Since the start of the COVID-19 pandemic, ICCS has been busy providing a variety of infection prevention and control services to the healthcare sector and facility types that include nursing homes, assisted living, group homes, dental practices, behavioral health facilities, substance abuse treatment centers, physical therapy organizations, ambulatory surgery centers (ASCs), federally qualified healthcare centers, outpatient clinics, and hospitals. In addition to these healthcare facilities, the pandemic motivated ICCS to expand its support to non-healthcare businesses. We are currently providing COVID-19 strategies to companies in the entertainment, food service, and pet therapy industries, just to name a few.
Our recent successes include helping many nursing homes in several states with their CMS deficiencies and fulfilling the requirements of a directed plan of correction (DPOC). In addition, we have been busy assisting our clients with many situations relating to COVID-19 as the Delta variant has increased exponentially, vaccines have been rolled out, breakthrough infections have been occurring, and more. We have also been busy reviewing, updating, and advising clients on a multitude of federal and state updates, new programs, and mandates.
Along with pandemic assistance, we continue to provide ongoing services to our clients. These include onsite and virtual visits to assess "best practices," writing and updating annual infection prevention annual plans, performing facility risk assessments, and helping organizations achieve a wide range of goals. We also assist with department of health and accreditation agency survey preparation and policy writing.
To learn what ICCS can do for your organization or company, contact us. You can fill out the form here or email info@iccs-home.com. If you have time-sensitive matter, call ICCS at (215) 692-3485.
Please continue to stay safe!
Phenelle Segal, RN, CIC, FAPIC
President
Infection Control Consulting Services
How COVID Changed the Ambulatory Surgery Center Infection Prevention Landscape
By Phenelle Segal, RN, CIC, FAPIC, Founder and President, Infection Control Consulting Services
At the beginning of the COVID-19 pandemic in 2020, ambulatory surgery centers (ASCs) were severely impacted as state governors issued executive orders directing that essentially required all ASCs as well as hospitals; office surgery centers; dental, orthodontic and endodontic offices; and other healthcare practitioners' offices to immediately stop providing any medically unnecessary, non-urgent, or non-emergency procedures or surgeries.
The reason for suspending elective surgeries in outpatient surgical centers was to assess for surge capacity — use of outpatient beds to house ill patients — if hospitals began running out of beds, potential use of staff for hospital care, use of anesthesia machines to be converted into ventilators, and preservation of personal protective equipment (PPE) for the most medically necessary needs in hospitals.
During this "down time," facilities began developing COVID-19 response plans in anticipation of reopening while the threat of the coronavirus remained. When states began providing guidance for reopening ASCs, these plans needed to be put into effect.
Newly developed prevention practices based on CDC guidance included the following:
Social distancing in waiting rooms, patient care areas, office space, and break rooms.
Placement of additional hand sanitizer stations and increased environmental cleaning.
Procuring more PPE supplies and understanding how to safely reuse masks.
Development and implementation of patient and staff screening tools.
The reopening was slow and calculated as the nation continued to grapple with critical shortages of PPE and disinfectants, chaotic testing issues, and often confusing guidance from CDC and other bodies issuing recommendations. Patient hesitation to come out of their homes and spend several hours indoors played a significant role in the completion of fewer procedures than during a typical summer. Further complicating matters: Many ASC staff members were either too afraid to return to work or had moved on to find other jobs.
New reopening practices included the following:
Universal masking of staff and patients.
COVID-19 testing of patients prior to surgery (at the center or independent testing with a written result).
Banning/restricting visitors.
Screening staff and testing via point-of-care or polymerase chain reaction (PCR) methods.
Contact tracing and staff quarantine.
Updating guidelines and increased staff education.
The "new norm" continues with COVID-19 prevention practices shaping the future for improved health and wellbeing of patients and staff. Among them:
Facilities should maintain ongoing preparedness strategies for future pandemics that historically occur every 4-6 years.
Vaccination of employees and patients have greatly reduced the risk of acquiring severe illness, hospitalization, and death.
Pre-COVID and additional practices should be maintained by ASCs and other facilities. These practices include:
Assessment and meticulous monitoring of the HVAC, filtration, and air exchange systems.
Increased environmental disinfection and monitoring for compliance.
Review of newer technologies for disinfection, such as ultraviolet options.
Enhanced supply chain management with stockpiling strategies.
Return to conventional capacity use of PPE.
Increased surveillance for surgical site infections (SSIs).
Increased compliance monitoring/auditing for hand hygiene and use of PPE.
At the time of this column, the pandemic continues to surge through the country (especially in the Southern states) with the highly transmissible Delta variant, particularly among the unvaccinated. Breakthrough infections are occurring among vaccinated personnel, with similar rates of spread as unvaccinated. However, breakthrough infection in vaccinated individuals is not resulting in severe illness, hospitalization, or death, except on rare occasions in high-risk persons. A CDC study found that unvaccinated people are about 29 times more likely to be hospitalized with COVID-19 than those who are fully vaccinated.
