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SECONDARY INFECTIONS: Addressing the COVID-19 fallout As COVID-19 has stressed healthcare systems worldwide, a pre-existing healthcare worker shortage coupled with caregiver burnout has only become more visible. The healthcare workforce has had to triage not only their incoming patients, but also their daily responsibilities, prioritizing only the most essential elements of the job. Well before COVID-19 appeared, Infection Prevention and Control teams battled tirelessly to control and prevent Antimicrobial Resistant Organisms (AROs) transmission in our communities and healthcare organizations. The work to reduce Healthcare Acquired Infections (HAIs) with fiscal restraints, limited resources and an overburdened workforce has always been challenging, but the pandemic has further stretched limited and overworked staff leading to a cascade of negative secondary impacts that could be mitigated with improved infection surveillance capabilities. Current Challenges What we know With the present pandemic, Infection Prevention and Control teams' challenges have only intensified. According to the Cambridge University Press, significant increases in the national Standardized Infection Ratios for CLABSI, CAUTI, VAE and MRSA bacteremia were observed in 2020. This increase in HAIs during COVID-19 has highlighted the critical need to build resiliency into infection control programs, to ensure healthcare security and continuity of services while ensuring safer patient care and a safer environment for employees and contractors. Staff shortages and staff burnout. The potential for cross contaminations, breaches in protocol and breaches in care pathways increase substantially when staff members are overtaxed and rely on strained resources, requiring a focus on patients' immediate care needs. Although this focus is necessary given the extreme pressure healthcare workers are under, infection surveillance processes can help to make reporting easier to mitigate and understand HAIs. Environmental concerns. If a health system does not have the resources to maintain a clean environment, the procedure and protocols can be followed perfectly and still result in negative health outcomes because of airborne, water or surface contaminants. Healthcare environments are complex and large numbers of patients, clients, staff and visitors can result in contamination of environments, equipment and surfaces. Increased bed turnover and patient volumes result in bio burden and contaminant reservoirs, which lead to escalating contamination risks and associated costs. It is essential to have a monitoring process with timely and effective audit and feedback systems to ensure safer care. Additionally, turnover has been high for staff who monitor and audit for infection compliance, resulting in a more junior workforce responsible for interpreting and managing frequently changing guidance from governing bodies. Multi-drug resistant organisms. Rising HAIs directly leads to increases in multi-drug resistant organisms. The increased use of empiric antibiotics to proactively treat secondary infection risks may contribute to evolutionary resistance increases, therefore making infections more difficult to treat in the future. Delayed acute patient care. Many people are aware of the increased infection risks in hospitals right now, causing them to delay seeking care, leading to sicker patients who are more susceptible to infection. These same patients have moved from an acute phase of illness to a chronic phase, adding to the complexity related to treatment and recovery. However, delayed patient care is not limited solely to not seeking care when needed, but also includes "care gaps," which commonly occur in outpatient settings. These care gaps can include missed diagnoses, medication errors in prescribing practice and decreased monitoring of patients, especially those with chronic conditions. These chronic conditions have the potential to become acute in presentation with delayed care. Reporting A tool to meet surveillance mandates and improve patient safety The temporary reprieve from governing bodies' reporting requirements is unlikely to last long term and putting structures and technology in place to provide data feedback by surveillance will set your organization up to ensure the continuity of care and security of care delivery. Additionally, the CDC plans to issue $2.1 billion in funding to U.S. health organizations to improve infection prevention and control and expand public health measures. Part of the funding is intended to strengthen states' capacity to prevent, detect and contain infectious disease threats across healthcare settings and help provide data analysis about antibiotic use which will help to improve antibiotic prescribing. Staff shortages and staff burnout. Implementing systems allows for consistency in protocols and procedures and for a standardization of workflow, even with high turnover. With limited staff, it's more important than ever to be able to save time through reduction of routine data aggregation and analysis to collaborate interdepartmentally more easily. Having consumable data reports and displays for shared distribution to care teams both at the macro (total care population) and micro (specific care services and patients) levels helps to keep everyone abreast of rising concerns and be proactive in addressing them. Environmental concerns. Quality assurance auditing of environmental services, cleaning and disinfection reports and collaborative monitoring of environmental reports like HVAC systems or climate humidity can help both cleaning teams and engineers to have real-time data available to them when they need it to highlight problem areas and address them before there is an event. This data can also help systems to focus limited resources in the most critical areas. Multi-drug resistant organisms. Managing MRDOs is a multifaceted problem that works best in a data- democratized facility, meaning a facility where all staff members have access to the data impacting their work. With the right data, IPAC teams and bed managers can ensure isolation and precautions are in place to limit spread, while also partnering with AMS teams and physicians to ensure good clinical guidelines exist for empiric therapy and perform timely prescription interventions. Delayed acute patient care. With such crushing urgency and demand on traditional healthcare systems, tracking, tracing, updating records and gaining insight from health systems and disparate data streams is not possible without specialized tools which notify providers of changes in data. This critical data is necessary to aid providers with the information they need to treat both the patients immediately in front of them and those whom are being cared for remotely. Patient status and dispositions may now be treated by hospitalists; however, the patient is likely to be outside the hospital environment for treatment and/or convalescing. In all cases, having access to clinical information in a centralized, consumable format is essential to a care provider so that they can bring context to the patient's current presentation. The global healthcare continuum is rapidly changing in complexity and urgency, requiring healthcare systems and their workforces to consistently adapt and innovate. Prioritizing a culture where departments collaborate together with access to relevant data and tools informs both immediate acute actions and longer-term strategic decisions which leads to safer patients, a safer workforce and ultimately, a safer organization. Questions to ask your teams Is your healthcare system prepared to handle the increase in HAIs following the COVID-19 pandemic to keep patients safer? As you think toward the future, what gaps do you see? What technology will you need to address those gaps? What resources will you need to ensure a safer workforce and improve staff retention? How can you engage multiple departments for a more collaborative approach to achieve a safer organization?

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