Infection Control Today

OCT 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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33 October 2018 ICT Epidemiologists in United States Acute-Care Hospitals, leads epidemiologists through how to apply, use, and interact with emergency response structures, groups, and frameworks from the institutional to the federal levels, and provides an overview of essential resources. The principles in the guidance are intended for acute-care hospitals, but may apply to other types of healthcare facilities, such as free-standing emergency departments and long-term care facilities. According to the guidance document, during a crisis the epidemiologist provides medical and technical expertise and leads infection prevention and control efforts, coordinates with institutional stakeholders, and provides input into internal and external communications. "We will always be faced with new and re-emerging pathogens," says Lynn Johnston, MD, co-chair of the writing panel and professor of medicine and infectious diseases at Dalhousie University, Halifax, Canada. "This guidance is part of an ongoing effort to develop tools and strategies to prevent and manage contagious diseases to ensure patient and public safety." The document is part of a partnership between SHEA and CDC to prepare for emerging and re-emerging infections by providing training, educational resources, and expert guidance for dealing with outbreaks in healthcare facilities. The program is designed to train U.S. healthcare epidemiologists, who oversee infection control programs, to have the skills, abilities, and tools available to implement infection control practices and provide a leadership voice in responding to infectious threats. The Nurse's Role Corless, et al. (2018) posit that, "The unpredictability of pandemic outbreaks (agents, time, and place) is a given in communicable diseases. The gap in the incorporation of nursing knowledge and skills related to screening, disease identifcation, rapid response, community involvement, inter and intra-agency communication, governmental notifcation, and coordination need not remain challenges to adequate and timely responses. The failure to develop a coordinated system of healthcare workers who understand the importance of detecting and forwarding information about the identifcation of an illness is a major gap in our ability to contain new infections. A key issue is the time delay in the early identifcation of infections that pose a threat to potential epidemics/pandemics. To mitigate the delay, it is essential that the healthcare professional who is the initial point of contact with the infected person, likely the community health worker in many global settings, communicate with the appropriate provider or agency to initiate the next steps including identifcation of the pathogen, initiation of appropriate treatment, and prevention of further dissemination. In addition, recognition of a pattern, alerting others as to the emerging disease, and preventive services will aid in preventing further diffusion of pathogens from isolated cases. A delay in such identifcation may lead to the development of epidemics/pandemics and be an impediment to the prompt initiation of treatment for the infected individual, appropriate interventions and protective devices, and efforts to curtail the spread of the epidemic." The authors outlined several recommen- dations for the future: - Encourage the International Council of Nursing (ICN), World Health Organization (WHO) Dept. of Pandemic and Epidemic Diseases, the U.S. Department of Health and Human Services Offce of Pandemic and Emerging Threats, the U.S. Centers for Disease Control and Prevention (CDC), and national nurse leaders, to build an in-country community health worker-to-clinic nurse to physician/lab technologist network. • Collaborate with identifed country nurse leaders who have developed a national grounds-up nurse-coordinated network, advocate for funding from appropriate sources (e.g., the Gates Foundation, the World Bank) for the education of community health workers and for the distribution of cell phones or other devices to personnel likely to be first points of contact with infected individuals to facilitate rapid communication with next level providers. • Encourage the ICN, the National League for Nursing, the Centers for Disease Control and Prevention, and community health worker representatives, to develop a curriculum for community health workers regarding the identifcation and reporting of infectious diseases. • Urge global leaders (ICN, WHO, CDC) to develop a strategic plan for local distri- bution of resources (pharmaceuticals, lab equipment, and other treatment-related materials) in case of emerging epidemics. Clinicians will always be on the front line against infectious threats, and the work is often invisible until a large-scale event occurs. "It's the classic conundrum that healthcare epidemiology and infection prevention face," says Kaye. "In prevention work, when things are going well, people don't think about you. But suddenly when there is an outbreak, everyone focuses on you and wants answers — it's either all of nothing, unfortunately. And the strides we have made toward prevention takes time; for example, development of a universal fu vaccine, development of rapid field diagnostics for emerging viral and bacterial infections, and perfecting response and management in different settings and locales — these advances take commitment over years and in some cases, decades, to move the needle. Regrettably, what happens is after three or four years with Ebola in our rearview mirror, or 10 years with an infuenza pandemic in the rearview mirror, people develop short-term memory issues and pull funding and resources back. Like the old saying goes, 'an ounce of prevention is worth a pound of cure,' but it's hard to measure prevention in an impactful way; hospitals get the most attention when there is an outbreak or infection rates are high. Huge reductions in public health appropriations and funding is a signifcant issue that could have long-lasting adverse effects. By the time you have an outbreak, it's often too late — not in terms of response, but you are simply putting out fres and playing catch-up, rather than preventing these problems in the frst place. We fail to remember history — even recent history — and that's what effective prevention is about. I think that the only way to truly value prevention is to remember the bad outcomes when preparedness was lacking." References: Banach D, Johnston L, et al. Outbreak Response and Incident Management: Guidance and Resources for Healthcare Epidemiologists in United States Acute Care Hospitals. Online Nov. 30, 2017. Barclay W and Openshaw P. The 1918 Infuenza Pandemic: one hundred years of progress, but where now? The Lancet Respiratory Medicine. Vol. 6, No. 8. Pages 588-589. August 2018. Corless IB, Nardi D, Milstead JA, Larson E, Nokes KM, Orsega S, Kurth AE, Kirksey KM an Woith W. Expanding nursing's role in responding to global pandemics. Nursing Outlook. online June 28, 2018. Department of Health and Human Services (HHS). Pandemic Infuenza Plan: 2017 Update. Dzau VJ and Sands P. Perspective: Beyond the Ebola Battle — Winning the War against Future Epidemics. N Engl J Med 2016; 375:203-204 Gamhewage G. Evolutions in global epidemic and pandemic preparedness. International Journal of Infectious Diseases. Vol. 73. Supplement, page 39. August 2018. https://www.ijidonline.com/article/ S1201-9712(18)33595-1/fulltext Government Accountability Offce (GAO). Infectious Disease Threats: Funding and Performance of Key Preparedness and Capacity-Building Programs. May 2018. National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737. Sands P, Mundaca-Shah C and Dzau VJ. The Neglected Dimension of Global Security — A Framework for Countering Infectious-Disease Crises. N Engl J Med 2016; 374:1281-1287. The Lancet Infectious Diseases. Editorial: How to be ready for the next infuenza pandemic. Vol. 18, No. 7. Page 697. July 2018.

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