By Marc-Oliver Wright, MT(ASCP), MS, CIC, FAPIC / PDI Clinical Science Liaison (CSL)
At the height of COVID-19, healthcare facilities were struggling with access to and availability of COVID tests, respirators, personal protective equipment (PPE), and more. In light of this, the CDC issued a “Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages” that summarized the CDC’s strategies to optimize PPE and provided a continuum of options using the framework of surge capacity when PPE supplies are stressed, running low, or absent.
But what is often overlooked is the ripple effect on surface disinfectants. The availability of surface disinfectants can become an issue in facilities dealing with an influx of persons, even more so in a pandemic scenario, and is one of the first items used in infection control practices against HAIs and to bolster emergency preparedness.
The pandemic truly exposed the fragility of healthcare’s supply chain. Risk mitigation is the name of the game in emergency preparedness, and for good reason—the ability to effectively prepare can often be the deciding factor in successfully navigating challenging times. So now, as vaccinations are being administered en masse and the country is slowly emerging from tiered shutdown phases, it is important to reflect on effective mitigation strategies to employ during supply shortages to ensure healthcare facilities are better prepared for future crises,.
Inventory Reallocation: Options may include reallocating surface disinfectants from areas of suspended activity (e.g., same day surgery when elective procedures are suspended). Another option may be to prioritize disinfectants approved for a specific microorganism or virus, in this case COVID-19, to areas of a facility most probable to encounter infected patients (emergency room, ICU) and allocate alternate disinfectants to lower risk settings (ambulatory specialty settings of lower risk).
Modified Delivery System: In some cases, a modified delivery system can make a substantial difference. For example, bulk liquid disinfectant solutions, such as those commonly used by environmental service professionals may be used in a different format, with manufacturer instructions for use authorization, such as dispensed into canisters or alternate receptacles with disposable or launderable cloths for point of care use. Facilities should work collaboratively with manufacturers and their internal safety department to explore outside-the-box solutions, while complying with EPA regulations
Utilization of Advanced Technologies: In non-pandemic scenarios, supplemental disinfection strategies such as the use of UVC-light no-touch disinfection have been demonstrated to be advantageous when used to supplement traditional manual cleaning and disinfection procedures alone.
This layered approach to environmental disinfection has shown benefits in reducing transmission of multi-drug resistant organisms through studies such as the BETR-D Disinfection Study conducted at Duke University as part of a CDC Epicenter project (Rutala et al in Infection Control and Hospital Epidemiology. 2018 Sep;39(9):1118-1121.). Arguably, the same approach could show additional benefit during pandemics. In 2020, researchers at the University of Iowa recommended whole room application of supplemental ultraviolet light disinfection (UV-C) in perioperative settings after each case to manage potential carriers/cases of COVID-19 (Loftus et al in Anesthesia & Analgesia: Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management 2020 Jul;131(1):37-42).
Importantly, these advanced technologies are supplemental, and not a replacement, for manual cleaning and disinfection. Staff should be properly trained in the use and application of such technology with a specific emphasis on the role of said technology as an adjunct to, and not a replacement for, the manual cleaning process.
Effective Demand Management: The pandemic laid bare the issues of inventory supply, storage, and demand. As supply storage in healthcare facilities is non-revenue generating space, many facilities had historically engaged in a “just-in-time” model of inventory management, keeping on hand the minimum necessary supply for operations with the assumption that should they need more, it would arrive in a timely manner without a potential disruption in operations. This approach does not bode well for a pandemic surge of potentially infectious patients along with supply disruptions from around the world. Infection prevention staff, supply chain and clinical end users needed to suddenly understand consumption and usage patterns and proactively respond and adjust during this crisis.
Notably, there were some tracking resources available for healthcare facilities. For example, the Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety and Health (NIOSH) released a mobile app for users to track PPE supplies, but made the app adaptable to any/all consumable supplies (e.g., surface disinfectants) (https://www.cdc.gov/niosh/ppe/ppeapp.html). This ability to proactively calculate burn rate of consumables and plan accordingly is a skillset that can serve healthcare facilities in normal operating times, let alone during a pandemic.
Applying Critical Thinking: If the past year (plus) has taught us anything, it may be that to be resilient, organizations and individuals must be adaptive and creative. Thinking outside the box is not only desirable, but it can also be essential in critical times. However, creative ideas should not circumvent the standard of care. Indeed, creative solutions for reducing healthcare worker exposure to COVID-19 patients, such as moving medication pumps and dialysis machines to outside the room and using elongated IV tubing, may have been a factor in the sharp increase in central line associated bloodstream infection rates many organizations experienced in 2020 (McMullen et al. in American Journal of Infection Control, Impact of SARS-CoV-2 on Hospital Acquired Infection Rates in the United States: Predictions and Early Results Volume 48, Issue 11, 1409 – 1411 and Fakih et al in Infection Control & Hospital Epidemiology, COVID-19 Pandemic, CLABSI, and CAUTI: The Urgent Need to Refocus on Hardwiring Prevention Efforts. 1-22. doi:10.1017/ice.2021.70). While rationing resources in challenging times might sound like a solution, it may result in an increase in infection risk for little gain.
The past year is a call to action for all of us in healthcare. The lessons we learned through both failure and success should guide our future strategies for both the (hopefully) waning days of this pandemic, a return to our new-normal operations, and the inevitable future challenges we will face together.
Marc-Oliver Wright, MT(ASCP), MS, CIC, FAPIC
Science Liaison, PDI Healthcare
Marc was first introduced to infection prevention when he performed DNA fingerprinting of multidrug resistant organisms for research activities, surveillance, and outbreak investigations while in graduate school. He became an infection preventionist, a research epidemiologist and ultimately a corporate director of infection prevention and quality for a multi-hospital system. Marc served APIC at the local and national level, has published over 70 articles and served on the editorial board of the American Journal of Infection Control for a decade.
Marc now serves as PDI’s Clinical Science Liaison (CSL), for the Central Region-14 states across the Midwest.