-related SSI. A recently published longitudinal study of colon-related surgical procedures found that an additional 25% of infections were identified within the second post op month. Are more studies needed and will this time frame of 30 days be amended?

Normothermia, antimicrobial prophylaxis, glycemic control, preadmission showers with CHG, and use of antimicrobial sutures are all “1A” recommendations. Implementation of these and other well know interventions will continue to reduce the risk of SSIs. The day-to-day challenge for all hospitals and surgical centers remains full adoption of these practices, as well as consistent process improvement observations to ensure optimized use of SSI reduction bundles.

A key takeaway for me is the following quote.

The practice of evidence-based medicine means integrating individual clinical expertise with the best external evidence from systematic reviews.
Innovative clinicians frequently lead the gradual evolution to full development of nationally accepted HAI reduction guidelines and bundles.
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