ICCS Infection Prevention & Control Newsletter: December 2021

This issue covers some of the most significant news from December. Topics include Omicron, accreditation standards, face-mask practices, updated CDC guidelines, and antibiotic resistance.

Note: Stay tuned for the annual special edition of the ICCS Infection Prevention & Control Newsletter where we highlight some of the biggest news and ICCS reports from 2021.

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CDC Confirms First U.S. Case of Omicron COVID Variant Has Been Detected in California — The month kicked off with this news. Within just a few weeks, Omicron became the dominant COVID strain.

Holiday Gathering: Omicron Precautions From ICCS — ICCS Founder Phenelle Segal, RN, CIC, FAPIC, provided advice on how to travel and gather more safely as the country confronted the Omicron surge — guidance that is worth following even with the holidays behind us.

Hospitals Confront New Accreditation Standards to Come — MedPage Today discusses possible new hospital Joint Commission standards for 2022 in areas that include medication management, antimicrobial stewardship, community-acquired pneumonia, and other infections.

2020 Report to Congress: CMS Remains Critical of AO Performance — Infection control, missed deficiencies within the physical environment, and a few other issues were highly cited in CMS' latest annual report card on the performance of accrediting organizations.

High-Flow Oxygen Reduces Need for Mechanical Ventilation in Severe COVID-19 — Investigators found that patients with severe COVID who received high-flow oxygen therapy were less likely to need mechanical ventilation and had a shorter time to clinical recovery.

New Study Identifies Most Effective Face-Mask Practices to Reduce Spread of Infection — Study findings provide guidance for increasing the effectiveness of face masks.

Update to 'Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients' — CDC updated four parts of the "Epidemiology and Control of Selected Infections" section of the "Guideline for Infection Control in Healthcare Personnel." The updates concern diphtheria, group A streptococcus, meningococcal disease, and pertussis.

Candida auris: Coming Soon to a Facility Near You? — This is a good summary about and guidance concerning Candida auris, which we are increasingly seeing throughout the country.

Hope on the Horizon: Treatment for Carbapenem-Resistant Acinetobacter baumannii Infections — Study results provide hope for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections.

Brown Introduces Legislation to Combat Threat of Antibiotic Resistant 'Superbugs' — U.S. Sen. Sherrod Brown reintroduced The Strategies to Address Antibiotic Resistance (STAAR Act), which would provide a multipronged strategy to limit the growing impact of antibiotic resistance.

CDC Launches Networks to Boost Global Response to Antibiotic Resistance — The CDC announced an initiative to bolster the global response to antimicrobial resistance, awarding millions of dollars to organizations in more than 50 countries.

Add Biopreparedness to IP Checklist — A column in Infection Control Today details why infection preventionists should "harness the current attention to biopreparedness and use the momentum to build the foundations for strong local programs that can be sustained through future waves of competing priorities."

'Implementation Science' Critical to Reducing Antibiotic Resistance — A white paper published in Infection Control & Hospital Epidemiology outlined the steps involved in designing and conducting an implementation research study in support of antibiotic stewardship.

Holiday Gathering: Omicron Precautions From ICCS

By Phenelle Segal, RN, CIC, FAPIC, Founder, Infection Control Consulting Services (ICCS)

The risk of getting infected with COVID-19 when gathering with friends/family during the holidays is lower if the people congregating are all vaccinated and boosted. If not boosted, people should seriously consider the added protection it provides. Limiting the size of crowds gathering is also advisable.

Fortunately, the symptoms of Omicron to date in vaccinated persons appear to be mild and short-lived, but we don't want to pass it to others, nor do we want to be presumptive. Omicron is tricky

The following steps should be highly considered:

1. Symptoms: Omicron is causing cold- or allergy-like symptoms in vaccinated persons. There is more severe disease in the unvaccinated, so limit or forego contact with them if possible. Scratchy or sore throat seems to be high on the list of initial symptoms. I highly suggest that if anyone has any symptoms suggested of "allergies" or a cold/respiratory infection, they isolate for at least 5-7 days (as per Dr. Fauci during media discussion) and symptoms must be significantly better (no fever for 24 hours or more without fever reducing meds). Testing is an option too (strategies discussed below). Omicron is highly transmissible while acting like a mild infection.

2. It is also causing headache, body aches and mild GI symptoms with some people complaining of a mild fever — all indicative of general viral syndromes particularly in the winter.

3. There are other lousy viruses circulating, and I suggest these strategies so that you're protected from these additional illnesses.

