Infection preventionists and antibiotic stewards struggled mightily during the height of the pandemic, largely overwhelmed like the rest of the healthcare system. No doubt they prevented some of the impact, but it was a losing effort and those results spoke to their importance as much as any success.
Both healthcare-associated infections (HAIs) and antibiotic-resistant bacteria rose sharply during the COVID-19 pandemic. (See Hospital Infection Control & Prevention, December 2023.) This did not go unnoticed, although infection preventionists and drug stewardship typically are not an emphasis in pandemic planning.
A Presidential Advisory Council (PAC) report on preparing for the next pandemic corrects this oversight, recommending “infection prevention and control and antimicrobial stewardship as core capabilities and goals in pandemic preparedness policies.”1
During the pandemic, lapses in basic infection prevention and control included less attention to hand-hygiene, halting surveillance for multidrug-resistant organisms, suspending environmental cleaning audits, and interruption of unit-based HAI-prevention quality improvement efforts, the report noted.
“Antibiotic stewardship often lapses during emergencies because there is little or no diagnostic information to guide treatment decisions when the healthcare system is overwhelmed,” the PAC reported. “[We] recommend that future versions of the national biodefense strategy and the American pandemic preparedness [documents] recognize infection prevention and control and antibiotic stewardship as key elements in the fight against antimicrobial resistance and direct federal efforts to strengthen the nation’s capabilities in these areas.”
Even if pandemics primarily are viral, secondary bacterial infections add a deadly toll. Although there was no vaccine nor antibiotics, much of the mortality in the 1918 influenza pandemic was caused by bacterial infections. “During the COVID-19 pandemic, antimicrobial-resistant infections caused substantial morbidity and mortality in hospitalized patients,” the report stated. “For example, U.S. hospitals saw a 15% increase in resistant hospital-onset infections and deaths.”
Important Recognition
“It is important [that they] highlight the role of the infection preventionists and infectious disease specialists in response to the next pandemic,” says Pat Jackson, RN, MA, CIC, FAPIC, immediate past president of the Association for Professionals in Infection Control and Epidemiology (APIC). “[The PAC report] specifically says bolster the workforce by expanding recruitment and support of public health officials, including infection preventionists and infectious disease specialists.”
Jackson spoke at a recent webinar highlighting the connection between APIC and their colleagues in the Society for Healthcare Epidemiology of America (SHEA). Deborah Yokoe, MD, MPH, FSHEA, FIDSA, immediate past president of SHEA was the co-speaker.
“To protect our patients and healthcare personnel, [we must] respond and prevent outbreaks in healthcare settings of new emerging and re-emerging infectious diseases,” Yokoe said. “And that includes ongoing work to prevent the spread of COVID-19, even as we transition from thinking about [it] as a new emerging, infectious disease crisis, to an endemic infection that continues to present risks.”
SHEA and APIC must reinforce the message “that there are really no other healthcare groups that have our level, our breadth, and our depth of expertise and experience around these issues,” Yokoe added. However, current challenges go beyond that immediate purview, since APIC and SHEA must deal with burnout and other lingering psychological effects in the infection prevention and healthcare epidemiology workforce. It is not just individuals but system resilience that must be restored.
“Infection prevention and control programs have many competing priorities,” Jackson said. “We are dealing with compliance and regulatory requirements, training staff, [workforce] reductions. We know that that burnout is associated with increased medical errors and increases in HAIs.”
There are ways to reduce burnout, Yokoe noted, citing approaches such as including healthcare workers in decision making, having dedicated resources focused on staff well-being, ensuring adequate staffing, and giving workers sufficient time to complete tasks.
“These are the factors that will be important for us to keep in mind, as we continue to advocate for the support that our members need to do our work in an environment that supports our mental health [and] resilience, and protects against burnout,” she said.
Shared Goals
Although the pandemic data showed the cost in increasing infections as infection preventionists and antibiotic stewards were sidelined, it remains a challenge to show that a prevented infection — which by definition did not occur — saved a hospital money. A common approach to overcome this is to compare rates of a given HAI after a focused intervention to past, higher numbers of the same infection.
Still, this may end up being categorized as a cost “avoidance” rather than a “savings,” Jackson said.
“Our administrators want to see a decrease in the bottom line, and not necessarily an avoidance of costs,” she said. “It is often hard for us to convince our administrators [of] the value that we provide. “
Other shared goals mentioned by the APIC and SHEA leaders included standardizing and updating minimum staffing levels, and ensuring compensation is appropriate for the expertise and important impact of the professions.
“We are also committed to working together to counter the spread of misinformation and to counter the public’s mistrust in public health that is threatening the support and funding of our public health infrastructure,” Yokoe said. “We are trying to actively promote our members when there are opportunities to talk to the public through the media when these issues come up. We are really trying to push out our members to be spokespeople to respond to some of these areas of misinformation.”
“This is definitely a crisis of our time — social media,” Jackson noted. “We have talked about coming up with some kind of resource that we can give our members on how to respond to this.”
In closing, both Yokoe and Jackson were asked to highlight an aspect of their one year as president of their respective associations in 2023. “Being part of the the network of the amazing high-quality work that goes on within SHEA, and to have the opportunity to interact with the thoughtful, talented, innovative, dedicated individuals who lead and participate in the work of our boards, committees, special-interest groups, and task forces,” Yokoe said.
Jackson emphasized that APIC has created diversity inclusion statements and established a health equity task force. The taskforce is “helping to define how to look at health equity through the lens of healthcare-associated infection. We’re excited about the work of that task force that’s coming up.”
REFERENCE
- Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. Preparing for the next pandemic in the era of antimicrobial resistance: A report with recommendations. Published March 24, 2023. https://www.hhs.gov/sites/default/files/paccarb-pandemic-preparedness-report.pdf
Infection preventionists and antibiotic stewards struggled mightily during the height of the pandemic, largely overwhelmed like the rest of the healthcare system. No doubt they prevented some of the impact, but it was a losing effort and those results spoke to their importance as much as any success.
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