ICCS Infection Prevention & Infection Control Newsletter: 2021 Year in Review

Another year — and another with COVID — is behind us. It was a wild year of some highs and more lows than any of us wanted. Let's look back at what happened with infection prevention and control during 2021 in this special edition of the ICCS Infection Prevention & Control Newsletter.

* * *

Delta Variant Reaches the United States — The delta variant strain of SARS-CoV-2 was first detected in the United States in March. By the end of June, it was detected in all 50 states and Washington, DC. By the end of July, it became the dominant variant in the country. Delta held this title until…

Omicron Becomes the Dominant Variant — Near the end of the year, the omicron variant overtook delta as the dominant strain circulating in the United States, accounting for nearly 60% of all variants by Christmas. ICCS Founder Phenelle Segal, RN, CIC, FAPIC, provided advice on how people could travel and gather more safely as the variant continued its rapid spread. Omicron now accounts for about 95% of all reported cases.

Impact of COVID-19 on Healthcare-Associated Infections in 2020 — A CDC analysis comparing infection rates before and during pandemic revealed a significant increase in healthcare-associated infections in 2020.

Personal Protective Equipment: An Ongoing Challenge — While 2020 was full of stories about PPE shortages, 2021 was more about PPE fatigue. Phenelle discussed the subject and importance of employers keeping current with and following guidelines and best practices.

Drug-Resistant Infections Claims Thousands of Lives, Nearly $2 Billion in Healthcare Costs — Results of a study published in October reminded us of the significant burden of antibiotic-resistant infections on patients and the healthcare system.

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

Joint Commission Infection Control Standards Among the Most Challenging in 2020 — The Joint Commission issued its top 5 most challenging requirements for 2020. Once again appearing on multiple programs' lists: infection control standards.

Infection Control Immediate Jeopardy Citations of Nursing Homes Tripled — An analysis of citations of non-compliance with federal regulations received by nursing homes showed that the F-tag F880, for the presence of an infection prevention and control program, was cited more than 11,500 times in 2020. That figure was expected to increase in 2021.

Top 10 Nursing Home Survey Citations — An analysis of federal survey data showed that infection prevention and control deficiencies are among the top citations for nursing home providers.

ECRI Top Patient Safety Concerns for 2021 Include Multiple Infection Risks — Multiple safety challenges associated with infections earned places in ECRI's annual list of top 10 patient safety concerns.

Infection Hazards Appear on ECRI's Top Health Technology Hazards List — Multiple infection-related issues also earned places in ECRI's annual list of top 10 health technology hazards.

Infection Prevention Getting More Closely Scrutinized — Reports indicated that new hospital Joint Commission standards for 2022 are expected in areas that include medication management, antimicrobial stewardship, community-acquired pneumonia, and other infections.

2021 Focused Update Guidelines on Management of C.Diff in Adults — In June, IDSA and SHEA published new clinical guidelines for C. diff in adults.

Nursing Homes: CMS Adds New Triggering Factors for Focused Infection Control Surveys — In January, CMS expanded the criteria that would trigger a focused infection control survey at nursing homes.

Joint Commission Spotlights Non-Ventilator Hospital-Acquired Pneumonia — It is estimated that one in every 100 hospitalized patients will be affected by NVHAP. The Joint Commission issued an advisory on preventing the condition.

Antibiotic Development, Stewardship Advocates See Window of Opportunity — Clinicians, scientists, and public health advocates called for renewed attention to antimicrobial resistance, which was in the spotlight before the pandemic.

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.

* * *

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!