Due to the disparity in vaccination acceptance based on regions of the country, non-pharmaceutical interventions (NPIs) have been reinstituted in several states. While most of the prior practices are still in place in ASCs and other healthcare facilities, ICCS suggests that the following steps continue or be reconsidered.
Daily screening of staff and patients should be continued (screening strategies individualized to the facility).
Pre-operative COVID-19 testing of patients should be continued or reconsidered.
Social distancing in waiting rooms should be continued.
Universal masking for the entire building if people are congregating in common areas. Masks can be removed in breakrooms, but staff should be mindful of social distancing.
N95 mask use during intubation or extubation.
As COVID-19 continues to mutate and with influenza season approaching in the late fall/early winter, ASCs should remain diligent and refer to CDC guidelines for handling of different situations as they arise. Vaccines should be encouraged for staff who are unvaccinated, and all staff should be offered the flu shot in the coming months.
If we hope to finally put the worst of COVID-19 behind us, we must all do our part by emphasizing safety and not putting our guard down.
ICCS Infection Prevention & Control Newsletter: July 2021
This issue covers some of the most significant news from July. Topics include CMS penalties, vaccine reporting, high-level disinfection, OSHA, Delta variant, vaccine mandates, and outpatient antibiotic use.
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CMS Per-Incident Penalties for Providers Soar — And Could Be Headed Higher — The total amount of fines CMS has collected through per-incident penalties has increased more than eight-fold from 2016 to 2020, and the figure is projected to reach new heights by the end of 2021.
Burdensome Vaccine Reporting Requirements Overwhelming Providers Dealing With COVID Outbreaks, Staff Shortages — Short-staffed long-term care providers are struggling to respond to COVID-19 outbreaks at their facilities and comply with a federal requirement to report COVID vaccination data.
How to Document the High-Level Disinfection Patient Connection — Insight from Phenelle: "Endocavitary or ultrasound probes have been highlighted for many years as an important component of medical device reprocessing. These devices require high-level disinfection, and strict use of manufacturers' instructions is imperative to the safety and wellbeing of patients. This article highlights the importance of monitoring for appropriate disinfection and tracing the individual probe used to a specific patient. The ability to link a specific piece of equipment or device to each patient allows for confirmation of high-level disinfection and a much smoother process should an issue arise."
Too Much, Too Late: Health Groups Pan OSHA Rule on COVID Precautions — It comes as no surprise to see this reaction to the new rule from the Occupational Safety and Health Administration (OSHA) intended to protect healthcare workers from COVID-19.
Larger Staff Size Increased Risk of COVID Outbreaks, Study Finds — Operators that had more staff coming in and out of a skilled nursing facility, while maintaining comparable direct care hours to those with fewer staff, had increased susceptibility to COVID-19 outbreaks last year.
Unvaccinated Nursing Home Staff in the Hot Seat as CDC Investigates COVID-19 Breakthrough Cases — Several Colorado senior care facilities are at the center of a CDC COVID-19 investigation, and public health officials there are zeroing in on unvaccinated staff as the cause of breakthrough cases.
Why the Delta Variant is Hyper-Contagious: A New Study Sheds Light — After months of data collection, scientists agree: The delta variant is the most contagious version of the coronavirus worldwide.
V.A. Issues Vaccine Mandate for Health Care Workers, a First for a Federal Agency — Employees who provide direct patient care have eight weeks from the issuing of the mandate to get inoculated against the coronavirus or face penalties including possible removal.
National Organizations in Epidemiology and Infection Prevention Say COVID-19 Vaccines Should Be Required for Healthcare Personnel — Seven leading organizations issued this important joint statement, including APIC, SHEA, and IDSA.
AMA, 56 Other Groups Back Mandatory COVID Vax for Healthcare Workers — Major medical groups joined the call for healthcare and long-term care employers to require vaccination.
Nurses Urge CDC to Reinstate Universal Masking to Reduce the Spread of COVID-19 and Protect RNs, Essential Workers, and the Public — The National Nurses United sent a letter to CDC, urging the agency to update its Covid-19 guidance and reinstate "the recommendation for everyone to wear masks in public or in physical proximity to others outside their own household."
Urine Culture Stewardship Linked to Reduced Catheter Infections — Researchers reported that a urine culture stewardship initiative at a teaching hospital reduced overuse of urine cultures and was associated with a significant decline in catheter-associated urinary tract infections.
VA Study Spotlights Decline in Outpatient Antibiotic Use — It's encouraging to see improvement in this critical yet often overlooked area, but as the story notes, there's much work left to be done.