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Resetting Infection Prevention Strategies in the Wake of COVID-19 Challenges

In a post-pandemic landscape, healthcare organizations are tasked with countering the negative impacts issues such as antibiotic use, antimicrobial resistance, and healthcare-associated infections (HAIs) have incurred. This challenging task has become more pressing due to setbacks in prevention methods attributed to the unexpected onset of the COVID-19 pandemic and its ongoing implications, suggests Tracey Odachowski, MSN, BABA, RNRN, CIC, CCRN, NE-BC, System Director at Sentara Health.

Before the pandemic, substantial advancements were made in reducing antimicrobial-resistant infections and associated fatalities. However, the COVID-19 pandemic disrupted this progress as desperate measures to improve patient outcomes meant an escalated administration of antibiotics. The Centers for Disease Control and Prevention (CDC)’s ‘COVID-19: US Impact on Antimicrobial Resistance, Special Report 2022’ affirms this trend as it points towards a hike in antimicrobial-resistant infections inclusive of a rise in antibiotic use since COVID-19 hit.

This reality has seen a resurgence of antifungal-resistant infections like Candida auris in hospitals, emphasizing the urgency to reverse this upward trend. During the first two years of the pandemic, similar hikes have been reported in HAIs such as central-line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated events (VAE), and Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, according to the CDC. Patient wellbeing was heavily impacted by this as patients were sicker, required more devices and staffing, and supply shortages often led to practices that contradict traditional infection prevention methods.

So, how can healthcare organizations course correct back to pre-pandemic improvements? The answer lies in focusing on prevention and basic practices and interventions to improve patient outcomes and restrict the spread of Multi-drug-resistant Organisms (MDROs).

Prevention methods should go back to the basics – hardwired prevention protocols involving hand hygiene, cleaning and disinfection, vaccinations, and standard precautions can significantly reduce the risk of HAIs and improve outcomes. Hand hygiene programs by the World Health Organization (WHO) or CDC’s Clean Hands Count can provide essential educational resources for both healthcare providers and patients.

Respiratory hygiene and cough etiquette remain crucial as COVID-19 and other respiratory illnesses like influenza and respiratory syncytial virus (RSV) persist. It’s critical to ensure facilities offer simple, posted reminders along with readily available masks and tissues to bolster compliance. Also, stringent measures should be deployed to clean and disinfect patient equipment and the environment to aid in alienating the transmission of infectious organisms.

Poor culture collection techniques are a significant concern that may expose patients to unnecessary antibiotics and extended hospital stays. Diagnostic stewardship should be promoted, this means capturing cultures only from patients that depict the requirement based on symptom displays and potential sources. Adequate antibiotic use and necessity should be continuously tracked, monitored, and reported by healthcare facilities.

Education about antibiotics and antibiotic resistance should be consistently rendered to prescribers, nurses, pharmacists, and patients. This education which is essential for improving antibiotic prescribing practices and usage is most effective when personalized. A robust partnership and involvement with pharmacists can also pinpoint and enhance prescribing practices.

In sum, it’s imperative for healthcare providers to double down on prioritizing practices and interventions to enhance patient outcomes and slow down the spread of MDROs. The advancements achieved pre-pandemic in mitigating antibiotic use, antimicrobial resistance, and HAI prevention are attainable once more through the implementation of well-defined, tactical, and smaller changes. These impact general infection prevention and safety, positioning it to be a controllable variable rather than a persistent adversary.


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