It’s an old truism that infection control is everyone’s job in healthcare, and that has become more apparent than ever in the ongoing pandemic of SARS-CoV-2. In response, some infection preventionists (IPs) have extended their reach by recruiting infection control champions or ambassadors to keep their colleagues updated on the ongoing changes and recommendations in the pandemic response.
There was a lot of anxiety and uncertainty as the pandemic began, only to be compounded by mixed messages from public health, political forces, and the media.
“Staff were verbalizing anxiety, fear, and confusion,” said Edahrline Salas, RN, manager of infection prevention at Children's Hospital Los Angeles in Glendale, CA. “There were department-based clusters revealing lack of awareness or a knowledge deficit. There were PPE (personal protective equipment) variations among different units.”
In addition, some healthcare workers did not understand the “why” behind revised policies, which could have undermined compliance.
“Ultimately, we wanted to empower staff and to promote a culture of safety,” Salas said recently in Indianapolis at the 2022 conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
The hospital’s command center was activated in March 2020, just before the first cases were admitted. The need for the ambassador program was realized in the following months and the project was developed and launched later that year in August and September.
“We had meetings with all of the managers — clinical managers, as well as nonclinical managers,” Salas said. “We reached out to key stakeholders to be able to get some support and buy-in. Ultimately, we did get that, and we started recruitment of team members across the organization for this volunteer position.”
The hospital recruited staff members who wanted to be trained as COVID-19 subject matter experts and serve as liaisons between their departments and IPs/incident response leaders.
The roles and responsibilities of the ambassadors included:
keeping up with all incident emails and all assigned work;
sharing pertinent information and being a COVID-19 resource to peers;
collaborating with work area leadership;
communicating questions and concerns, and notifying leaders if unable to perform the program requirements.
A Peer Support System
“We wanted to increase frontline staff engagement with COVID-19 response and the processes that were being developed,” Salas said. “We also wanted to have a better dialogue — a better bidirectional feedback between frontline staff and the hospital command center.”
Essentially, the ambassadors functioned as a peer support system, helping their teams understand changes and new developments in the pandemic response. They were to check in with infection control as needed or at least once per week. A key point was right after they volunteered, and they called in as a group.
“We asked them about why they became COVID-19 ambassadors,” she said. “The number one reason that came up was that they wanted to provide support to others. That altruistic sort of drive was really important. They were concerned about their fellow staff and wanted to make sure that they would be able to provide support.”
Another factor was the desire to learn more about COVID-19 to bolster a sense of personal safety along with the team education.
“A great majority of them were patient care providers, but we also had a portion of non-clinical and non-direct patient care providers,” she said.
Overall, 136 employees volunteered, representing all areas and disciplines at the hospital.
“During the height of all the rapid changes, the program leads met with infection prevention leadership on a weekly basis to discuss any new and upcoming topics or protocol changes,” said co-presenter Marvin Mangahis, BSN, RN, an IP at the hospital. With a large variety of topics to discuss, we created a line-up of these and prioritized them for action.”
Email communications highlighted any new educational content or resources and provided a short assignment for the ambassadors to complete for that particular week, he said.
“Knowing that the ambassador group is comprised of a variety of clinical and nonclinical staff, the tasks were designed to be easily completed and, hopefully, not too time-intensive,” Mangahis said. “But at the same time, we stressed that these assignments were meaningful and made an impact toward meeting the program’s goals.”
Ambassadors were asked to navigate through the COVID-19 resources on the hospital’s intranet. “They may have also been asked to print and post handouts that were provided in the emails for the staff to read,” he said.
The ambassadors who wanted to do educational presentations had access to ready-to-use content created by the infection prevention team.
For example, available presentations included primers on contact tracing, COVID-19 screening, protective eyewear, visitation, and patient cohorting.
The program has been well received by the staff and hospital administration, and there are thoughts now of having such ambassadors as a full-time adjunct to infection control in general.
“With that goal in mind, steps would be taken to recruit not only new ambassadors to the program, but possibly recruit other IPs to help lead the program,” Mangahis said. “All in all, the focus of a new group of ambassadors would keep the spirit of the original team, which is to maintain proactive engagement between hospital leaders and frontline staff, and to empower staff to have a voice for hospital change.”