4. Testing: If a person tests negative via rapid test (particularly if symptomatic), it doesn't mean they are COVID free. The question is whether the "negative" person is incubating it and are they transmissible? That's based on how much virus is in the nasal passages or throat. Could they have another respiratory virus?

In summary, if anyone has any cold-like symptoms or thinks they have allergies, they must isolate as they can infect a lot of people if it's "hidden" COVID or another virus. Symptoms and a negative rapid test (ensure you research which home-based test kits are reliable) could still be a mild Omicron infection that is transmissible, but we don't know how infectious.

5. Rapid test kits are effective at detecting Omicron, but it all depends on whether there is enough virus to detect and at what stage the illness is tested. There is a risk of people who are infected testing negative, but if they are asymptomatic, it is thought that the likelihood of transmitting Omicron may be less. However, we really don't know all the details at this juncture.

6. Before traveling and during a trip, you could undertake screening daily to help identify the virus. There is no hard science to support this strategy, and you will need access to tests to do so, but some took this approach during the Thanksgiving holiday and will also be doing so for the upcoming holidays.

7. It is advisable to stay home or isolate if you develop symptoms while away.

8. Isolation: If a test is positive on rapid and/or PCR, CDC has not changed its isolation guidelines to date (I’m expecting updates soon). but, as mentioned above, Dr. Fauci has stated 5-7 days may be all that is needed, provided the person is no longer symptomatic and feeling better. Bear in mind though that these are suggestions and not evidence-based, written guidelines. 

Strategies to Prevent Infection: The Most Important Information

Follow these strategies to reduce your risk of infection:

• Step up your masks to a well-fitting KN95 that has at least 5 layers or an N95 that is vetted by OSHA/NIOSH.

• Masks should be worn in every indoor setting prior to gathering, including elevators, offices (even if others are masked and/or the office is quiet), stores, and public transportation.

• If possible, limit mass transit use or avoid altogether as COVID and respiratory viruses, including the flu and RSV, are also circulating. Given how many people take mass transit, the amount of circulating virus is exponentially increased, and we suspect that virus can bypass your mask if it is not well fitted.

• Always keep your fingers away from your eyes and nose.

• Wash your hands when you get home from shopping or other tasks outside the house. Do so when inside the house at intervals, but especially upon returning home.

• I'd hold off on going to the gym during this heightened period, but if you must go, I'd wear at a minimum a tight fitting KN95.

Finally, enjoy your time together and be wise!

ICCS Infection Prevention & Control Newsletter: November 2021

This issue covers some of the most significant news from November. Topics include nursing home federal guidance, omicron, booster shots, antimicrobial infections, COVID test kit recall, and breakthrough infections.

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CMS Increases Oversight of Nursing Home Survey Process and Expands Nursing Home Visitation Policy in 2 New Guidances — CMS issued two memos affecting nursing homes. They concern 1) increased oversight and surveyor scrutiny, and 2) resident visitation. An important note: CMS has instructed surveyors to pay particularly close attention to facilities with higher infection rates but lower COVID vaccination rates.

Experts Urge Vaccinations to Protect Against Omicron Variant, Other Possible Mutations — ICCS Founder Phenelle Segal, RN, CIC, FAPIC, discussed the omicron variant with WPBF 25 News.

The FDA Authorizes COVID Booster Shots for All U.S. Adults — FDA gave the green light for fully vaccinated Americans age 18 and older to receive a COVID booster.

FDA Panel Recommends Molnupiravir, First Pill for COVID-19 — The FDA's antimicrobial drugs advisory committee voted to recommend the use of Merck's molnupiravir — the first pill indicated to treat COVID-19 infections and prevent hospitalization and death. If taken within the first 5 days of infection, the pills offers a 30% reduction in the risk of hospitalization and death.

New Guidance for Treating Antimicrobial-Resistant Infections Released — IDSA issued new guidance for treating three of the most common drug-resistant pathogens: AmpC b-lactamase producing Enterobacterales (AmpC-E), Carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia.

FDA Recalling 2 Million Ellume At-Home COVID-19 Test Kits Because of False Positives — FDA announced a recall of COVID-19 test kits made by biotech company Ellume.

Avoiding False Positives for SARS-CoV-2 When Using Rapid Antigen Tests — We put misinformation at the top of our 2021 "10 of the Scariest Healthcare Infections and Threats," and for good reason. This story details an unnecessary study that became necessary due to misinformation.

What Data From 20 Systems Shows About Breakthrough Infections — This report provides interesting statistics concerning trends in breakthrough infections and hospitalizations.

How Did We Develop a COVID-19 Vaccine So Quickly? — This article provides a good answer to a question many have asked over the past year.